Denial code library

CO-97: Bundled into another service

Triage: Correct and resubmit

What CO-97 means

The payer considers this service part of another service billed the same day, so it paid nothing separately.

What it usually means in a chiropractic office

This is the most chiropractic denial there is: 97140 manual therapy billed the same day as a CMT adjustment without a 59 or XS modifier showing it was a distinct service on a separate region. Exams billed with adjustments without a 25 modifier produce the same result.

How to work it

  1. Confirm the two services truly were distinct: different region, separate time, documented separately.
  2. If distinct, add 59 or XS to 97140, or 25 to the exam, and resubmit as corrected.
  3. If not distinct, the bundling is correct and the line is a write off. Do not bill the patient for a bundled line.

What this looks like in practice

A patient gets a four region adjustment and fifteen minutes of manual therapy on the neck, documented as distinct work on a separate region. The claim goes out as 98942 plus 97140 with no modifier. The payer bundles the 97140 into the CMT and pays nothing for it. With the 59 or XS modifier and region separation documented, the same claim pays both lines.

What the authorities say

The 97140 with CMT combination is governed by the National Correct Coding Initiative procedure to procedure edits, which define when two services billed together are payable separately and which modifiers can appropriately break the pair.

How to stop it from happening again

How Cervica handles CO-97

The scrubber checks NCCI bundling pairs before submission and the denial worklist suggests the exact modifier remedy when a bundling denial comes back on the ERA.

Related codes

  • CO-4 · Procedure code inconsistent with the modifier
  • CO-16 · Claim lacks information

References

  1. X12, Claim Adjustment Reason Codes (the official CARC list)
  2. CMS, National Correct Coding Initiative (NCCI) edits

General information for billing teams, not legal or payer specific advice. CARC definitions belong to X12; payer policies vary and control. Verify against the payer contract before acting on any individual claim.

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