Specialty billing
Orthopedics billing
We code orthopedics to your payer rules, not a generic template, managing surgical global periods, implant and supply billing, fracture care, and workers' comp the way each plan expects.
Where claims slip
Billing considerations for orthopedics
Common places orthopedics revenue leaks. We code each of these to your payer rules, not a one-size-fits-all template.
The 90-day surgical global period determines what post-op work is bundled versus separately billable, and getting it wrong leaves revenue unbilled.
Implants and supplies usually bill separately from the procedure and need their own documentation.
Workers' compensation runs on state-specific fee schedules and documentation rules that differ from commercial payers.
Fracture care coding (closed, open, with or without manipulation) is frequently selected incorrectly.
Modifiers 58, 78, and 79 for staged, related, and unrelated procedures are easy to misapply during a global period.
Representative codes
Codes we see in orthopedics
A few illustrative CPT and HCPCS examples, not an exhaustive or guaranteed list. We code from your documentation and each payer's current rules.
- 29827
- Arthroscopy, shoulder, with rotator cuff repair
- 27447
- Total knee arthroplasty (knee replacement)
- 20680
- Removal of deep implant (plate, screw, or rod)
- 25500
- Closed treatment of radial shaft fracture, without manipulation
- 20610
- Arthrocentesis or injection, major joint
Illustrative examples for context only. Actual codes depend on documentation, setting, and payer rules, and code sets change over time.
How we help
How our services apply to orthopedics
The same accountable team handles the work behind your orthopedics claims. Here is where each service fits.
Common questions
Orthopedics billing, answered.
How do you track 90-day global periods?
We tie each surgical claim to its global period and flag post-op encounters so bundled visits are not over-billed and unrelated or staged procedures are still captured with the right modifier.
Do you bill workers' compensation claims?
Yes. We bill workers' comp to the applicable state fee schedule and documentation rules, which differ from commercial and Medicare claims.
Can you separate implant and supply charges correctly?
We code implants and supplies separately from the procedure where payer rules allow, with the documentation each requires, so those charges are not lost in the surgical bundle.
Ready to bill orthopedics the right way?
732-209-1487 · info@vertexmedicalbilling.com