Wiki CO-97 Denials

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aridalia

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I work for a Maternal Fetal Medicine doctor. Lately with Carefirst we are getting a lot of denials on ultrasounds. The denial code is CO-97. Is there anything we can do with these ultrasounds to minimize the denials? Any modifiers that we can use.

Thank you in advance for your help.
 
aridalia said:
I work for a Maternal Fetal Medicine doctor. Lately with Carefirst we are getting a lot of denials on ultrasounds. The denial code is CO-97. Is there anything we can do with these ultrasounds to minimize the denials? Any modifiers that we can use.

Thank you in advance for your help.
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Usually CO-97 is the code is bundled into another code being billed the same day by your group. Is there another code that is being billed on the same day as your denied coded? Can you tell me the codes are being billed together on same day as the ultrasound code?
 
I think what is happening is the patient gets referred to our Testing Center for another ultrasound on the same day. Due to the fact that some abnormality was seen in their primary OB's office. When they go to our Testing Center we perform the same ultrasound and both her primary OB and our office are billing for the ultrasound on the same day. That was the reason why I asked if a modifier can be used. Please let me know if there is anything we can do to avoid these denials. Thank you in advance!
 
I would use modifier 59; we were having the same problem when the OB was performing an U/S on the same date as the MFM. The 59 usually works on the denials to bypass the insurance edits but you might also have to send medical records to support.
 
if you are billing for the provider then you cannot use the 77 modifier as that is for facility outpatient only. if you are billing for the provider of the second service then try using the XP modifier, which indicates a separate provider on the same day, instead of a 59.
 
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