Orthopedic Medical Billing Services

It depends on the procedure's global length and whether the visit relates to the surgery. Routine follow-up inside the window is already paid for. Care for something unrelated stays billable when flagged with the correct modifier. We record every procedure date with its global period, so your front desk sees a flag at check-in instead of guessing after the fact.

That is usually a global period recoupment. A post-operative visit was billed separately, paid on first pass, then caught later during the payer's automated review. These reversals often arrive six months or more after the original payment. Preventing them is far cheaper than appealing them, which is why we track surgical windows from the day the procedure is performed.

Restorative care means you assumed responsibility for the fracture's treatment, and it carries a global period. Simple stabilisation, such as applying a splint before sending the patient elsewhere, is billed differently and carries no such commitment. The operative or office note has to make clear which happened. Billing restorative care for a temporary splint is a recognised audit target.

Yes, and many practices do not. Boots, splints, slings, and supports are billable items with their own coding. What is required is a fitting note, medical necessity documentation, and in some cases separate supplier enrollment with the payer. We reconcile dispensed equipment against inventory each week so items handed to a patient always reach a claim.

Only when the injection code does not already include it. Several injection codes bundle the guidance into the primary service, and adding a separate line triggers a correct coding edit. Others do allow it. The distinction depends on the specific code and the guidance method used. We resolve this at the coding stage rather than reacting after the denial arrives.

As a separate track. Workers' compensation uses state-specific fee schedules, its own forms, and adjuster authorisation rather than standard insurance benefits. Filing deadlines and required documentation differ from commercial payers. We keep the adjuster's authorisation number attached to the claim and follow the state's format, which is what stops these claims from stalling.

Usually multiple-procedure reductions or bundling within the same compartment. Arthroscopic procedures performed together in one joint often have defined relationships, and payers apply automatic reductions to secondary procedures. When the reduction exceeds your contract, that gap disappears into the contractual adjustment. Line-level posting against loaded rates is what surfaces it as recoverable revenue.

Constantly. Extremity procedures and imaging need the side identified, and payers reject claims where laterality is missing or contradicts the diagnosis. It also creates problems later, when a second procedure on the opposite side looks like a duplicate. We check laterality on every extremity claim before submission, which removes a surprisingly large denial category.

Therapy performed by qualified staff in your practice is billable, with time-based units requiring documented treatment minutes. Supervision requirements and payer rules on who may deliver the service vary. Some plans also cap visits per year. We track units and remaining visit benefits per patient, because exceeding a cap means absorbing the cost entirely.

Yes. Aged orthopedic balances are often recoverable, particularly surgical claims denied for authorisation or documentation reasons rather than clinical ones. We triage the backlog by dollar value and remaining appeal window, working the largest recoverable claims first. The patterns we find usually reveal what to fix in the current workflow as well.