Orthopedic Medical Billing Experts

Maximize your orthopedic practice revenue with specialized billing for joint replacements, spine surgery, sports medicine, and trauma procedures. Our certified orthopedic coders achieve 97% clean claim rates and optimize every case for maximum reimbursement.

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97.2%
Clean Claims
$12,450
Avg Surgical Case
2.3%
Denial Rate

Industry-Leading Orthopedic Billing Performance

Our specialized orthopedic billing consistently outperforms industry benchmarks

97.2%
Clean Claim Rate
Industry avg: 84%
First-pass acceptance for orthopedic claims
99.1%
Implant Claim Accuracy
Industry avg: 87%
Hardware and implant claims paid correctly
$12,450
Surgical Reimbursement
Industry avg: $10,200
Average per-case reimbursement
2.3%
Denial Rate
Industry avg: 11.2%
Orthopedic claims denied on submission
24 days
Days in AR
Industry avg: 52 days
Average collection timeframe
94%
Appeal Success Rate
Industry avg: 76%
Denied claims successfully appealed

Orthopedic Billing Challenges We Solve

Complex orthopedic procedures require specialized coding expertise to avoid costly denials

Complex Surgical Bundling

Orthopedic procedures often involve multiple components billed separately - the surgery itself, hardware/implants, anesthesia, and facility fees. Medicare's NCCI edits and commercial payer bundling policies create constant coding challenges.

Without specialty expertise, practices lose 15-25% of potential surgical revenue

CPT 27447 (Total Knee)CPT 27130 (Total Hip)CPT 22633 (Spine Fusion)

Implant and Hardware Billing

Orthopedic implants represent significant costs and revenue. Proper coding requires tracking manufacturer information, lot numbers, and specific HCPCS codes. Missing documentation or incorrect coding leads to automatic denials.

Average implant claim: $8,000-$45,000 - denials are financially devastating

C1713 (Anchors)C1776 (Joint Device)C1821 (Generator)

Global Surgical Packages

Orthopedic surgeries include 90-day global periods covering all related E/M services. Billing separately for routine postoperative care triggers denials, while missing billable complications leaves revenue on the table.

Incorrect global period billing causes 23% of orthopedic denials

Modifier 24 (Unrelated E/M)Modifier 25 (Significant E/M)Modifier 79 (Unrelated Procedure)

Laterality and Modifier Requirements

Bilateral procedures, staged surgeries, and specific anatomical locations require precise modifier usage. RT (right), LT (left), 50 (bilateral), and anatomical modifiers must be applied correctly to avoid rejections.

Modifier errors account for 18% of orthopedic claim denials

Modifier RT/LTModifier 50Modifier 59 (Distinct Service)

Workers' Compensation Complexities

Many orthopedic cases involve work-related injuries with unique billing requirements, different fee schedules, and extensive documentation demands. Each state has distinct WC billing rules and prior authorization requirements.

WC claims have 40% longer payment cycles without specialty knowledge

State-specific WC codesIME billingDisability ratings

Sports Medicine Coding

Arthroscopic procedures require detailed documentation of each compartment examined and structure repaired. Incomplete operative reports or missing diagnostic arthroscopy codes result in downcoding and reduced payment.

Arthroscopy downcoding reduces reimbursement by 30-45%

CPT 29827 (Shoulder Arthroscopy)CPT 29881 (Knee Arthroscopy)CPT 29888 (ACL Repair)

Comprehensive Orthopedic Procedure Coverage

Expert billing across all orthopedic subspecialties and procedure types

Joint Replacement Surgery

Total and partial joint replacements including hip, knee, shoulder, and elbow arthroplasty procedures.

Total Hip Arthroplasty

$14,500

CPT 27130

Total Knee Arthroplasty

$13,200

CPT 27447

Reverse Shoulder Arthroplasty

$16,800

CPT 23472

Revision Hip Arthroplasty

$19,200

CPT 27134

Billing Note: Requires implant tracking, component codes (C-codes), and specific documentation of approach (anterior vs posterior).

Spine Surgery

Spinal fusion, decompression, discectomy, and minimally invasive spine procedures.

Lumbar Fusion (Single Level)

$18,500

CPT 22633

Cervical Discectomy with Fusion

$15,200

CPT 22551

Laminectomy

$8,900

CPT 63030

Kyphoplasty

$6,200

CPT 22514

Billing Note: Multiple level procedures require add-on codes, instrumentation codes, and bone graft documentation.

