Orthopedics Medical Billing Services
Orthopedic billing runs on global surgical periods, modifier precision, and coordination between surgical and DME claims. Flint RCM tracks each account's global period windows and payer rules so related follow-up care doesn't get billed — or denied — incorrectly.
Specialty-specific pitfalls we watch for.
- Global surgical periods (10-day and 90-day) that make follow-up visits non-billable unless correctly modified
- Modifier −58, −78, and −79 confusion for staged, related, and unrelated procedures during a global period
- DME crossover billing (braces, casts, orthotics) that follows different payer rules than the surgical claim itself
- High-dollar implant and hardware claims that get held for additional documentation
- Prior authorization for MRI, elective surgery, and injections, often required before scheduling
- Global period windows tracked per patient, per payer, so follow-up billing is never left on the table or billed in error
- Modifier logic (−58/−78/−79) applied and documented before claims go out
- DME billing coordinated as a separate, correctly-routed claim from the surgical episode
- Authorization confirmed before surgery or imaging is scheduled, reducing day-of-service denials
What makes Orthopedics coding different.
- Global surgical period tracking (typically 10 or 90 days depending on the procedure) to avoid billing related follow-up care separately
- Modifiers -58, -78, and -79 applied correctly for staged, related, and unrelated procedures occurring during a global period
- DME billing (braces, walking boots, slings) coordinated alongside the procedure claim rather than filed as an afterthought
What to confirm before the visit.
- Prior authorization confirmed before scheduling most surgical procedures and advanced imaging (MRI)
- Global period length verified per payer, since some payers apply different windows than Medicare's standard
Surgical claims are often high-dollar, and denials tied to global-period confusion are common — appealing them requires documentation proving a visit was genuinely unrelated to the original procedure, not just asserting it.
Our workflow for orthopedics billing.
Pre-Surgical Documentation Review
Clinical notes are reviewed before the procedure is coded to confirm what's actually billable separately.
Global Period Tracking Setup
The applicable global period window is set per payer so related follow-up visits aren't billed in error.
Procedure Coding & Modifier Application
CPT and modifier selection reflect the exact procedure and any staged or related follow-up care.
Post-Op Claim Monitoring
Follow-up visits during the global period are checked against the tracked window before submission.
What shapes orthopedics reimbursement.
Global period lengths for the same procedure sometimes differ between Medicare and commercial payers — tracked per payer rather than assumed uniform across your whole payer mix.
Orthopedics billing, answered.
How do you handle billing during a patient's global surgical period?
We track each procedure's global period length and apply the correct modifier (−58, −78, or −79) based on whether follow-up care is staged, related to a complication, or unrelated — so you're not losing billable follow-up care or triggering denials.
Do you bill DME separately from the surgical claim?
Yes. DME items like braces and orthotics typically follow different payer rules than the surgical procedure, so we route those as separate, correctly-coded claims rather than bundling them incorrectly.
Explore more specialty billing pages.
Get a free orthopedics billing audit.
We'll review your current claims, denials, and AR to show exactly where orthopedics revenue is being missed.