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Orthopedic Billing

Billing for orthopedic practices where a missed modifier costs more than a missed visit.

Global surgical periods, modifier 25/57/58/59/78/79 logic, DME billing, and imaging bundling handled by coders who know orthopedic edits by heart.

▤Orthopedic surgeon or clinic
Specialty Challenges

Orthopedic billing is where modifiers and bundling rules bite hardest.

Global surgical periods

10-day and 90-day globals fold post-op visits into the surgery; billing inside a global without modifier 24/79 causes bundling denials.

Modifier discipline

25, 57, 58, 59, 78, and 79 each mean something specific; incorrect use triggers CO-4 or CO-B15, correct use unlocks legitimate payment.

DME billing

Splints, braces, and L-codes need HCPCS accuracy, supplier standards, and medical necessity documentation to survive audit.

Imaging bundling

Fluoroscopic guidance (77002, 77003) is bundled into many procedures; separate billing gets clawed back.

Joint injections and J-codes

20610 and family plus the correct J-code for the substance injected; units and NDCs must match.

Workers comp and personal injury

Different fee schedules, different documentation, and long timelines; a separate workflow prevents mixed billing.

Common Denials

The reason codes we see most, and how we prevent them.

CO-97
Included in another procedure (bundling / global)
Post-op visits inside global periods flagged; separate services billed with 24/79 only where supported.
CO-B15
Missing/incomplete required modifier
Modifier logic applied at scrub for 25, 57, 58, 59, 78, 79 based on encounter type.
CO-4
Procedure inconsistent with modifier
Same-day E/M with a procedure validated against payer-specific modifier 25 rules.
CO-11
Diagnosis inconsistent with procedure
ICD-10 specificity checked against CPT laterality and anatomical site before submission.
Workflow

Built around the surgical calendar.

1
Pre-op eligibility & authorization
Imaging, surgery, and DME authorizations obtained before the date; auth numbers stored on the encounter.
2
Op report to coder
Operative reports routed to coders same-day; queries sent to the surgeon within 24 hours where documentation gaps exist.
3
Modifier logic at coding
25, 57, 58, 59, 78, 79 assigned based on relationship to the surgery and payer rules.
4
DME billing routed separately
L-codes and supplies billed on the correct claim form with supporting documentation attached.
5
Global period tracking & follow-up
Post-op visit counts tracked against global periods; A/R worked bucket-by-bucket, workers comp on its own cadence.
Services for Orthopedics

What we run for you

FAQ

Orthopedic billing questions

Do you code from operative reports, or do you rely on the surgeon's charge sheet?+
We code from operative reports. Charge sheets are used only as a cross-check, not the source of truth.
Can you bill DME (splints, braces, L-codes) alongside our professional fees?+
Yes. DME is billed on the correct claim form with medical necessity documentation and supplier standards observed.
How do you handle post-op visits inside a global period?+
Post-op visits within the global period are not billed separately unless a distinct problem is documented, in which case modifier 24 is applied with supporting notes.
Do you support workers comp and personal injury billing?+
Yes. Separate workflows for state fee schedules, adjuster communication, and extended A/R timelines are standard.

Find out what modifier and global-period errors are costing your practice.

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