Orthopedic Surgery & Sports Medicine Billing & Revenue Cycle Management
Protect High-Value Surgical Claims & Master Global Period Billing
Orthopedic surgery accounts for some of the highest-dollar claims in outpatient and inpatient medicine. Denials commonly stem from misunderstood 90-day global surgical packages, assistant surgeon modifiers, multiple procedure discounts, and unbundled DME supplies.
Where Orthopedic Surgery & Sports Medicine Practices Lose Revenue
Commercial and government payers rely on specialty-specific algorithmic scrubbers to reject claims. These are the most common denial vectors our audit teams identify and resolve:
Post-operative E/M visits denied within the 90-day global surgical period without Modifier-24 or Modifier-79
Assistant at surgery claims (CPT -80 / -82 / -AS) rejected due to payer-specific surgical policy restrictions
Multiple arthroscopic procedures improperly unbundled or subject to aggressive 50% second-procedure reductions
Fracture care (e.g., 27244, 27506) denials when casting/splinting supplies (Q4000 series) are billed without separate identifiers
Key CPT Codes & Compliance Guardrails
Our AAPC-certified coders enforce stringent documentation and modifier scrubbing for high-volume Orthopedics procedures:
Arthroscopy, knee, surgical; with meniscectomy (medial OR lateral, including any meniscal shaving)
Payers bundle debridement or synovectomy in the same compartment, denying secondary arthroscopy codes.
Enforce anatomical modifiers (e.g., lateral vs. medial compartment) and verify NCCI mutually exclusive column guidelines.
Arthroplasty, knee, condyle and plateau; medical and lateral compartments with or without patella resurfacing (total knee arthroplasty)
High-cost implant hardware denied when separate invoice documentation or specific HCPCS codes (C1776) are missing.
Include detailed implant manufacturer logs and itemized cost reports in the initial submission packet.
Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee, joint); without ultrasound guidance
Denied when billed on the same day as an office visit without Modifier-25, or billed with ultrasound without code 20611.
Ensure injection notes specify anatomical joint, medication dosage (J-codes), and separate reason for encounter.
Arthroscopy, shoulder, surgical; with rotator cuff repair
Billed alongside subacromial decompression (29826) without confirming whether payer requires an add-on code or distinct modifier.
Cross-check annual AMA CPT updates regarding shoulder arthroscopy bundling conventions.
Essential Modifiers for Orthopedics
Payers automatically deny unbundled claims when modifiers lack supporting clinical evidence. Our scrubbers verify every modifier before dispatch.
Unrelated evaluation and management service by the same physician during a post-operative period (e.g., patient seen for knee pain during shoulder 90-day global).
Unrelated procedure or service by the same physician during the post-operative period (e.g., emergency fracture reduction on contralateral limb).
Assistant surgeon services: Modifier-80 for MD/DO assistants; Modifier-AS for Physician Assistants (PA) or Nurse Practitioners (NP).
Our Orthopedics Revenue Recovery Strategy
We perform granular operative note reviews to capture missed surgical components, appeal unbundled denials with operative reports highlighted by certified orthopedics coders, and recover trapped high-dollar surgical revenue.
Orthopedics Billing FAQs
How do you recover payment for visits during the 90-day global surgery period?
When an established patient returns during the 90-day window for a new issue or unrelated trauma, payers deny by default. We scrub records to ensure Modifier-24 is paired with a distinct diagnosis code and medical narrative.
Can you collect unpaid DME (braces, splints, walkers) for our clinic?
Yes. DME billing requires DMEPOS Medicare supplier numbers, proof of delivery certificates, and specific HCPCS codes. We eliminate DME write-offs through front-end documentation checklists.
Get a Complimentary 10-Claim Audit for Your Orthopedics Practice
Discover exactly how much revenue your practice is writing off due to payer downcoding, missing modifiers, or unappealed claim denials. We return your actionable audit report within 48 hours.
What we evaluate on your 10 sample claims:
• CPT code unbundling and NCCI edit adherence
• Specialty modifier validation (-25, -59, -QW, -26/TC)
• Payer medical necessity LCD/NCD compliance
• Timely filing recapture opportunities
Request Your Free 10-Claim Orthopedics Audit
Zero upfront cost. We sign a HIPAA BAA before examining any documentation.