Sports Medicine & Arthroscopy

Arthroscopic repairs including rotator cuff, ACL reconstruction, meniscus repair, and labral repairs.

Rotator Cuff Repair

$8,500

CPT 29827

ACL Reconstruction

$9,200

CPT 29888

Meniscus Repair

$4,800

CPT 29882

Labral Repair (Shoulder)

$6,700

CPT 29806

Billing Note: Documentation must specify all compartments examined, structures repaired, and graft type/source.

Fracture Care & Trauma

Open reduction internal fixation (ORIF), closed reductions, and fracture stabilization procedures.

Hip Fracture ORIF

$10,500

CPT 27244

Distal Radius ORIF

$5,200

CPT 25609

Tibial Plateau ORIF

$9,800

CPT 27535

Ankle Fracture ORIF

$6,900

CPT 27814

Billing Note: Requires detailed fracture classification, hardware documentation, and appropriate use of modifier 25 for E/M services.

Pain Management Procedures

Injections, nerve blocks, and interventional pain procedures often performed by orthopedists.

Epidural Steroid Injection

$850

CPT 62323

Facet Joint Injection

$720

CPT 64493

Trigger Point Injection

$180

CPT 20552

Joint Injection (Large)

$240

CPT 20610

Billing Note: Imaging guidance codes (fluoroscopy/ultrasound) must be billed separately when documented.

Specialized Orthopedic Expertise

Deep subspecialty knowledge ensures optimal coding and reimbursement

Joint Replacement Centers

Procedures:

  • Total hip/knee arthroplasty
  • Revision surgery
  • Partial joint replacement
  • Robotic-assisted surgery

Billing Expertise:

  • Implant component coding
  • Hospital vs ASC billing
  • Bilateral procedure optimization
  • Revision complexity documentation

Spine Surgery

Procedures:

  • Spinal fusion (cervical/thoracic/lumbar)
  • Disc replacement
  • Decompression surgery
  • Minimally invasive procedures

Billing Expertise:

  • Multi-level add-on codes
  • Instrumentation billing
  • Bone graft documentation
  • Approach-specific coding

Sports Medicine

Procedures:

  • Arthroscopic repairs
  • ACL/PCL reconstruction
  • Rotator cuff surgery
  • Labral repairs

Billing Expertise:

  • Compartment documentation
  • Graft source coding
  • Multiple structure repairs
  • Diagnostic arthroscopy optimization

Trauma & Fracture Care

Procedures:

  • ORIF procedures
  • External fixation
  • Polytrauma management
  • Emergency orthopedics

Billing Expertise:

  • Fracture classification coding
  • Hardware documentation
  • Emergency modifier usage
  • Trauma case complexity

Orthopedic Practice Success Stories

Real results from orthopedic practices we've transformed

Multi-Surgeon Orthopedic Practice Transformation

8-surgeon practice with ASC

Challenge

Practice was losing $180K annually on implant denials, struggling with modifier errors, and experiencing 14% denial rate on joint replacements.

Solution

Implemented orthopedic-specialized coding team, real-time implant tracking system, and comprehensive documentation review protocols.

Results

  • ✓Denial rate reduced from 14.2% to 2.1%
  • ✓Implant claim rejections eliminated (99.1% accuracy)
  • ✓Average reimbursement per case increased 18%
  • ✓Annual revenue increase of $680,000
Full optimization within 90 days

Spine Surgery Center Revenue Recovery

Dedicated spine surgery center

Challenge

Complex multi-level fusion procedures being routinely downcoded, instrumentation fees denied, and bone graft billing inconsistent.

Solution

Deployed spine surgery coding specialists, implemented CPT add-on code tracking system, and enhanced operative report template.

Results

  • ✓Fusion case reimbursement increased 22%
  • ✓Instrumentation denials reduced from 31% to 3%
  • ✓Average case value increased from $15,200 to $18,500
  • ✓Monthly revenue increase of $125,000
Results visible within 60 days

Sports Medicine Practice Optimization

High-volume arthroscopy practice

Challenge

Arthroscopic procedures being downcoded due to incomplete documentation, modifier 59 overuse triggering audits, and poor WC claim management.

Solution

Implemented compartment-specific documentation templates, modifier usage training, and dedicated WC billing workflows.

