Orthopedic billing and coding is no easy walk. The more you are aware about the documentation, accurate codes, modifiers, changing rules etc, the better your results will be while submitting the claims.

Following are some of the best practices to make your orthopedic billing and collections services simple and effective:

Little things matter:

Denials worth $50 or $60 may seem less but these may multiply many fold if the same simple error is repeated every time. Look for pattern of rejected bills. If you see the same error is resulting in the rejection, you may want to train the person handling the bills. If you let it go, then someone has to go and correct the error every time which could be a big drain on work time.

Spot-check the billing work:

It's important to spot check the work of billing employees by checking the "explanation of benefits" reports that comes back from the insurers. This will convey the billing staff personnel that you expect timely appeals and corrections.

Understanding rules on global services:

It's important for Orthopedic and spine practices to understand and stay up-to-date on rules that specify when the services should be bundled into global service codes and when they can be billed separately.

For example, services that meet CPT (carriage paid to) criteria as a "distinct procedural service" need to be supported with -59 modifier.

Follow AAOS (American Academy of Orthopedic Surgeons) guidelines:

Don't get bogged down with the billing practices that are denied in AAOS guidelines. It will only waste your time.

For example, fluoroscopic guidance is included in almost all surgical procedures as per AAOS guidelines, so it should not be coded separately. It's better to read these guidelines to avoid such mistakes.

Know the rules:

There are practices that bill too many services separately whereas some lean too much on bundling them up more than they need to. The AAOS guidelines helps physicians/staff members to understand what is included or excluded in any surgical procedure code.

For example, if a new problem is encountered by a surgeon within the 90-day global period, -24 modifiers should be used with an appropriate diagnosis to support the new problem. So, it's important to know the rules to get the full amount one deserves for the services rendered.

Meet deadlines for appeals:

Medicare has a 120-day deadline between denial and follow-up. Four months though seem like a lot of time but if no one is directly responsible, one may miss the deadline.

Know pre-authorization requirements:

When two practices such as orthopedic and spine practice adds an ancillary service like physical therapy or in-house MRI scanning, it's important to know the administrative rules that each plan has for these services else the practice may receive denials on its claims.

Track changes in billing status:

The practice should use unique tracking codes in order to quantify a particular bill's status changes over time.

For example, when inquiries on a denied claim run its course and in case the practice is not to be paid, a unique adjustment code should be used to report the reason for the lack of payment for easy reference.


You may consider outsourcing. In many instances, outsourcing your medical billing services may actually decrease your costs. It may also save your staff time for appealing and re-filing denied claims. Outsourcing may also save you from slowdowns that may occur because of illness, vacation and employee turnover.

Partnering with an expert revenue cycle management company for managing practice's billing services definitely results in increased revenues, maximized profitability and lower overhead costs.

No doubt, it is imperative that your practice gets paid for the valuable work you provide. To ensure you are compensated properly, your billing needs to be completed accurately, effectively and in a timely fashion.

Medical Billers and Coders (MBC) is a leading medical billing company providing complete revenue cycle services. To know more about our Orthopedic billing and coding services, contact us at

Published By - Medical Billers and Coders
Published Date - Mar-21-2017 Back

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