Orthopedic RCM

Orthopedic Surgery Billing & RCM Services

Maximizing reimbursement for high-value surgical cases — from total joint arthroplasty to complex spine procedures — with expert implant billing and global period management.

98.7% Surgical Claim Accuracy
$2.8M Avg. Implant Revenue Protected Annually
90-Day Global Period Tracking & Compliance
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The Challenge

Orthopedic Billing Is Uniquely Complex

Orthopedic surgery combines high-dollar implant costs, strict global period rules, bundling edits for multi-component procedures, and laterality requirements that trip up general billing teams daily.

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Implant Cost Recovery

Implant costs can exceed $10,000 per case. We ensure proper invoice-to-claim reconciliation, negotiate implant carve-outs with payers, and apply HCPCS L-codes and C-codes to capture full device reimbursement in facility and ASC settings.

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Global Period Management

Major orthopedic procedures carry 90-day global periods with strict rules on what is and isn't included. We track every post-op visit, identify separately billable complications (modifier -24), unrelated procedures (-79), and staged procedures (-58).

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Modifier Mastery

Orthopedic coding demands precise modifier application: -RT/-LT for laterality, -59/XS for distinct anatomic sites, -22 for increased complexity, -62 for co-surgery, and -80/-82 for assistant surgeon billing — each with payer-specific acceptance rules.

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Bundling & Unbundling

Multi-level spine fusions, rotator cuff repairs with decompression, and fracture care with hardware all have NCCI bundling rules that either include or exclude add-on components. Incorrect bundling leaves thousands on the table — or triggers audits.

Our Approach

Purpose-Built for Orthopedic Revenue

Our orthopedic billing team includes COSC (Certified Orthopedic Surgery Coder) credentialed specialists who review every operative report line by line. We don't rely on templates — we code from documentation.

  • Operative report review within 24 hours of dictation to ensure timely charge capture
  • Implant log reconciliation matching surgical invoices to claims for full cost recovery
  • Prior authorization tracking for total joints, spinal fusions, and arthroscopic procedures
  • Global period calendar management with automated tracking of 10-day and 90-day windows
  • Workers' comp and auto injury billing with state-specific fee schedule compliance
  • ASC vs. hospital outpatient optimization for procedures migrating to ambulatory settings
Orthopedic surgery in operating room
28% Average Revenue Increase
$850K Avg. Annual Denied Revenue Recovered
99.2% Implant Billing Accuracy
13 Days Average Days in AR
FAQ

Orthopedic Billing Questions Answered

We maintain a global period tracking calendar for every surgical patient. During the 90-day global window for total joints, we identify visits that qualify as separately billable — complications unrelated to the surgery (modifier -24), return trips to the OR for related procedures (-78), and staged procedures (-58). This prevents both lost revenue from unbilled qualifying visits and compliance risk from incorrectly billing included services.
We reconcile every surgical case against implant invoices, ensure HCPCS device codes are linked to claims, and negotiate implant carve-out arrangements with commercial payers. For ASC cases, we verify that implant-intensive procedures qualify for device-intensive add-on payments and that invoices are submitted with claims when required.
Yes, we manage workers' comp billing across all 50 states, including state-specific fee schedules, pre-authorization requirements, utilization review responses, and IME coordination. For auto injury claims, we handle PIP/MedPay billing and lien-based billing where applicable.
Spine coding is among the most complex in orthopedics. We meticulously review operative reports for approach (anterior, posterior, lateral), number of levels, instrumentation, grafting (autograft vs. allograft vs. synthetic), and decompression components. Each element maps to distinct CPT codes with specific add-on hierarchies that must be sequenced correctly.
Absolutely. With CMS continuously expanding the ASC-approved procedure list — including total knees and now total hips — we help practices navigate the transition, model revenue impact, ensure implant cost recovery in the ASC payment structure, and establish compliant billing workflows for the ambulatory setting.
We manage co-surgeon (-62), team surgery (-66), and assistant surgeon (-80/-82) billing with full documentation of medical necessity. We know which payers require AS modifier for PA/NP assistants, which allow -82 only in teaching hospital exceptions, and ensure each surgeon's operative report supports their individually billed components.