Full Cycle RCM Free A/R Audit

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Medical billing for orthopedics

Orthopedics combines surgery, imaging, DME and injections in one visit, which is precisely why its claims are denied more often than most.

What makes orthopedic billing hard

An orthopedic encounter frequently contains several separately billable elements at once: an evaluation, an in-office X-ray, a joint injection, a cast or brace, and a plan for surgery. Each has its own coverage rules, and the relationships between them are exactly where payers apply bundling edits.

  • Global surgical periods. A 90-day global means post-operative visits are not separately payable, but genuinely unrelated care during that window is billable, with the right modifier and documentation to support it.
  • Modifiers 25 and 59. Both are heavily audited. A significant, separately identifiable E/M on the same day as a procedure is legitimate and common in orthopedics, and it is also one of the most scrutinised patterns in the specialty.
  • DME and casting supplies. Braces, splints and casting materials carry HCPCS codes, their own coverage policies, and sometimes separate supplier enrollment requirements.
  • In-office imaging. Professional and technical components, and whether you bill globally, change the claim entirely.
  • Workers compensation and personal injury. Different fee schedules, different authorisation rules, different filing deadlines, and far more documentation, and these claims age badly when nobody owns them.
  • Prior authorisation on surgery, advanced imaging and some injections, where a missing authorisation is an unappealable denial rather than a slow one.
A single orthopedic encounter split into five separately billable elements: evaluation, in-office X-ray, joint injection, casting or DME, and supplies. E/M visitIn-office X-rayJoint injectionCasting / DMESuppliesOne orthopedic encounter, five separately billable elements
Each element carries its own coverage rules, and the relationships between them are where payers apply bundling edits.

How we work it

Coders who know the global-period rules and apply modifiers against the operative note rather than a template. Authorisation tracked before the procedure, not discovered after the denial. Workers compensation claims worked as their own queue with their own deadlines, because mixing them into commercial follow-up is how they end up at 180 days.

The free A/R audit on an orthopedic practice usually surfaces the same two things first: bundled E/M denials that were never appealed, and workers compensation claims nobody has touched in months.

Common questions

Do you handle workers compensation claims?

Yes, as a separate queue. They follow different fee schedules and deadlines and need more documentation, and folding them into ordinary commercial follow-up is the usual reason they age out.

Can you bill an E/M on the same day as an injection?

When the E/M is significant and separately identifiable from the procedure, and the documentation shows it. That is a real and common scenario in orthopedics, and also one payers audit closely, so it has to be supported in the note rather than applied by habit.

Start with the free audit

Send us ninety days of claims data and we will show you what was left uncollected. No charge, no obligation, and the findings are yours either way.

Request my free audit