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Orthopedic Medical Billing: Surgery, Injections and Fracture Care Done Right
Global Periods, Modifiers and Workers’ Comp
Orthopedic billing is built around surgical global periods, modifiers and a mix of payers that includes workers’ compensation and auto insurance. One missing modifier can wipe out payment for a procedure or a follow-up visit. Billing Care Assistant handles orthopedic billing so surgeries, injections, imaging and follow-up care are all paid correctly.
Common Orthopedic Billing Problems We Fix
| Billing problem | Why it costs you | How we fix it |
|---|---|---|
| Post-op visits billed inside the global period | Routine follow-up is included in the surgery payment, so separate visits deny | We track 10- and 90-day global periods and bill only what is separately payable |
| Missing modifiers 24, 25, 57, 58, 78 or 79 | Unrelated visits, decisions for surgery and staged or return-to-OR procedures need the right modifier | Coders review each case and apply the modifier the documentation supports |
| Incomplete injury and side codes | ICD-10 injury codes need laterality and a 7th character for the encounter type | We code side, encounter type (A, D or S) and cause of injury where required |
| Workers’ comp and auto claims delayed | These claims need claim numbers, adjuster details and state-specific forms | We set up each case correctly and follow up with adjusters |
| Braces and supplies not paid | DME has its own codes, documentation and supplier rules | We bill DME correctly when your practice is enrolled to supply it |
Orthopedic Codes We Handle
From clinic visit to the operating room
We code joint replacements, arthroscopy, fracture care, spine and hand surgery, joint injections (20610-20611), casting and splinting, in-office X-rays and office visits. We apply global surgery rules and modifiers 24, 25, 57, 58, 78 and 79, assistant-at-surgery modifiers, and RT, LT and finger and toe modifiers so every claim matches the operative report.
How We Keep Orthopedic Claims Clean
Clean claims from the start
We verify benefits and prior authorization for surgery and imaging, review operative notes before coding, and scrub claims for bundling edits. Denied or underpaid claims go to our denial management team, and new surgeons are enrolled quickly through our credentialing services. Read our guide to modifiers 24 and 25.
Payer Rules Orthopedic Practices Should Watch
Know the package before you bill
Medicare’s global surgery package includes the pre-op visit the day before or day of major surgery, the procedure and routine post-op care. Complications that need a return to the operating room, unrelated problems and staged procedures can be billed separately with the right modifier. Workers’ compensation fee schedules and filing rules vary by state, and we follow the rules for each case.
Why Orthopedic Practices Choose Billing Care Assistant
Surgical coding expertise
Our coders know orthopedic surgery coding, we follow up on every open claim including workers’ comp, and you get monthly reports by surgeon, procedure and payer. Want to see where your practice is losing revenue? Start with a free medical billing audit, or see all the specialties we bill for.
Orthopedic Billing FAQs
What is included in the 90-day global period?
For major surgery, Medicare’s global package covers the pre-op visit the day before or the day of surgery, the surgery itself, and routine follow-up care for 90 days. Treatment of unrelated problems and returns to the operating room for complications can be billed with the right modifier.
When is modifier 57 used?
Modifier 57 is added to an office or hospital visit on the day before or the day of a major surgery when that visit led to the decision to operate. Without it, the visit is treated as part of the global package.
Do you bill workers’ compensation and auto injury claims?
Yes. We set up each case with the claim number and adjuster details, follow state fee schedules and forms, and follow up until the claim is paid.
How are joint injections billed with an office visit?
The injection (for example 20610) is billed with its drug code. An office visit can be added with modifier 25 only when it is significant and separate from the decision to inject.
Not Sure Where Your Revenue Is Leaking?
Get a free, no-obligation medical billing audit. We review your claims, denials and A/R, then show you what to fix first.
