Orthopedic Billing That Stands Up to Payer Challenges
Between global period complexities, DME documentation requirements, and ever-changing surgical modifiers, orthopedic billing can feel like navigating a fracture without imaging. We specialize in turning your clinical expertise into collected revenue—whether it's properly coding a multi-level spinal fusion or fighting for that PRP injection reimbursement.
Last quarter, we recovered $189,000 in previously denied claims for a 10-surgeon orthopedic group by correcting modifier 58 usage alone. But what our partners value most is getting back 15+ hours per week previously spent arguing with payers about global periods or missing DME documentation.
Get Your Free Revenue AnalysisSurgical Coding That Holds Everything Together
We navigate the complexities that trip up most practices:
- Global periods - Proper use of modifiers 58, 78, 79 for staged procedures
- Fracture care - Distinguishing between open vs closed treatment
- Spinal procedures - Accurate level counting and approach documentation
Real Example: For a total knee revision, we ensure documentation includes:
✓ Reason for revision ✓ Components removed/replaced ✓ Surgical approach ✓ Any bone grafting
DME & Injections Done Right
We've mastered the nuances of:
DME Billing
- Custom orthotics (L3000-L5000)
- Bone growth stimulators (E0747-E0760)
Injections
- PRP documentation requirements
- J-code selection for viscosupplementation
Pro Tip: We maintain templates for 32 different DME letters of medical necessity - from spinal orthoses to post-op fracture braces.
Pre-Auths That Don't Crack Under Pressure
We secure approvals for:
Our Approval Success Includes:
✓ 94% first-pass approval rate for spinal fusions ✓ Average 48-hour turnaround for PT auths ✓ $250K+ in implant costs pre-approved monthly
Global Periods & Denials That Won't Heal
Common orthopedic denials we routinely overturn:
Our Appeal Process:
✓ Clinical peer-to-peer support ✓ Payer-specific global period logic ✓ Operative note excerpts ✓ Implant invoices when required
"Their team increased our collections for complex spinal cases by 35% in six months. They identified that we were undercoding our approach for TLIF procedures—that correction alone added $150,000 annually. Now I spend my time in the OR, not fighting with payers about global periods."
Dr. Sarah Chen
SpineCare Orthopedics
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