Expert Orthopedic Medical Billing & Coding Services
Maximize your orthopedic practice revenue with specialized billing expertise in surgical procedures, implant billing, and global period management. Our certified orthopedic billing specialists understand complex fracture care, arthroscopy bundling, and workers compensation requirements unique to musculoskeletal practices.
Proven Results
30% Average Revenue Increase
98% First-Pass Claim Rate
42% Reduction in Denials
14 Days Faster Payment Collection
Common Billing Challenges
Surgical Global Period Management
Orthopedic surgeries have 90-day global periods where most related services are bundled, requiring careful tracking to avoid denials.
Fracture Care Billing Complexity
Fracture treatment includes initial care, follow-ups, and cast changes within the global package, with specific rules for when to bill separately.
Implant & Hardware Cost Recovery
High-cost implants, plates, screws, and prosthetics require separate billing with proper documentation and manufacturer information.
Arthroscopy Procedure Bundling
Multiple arthroscopic procedures on the same joint require proper modifier usage to prevent bundling and ensure full reimbursement.
Workers Compensation Claims
Work-related orthopedic injuries involve different coding requirements, fee schedules, and authorization processes than standard insurance.
Imaging Coordination & Billing
Orthopedic practices often provide in-office imaging requiring technical and professional component billing with proper modifiers.
Our Solutions
Orthopedic Surgery Billing Specialists
Our team includes certified coders with specialized training in orthopedic procedures, global period management, and implant billing.
Expert CPT coding for all orthopedic procedures
Global period tracking and management
Proper modifier application for multiple procedures
Maximized reimbursement for complex surgeries
Implant Cost Recovery Expertise
Dedicated support for tracking and billing high-cost implants, hardware, and prosthetics with proper documentation.
Accurate implant billing with manufacturer codes
HCPCS code expertise for orthopedic supplies
Documentation support for medical necessity
Full cost recovery for expensive hardware
Global Period Tracking Systems
Advanced technology automatically tracks global periods and identifies billable services that fall outside global packages.
Automated global period monitoring
Alerts for separately billable services
Modifier 24 and 25 guidance
Reduced denials from global period errors
Workers Compensation Expertise
Specialized knowledge of workers comp billing requirements, fee schedules, and authorization processes for orthopedic injuries.
State-specific workers comp compliance
Fee schedule optimization
Authorization management
Faster workers comp payment collection
Specialized Services
Surgical Procedure Billing
Expert coding for joint replacement, arthroscopy, fracture repair, and spinal surgeries with global period management.
Joint replacement (27447, 27130)
Arthroscopic procedures
Fracture repair (ORIF/CRIF)
Spinal fusion procedures
Injection & In-Office Procedures
Accurate billing for joint injections, trigger point injections, and in-office orthopedic procedures.
Joint injections (20610-20611)
Trigger point injections
Bursa aspirations
Casting and splinting
Imaging & Diagnostic Services
Complete billing support for in-office X-rays, ultrasound, and other diagnostic imaging with proper component coding.
X-ray technical/professional split
Ultrasound guidance (76942)
Bone density scanning
Modifier 26 and TC application
Hardware & Implant Billing
Specialized billing for orthopedic implants, plates, screws, prosthetics, and surgical hardware.
Implant HCPCS codes
Manufacturer documentation
Prosthetic device billing
Hardware removal procedures
Common CPT Codes Reference
Key codes include 27447 (total knee arthroplasty), 27130 (total hip arthroplasty), 29881 (knee arthroscopy with meniscectomy), 22551 (anterior cervical discectomy and fusion - ACDF), 63030 (lumbar discectomy), 27235-27245 (femoral fracture treatment), 29827 (arthroscopic rotator cuff repair), 20610 (major joint aspiration/injection), 27446 (medial or lateral knee arthroplasty), and 22612 (posterior lumbar interbody fusion). Accurate code selection requires understanding of global surgical periods, bilateral procedure rules, and multiple procedure reduction guidelines.
Expert Billing Insights
Global Surgical Period Management in Orthopedics
Orthopedic surgeries carry 90-day global periods where pre-operative visits (1 day prior), intra-operative services, and post-operative follow-up care are bundled into the surgical fee. Identifying and properly billing complications, unrelated services, and return-to-OR procedures using modifiers 24, 25, 78, and 79 during the global period can recover 8-12% of otherwise lost revenue. Practices must maintain a global period tracking system to flag separately billable services and ensure that E/M visits during the post-op period are documented as unrelated to the original surgery.
