Orthopedic Billing Guide: Surgical Global Periods, Implant Coding, and Workers Comp

Understanding surgical global periods

Medicare assigns global periods to surgical procedures: 0-day, 10-day, or 90-day. Major orthopedic surgeries typically carry a 90-day global period.

• Pre-operative visits (day -1 to day 0): Included in the global package
• Intra-operative services: The procedure itself and immediate post-op care
• Post-operative visits (day 1 to day 90): Typically included unless unrelated, or a separate E&M with modifier 24

Modifiers for post-op billing

• Modifier 58: Staged or related procedure by the same physician during the post-op period
• Modifier 78: Unplanned return to the operating room for a related procedure
• Modifier 79: Unrelated procedure by the same physician during the post-op period
• Modifier 24: Unrelated E&M service during a post-op period

Implant and supply billing

Orthopedic implants and supplies require separate billing from the procedure code:

• Bill implants using HCPCS Level II codes (e.g., L8699 for unspecified prosthetic implant)
• Use revenue code 278 for prosthetic/orthotic implants
• Document implant manufacturer, model, lot number, and serial number
• Pass-through payments may apply for new technology implants under OPPS

Workers compensation billing

Workers comp claims require specific documentation and follow state-specific fee schedules:

• Submit the First Report of Injury within state-mandated timeframes
• Use state-specific workers comp fee schedules, not standard Medicare rates
• Obtain employer and insurance carrier information at the first visit
• Document causation and work-relatedness clearly in every note
• Track authorization requirements; workers comp often requires pre-auth for surgery and PT