Orthopedic Billing Services

Orthopedic billing spans a busy mix of work: joint replacement, fracture care, arthroscopy, spine, and sports injuries. Many practices also run in-office x-ray, casting, injections, and braces. That means professional claims, supplies, and durable medical equipment all need attention.

Fracture care and joint surgery are usually reported with global periods, so the first visits after treatment are often bundled. Prior authorization is common for elective joint and spine surgery. An orthopedic billing company has to track side of body, modifiers, implants, and payer rules for the site of service, since the same operation may be done in a hospital or an ambulatory surgery center.

Who this is for

• Orthopedic groups, from solo surgeons to large multi-site practices
• Joint replacement, spine, hand, foot and ankle, and sports medicine surgeons
• Practices with in-house imaging, casting, and bracing
• Surgeons who operate in hospitals and ambulatory surgery centers
• Groups that cover fracture and trauma call

What gets billed

• Total knee and total hip replacement
• Knee arthroscopy and meniscus procedures
• Shoulder arthroscopy and rotator cuff repair
• ACL reconstruction
• Fracture treatment, with or without surgery
• Hip fracture repair
• Joint injections
• Carpal tunnel release
• Casting, splinting, and bracing
• In-office x-rays
• Pre-operative visits and post-operative care within the global period

Commonly billed codes

Code	Type	What it covers
27447	CPT	Total knee replacement
27130	CPT	Total hip replacement
29881	CPT	Knee arthroscopy with meniscus removal
29888	CPT	Arthroscopic ACL reconstruction
29827	CPT	Arthroscopic rotator cuff repair
23412	CPT	Open repair of a chronic rotator cuff tear
27244	CPT	Treatment of a hip fracture near the top of the thigh bone using a plate and screw
64721	CPT	Carpal tunnel release
20610	CPT	Injection or draining of a large joint without ultrasound
M17.11	ICD-10-CM	Primary osteoarthritis of the right knee
M75.121	ICD-10-CM	Complete rotator cuff tear of the right shoulder, not caused by injury
S72.141A	ICD-10-CM	Displaced fracture near the top of the right thigh bone, first treatment

Note

Codes are examples for orientation, not a complete list, and do not guarantee coverage or payment. Always check current code sets and payer policy.

Billing challenges in orthopedics

Global periods for surgery and fractures. Joint surgery generally carries a 90-day global, and fracture care has its own global rules. A biller experienced in orthopedics tracks dates and separates related and unrelated visits, using modifiers 24, 25, 57, or 79 when documentation supports them.

Left, right, and bilateral coding. Laterality modifiers such as RT, LT, and 50 matter. Billers check them against the note and diagnosis, because mismatches are a common denial.

Prior authorization for elective surgery. Many payers require imaging, conservative treatment records, and sometimes a specific facility. Billers collect these before scheduling and keep reference numbers on file.

Implants and supplies. Implants are often paid to the facility, not the surgeon. In an ASC or office setting, payer rules differ. Billers verify who bills what to avoid duplicates.

Durable medical equipment. Braces, boots, and walkers use HCPCS codes and follow payer rules for medical necessity and documentation. Billers check coverage and signed orders before billing.

Assistant surgeon and multiple procedures. Payers set rules for assistants and reduce payment for additional procedures. Billers apply modifiers 80, 82, or 51 as allowed and check bundling edits.

Site of service and payment models. Medicare has bundled payment programs for some joint replacement episodes, and rules change. Billers watch current-year program updates and payer contracts that affect hospital-based surgeons.

How Westmont can help

• Matches your practice with vetted medical billing experts who work with orthopedic surgeons
• Connects you with end-to-end revenue cycle support, from authorization to payment posting
• Helps you find denial management support for modifier and laterality denials
• Connects you with credentialing support for new surgeons and locations
• Provides a way to request a quote based on your procedure mix

Frequently asked questions

How do global periods work for orthopedic surgery?

A global period bundles related care after surgery into the surgical payment. Medicare assigns most major joint operations a 90-day global, and minor procedures 0 or 10 days. Fracture care follows its own rules. Payers vary, so an orthopedic billing company checks the current indicator and policy for each code.

Can we bill for a visit on the day of surgery?

Only in limited cases. A visit on the day of or the day before a major operation, where the decision for surgery is made, may be reported with modifier 57. A visit on the same day as a minor procedure may need modifier 25. Notes must show a separate, identifiable service.

Who bills for implants in orthopedic surgery?

It depends on the setting and payer. In a hospital, implants are usually part of the facility claim. In an ASC or office, there may be separate payment rules. Surgeons generally bill for professional services. Verify payer policy so implants are not billed by the wrong party.

Do bracing and DME need special documentation?

Yes. Payers often require a signed order, a diagnosis that supports the item, and notes showing medical need. Some items need proof of delivery. Check the current policy for the product and the payer, since requirements can differ for the same item.

Does orthopedic surgery usually need prior authorization?

Often, yes, for elective joint and spine procedures, though rules vary by payer and plan. Requirements may include imaging, treatment history, and facility choice. Billers check requirements before scheduling and track approvals so surgery is not delayed or denied.

Related billing services

• Neurosurgery
• Sports Medicine
• Physical Medicine & Rehabilitation (PM&R)
• Physical Therapy
• Durable Medical Equipment (DME)
• Ambulatory Surgery Centers (ASC)