Orthopedic Billing Services
Orthopedic billing services for surgical and non-surgical musculoskeletal care. Accurate coding for joint procedures, fracture care.
What Orthopedic Billing Turns On
Orthopedics is dominated by global periods and by the distinction between surgical and conservative care. Procedures carry follow-up windows during which related care is included, and durable equipment dispensed in the office follows separate rules entirely.
- Global periods established per procedure and applied to follow-up
- Fracture care distinguished from routine evaluation
- Injections and imaging guidance reported together correctly
- Office-dispensed equipment billed under its own requirements
Orthopedic Billing Services Explained
Orthopedic billing covers a wide range of surgical and non-surgical procedures with complex modifier requirements for bilateral procedures, staged surgeries, and assistant surgeon services. Fracture care CPT coding requires distinction between initial care, subsequent care, and manipulation vs non-manipulation treatment per AMA guidelines, while joint replacement procedures carry 90-day global periods that affect how follow-up care is billed. Spine cases that cross into neurosurgical territory are handled under neurosurgery billing, and bracing dispensed in the office falls under DME billing.
Medsure RCS manages orthopedic medical billing services in Florida for surgical and non-surgical practices. We apply correct CPT codes for arthroscopic and open surgical procedures, handle global period management for major joint surgeries, and ensure prior authorization workflows are completed before high-cost orthopedic procedures. Orthopedics is part of our specialty medical billing program.
How It Works: Step by Step
Surgical Report Review
Operative reports are reviewed for procedure type, approach (arthroscopic vs open), anatomic site, complexity, and any additional procedures performed during the same surgical session.
Global Period and Modifier Assignment
Global period classification (0-day, 10-day, or 90-day) is applied correctly to each procedure, with modifiers 24, 25, and 57 used for separately billable services during and after the global period.
Bilateral and Multiple Procedure Billing
Bilateral procedure modifier 50 and multiple procedure modifier 51 are applied correctly to bilateral surgeries and same-session procedure combinations.
Authorization and Pre-Certification
Prior authorizations for elective joint replacement, arthroscopy, and spine surgery are requested and tracked through the pre-certification process before scheduling.
Why This Matters for Your Revenue Cycle
Orthopedic modifier accuracy and global period management drive first-pass acceptance above 95%.
Every surgical procedure global period is tracked and applied to post-operative visit billing.
Prior authorization requests are submitted within 48 hours of scheduling for covered orthopedic procedures.
All bilateral orthopedic procedures are billed with correct modifier 50 application and payment reduction awareness.
Common Mistakes in Orthopedic Billing Services
Billing Post-Op Visits Separately During Global Period
Major orthopedic surgeries have a 90-day global period. Routine follow-up visits within this period are included in the surgical fee. Billing them separately without appropriate modifiers results in denial and potential overpayment.
Incorrect Fracture Care Code Selection
Fracture care codes are selected based on whether treatment was with or without manipulation, the fracture location, and whether the patient was seen for initial care, subsequent care, or complication. Using the wrong phase or treatment type creates medical record discrepancies.
Missing Assistant Surgeon Modifier
When an assistant surgeon is present for a major orthopedic procedure, modifier 80, 81, or 82 must be appended to the procedure code on the assistant's claim. Missing this modifier results in payment reduction or denial.
Wrong Code for Arthroscopic vs Open Procedure
Arthroscopic and open procedure codes are distinct. Billing an arthroscopic code (29881 knee arthroscopy) when an open procedure was performed (or vice versa) is a medical record accuracy issue that creates compliance exposure.
How Medsure RCS Manages Orthopedic Billing Services
Joint Replacement Surgery Billing
Total hip, knee, and shoulder replacement billing with 90-day global period management and implant cost coordination.
Arthroscopic Procedure Coding
Knee, shoulder, hip, and ankle arthroscopy billing with correct diagnostic vs therapeutic code selection per procedure performed.
Fracture Care Management
Fracture care coding by type, location, treatment method, and phase of care from initial treatment through delayed treatment when applicable.
Spine Surgery Billing
Spinal fusion, laminectomy, discectomy, and anterior vs posterior approach coding with correct level-by-level code stacking.
Modifier Application
Bilateral (50), multiple procedure (51), assistant surgeon (80-82), distinct procedural service (59), and staged procedure (58) modifiers applied correctly.
DME and Surgical Supply Billing
Post-surgical bracing, cast application, and durable medical equipment billing coordinated with the surgical claim.
Orthopedic Billing Services, Frequently Asked Questions
Major surgical procedures carry a 90-day global period during which routine post-operative care is included in the surgical fee. We track every surgery's global period start and end date, and bill post-op visits separately only when they involve a new condition, complication, or service unrelated to the surgery using the appropriate modifier.
The primary procedure is billed at the full rate. Secondary procedures performed through the same incision or approach are billed with modifier 51 (multiple procedures), which triggers a 50% reduction on the lesser procedure. We apply these reductions correctly to prevent overpayment.
Yes, when the PT is employed by or contracted through the orthopedic practice, their services can be billed under the practice NPI. Services must be personally supervised by the physician in some settings, or under general supervision in others, depending on the service type and setting.
Spinal procedures are coded by approach, level, and technique. Many spinal codes have add-on codes for each additional level. We code each level separately using the base code for the first level and the appropriate add-on code for each additional level, per the documented operative report.
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