Eligibility & Verification
Coverage checks before every visit.
Specialty Billing
Orthopedics Medical Billing
Orthopedic billing combines surgery, global periods, DME, and implants. We manage global-period rules and modifier usage so post-op care and supplies are billed accurately and never written off.
The Challenge
Orthopedics billing, solved
We understand the billing complexities unique to orthopedics and build them into every claim.
- Surgical global-period tracking
- Implant and DME billing
- Correct modifier 25 / 59 usage
What we focus on
- Surgical & fracture care coding
- DME and implant claims
- Global period management
Coding Focus
Orthopedics code sets we work in
The CPT/HCPCS procedure families and ICD-10 diagnosis groups our certified coders handle for this specialty every day.
Common CPT / procedure codes
- 20600–20610Joint, bursa, and cyst aspiration or injection
- 27130–27447Hip and knee total joint replacement
- 29000–29799Cast, splint, and strapping application
- 25600–25609Closed or open distal radius fracture treatment
ICD-10 diagnosis focus
- S-code fractures with laterality, encounter type, and healing status seventh characters
- M17 knee and M16 hip osteoarthritis for arthroplasty candidates
- M25 joint pain, effusion, and derangement findings
- M54 back and spine pain supporting conservative and surgical care
Code references are shown as general identifiers for illustration. Actual code selection always follows current payer rules and your provider's documentation.
Clean Claims
Modifiers, denials & billing rules we manage
How our team keeps orthopedics claims compliant — the modifiers that matter, the denials we prevent, and the guidelines we follow.
Key modifiers
- RT/LT
Identifies the specific right or left side treated for extremity procedures and injections.
- 24
Reports an unrelated evaluation and management visit during another procedure's global period.
- 58
Marks a planned or staged procedure performed within the surgical global period.
- 78
Indicates an unplanned return to the operating room for a related postoperative complication.
Common denials & fixes
Services within the global period denied as included in the surgery.
Apply 24, 58, 78, or 79 with documentation showing the service is separately billable.
Extremity procedure rejected for missing laterality.
Append RT, LT, or bilateral modifier 50 as supported by the operative note.
Implant or DME claim denied for authorization or documentation gaps.
Secure prior authorization and attach the invoice and medical-necessity records.
Fracture claim denied due to overlap between global care and separate E/M.
Decide deliberately between the fracture-care global package and itemized visit-plus-casting billing.
Billing guidelines
- Track each surgical global period and choose 24, 58, 78, or 79 to bill related services correctly.
- Append laterality modifiers to every extremity procedure and injection performed.
- Obtain prior authorization and document medical necessity for implants and durable medical equipment.
- Decide between global fracture-care coding and itemized evaluation plus casting before submitting claims.
End-to-End
What we handle for Orthopedics
A complete revenue cycle service tailored to your specialty.
Specialty Coding
Certified, specialty-trained coders.
Charge Entry & Claims
Clean, accurate claim submission.
Payment Posting
ERA/EOB posting and reconciliation.
Denial & AR Management
Appeals and aggressive AR recovery.
Reporting & Analytics
Real-time KPIs and insights.
98%
Clean claim rate
30%
Average revenue lift
24/7
Operations coverage
HIPAA
Compliant processes
FAQ
Orthopedics billing — FAQs
Yes — our certified coders are trained on specialty-specific rules, code sets, and payer policies, and we assign coders with experience in your specialty.
We work in your current practice management system and EHR, so your workflows and reporting stay intact while we handle the billing.
Through accurate specialty coding, front-end eligibility checks, clean claim submission, and relentless denial and AR follow-up — typically lifting first-pass acceptance and net collections.
Always. We use strict access controls, encryption, signed BAAs, and audit trails to protect patient data.
More Specialties
Other specialties we bill for
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