Orthopedic billing is among the most complex areas in medical billing due to the wide range of procedures, surgical modifiers, fracture care rules, and bundled services. From joint injections to spine surgeries, orthopedic practices face constant challenges with accurate coding, payer policies, and timely reimbursements.
Orthopedic Medical Billing Services
At Smart RCM Solutions, we specialize in orthopedic billing services that eliminate revenue leaks and ensure every procedure — from a simple cast application to a total knee replacement — is billed with precision.
Why Orthopedic Billing Is Challenging?
Orthopedic procedures are high-value but also high-risk in terms of billing errors. Challenges include:
- Fracture care billing (with or without manipulation)
- Global surgical packages and post-op services
- Multiple surgical procedures requiring correct modifier use (e.g., 51, 59, 78, 79)
- Joint injections, aspiration, and imaging coding
- Durable Medical Equipment (DME) billing and documentation
- Orthopedic-specific denial trends and payer edits
Without orthopedic billing expertise, practices can suffer from frequent denials, underpayments, and audit risk.
Our Orthopedic Billing Services Include
✔ Surgical Procedure Coding
We handle complex surgical claims involving spine, shoulder, hip, knee, or trauma cases, applying the correct CPT, ICD-10, and modifiers.
✔ Fracture & Casting Billing
We ensure proper use of initial vs. subsequent care codes, bundling logic, and inclusive services in fracture management.
✔ Modifier Management
Our coders apply precise modifiers for bilateral surgeries, staged procedures, and post-operative complications.
✔ Injections, Arthroscopy, and Joint Care
We capture revenue for all injections, arthroscopies, aspirations, and related services with proper code sequencing.
✔ DME and Bracing Billing
We manage documentation, coding, and claim submission for orthopedic braces, splints, crutches, and more.
✔ Preauthorization and Eligibility
We verify coverage, obtain authorizations, and confirm benefits before any surgical or procedural billing occurs.
Common CPT Codes in Orthopedics
- 20610 – Aspiration/injection of major joint (e.g., knee)
- 27130 – Total hip arthroplasty
- 27506 – Open treatment of femur fracture
- 29881 – Knee arthroscopy with meniscectomy
- 27245 – Treatment of hip fracture
- 99203 – Office visit for new patient
- L1832 – Knee orthosis (DME code)
We ensure accurate, compliant coding so your practice maximizes reimbursement for each visit and procedure.
Why Choose Smart RCM Solutions for Orthopedic Billing?
Orthopedic billing isn’t just about submitting claims — it’s about understanding surgical complexity, global periods, and payer nuances. That’s where we shine.
✅ Over 8 years of orthopedic billing experience
✅ Trained in modifier usage and surgical bundling rules
✅ Fast turnaround on claims with pre-check audits
✅ Clean claim rate above 98%
✅ Detailed reporting and revenue insights
✅ Seamless integration with your EHR system
We act as an extension of your team — making sure every screw, cast, and incision translates to accurate payment.
FAQs – Orthopedic Billing Services
Q: What is global billing for orthopedic surgery?
Global billing includes pre-operative, intra-operative, and post-operative services for a set period (e.g., 90 days). We track and code these correctly.
Q: Can I bill separately for a cast or brace?
Yes, if documented and billed with correct HCPCS codes and modifiers. We handle DME billing and ensure compliance.
Q: Do you manage orthopedic surgery authorizations?
Yes. We handle eligibility checks and obtain prior authorizations for procedures, injections, and imaging.
Q: How do you reduce orthopedic claim denials?
By performing pre-submission reviews, applying correct modifiers, and ensuring documentation supports each billed service.
Elevate Your Orthopedic Practice With Better Billing
Whether you’re performing joint replacements, sports injury treatment, or fracture care, Smart RCM Solutions ensures every dollar you deserve is captured — quickly, compliantly, and transparently.
📞 Ready to Improve Your Billing?
📧 Email: [email protected]