Implement automated global period tracking for all surgical patients to flag billable services during the 90-day window
Use modifier 24 for unrelated E/M services and modifier 79 for unrelated procedures during the global period
Document complications requiring return to OR with modifier 78 and include separate operative reports
Train providers to document when post-op visits address conditions unrelated to the surgery to support modifier 24 usage
Implant and Hardware Billing Optimization
Orthopedic implants represent a significant portion of procedure costs, and accurate billing using HCPCS codes (C-codes for hospital outpatient, L-codes for prosthetics) with proper manufacturer documentation is essential for full cost recovery. Invoice pricing, ASP-based reimbursement, and pass-through payment status must be understood for each implant category to negotiate favorable contracts and maximize margins. Maintaining comprehensive implant logs with manufacturer, catalog number, lot number, and invoice cost supports both accurate billing and regulatory compliance.
Create a detailed implant log template capturing manufacturer, model, serial/lot number, and invoice cost for every case
Verify HCPCS code assignments for all implants against quarterly CMS updates and payer-specific fee schedules
Negotiate implant pricing with distributors using volume-based contracts to improve margin between cost and reimbursement
Bill implant costs separately from the procedure using appropriate C-codes or miscellaneous HCPCS codes with supporting invoices
Multiple Procedure Discounting and Bilateral Coding
When multiple orthopedic procedures are performed during the same operative session, Medicare applies a multiple procedure payment reduction (MPPR) of 50% to the second and subsequent procedures, making accurate code sequencing critical to maximize reimbursement. Bilateral procedures require modifier 50 or LT/RT modifiers depending on payer preference, and reimbursement is typically 150% of the unilateral rate rather than 200%. Understanding the interaction between multiple procedure discounting, bilateral modifiers, and co-surgery modifiers (62) is essential for complex orthopedic cases involving multiple surgeons or staged procedures.
Always sequence the highest-RVU procedure first to maximize reimbursement under multiple procedure reduction rules
Verify payer preference for bilateral procedure reporting: modifier 50 on one line vs. LT/RT on separate lines
Apply co-surgery modifier 62 when two surgeons of different specialties perform distinct portions of the same procedure
Document the medical necessity for each separate procedure when performing multiple procedures on the same joint or anatomical region
Payer-Specific Billing Tips
Medicare Part A (DRG/CJR)
Understand DRG assignment for inpatient orthopedic procedures, as MS-DRG 469-470 (major joint replacement) reimbursement varies significantly based on complication/comorbidity documentation
For practices in Comprehensive Joint Replacement (CJR) model areas, track 90-day episode costs including post-acute care to maximize shared savings
Document all comorbidities and complications to ensure accurate MS-DRG assignment and avoid underpayment on complex cases
Monitor readmission rates and post-discharge complications as they directly impact CJR model performance and bonus payments
Medicare Part B (ASC)
Verify ASC-covered procedure list updates quarterly, as CMS continues to add orthopedic procedures eligible for ambulatory surgery center payment
Bill ASC facility fees using appropriate HCPCS codes with the correct ASC payment indicator for each procedure category
Track implant costs against ASC packaging thresholds, as high-cost devices may qualify for separate pass-through payment
Ensure proper site-of-service documentation when transitioning procedures from hospital outpatient to ASC settings
Commercial Payers
Obtain prior authorization at least 10 business days before elective orthopedic surgeries and verify that the authorized procedure matches the planned CPT codes
Follow step-therapy protocols for conservative treatment documentation before surgical authorization, including physical therapy completion and imaging requirements
Negotiate single-case agreements for out-of-network patients requiring urgent orthopedic procedures with clear fee schedule terms
Verify implant coverage and pre-approved implant vendors before surgery to prevent post-operative claim denials for unapproved devices
Workers' Compensation
Use state-specific workers' compensation fee schedules, which may differ significantly from Medicare and commercial rates for orthopedic procedures
Obtain employer and carrier authorization before performing surgical procedures and document the work-related mechanism of injury
Bill using the appropriate workers' compensation billing format and include first report of injury documentation with initial claims
Track maximum medical improvement (MMI) determinations and impairment ratings as they affect ongoing treatment authorization and billing
Client Testimonial
Managing billing for an orthopedic surgery practice is incredibly complex with global periods,
implant billing, and workers compensation claims. Medtransic's team has deep expertise in
orthopedic coding and has helped us recover costs on high-value implants that we were previously
missing. Their global period tracking system alone has increased our revenue by 28%. They truly
understand the unique challenges of orthopedic billing.