Orthopedic Billing Services
Orthopedic billing covers everything from a 10-minute office visit for knee pain to a 6-hour spinal fusion. The coding spans E&M visits, fracture care with global period management, arthroscopic procedures, joint replacements, and spine surgery. Each category has its own rules for bundling, global periods, and modifier usage. The financial stakes are high — a single total knee replacement reimburses $1,500-2,500 for the surgeon, and a coding error can lose the entire claim.
We bill for orthopedic practices ranging from solo sports medicine physicians to multi-surgeon groups performing joint replacements and complex spine cases. We track global periods, manage post-operative E&M visits, and know when a return visit during the global period is separately billable vs. included.
Orthopedic billing at a glance
Common orthopedic procedures we bill daily.
Joint Replacement
Arthroscopy
Fracture Care
Orthopedic billing challenges we solve every day.
Orthopedic is one of the most complex specialties to bill. High-value procedures, strict documentation requirements, and frequent payer policy changes mean even experienced in-house billers miss revenue. For coding standards, see the American Academy of Orthopaedic Surgeons.
Global period management
Most orthopedic surgical procedures carry a 90-day global period during which all routine post-operative care is included in the surgical fee. E&M visits during the global period for the same condition are not separately billable. But visits for unrelated conditions or complications that require a return to the OR are separately reportable with modifier 24 or 78. We track every patient’s global period and code accordingly.
Fracture care coding
Fracture management uses a unique coding structure: initial treatment code, type of treatment (closed vs. open, with or without manipulation), and anatomic site. The initial fracture care code includes the first cast application and X-ray. Subsequent cast changes and follow-up X-rays during the global period are included. We capture the correct initial code and track the global period to prevent lost revenue on re-treatment or complications.
Bilateral procedure modifiers
Orthopedic procedures are frequently performed bilaterally (both knees, both hips, both wrists). Modifier 50 for bilateral procedures has specific payer rules — Medicare pays 150% of the unilateral rate, but some commercial payers pay 200% or require two line items with RT/LT modifiers. We code bilateral procedures per payer to maximize reimbursement.
Implant and hardware billing
Joint replacements and fracture fixation involve implants that may be separately billable depending on the payer and setting. ASC billing includes implant costs in the facility fee for some procedures but not others. We coordinate with the facility to ensure implant costs are captured without double-billing.
Full-service orthopedic billing across your revenue cycle.
Simple, transparent orthopedic billing pricing.
We also bill for these specialties.
Ready to fix your orthopedic billing?
Schedule a free consultation. We’ll review your current billing performance, identify where you’re losing revenue, and build a plan to get your orthopedic practice paid faster.
