Orthopedics billing, handled with care
Where orthopedics billing gets difficult
The issues we see most often, and the ones that quietly cost practices the most.
Visits inside a global period
Follow-up care is often included in the surgical fee, so separately billable visits must be clearly unrelated or otherwise justified.
Laterality and multiple procedures
Missing side indicators or unclear sequencing on multi-procedure cases can trigger denials or reduced payment.
Surgical authorizations
Arthroscopy, joint replacement and spine procedures commonly require approval tied to specific codes, sites and dates.
Bracing and supplies
Orthotics and DME dispensed in the office have their own documentation, supplier and coverage rules.
How we handle them
Global period tracking
We track each patient’s surgical global period so visits and procedures during that window are coded with the right modifier, or not billed when included.
Operative note review
Coders read the operative report to sequence procedures, confirm laterality and identify distinct work that may be separately reportable.
Authorization matching
We compare the authorized codes and sites with what was actually performed and help update approvals when the plan changes in the OR.
DME documentation checks
Bracing and supplies are reviewed for orders, medical necessity and proof of delivery before they go out.
Coding notes
General guidance only. Code sets update every year and payer policies vary, so we check current rules on every claim.
- Global surgical periods
- Procedures carry a 0, 10 or 90-day global period. Routine postoperative care during that window is included in the surgical payment.
- Modifiers within the global
- 24 is used for an unrelated E/M visit during the postoperative period, 25 for a significant, separate E/M on the day of a minor procedure, and 57 when the visit led to the decision for major surgery.
- Return trips and staged procedures
- 58 indicates a staged or planned related procedure, 78 an unplanned return to the operating room for a related problem, and 79 an unrelated procedure during the postoperative period.
- Laterality
- RT and LT identify the side of the body, and finger and toe modifiers (F1–F9, FA, T1–T9, TA) identify digits. Bilateral procedures may use modifier 50 or two lines, depending on the payer.
Orthopedics billing questions
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