Results

  • ✓Arthroscopy downcoding eliminated
  • ✓Average arthroscopic case value increased 35%
  • ✓WC payment cycles reduced from 89 days to 34 days
  • ✓Practice gross revenue increased $420,000 annually
Full implementation in 45 days

Orthopedic Billing Questions Answered

Common questions about orthopedic medical billing and our services

How do you handle complex implant billing for joint replacement procedures?

We maintain a comprehensive implant tracking system that captures manufacturer information, lot numbers, and specific HCPCS codes for every implant used. Our certified orthopedic coders coordinate with your surgical team to ensure all components are documented - including acetabular cups, femoral stems, polyethylene inserts, and cement when applicable. We submit implant claims with complete documentation on first pass, achieving 99.1% accuracy compared to the industry average of 87%.

What makes orthopedic billing different from general surgical billing?

Orthopedic billing requires specialized knowledge of global surgical packages, complex modifier requirements, bilateral procedure rules, and intricate anatomical coding. Orthopedic cases involve expensive implants averaging $8,000-$45,000 per case, multiple surgical components billed separately, and extensive post-operative care within global periods. Our orthopedic-certified coders understand these nuances, from CPT add-on codes for multi-level spine fusions to proper documentation of fracture classifications for trauma cases.

How do you optimize reimbursement for arthroscopic procedures?

Arthroscopic optimization starts with comprehensive operative report documentation. We work with surgeons to ensure every compartment examined and structure repaired is properly documented and coded. This includes diagnostic arthroscopy codes, specific repair codes for meniscus/labrum/rotator cuff, debridement procedures, and removal of loose bodies. We also ensure appropriate use of unlisted procedure codes when innovative techniques are employed. Our systematic approach has increased average arthroscopic case reimbursement by 35% for sports medicine practices.

Can you handle Workers' Compensation orthopedic claims?

Yes, we have extensive experience with WC orthopedic billing across all 50 states. Our team understands state-specific fee schedules, prior authorization requirements, and documentation standards. We manage IME (Independent Medical Examination) billing, permanent disability assessments, and complex case management. For practices with significant WC volume, we've reduced payment cycles from 89 days to 34 days while improving approval rates to 96%.

What coding certifications do your orthopedic billers have?

Our orthopedic billing team includes AAPC-certified coders with CPC (Certified Professional Coder) credentials and many hold the specialty CPC-ORTHO certification specifically for orthopedic coding. Team members complete annual continuing education in orthopedic coding updates, NCCI edit changes, and payer policy modifications. We maintain active memberships in orthopedic coding professional organizations and attend specialty-specific coding seminars.

How do you handle global surgical package billing?

We maintain detailed surgical calendars tracking all global periods (10-day and 90-day) for every procedure. Our system automatically flags E/M services during global periods, determining whether they're related to the surgery (bundled and not separately billable) or unrelated (billable with modifier 24). We also identify complications requiring return to OR (modifier 78) versus unrelated procedures (modifier 79). This precision prevents inappropriate billing while capturing all legitimately billable services.

What is your experience with spine surgery billing?

Spine surgery represents one of the most complex orthopedic billing areas. Our team specializes in multi-level fusion procedures, understanding how to properly bill primary procedure codes, add-on codes for additional levels, instrumentation placement, and bone graft harvesting/application. We document approach methods (anterior, posterior, lateral), ensure appropriate use of biomechanical device codes, and manage the complex interplay between neurosurgical and orthopedic spinal procedures. Average spine surgery reimbursement for our clients exceeds industry benchmarks by 22%.

How quickly will we see improvements in orthopedic billing performance?

Most practices see immediate improvement in clean claim rates within 30 days as we implement specialty-specific scrubbing and validation. Denial rate reductions typically become visible within 45-60 days as claims work through the system. Full revenue optimization, including appeals resolution and workflow refinement, generally achieves target metrics within 90 days. Our fastest turnaround was a sports medicine practice that saw 35% case value increase within 45 days.

Ready to Optimize Your Orthopedic Practice Revenue?

Join hundreds of orthopedic surgeons and practices who have increased revenue by an average of 23% with our specialized billing services. Get a free practice analysis today.

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✓ No setup fees ✓ 90-day optimization guarantee ✓ Certified orthopedic coders

Related Specialties & Services

Spine Surgery →Sports Medicine →Pain Management →Surgical Billing Services →