Orthopedic surgery: joint & extremity · Nationwide
Billing for orthopedic joint and extremity surgery
Joint replacements, arthroscopy, fracture care and in-office injections each bring their own authorizations, global periods and modifiers. We handle them so surgical revenue is not left in A/R.
Where orthopedic joint and extremity practices lose money
Global periods and modifiers
Post-op visits, staged procedures and unrelated problems during a global period need the right modifier or they get bundled away.
Prior authorizations
Joint replacements, advanced imaging and injectables like viscosupplementation often need approval first. We check status before the case is scheduled.
Laterality and bundling edits
Right, left, finger and toe modifiers and procedure-to-procedure edits trip up arthroscopy and hand claims. We check them before claims go out.
Workers' comp and injury claims
Many orthopedic patients come through workers' comp or auto claims. We follow them to payment.
What we handle
- Total joint replacement
- Arthroscopy of the shoulder, knee, hip and other joints
- Fracture care
- Hand, foot and ankle surgery
- In-office injections and drug units
- Bracing and in-office imaging
Also included
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How it worksFAQ
Orthopedic surgery: joint & extremity billing questions
What is a global period in orthopedic surgery?
Most major orthopedic surgeries carry a 90-day global period: routine follow-up visits in that window are included in the surgical payment. Visits for unrelated problems, returns to the operating room and staged procedures can be billed separately with the right modifier, such as 24, 78, 79 or 58.
Do joint replacements need prior authorization?
Many commercial and Medicare Advantage plans require it for total knee and hip replacement, and some want documented conservative treatment first. We check authorization status before the case is scheduled.
Why do hand and foot claims get denied for modifiers?
Payers expect modifiers that identify the exact finger (FA–F9), toe (TA–T9) or side (RT, LT). Missing or conflicting modifiers make claims look like duplicates, and they get denied.
How are knee injections like viscosupplementation billed?
The injection and the drug are billed separately, with the drug in the right number of units. Many payers require prior authorization and documentation that other treatments have not worked.
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Free revenue audit for orthopedic joint and extremity practices. Written report, no obligation.