Orthopedics billing and coding
Orthopedic billing that respects global periods and modifiers
Surgery, injections, DME and follow-up visits all interact in orthopedics. Global surgical periods and modifiers decide whether each service is paid.
What makes orthopedics billing hard
Global surgical periods
Visits inside a 10- or 90-day global period are usually bundled; separately billable ones need the right modifier.
Modifiers everywhere
Modifier 57 for the decision for surgery, 25 for a separate E/M, 59 or XS for distinct procedures, RT/LT for laterality.
Injections and supplies
Joint injections and the drug supplied are billed separately, with correct units and HCPCS J-codes.
Codes we see every day
Examples of the codes and modifiers our coders handle for this specialty.
| Code | What it describes |
|---|---|
| 20610 | Arthrocentesis, aspiration or injection of a major joint (such as knee or shoulder), without ultrasound guidance |
| 29881 | Knee arthroscopy with meniscectomy (medial or lateral) |
| Modifier 57 | Decision for surgery made at an E/M visit the day before or day of a major procedure |
| RT / LT | Right side / left side |
CPT codes and descriptions are summarised for readability. Always code from the current code set and payer policy.
How we help
- Track global periods so post-op visits aren't billed or missed incorrectly
- Apply 25, 57, 59/XS and laterality modifiers from the documentation
- Bill injection drugs with correct HCPCS codes and units
- Appeal bundling denials with operative notes
Related services: Medical billing, Medical coding, Medical transcription, Revenue cycle management, Denial management