Orthopedic surgery billing is driven by structure, not flexibility. Payers apply strict rules around global surgery periods, bundled procedures, and modifier usage. A single missed detail can result in underpayment that is never recovered. For orthopedic practices, revenue leakage often happens quietly through global mismanagement, modifier errors, and documentation gaps.
Medhasty provides orthopedic surgery billing services for practices performing high-volume procedures under Medicare and commercial plans. Our orthopedic billing workflows track every phase of care, from pre-op evaluation to post-op follow-up, ensuring services are billed correctly and compliantly
Orthopedic surgery billing is among the highest reimbursing specialties in healthcare. It also carries some of the highest risk. One incorrect modifier, one missing operative detail, or one poorly linked diagnosis can cost thousands on a single case. Unlike routine office billing, orthopedic claims are subject to scrutiny by Medicare and commercial payers.
Orthopedic surgeons treat complex conditions across multiple settings. Office visits, surgery centers, hospitals, and post-op care all intersect. Billing must track the full episode of care. When it does not, payers flag claims for unbundling, global period violations, or medical necessity reviews. For Medicare-focused orthopedic practices, audits are not rare. They are expected.
Key orthopedic billing challenges that impact revenue include:
Global surgery period errors are causing post-op visit denials
Incorrect modifier usage, such as -59, -25, -51, and -78
Bundling conflicts between procedures performed in the same session
Incomplete operative notes failing to support CPT complexity
Implant and DME billing mismatches with surgical claims
Medicare scrutiny on joint replacements and repeat procedures
ASC vs. hospital billing inconsistencies
Delayed authorizations for elective orthopedic surgeries
Underbilling due to missed add-on and component codes
Detailed coding for surgical, non-surgical, and post-operative orthopedic care. We ensure accurate modifier use and documentation alignment for Medicare and commercial compliance.
Complete handling of orthopedic claims from office visits to hospital and ASC procedures. Claims are monitored closely to protect high-value surgical reimbursements.
Targeted denial management for global period conflicts, bundling issues, and medical necessity reviews. Appeals are handled with payer-specific orthopedic billing logic.
Authorization coordination for elective and complex orthopedic surgeries. We verify coverage and timing to reduce delays, reschedules, and post-op payment disputes.
Thorough payment posting with review of surgical reimbursements and adjustments. Discrepancies are identified early to prevent revenue loss on complex cases.
HIPAA-aligned billing operations with orthopedic-focused reporting. Insights into procedure profitability, denial drivers, and payer trends help strengthen financial outcomes.
Orthopedic surgery billing varies widely depending on anatomy, surgical approach, and post-operative care. A knee arthroscopy does not follow the same billing logic as a total joint replacement or spine surgery. Medicare policies also vary by procedure category and site of service. Our orthopedic billing model is built around surgical workflows, not generic coding templates. Orthopedic Specialties We Support
Each specialty is supported with a procedure-specific modifier strategy and global period tracking.
Each orthopedic subspecialty introduces different billing and documentation requirements. Our teams work across a wide range of surgical specialties.
General orthopedic surgery
Joint replacement and reconstruction
Sports medicine and arthroscopy
Spine and complex orthopedic procedures
Hand, wrist, and upper extremity surgery
Trauma and fracture care
Orthopedic revenue is tightly connected to implants, devices, and durable medical equipment. When implant documentation does not match the surgical claim, payers delay or deny payment. Medicare also closely reviews implant usage for medical necessity and coding accuracy.
We coordinate surgical billing with implant and DME workflows.
Implant and Supply Billing Support
Alignment between operative notes and implant claims
HCPCS and CPT cross-verification
ASC and hospital implant billing coordination
Medicare documentation support for device necessity
Prevention of mismatched or duplicate billing
This ensures surgical revenue remains intact across all components of care.
Orthopedic billing involves detailed operative reports, implant documentation, and post-op care notes. Medicare and commercial payers frequently audit these records. HIPAA compliance protects patients while safeguarding the practice during payer reviews and legal inquiries.
Our orthopedic billing operations follow strict compliance standards without slowing surgical throughput. Compliance Measures Built Into Orthopedic Billing
Secure handling of operative reports and implant documentation
Controlled access to surgical notes and post-op visit records
HIPAA-trained billing and AR specialists
Audit-ready documentation alignment with CPT and ICD-10
Secure EHR and PM system integrations
Compliance is treated as part of revenue protection, not an afterthought.
Global surgery rules are among the most misunderstood areas of orthopedic billing. Medicare closely monitors post-op visits, injections, imaging, and therapy services. Incorrect billing during the global period triggers denials and audit flags.
We actively manage global periods to ensure orthopedic practices remain compliant while capturing legitimate revenue. Global Billing Oversight Includes
Tracking global periods by procedure and payer
Modifier validation for unrelated services
Post-op visit billing compliance checks
Prevention of duplicate or bundled service denials
Clear separation of surgical and non-surgical care
This protects high-dollar surgical claims from clawbacks.
Orthopedic care is complex, high-value, and closely audited. Your billing must reflect that reality. From pre-op authorization to post-op global period management, every step affects reimbursement. Small billing mistakes in orthopedic surgery do not stay small. They turn into delays, denials, and lost revenue.
Our orthopedic billing team works alongside your surgical workflow to keep claims compliant, complete, and paid correctly. We focus on protecting what you earn after the procedure.
FAQS
Global periods are tracked by procedure and payer to avoid post-op billing conflicts. We review documentation to determine when modifiers are appropriate. Non-global services are billed carefully to remain compliant. This reduces denials and audit risk. Surgeons maintain confidence that care episodes are billed correctly.
ASC and hospital billing follow different rules and reimbursement structures. We manage claims based on the service site and contractual requirements. Facility and professional billing are coordinated to avoid mismatches. This approach prevents payment delays and payer inquiries. Practices benefit from cleaner claim cycles.
Documentation alignment is a key focus from day one. Operative notes, diagnoses, and modifiers are reviewed for consistency. Claims are built to support medical necessity and procedure complexity. When audits occur, records are organized and defensible. This reduces stress and financial exposure for providers.
Denial trends are analyzed at the root cause level. Common issues like bundling conflicts and modifier misuse are corrected upstream. Education and process changes prevent repeat problems. Appeals are structured with payer-specific logic. Over time, denial rates decline consistently.
Reports focus on procedure profitability, AR aging, payer behavior, and denial drivers. Surgeons and administrators gain visibility into financial performance. Data supports smarter scheduling and contract evaluation. Reporting remains easy to understand without sacrificing detail. This helps practices plan with confidence.
Let our medical billing experts optimize your revenue cycle management. We enable healthcare practices to increase cash flow and avoid denials. Permanently!
