Orthopedic Billing Services Without Write-Offs
Global periods tracked per patient, modifiers 58/78/79 applied correctly, prior auths secured before the OR date, and workers' comp billed on the right state fee schedule. We help you attract surgical and rehab patients online too.
Medical Billing for Orthopedics
Our orthopedic billing services are built for revenue dominated by surgical episodes, which means global periods, modifier discipline, and prior authorization. A missed modifier 58 or 79 inside a 90-day global writes off an entire procedure, and workers' compensation adds a parallel billing universe with its own fee schedules and paperwork. We track every global period per patient, apply post-op modifiers correctly, and keep work comp receivables from aging like commercial claims.
Global period management with correct modifiers 58/78/79 so post-op procedures during the 90-day window are paid, not absorbed
Prior authorization for MRIs, injections, and elective surgery, orthopedics' biggest scheduling bottleneck
Workers' compensation claims with state fee schedules, authorization letters, and employer paperwork handled properly
Fracture care billed as global versus itemized based on payer math, not defaulted one way
DME and casting supplies captured alongside the procedure instead of forgotten
Key CPT Codes in Orthopedics Billing
The codes that drive most of the revenue in this specialty, and what has to be right on each one.
| Code | Service | Billing Note |
|---|---|---|
| 29881 / 29880 | Knee arthroscopy with meniscectomy (single / multiple compartment) | Carries a 90-day global. Anything performed in that window needs 58, 78, or 79 to pay. |
| 27447 | Total knee arthroplasty | 90-day global, near-universal prior authorization, and high-dollar. One auth failure here is a major write-off. |
| 20610 / 20611 | Major joint injection (without / with ultrasound guidance) | 20611 includes guidance with permanent image documentation; billing 76942 separately alongside it denies. |
| 99024 | Post-op visit within the global period | Zero-payment tracking code. Reporting it is how you document global-period utilization for Medicare. |
| Modifier 58 | Staged or planned procedure during the global | For anticipated follow-up surgery. Restarts the global period. |
| Modifier 78 | Unplanned return to the OR for a related problem | Pays a reduced intraoperative-only rate and does not restart the global. |
| Modifier 79 | Unrelated procedure during the global period | Pays at full rate and starts a new global. The most commonly missed of the three. |
| 29075-29450 | Casting and splinting application | Billable with supplies (Q-codes) when the application is not included in a fracture care global. |
Top Orthopedics Denials We Prevent
Procedure inside the 90-day global billed without a modifier
How we prevent it: Global periods are tracked per patient with the surgery date, so any procedure in the window is coded 58, 78, or 79 based on what actually happened rather than absorbed as included.
Elective surgery or MRI performed without prior authorization
How we prevent it: Auth is verified before the procedure is scheduled and chased to approval, which protects both the OR calendar and the claim.
Workers' comp claim missing the authorization letter or claim number
How we prevent it: Work comp encounters are flagged at intake and held until carrier and employer data is complete, then billed on the correct state fee schedule.
Image guidance billed separately when it is already included
How we prevent it: Code pairs like 20611 with 76942 are caught at scrubbing, so bundled guidance never bills twice and legitimate guidance bills only with image documentation.
Fracture care coding choice left to default
How we prevent it: We run the global-versus-itemized math per payer and expected follow-up, so the more profitable compliant option is chosen deliberately.
Orthopedics Billing FAQs
Any procedure within a 90-day surgical global denies as included unless the correct modifier distinguishes it: 58 for staged/planned, 78 for unplanned return to the OR, 79 for unrelated procedures. Practices without global-period tracking lose these routinely, and the fix is workflow, not appeals.
Closed fracture care codes carry a 90-day global that includes the initial treatment and routine follow-up. The decision to bill global fracture care versus itemized E/M-plus-casting depends on payer, follow-up expectations, and reimbursement math, so we run that analysis rather than defaulting.
Yes. Work comp claims bill on state-specific fee schedules with employer and carrier authorization requirements and separate timely-filing rules. They're high-value claims that need dedicated follow-up, exactly the AR that ages when a billing team treats them like commercial claims.
Orthopedic billing typically runs 3% to 6% of collections, toward the lower end of specialty pricing because average claim values are high. The fee usually recovers itself in global-period modifiers that stop getting missed and work comp receivables that stop aging past filing deadlines.
Yes. MRI, elective arthroplasty, and injection series routinely require authorization from commercial plans and Medicare Advantage. We verify requirements at scheduling and work the approval, because an unauthorized total knee is one of the largest single write-offs an orthopedic practice can take.
Yes, and orthopedic AR is often unusually recoverable: the common failures are global-period modifier errors and work comp claims missing paperwork, both of which are correctable on resubmission if the filing window is still open. We triage by dollar value and deadline, then fix the workflow that produced the pattern.
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