High-performing billing partners provide specialized billing for orthopedic surgery and sports medicine practices — global period management, implant billing, prior authorization for elective procedures, and systematic AR follow-up. Performance-based billing that captures the full value of complex orthopedic cases.
Orthopedic billing is among the most complex in surgical specialties — global periods, implant billing, laterality modifiers, arthroscopic code selection, and prior authorization for all elective procedures create a billing environment where errors are frequent and revenue leakage is significant. A single joint replacement case involves the surgeon's fee, implant billing, assistant surgeon, and anesthesia — each with separate rules and payer-specific nuances. Orthopedic practices with specialized billers consistently outperform those using generalist billing staff by 20–35% in net collections per case.
TKA (27447), THA (27130), shoulder (23472). 90-day global period management. Implant component billing (L-codes). Prior auth with conservative treatment documentation.
Knee arthroscopy (29880–29889), shoulder arthroscopy (29821–29828), hip arthroscopy (29860–29863). Arthroscope + procedure code selection. Bilateral and multiple-procedure modifier rules.
Closed (no surgery) and open reduction/internal fixation (ORIF) codes. Fracture care global periods. Post-fracture follow-up during global period modifier compliance.
Discectomy, laminectomy, fusion procedures (22610–22630). Instrumentation add-ons. Prior auth with imaging and conservative treatment documentation.
ACL reconstruction (27407), rotator cuff repair (23412), meniscal repair (29882). Competition-injury documentation for workers' comp claims. Return-to-play visit billing.
Joint injections (20610/20611), aspiration, casting/splinting (29000–29799), durable equipment dispensing. Same-day E&M and procedure billing rules (-25 modifier).
Tracking all patients in a global period, applying correct modifiers (-24, -25, -57, -79) for services inside global periods, and ensuring no billable services are bundled incorrectly into the surgical fee.
Complete auth packages for elective surgical procedures — imaging documentation, conservative treatment failure evidence, physician clinical notes — submitted and tracked for every scheduled procedure.
Implant billing separate from the surgical fee where permitted. HCPCS L-code selection for orthotics and prosthetics. Cost report documentation for hospital-based billing.
Laterality (-LT/-RT), bilateral (-50), multiple procedures (-51), assistant surgeon (-80), and distinct service (-59/-XS) modifiers applied correctly for every claim — the biggest driver of orthopedic coding errors.
Correct place of service (22 = outpatient hospital, 24 = ASC) with appropriate fee schedules. Professional component billing coordinated with facility billing to prevent splits and duplications.
Workers' compensation claims require separate payer enrollment, different fee schedules, and injury documentation. We manage workers' comp billing alongside commercial claims for orthopedic practices with high WC volume.
We'll review your global period compliance, modifier accuracy, prior auth denial rate, and AR by procedure — and show you where your orthopedic practice is leaving revenue on the table.