Orthopedic billing built around every joint, every code, every claim.
Orthopedic practices lose revenue in places general billing teams don't watch for: bundled CPT codes, 90-day global surgery periods, modifier errors on bilateral procedures, and DME claims that get denied on a technicality. Our AAPC-certified orthopedic coders and billing specialists close those gaps so your claims get paid faster, the first time.
WHERE ORTHOPEDIC CLAIMS ACTUALLY STALL
- Bundled & bilateral CPT codes flagged before submission
- Global period tracking so follow-ups aren't billed in error
- DME & orthotics claims matched to payer policy
- Workers' comp & auto-liability claims routed correctly
Orthopedic revenue cycle management, not generic medical billing with a new label
Orthopedic practices run one of the most code-dense specialties in medicine. A single visit can involve an evaluation and management code, imaging, a procedure code, a modifier for laterality, and, in surgical cases, a 10- or 90-day global period that determines what can and can't be billed afterward. Payers know this complexity well, and it shows up in denial rates: incorrect modifier use, unbundled procedures, and missed medical-necessity documentation are consistently among the top reasons orthopedic claims get rejected or underpaid.
We built our orthopedic billing service around that reality. Our team works exclusively within orthopedic and musculoskeletal specialties joint replacement, spine, sports medicine, hand and upper extremity, foot and ankle, and trauma so the coders assigned to your account already understand payer-specific quirks for hardware removal, arthroscopy bundling, and post-op visit windows before we ever open your first chart.
"Orthopedic claims fail less often because of what the surgeon did, and more often because of how the visit around it was coded the modifier, the global period, the bundled procedure."
End-to-end orthopedic billing coverage
Every service below is handled by staff trained specifically on orthopedic coding conventions not routed through a general medical billing pool.
Orthopedic coding (CPT, ICD-10-CM, HCPCS)
Precise coding for arthroscopy, arthroplasty, spinal fusion, fracture care, and hardware procedures, with correct use of modifiers -RT, -LT, -50, -59, and -XS to prevent bundling denials.
Charge entry & clean claim submission
Same-day charge capture from operative notes and encounter forms, with scrubbing against payer edit rules before every claim leaves our system.
Global period & post-op tracking
We flag which post-surgical visits fall inside a 10- or 90-day global window so your practice never bills or leaves unbilled a service in error.
Denial management & appeals
Root-cause analysis on every denial not just resubmission. Repeated denial patterns get flagged back to your front office to prevent recurrence.
DME, bracing & orthotics billing
Correct HCPCS Level II coding and medical-necessity documentation for braces, walking boots, splints, and post-op equipment claims.
Workers' comp & auto-liability claims
Dedicated handling for third-party payers common in orthopedic and trauma cases, including case documentation and adjuster follow-up.
Coverage across every orthopedic focus area
Orthopedics isn't one specialty it's several, each with its own coding patterns. Our coders are cross-trained across the areas below rather than generalized across "surgery" broadly.
Who's actually working your claims
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Certified coding staff
Coders hold AAPC credentials and receive ongoing training on annual CPT and ICD-10-CM updates specific to musculoskeletal procedures.
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Orthopedic-only account teams
Your account isn't shared across unrelated specialties the team on your claims works orthopedics day in and day out.
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Payer-policy tracking
We maintain internal reference guides on Medicare LCDs and major commercial payer policies for common orthopedic procedures and DME.
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Documented, auditable process
Every code assignment and claim decision is logged, so your practice can review the reasoning behind any submission at any time.
We don't ask you to take our accuracy on faith. Every practice we onboard gets a documented coding audit trail: which codes were applied, which modifiers were used, and why tied back to the operative note or encounter documentation that supports it. If a payer questions a claim eighteen months later, that record is still there.
Our billing specialists also track payer-specific requirements that change year to year Medicare Local Coverage Determinations (LCDs), commercial pre-authorization rules for elective joint procedures, and documentation thresholds for DME. Rather than reacting to a denial after the fact, we build these requirements into the claim before it's ever submitted.
This is the same discipline we apply across every specialty page on our site — the details differ by specialty, but the standard of documentation, review, and accountability does not change. We're happy to share a sample audit report or walk your billing manager through our process before you sign anything.
From encounter to payment
Documentation review
We review the operative report or encounter note against the codes selected, checking for medical necessity, laterality, and any bundling conflicts before charge entry.
Coding & charge entry
CPT, ICD-10-CM, and HCPCS codes are applied with the correct modifiers, and the claim is entered with full charge detail the same day it's received.
Claim scrubbing & submission
Claims run through payer-specific edit checks before submission, catching mismatches that would otherwise trigger an automatic denial.
Payment posting & reconciliation
Insurance and patient payments are posted and reconciled against expected reimbursement, with discrepancies flagged for review.
Denial follow-up & A/R recovery
Denied or underpaid claims are corrected and appealed with supporting documentation, and aging A/R is worked on a set follow-up schedule.
Orthopedic billing FAQs
Why do orthopedic practices need billing specialists instead of general medical billers?
Orthopedic claims involve procedure-heavy coding: bundled surgical packages, laterality modifiers, and global surgery periods that determine what can be billed after a procedure. A general biller unfamiliar with these conventions is more likely to trigger denials for unbundling errors, missing modifiers, or billing follow-up visits that fall inside a global period. Specialists who work orthopedic claims routinely catch these issues before submission.
What is a global surgery period, and why does it matter for billing?
A global surgery period is the window typically 10 or 90 days depending on the procedure — during which routine post-operative visits are considered part of the original surgical payment and generally can't be billed separately. Getting this wrong in either direction either causes a denial or leaves money on the table for services that were legitimately separate from the original procedure. We track each patient's global period against their procedure code to bill correctly on both sides.
Do you handle workers' compensation and auto-liability claims?
Yes. Orthopedic and trauma practices see a higher share of workers' comp and auto-liability claims than most specialties. These follow different submission rules and timelines than standard commercial or Medicare claims, and often require direct follow-up with adjusters. Our team handles this documentation and follow-up as a distinct workflow.
How do you handle DME and orthotics billing?
Durable medical equipment braces, walking boots, slings, post-op equipment requires HCPCS Level II codes and specific medical-necessity documentation that differs from procedure billing. We verify that supporting documentation exists before the claim is submitted, since DME claims are frequently denied for missing justification rather than incorrect coding.
How long does onboarding take, and what do you need from our practice?
Most orthopedic practices are fully onboarded within 30–45 days. We'll need read access to your EHR/practice management system, a sample of recent operative notes and encounter forms, and your current payer mix. We use this to calibrate our coding review to your practice's specific procedure volume before going live.
Will we still have visibility into our claims and revenue once billing is outsourced?
Yes. You'll receive regular reporting on claims submitted, denial rates, days in A/R, and collections, and you retain access to review coding decisions at any time. Outsourcing the billing work doesn't mean losing visibility into it.
What's the difference between this page and your general medical billing service?
Our general medical billing service covers standard revenue cycle functions across specialties. This page describes the orthopedic-specific version of that service — the coding rules, modifier logic, global period tracking, and DME/workers'-comp handling here are unique to orthopedic and musculoskeletal practices and are staffed by team members who focus specifically on this specialty.
Ready to see where your orthopedic claims are leaking revenue?
Send us a recent batch of EOBs or denial reports, and we'll walk you through what we find — no obligation, no cost.