Orthopedics Billing

Orthopedics bills in episodes: a surgical decision can bundle ninety days of care into one payment, and every visit, cast and injection around it is judged against that package. Elite Bill Care's orthopedics billing is built around global-period discipline.

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Orthopedics billing specifics

• Global surgical packages — pre-op, procedure and routine post-op care inside 0/10/90-day globals; unrelated E/M billed with modifier 24, decision-for-surgery with 57, staged or related procedures with 58/78/79 — used correctly or not at all.
• Fracture care — restorative treatment billed as a global service vs. splinting/casting only, chosen by the actual treatment plan and documented intent.
• Injections — joint and soft-tissue injections (20610 family) with ultrasound guidance (20611) where documented, drug units for injectables, and image-guidance bundling rules respected.
• Imaging and DME — in-office X-ray with correct component billing, and braces/casts supplies under applicable rules.
• Authorization and medical necessity — advanced imaging and elective surgery authorizations with the conservative-care documentation payers require first (see prior authorization).

How we run it

Operative reports drive surgical coding under coding support, global-period calendars are tracked per patient so included visits are not billed and billable ones are not missed, and workers' compensation and liability cases are segregated from health-plan billing. Denials are appealed with the operative record through denial management. See our billing services for the complete operation.

Frequently asked questions