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Orthopedic Billing Services

Orthopedic billing lives and dies on the surgical global period and the modifiers around it. A 90-day global after a joint replacement, a return to the OR for a complication, a staged procedure, an unrelated visit, each one needs the right modifier or the revenue is written off or flagged for audit. Add multiple-procedure bundling, injections with their drug codes, implants, and workers comp, and one missed modifier on a busy surgical schedule is real money gone. We run the full orthopedic revenue cycle so every procedure and every post-op visit is coded right.

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All 50 States
Starting at 2.49%
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2.49%Of collections
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Why orthopedic billing breaks where other specialties hold

Most specialties bill a visit and maybe a procedure. Orthopedics bills a surgery that opens a 90-day window, during which some care is bundled and some is separately payable, and the only thing that tells the payer which is which is a two-digit modifier. On top of that, a single operative session can carry several procedure codes that reduce or bundle against each other, every injection has a drug that bills separately, and a large slice of the patient base runs through workers comp on a different fee schedule entirely.

That is four overlapping rule sets on one claim, and orthopedic practices lose money at every seam: post-op care written off because the modifier was missing, second procedures underpaid because they were sequenced wrong, injection drugs never billed, and workers comp claims sent to the wrong carrier. None of it shows up as a dramatic denial. It shows up as a collection rate a few points lower than it should be, every month.

The four things that cost orthopedic practices the most

Each one is a process we run on every claim, not a feature we mention once.

Global period and the modifier maze

90-day and 10-day globals, with modifiers 24, 25, 57, 58, 78, and 79 deciding what gets paid versus written off. We track every patient's global window and code the post-op against it, so billable care is billed and an audit stays away.

Multiple-procedure bundling

One arthroscopy, several codes that NCCI bundles. We sequence the highest-RVU procedure first, apply modifier 59 or X modifiers only where documentation supports it, and clear the bundle before submission so nothing is denied or downcoded.

Injections and their drug codes

20610 and 20611 for the joint injection, plus the separate J-code for the hyaluronic acid or steroid. Billing the injection without the drug code leaves real medication revenue uncollected on every injection visit.

Workers comp and auto

A large share of orthopedic revenue, on state fee schedules that often beat commercial rates. We bill the correct carrier with the state-required forms, never the patient's health plan, so injury claims actually get paid.

WHERE THE REVENUE LEAKS

The global period is where orthopedic revenue quietly disappears

When you bill a major orthopedic surgery, the payment includes the operation plus 90 days of routine follow-up. Bill a normal post-op visit inside that window and it correctly denies, it was already paid for. So far so good. The problem is everything that is not routine.

A patient comes back during the global with an unrelated complaint: that visit is billable with modifier 24. A wound infection sends them back to the OR: that is modifier 78. A staged procedure that was planned from the start: modifier 58. The decision to operate, made at the visit before surgery: modifier 57. Each of these is revenue the practice earned, and each one is invisible to the payer without the modifier. The default behavior of an overloaded billing workflow is to leave the modifier off and let the visit deny as part of the global, so the practice simply never collects for the extra care it provided.

We track the global window on every surgical patient and review each post-op encounter against it, so the billable exceptions get the right modifier and the routine visits do not get flagged for unbundling. When a payer does challenge a modifier 78 or 24, our A/R team defends it against the operative note. This single discipline is usually the biggest recovery for an orthopedic practice that has been billing post-op care by habit.

What we handle for orthopedic practices

The full revenue cycle for solo surgeons, ortho groups, and ASC-based practices.

Joint replacement and arthroscopy coding (27447, 27130, 29826, 29881)
Spine and trauma surgical coding
Fracture care: global package vs itemized casting
Global-period tracking and post-op modifiers (24, 57, 58, 78, 79)
Multiple-procedure sequencing and NCCI bundling resolution
Joint injections with drug J-codes (20610, 20611)
Implant and device reimbursement per payer policy
In-office imaging (X-ray, MRI) and prior authorization
DME and bracing dispensed in office (L-codes)
Workers compensation and auto injury billing
Denial work, appeals, and aged AR recovery
Credentialing and payer enrollment for every surgeon

Transparent pricing, no surprises

We start at 2.49% of collections, billed month to month. No setup fee, no long-term contract, no separate charge per claim or per provider. The fee covers surgical and office coding, global-period and modifier management, injection and drug coding, workers comp, denial work, and credentialing support.

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Free orthopedic billing review

Send us your last 90 days. Our AAPC-certified coders will show you where post-op modifiers are being missed in the global period, where multiple-procedure sequencing is costing you, and which injection drugs are going unbilled. No obligation.

92%+ clean claim rate
2.49% starting rate
Results in 30 days

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92% clean claim rate
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Orthopedic Billing Questions

Straight answers on global periods, modifiers, bundling, injections, implants, and workers comp.

Major orthopedic surgery carries a 90-day global and minor procedures a 10-day global, and routine post-op care is already bundled into the surgery payment. The revenue is in coding the exceptions correctly. An unrelated visit during the global gets modifier 24, the decision for surgery gets 57, a staged or planned related procedure gets 58, a return to the OR for a complication gets 78, and an unrelated procedure during the global gets 79. Miss those and you write off care you were entitled to bill; apply them wrong and you invite an audit. We track every patient's global window and code the post-op against it.
There are two parts practices often split incorrectly: the injection and the drug. 20610 covers a major joint injection and 20611 the same with ultrasound guidance, where the guidance is built in, so 76942 is not billed separately. The drug, a hyaluronic acid such as Synvisc or a corticosteroid, is billed separately with its own J-code and units. Billing the injection without the drug J-code leaves the medication reimbursement uncollected, which adds up fast on a busy injection schedule.
Yes. A single arthroscopy can involve several CPT codes that NCCI bundles together. We sequence the highest-RVU procedure first, because subsequent procedures are reduced under the multiple-procedure payment rule and the order changes the total, apply modifier 59 or the X modifiers only where documentation supports a genuinely distinct procedure, and confirm the bundle before submission so the claim is not denied or quietly downcoded.
Yes, and for orthopedics that is a large share of revenue. Workers compensation pays on state-specific fee schedules that often run above commercial rates, and it requires the correct carrier, forms, and documentation. We bill workers comp and auto injury claims to the right carrier, never the patient's health plan, with the state-required paperwork, so those claims actually get paid instead of bouncing.
Implant reimbursement varies by payer and by setting. Some commercial payers pay a separate device fee above the facility payment; others bundle the implant into it. We verify each payer's implant policy and document the device, including manufacturer and catalog number where required, so the practice or facility captures the reimbursement it is owed instead of absorbing the device cost.
We start at 2.49% of collections, with no setup fee and no long-term contract, billed month to month. That covers surgical and office coding, global-period and modifier management, injection and drug coding, workers comp, denial work, and credentialing support. There is no separate per-claim or per-provider charge.

Stop writing off post-op care you earned

Orthopedic billing built around the global period, the modifier maze, and the audits you actually face. AAPC-certified coders, 2.49% of collections, no setup fees, month to month.

Get Your Free AuditCall 888-701-6090