Orthopedic Medical Billing Services
Orthopedic billing is global periods and modifiers. A surgery bought a package of postoperative care, and everything that happens inside that window either belongs to the package or has to be shown not to. Most orthopedic revenue leakage happens in that argument.
Codes this specialty bills most
| Code | Description | Watch for |
|---|---|---|
| 20610 | Arthrocentesis, aspiration or injection, major joint or bursa | Add modifier 50 for bilateral. Billing two lines without it is a frequent underpayment. |
| 29881 | Knee arthroscopy with meniscectomy, medial or lateral, including debridement | Carries a 90 day global period. Post-op visits inside it are not separately billable. |
| 73721 | MRI of lower extremity joint without contrast | Denies where the record does not show conservative treatment was tried first. |
| 99024 | Postoperative follow-up visit within the global period | Zero payment, but several payers require it to be reported. Skipping it can affect future rate setting. |
The denials this specialty sees
Global period denials are the biggest single category, and most of them are correct. The claim that is worth appealing is the one where the patient was seen inside the window for something unrelated to the surgery, which needs modifier 24, or where an unplanned return to theatre was required, which needs modifier 78. Neither modifier works retroactively if the note does not support it.
The second pattern is multiple procedure reduction being mistaken for a denial. When two procedures are performed in one session, the second pays at a reduced rate by rule. That is the contract working as written, and appealing it wastes time that could be spent on real denials.
Third is imaging. Most payers want documented conservative treatment before they will cover an MRI on a joint. If the note does not show what was tried and for how long, the denial stands. See CO-50 and CO-16.
Our billing team tracks global periods per patient so post-op visits are coded correctly the first time.
Payer notes
Global period lengths follow the Medicare Physician Fee Schedule, and most commercial payers adopt them. Workers' compensation frequently does not, and carries its own fee schedules and authorization rules by state.
Prior authorization for advanced imaging is close to universal now, and several payers use third party benefit managers with their own criteria.
Common questions
Can we bill for a post-op visit inside the global period?
Not for care related to the surgery. If the patient was seen for something unrelated, modifier 24 applies and the note has to make the separation clear. Related complications are usually included unless a return to theatre was needed.
Why did our second procedure pay so much less?
Multiple procedure reduction. It is a payment rule rather than a denial, so there is nothing to appeal. What is worth checking is that the procedures were sequenced correctly on the claim, because the highest valued one should be paid in full.
How do we get MRIs approved more consistently?
Document the conservative treatment in the referral itself: what was tried, for how long, and what the response was. Most denials in this category are not disagreements about the patient, they are referrals that did not answer the payer's question.
See what your claims are leaving behind
Send us a month of remittance data and we will tell you what it says: which codes are being denied, how much of it is recoverable, and how long your money is sitting in A/R. It takes about a week and there is nothing to sign.