Why Orthopedics billing is different.
Orthopedics billing expertise.
- Total joint replacement and revision coding
- Arthroscopic procedure coding with correct bundling
- Closed and open fracture treatment billing
- Joint injection and aspiration coding with imaging guidance
- Modifiers -24, -25, -57, -58, -59 and -79
- DME bracing and supply billing
- Workers' compensation and personal injury claims
- Assistant surgeon and co-surgeon billing
Common Orthopedics codes we work with.
| Code | Description |
|---|---|
27447 | Arthroplasty, knee, condyle and plateau; medial and lateral compartments (total knee arthroplasty) |
27130 | Arthroplasty, acetabular and proximal femoral prosthetic replacement (total hip arthroplasty) |
29881 | Arthroscopy, knee, surgical; with meniscectomy (medial or lateral), including debridement or shaving |
29827 | Arthroscopy, shoulder, surgical; with rotator cuff repair |
20610 | Arthrocentesis, aspiration and/or injection, major joint or bursa; without ultrasound guidance |
25600 | Closed treatment of distal radial fracture; without manipulation |
CPT® is a registered trademark of the American Medical Association. Codes shown are examples; correct coding depends on documentation and payer policy.
Our processOrthopedics billing process.
Authorization and Eligibility
- Surgical and imaging prior authorizations
- Workers' compensation and auto claim setup
- Benefit verification for DME and injections
- Patient estimates for elective surgery
Orthopedic Coding
- Operative report coding with correct bundling
- Global period and modifier assignment
- Fracture care and casting coding
- Diagnosis specificity including laterality and encounter type
Claim Submission
- Scrubbing for NCCI and multiple-procedure edits
- Separate workflows for workers' compensation claims
- Assistant surgeon claim submission
- Electronic submission within 24 hours
Denial Management
- Authorization and medical necessity appeals
- Global period and modifier disputes
- Workers' compensation follow-up
- Underpayment recovery on surgical claims
Analytics
- Surgical revenue by procedure and surgeon
- Authorization turnaround
- Payer reimbursement for major procedures
- A/R by payer class including workers' compensation
Orthopedics billing FAQs.
How do global periods work in orthopedics?
Major surgeries such as joint replacements carry a 90-day global period that includes routine post-op visits. Unrelated visits, staged procedures and complications requiring a return to the OR are billed with modifiers like -24, -58 or -79.
Do you handle workers' compensation claims?
Yes. We manage claim numbers, adjuster communication, state-specific forms and fee schedules so workers' compensation claims don't stall in A/R.
Can we bill an injection and an office visit on the same day?
You can when the E/M service is significant and separately identifiable from the decision to perform the injection. We append modifier -25 when documentation supports it.
How is fracture care coded?
Fracture treatment codes include the initial treatment and routine follow-up care within the global period. We select codes based on whether treatment was closed or open and whether manipulation was performed.