Claim denials don’t just slow down your revenue. They erase it. In 2025, Experian Health’s 3rd Annual State of Claims Survey found that 41% of healthcare providers had at least 1 in 10 claims denied, marking the third consecutive year of increases. Among the most common culprits is the CO 97 denial code, and it’s … Read more
Before you spend time on a modifier, a corrected claim, or an appeal for a CO 97 denial, there’s one lookup that tells you whether any of that effort is worth it: the NCCI Procedure-to-Procedure (PTP) edit table. It tells you whether the code pair you billed is bundled, and if it is, whether a … Read more
Every CO 97 denial that gets caught before submission costs nothing. The same denial caught after submission costs an average rework fee, plus the time to research the NCCI pair, fix the modifier, and resubmit. The fix for that gap already exists in most practice management systems and clearinghouses; it’s just often sitting turned off, … Read more
Working CO 97 denials one claim at a time will always be reactive. The same NCCI bundling mistake can repeat across dozens of claims before anyone notices a pattern, because most billing teams review denials individually rather than in aggregate. A denial tracking dashboard flips that: instead of asking “why did this claim deny,” it … Read more
One of the most common reasons a legitimate, separately payable service gets denied isn’t a coding mistake. It’s a misunderstanding of what’s already bundled into the surgery itself. The global surgical package is the single biggest source of CO 97 denials tied to surgical billing, and it trips up experienced coders just as often as … Read more
A corrected claim isn’t the same thing as a new claim, and billing it like one is the fastest way to get it rejected, denied as a duplicate, or stuck in limbo for weeks. Payers need to know you’re replacing something they already processed, not submitting a brand new charge. That distinction lives in one … Read more
Short answer: CPT 27599 (unlisted femur/knee procedure) is the more technically accurate code for patellofemoral arthroplasty (PFA). But across three commercial payers I contacted directly, 27438 processes and pays without a flag while 27599 routes into manual pricing at 60–80% of the 27447 allowable. The right code depends on your payer, your documentation, and whether … Read more
Here’s What the Reps Actually Said vs. What the Policy States A CO-197 denial means the service required prior authorization and either it wasn’t obtained or it wasn’t valid. That’s what the policy says. It’s clean, short, and almost completely useless when you’re staring at a remit with a $4,200 denial and a 45-day timely … Read more
Category: Surgical Billing | Nerve Surgery | Orthopedic Hand Surgery Coding Reading Time: 9 minutes Last Updated: June 2026 CPT 64999 is the more defensible billing choice for selective thumb CMC joint denervation. This applies when the surgeon has addressed the superficial radial nerve branches. It also applies when the lateral antebrachial cutaneous nerve branches … Read more
Introduction: The Conflict Between Commercial and Medicare Billing Rules Medical billing professionals who handle coordination of benefits claims frequently encounter a challenging scenario: a global imaging code such as CPT 74181 (MRI abdomen without contrast) was correctly billed and paid by a commercial primary insurer, but the claim must now be submitted to Medicare as … Read more