CommonContractual Obligation (CO)Bundling & Unbundling

CO-97-BUNDLE: Procedure bundled into another service

The procedure or service has been bundled into (included with) another service that was billed on the same claim or same date of service. National Correct Coding Initiative (NCCI) edits or payer-specific bundling rules determined that this service is included in a more comprehensive procedure.

Common Causes

  • NCCI edit pairs identify this code as included in another billed code
  • Mutually exclusive procedure pair billed on the same date
  • Component service billed separately from a comprehensive procedure
  • Payer-specific bundling rules beyond standard NCCI edits
  • Missing or incorrect modifier to unbundle legitimately separate services

How to Resolve CO-97-BUNDLE

  1. 1Check NCCI edit pairs to determine if the codes are truly bundled
  2. 2If the services were distinct and separate, add modifier 59 or X{EPSU} modifiers and resubmit
  3. 3Provide documentation proving the services were performed at different anatomic sites, separate encounters, or distinct procedures
  4. 4If correctly bundled, write off the adjustment

How to Prevent CO-97-BUNDLE Denials

  • Check NCCI edits before submitting claims with multiple procedure codes
  • Train coders on proper use of modifier 59 and X{EPSU} modifiers
  • Use claim scrubbing software that checks for bundling edits
  • Document distinctness clearly in the operative/procedure note

Related Denial Codes

CO-4Very Common

Procedure code inconsistent with modifier or not valid for date of service

CO-97Common

Payment adjusted because already paid for this procedure/service

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