Key Takeaways Joint replacement denials are most often documentation failures, not coding errors — prior authorization and conservative treatment records have to be in the chart before the claim goes out. Fracture care claims fail at the ICD-10 level more than any other orthopedic category; episode-of-care suffix errors and missing laterality are consistent, avoidable denial […]
Orthopedic Billing Codes: The Errors Costing Surgical Practices the Most
Key Takeaways Global period exceptions require specific modifiers, and each carries a documentation requirement that, when unmet, turns a legitimate claim into a denial or a compliance flag. The multiple procedure reduction rule applies automatically to multi-procedure surgical cases; correct sequencing and modifier 51 exemptions still have to be managed manually. Modifier 22 is warranted […]
How to Choose the Right Orthopedic Billing Company (Without Regretting It Six Months Later)
Key Takeaways Orthopedic billing is uniquely complex. Global periods, modifier-heavy coding, implant reimbursement and workers’ compensation claims require specialty-level expertise. Not all medical billing companies understand orthopedic revenue cycle management. General billing vendors may miss nuances that directly impact collections. A strong orthopedic billing company should provide transparency into net collection rate, denial trends, days […]
Orthopedic Billing Services: Why Outsourcing to a Specialist RCM Partner Drives Growth
Every orthopedic practice faces a complex financial environment — global surgical periods, implant billing, payer policy changes, and documentation demands that can overwhelm even seasoned staff. A single missed modifier, coding oversight, or denied claim can quickly turn into weeks of delayed reimbursement. For orthopedic practice owners, administrators, and business office leaders, these challenges cut […]
Medicare Provides Guidance on Proper Coding of Facet Joint Injections
Over the years, Medicare has provided guidance on how to properly code facet joint injections. This education effort largely began after the Medicare Recovery Audit Program identified facet joint injection claims resulting in overpayments. Medicare has noted that it will consider facet joint blocks to be reasonable and necessary for chronic pain (persistent pain for […]