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 asks “why do we keep hitting this same code pair,” which is the question that actually stops the bleeding.
This guide walks through what to track, how to structure the report, and how to turn it into a weekly habit that catches systemic issues before they pile up.
Key Takeaways
- Tracking CO 97 denials by individual claim hides the pattern. Tracking by code pair, provider, and payer reveals it.
- A weekly cadence catches systemic issues faster than a monthly one, especially for high-volume practices where the same bundling error can repeat dozens of times before a monthly report would surface it.
- If the same code pair appears more than 3-5 times in a week, that’s not a one-off coding mistake. It’s a workflow gap that needs a fix upstream, not repeated claim-by-claim correction.
- Most practice management systems and clearinghouses can export denial data by CARC code, which is the raw material this dashboard is built from. You don’t need a separate analytics platform to start.
Why Track CO 97 Denials Separately from Other Denials
CO 97 behaves differently from most other denial types. It’s rarely a one-off coding error; it’s almost always tied to a specific, repeatable cause: a missing modifier on a known bundled pair, a misunderstanding of a global period, or a clearinghouse scrubbing rule that isn’t catching a particular code combination. That means CO 97 denials cluster. A handful of code pairs typically account for the majority of your CO 97 volume, which makes it one of the easiest denial types to fix at the root rather than chasing individually.
Lumping CO 97 into a general denial report buries this. A dashboard that isolates CO 97 and breaks it down by code pair turns a vague “we have a lot of denials” problem into a specific, fixable one: “this E/M and EKG combination keeps getting billed without modifier 25.”
What to Track
At minimum, a useful CO 97 dashboard needs to capture:
- The code pair: the Column 1 (paid) and Column 2 (denied) CPT codes involved in each denial.
- Frequency: how many times that specific pair has been denied in the reporting period.
- Provider or coder: whether the denial is concentrated under one provider’s billing, one coder, or spread evenly, which tells you whether this is a training issue or a systemic clearinghouse gap.
- Payer: whether the denial is payer-specific or happening across all payers, since some payers apply NCCI edits more strictly than others.
- Modifier indicator status: whether the NCCI pair allows an override modifier (indicator “1”) or is a hard bundle (indicator “0”). This tells you whether the fix is “add the modifier” or “stop billing this combination entirely.”
- Dollar impact: the denied amount per occurrence, so you can prioritize fixing the pairs costing the most, not just the ones occurring most often.
- Resolution status: whether each denial was successfully appealed, written off, or is still pending, so the dashboard also functions as a recovery tracker.
Step-by-Step: Building the Dashboard
Step 1: Pull Denial Data Filtered by CARC Code
Most practice management systems and clearinghouses let you filter or export denial reports by Claim Adjustment Reason Code. Filter specifically for CO 97 over a rolling period (start with 4-8 weeks of history to establish a baseline).
Step 2: Group by Code Pair
Sort the exported data by the combination of billed (denied) code and the code it was bundled into. This is the single most important grouping, since it’s where the repeatable patterns live. A simple pivot table in a spreadsheet is enough to start; you don’t need specialized software for the first version of this.
Step 3: Add Provider and Payer Breakdowns
Once the code pairs are grouped, add columns or filters for rendering provider and payer. This tells you whether a specific provider’s documentation habits are driving the denial, or whether it’s a payer applying a stricter edit than others.
Step 4: Flag the Repeat Offenders
Set a threshold, 3-5 occurrences of the same pair within a week is a reasonable starting point, and flag anything crossing it. These are your systemic issues, not isolated mistakes.
Step 5: Check the Modifier Indicator for Each Flagged Pair
For each flagged code pair, look up the NCCI modifier indicator. If it’s “1,” the fix is a coding workflow change: add a mandatory modifier check for that specific combination. If it’s “0,” the fix is different: stop billing that combination altogether, or confirm there’s a genuine reason it’s being billed that way and document it consistently.
Step 6: Build the Weekly Review Into Your Process
A dashboard only works if someone looks at it on a fixed schedule. Set a recurring weekly review, ideally with the billing manager and lead coder both present, where the flagged pairs from that week get assigned a fix: a coder training note, a clearinghouse scrubbing rule update, or a provider documentation conversation.
Sample Dashboard Structure
| Field | Example |
|---|---|
| Code Pair (Column 1 / Column 2) | 99213 / 93000 |
| Occurrences (this week) | 7 |
| Modifier Indicator | 1 (override allowed) |
| Primary Provider | Dr. Smith (6 of 7 occurrences) |
| Payer Breakdown | 5 Commercial, 2 Medicare Advantage |
| Dollar Impact | Denied amount across all 7 occurrences |
| Root Cause | Modifier 25 missing on E/M when billed with EKG |
| Action Assigned | Coder training note + clearinghouse rule check |
| Status | In progress |
Turning the Dashboard Into Prevention
The dashboard’s real value isn’t the report itself, it’s what it triggers. Once a code pair is flagged repeatedly:
- Add it to your clearinghouse or PM system’s pre-submission scrubbing rules if it isn’t already being caught there.
- Add it to a quick-reference list for coders covering your most frequently denied pairs and the correct modifier for each.
- If it’s concentrated under one provider, address it directly through documentation or coding workflow training rather than treating each instance as a separate denial to work.
The goal is for each repeat-offender pair to eventually drop off the dashboard, not stay on it indefinitely getting corrected claim by claim.
Frequently Asked Questions About CO 97 Denial Tracking
How often should I review the CO 97 dashboard?
Weekly is the recommended cadence for most practices, since it catches repeat patterns fast enough to fix before they compound into dozens of denied claims. Lower-volume practices may be able to review biweekly without losing much, but monthly is generally too slow to catch a systemic issue before it’s already cost significant revenue.
What counts as a “repeat offender” code pair?
There’s no universal rule, but 3-5 occurrences of the same code pair within a single week is a reasonable threshold to flag it as systemic rather than coincidental. Lower-volume practices may want to set the threshold lower since the same absolute number represents a larger share of their claims.
Do I need special software to build this dashboard?
No. A spreadsheet built from your PM system’s or clearinghouse’s denial export, filtered by CARC code and grouped by code pair, is enough to start. The structure matters more than the tool. You can move to a more automated reporting setup later if volume justifies it.
Should I track CO 97 denials that were successfully overturned on appeal?
Yes. Tracking resolution status, not just occurrence, tells you which code pairs are worth appealing versus which ones are hard bundles you should stop billing that way entirely. It also helps you measure whether your appeal process for CO 97 is actually working.
Can this dashboard structure work for other denial codes, not just CO 97?
Yes. The same approach, grouping by reason code, then by a relevant secondary dimension like code pair, provider, or payer, applies to most recurring denial types. CO 97 is a good place to start because its root causes are usually clean and specific, which makes the pattern easy to spot and the fix easy to assign.
Conclusion
A CO 97 denial tracking dashboard isn’t about generating another report nobody reads. It’s about turning a pile of individual denials into a short, prioritized list of fixable patterns. Pull the data, group it by code pair, flag what repeats, and assign each flagged pair an actual fix: a modifier check, a scrubbing rule, or a provider conversation. Done consistently, the same code pairs that show up every week now should start disappearing from the report instead.
Manikandan is a Revenue Cycle Management (RCM) specialist with over 10 years of hands-on experience in US healthcare billing. He has worked extensively with commercial payers, Medicare, and Medicaid across multiple specialties including surgery, orthopedics, and radiology. Manikandan founded Medical Billing 101 to provide free, accurate denial code guides, CPT coding references, and Medicare billing resources for US medical billing professionals.
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