Orthopedic Medical Billing Services

Orthopedic billing is dominated by the surgical package: what is included in the global period, what is separately billable, and how to document the difference. Add fracture care billing choices, casting and supply charges, in-office DME, imaging, and a meaningful workers’ compensation caseload, and orthopedic claims demand more per-claim judgment than most specialties.

Our orthopedic billing support builds the workflows this specialty needs: global-period calendars per surgery, workers’ comp claim handling with jurisdiction-specific requirements, and denial workflows tuned to the bundling and modifier disputes payers raise on surgical claims.

Why Orthopedics Billing Is Complex

The global surgical package concentrates risk: visits and services inside the global period are denied unless properly documented as unrelated or staged, while legitimately separate services go unbilled by cautious staff — losing revenue in both directions. Workers’ compensation adds a parallel billing universe with its own fee schedules, forms, and treatment-approval workflows; in Texas, DWC rules govern billing and disputes, and claims handled like commercial insurance simply fail.

Common Service Categories We Bill

• Surgical procedures with 10- and 90-day global periods
• Fracture care and casting services
• In-office imaging and musculoskeletal ultrasound
• Durable medical equipment and supplies
• Workers’ compensation injury care

Common Denial Causes in Orthopedics

• Global-period denials on post-operative visits and procedures
• Bundling and modifier disputes on multi-procedure surgeries
• Workers’ comp denials for missing authorization or wrong forms
• Medical-necessity denials on imaging and injections

Documentation Risks to Watch

• Post-operative visits not distinguishing global-included care from unrelated problems
• Operative notes lacking laterality, approach, or levels needed for code specificity
• Fracture care documentation ambiguous between global fracture treatment and itemized visits
• Work-injury records missing employer, injury-date, and causation details comp carriers require

Coding Considerations

• Modifier use around the global package (staged, unrelated, return-to-OR) requires documentation that survives payer review
• Multiple-procedure reductions and bilateral rules materially change expected payment and must be tracked at posting
• Fracture care can often be billed as a global package or itemized — the choice has documentation and revenue consequences per case

Typical Payer Challenges

• Texas workers’ compensation (DWC) fee schedules, treatment guidelines, and dispute processes
• Commercial prior authorization for surgeries, advanced imaging, and injections
• Payer-specific bundling edits stricter than standard NCCI on some contracts