Orthopedic Billing Services Through The Whole Global Period.
Orthopedic revenue is decided across an episode, not a single visit: the decision for surgery, the procedure, ninety days of follow-up and everything done in the office along the way. We bill each piece in the right relationship to the surgery.
- Global periods tracked
- Injections, imaging and bracing
- Keep your existing EHR
Your Surgical TeamDocuments each visitMedicare global periods are 0, 10 or 90 days depending on the procedure. Commercial payers may differ. No real patient or claim data.
The Modifiers That Decide Orthopedic Payment.
Most orthopedic denials trace back to the relationship between a visit or procedure and an open global period. The note has to say which relationship applies.
| Modifier | When it applies | What the note must show |
|---|---|---|
| 57 | Visit where the decision for a major surgery is made, on the day of or day before surgery | The evaluation and the decision to operate |
| 25 | Separate visit on the day of a minor procedure, such as an injection | A significant, separately identifiable evaluation |
| 24 | Unrelated visit during a global period | A problem unrelated to the surgery, by diagnosis and narrative |
| 58 | Planned staged or more extensive related procedure in the global period | That the procedure was planned or more extensive than the first |
| 78 | Unplanned return to the operating room for a related complication | The complication and the return to the OR |
| 79 | Unrelated procedure during a global period | Why it is unrelated to the original surgery |
| RT LT 50 | Side of the body, or a bilateral procedure | Laterality for every procedure and injection |
The Office Work That Adds Up.
Much of an orthopedic practice's billing happens in clinic. Each of these has its own rules.
Workers' Comp And Auto Claims Work Differently.
Injury claims follow their own rules, set by state and by carrier, and often run alongside a patient's health insurance.
Each injury claim has its own number and adjuster, separate from the patient's health plan.
Workers' compensation payment is often set by state fee schedules rather than contracts.
Carriers may require approval and work-status or progress reports before paying.
Tell us your injury-claim volume on the discovery call. We confirm in writing whether it is in scope.
Authorization For Imaging, Surgery And Site.
Many plans require approval for advanced imaging and elective surgery, and some approve a specific site of service, such as an ambulatory surgery center instead of a hospital. A change in procedure or site can need a new approval.
- Procedure codes, including laterality and levels
- Site of service and date range
- Implants or devices the payer reviews separately
- Changes made in the OR that differ from the approved procedure
Full RCM: we request and track approvals. Medical Billing: your team keeps them and we check claims against them.
Medical Billing Or Full RCM?
Medical Billing
Your team keeps registration, eligibility and authorizations. We track global periods, bill surgery, follow-up and office services, and follow every response. Coding can be added.
About Medical Billing Services →Full RCM
We also check eligibility, manage imaging and surgical authorizations and code every visit and procedure, with credentialing included.
About Full RCM →Surgery center facility claims, DME supplier billing and injury claims each need their own scope review.
Questions Orthopedic Practices Ask.
Please do not send patient records through the website.
How Do You Track Global Periods?
From each surgery date and its global days. Visits inside the period are billed only when the note supports an unrelated problem or another modifier; routine follow-up is tracked but not billed.
Do You Bill Injections And The Drug Separately?
Yes, as separate lines. The drug is billed in the units its HCPCS code defines, from the dose your team records.
Can You Bill Braces We Dispense?
Only if your practice is enrolled as a DMEPOS supplier for those items. We confirm enrollment before billing them.
Do You Handle Workers' Compensation Claims?
Tell us your volume and states on the discovery call. We confirm in writing whether injury claims are in scope.
What About The Surgery Center Claim?
The facility bills its own claim. If your practice owns the ASC, we can review it as a separate entity.
Talk Through Your Orthopedic Billing.
Tell us your case mix, where surgery happens, what you do in the office and your payer mix. Please do not send patient records through the website.
- Global periods tracked from surgery dates
- BAA signed before any patient-data access
- Medical Billing or Full RCM