Orthopedic Billing That Captures Every Dollar
Global period tracking, implant invoice reconciliation, fracture care coding, workers' comp — our orthopedic billing team handles the complexity that costs practices tens of thousands annually.
96.8%
Clean Claim Rate
4.1%
Average Denial Rate
23 Days
Average AR Days
99.2%
Implant Capture Rate
BILLING CHALLENGES WE SOLVE
Why Orthopedic Billing Leaks Revenue
These are the six most common orthopedic billing problems — and what we do about each one.
Global Period Management
Orthopedic surgery carries 90-day global periods on most procedures. Incorrectly billing subsequent visits, PT orders, or return trips during the global generates audits and recoupments. We track every global period automatically.
Implant & Supply Billing
Invoice-based implant billing — joint replacements, plates, screws, and biologics — requires accurate C-code and L-code submission with supporting invoice documentation. Missed implant charges are permanent revenue loss.
Fracture Care Bundling
What's included in fracture care vs. what can be billed separately differs by payer and code. Initial cast application, manipulation, and follow-up X-rays each have specific bundling rules our coders navigate daily.
Multiple Procedure Reductions
Modifier 51 reductions on multiple procedures in the same session significantly impact reimbursement. Our billing team sequences procedures strategically to minimize reduction impact within payer rules.
Workers' Compensation Complexity
Workers' comp billing requires state-specific fee schedules, lien management, and attorney coordination. Our WC specialists manage these cases separately from commercial billing.
Arthroscopy Bundling Rules
Arthroscopic procedures have specific bundling edits — certain diagnostic arthroscopy codes bundle into surgical codes at the same joint. Our coders know exactly which combinations are billable and which trigger edits.
How Aethera Handles Orthopedic Billing
Orthopedic billing has more revenue leakage points than almost any other surgical specialty — missed implant charges, global period violations, and multiple procedure reduction errors compound quickly across a high-volume practice. Our orthopedic billing team is built to close every one of those gaps.
Every orthopedic client receives a dedicated account team with deep surgical coding experience, a global period tracking system integrated with their PM, and an implant reconciliation process that runs before every claim submission.
Our orthopedic billing covers:
Joint replacement (hip, knee, shoulder, ankle)
Arthroscopic procedures (shoulder, knee, hip, wrist)
Fracture care — open and closed, with and without manipulation
Implant and supply billing with invoice reconciliation
90-day global period tracking and modifier management
Workers' compensation (all 50 states)
ASC facility billing vs. hospital outpatient
Physical medicine bundling analysis
Spine surgery (anterior, posterior, instrumented fusions)
Hand and upper extremity surgery coding
Biologics and bone graft documentation
Pre-surgical prior authorization tracking
PROCEDURE CODES
Common Orthopedic CPT Codes We Bill
A sample of the orthopedic procedure codes our team handles — each with specialty-specific billing rules.
| CPT Code | Description |
|---|---|
| 27130 | Total hip arthroplasty |
| 27447 | Total knee arthroplasty |
| 27486 | Revision of total knee arthroplasty, 1 component |
| 29827 | Arthroscopy, shoulder, surgical, with rotator cuff repair |
| 29881 | Arthroscopy, knee, surgical, with meniscectomy |
| 29882 | Arthroscopy, knee, surgical, with meniscus repair |
| 20610 | Aspiration/injection, major joint (knee, hip, shoulder) |
| 27370 | Injection procedure for knee arthrography |
| 97010 | Physical medicine, hot/cold pack |
| 99213 | Office visit, established patient, moderate complexity |
| 27650 | Repair, primary, open or percutaneous, ruptured Achilles tendon |
| 20900 | Bone graft, any donor area, minor |
Orthopedic Practice
High implant volume with inconsistent cost capture and global period violations causing payer audits. AR had reached 52 days and two audit letters arrived in 18 months.
Implant Revenue
Missed
+$124K/yr
AR Days
52
28
Payer Audits
2/yr
0
Global Violations
Frequent
Eliminated
FAQ
Orthopedic Billing Questions
Common questions from orthopedic surgeons and practice managers.
How do you track 90-day global periods across our entire schedule?
We build global period tracking directly into your billing workflow. Every procedure with a global period is flagged, and any claim submitted during that window is reviewed for correct modifier assignment (24, 25, 57, 58, 79) before submission.
We have high implant volume. How do you ensure we capture every implant charge?
We require invoice reconciliation as part of our charge capture process. Before a claim is submitted, the implant invoice is matched to the operative report. Our current implant capture rate is 99.2% across all orthopedic clients.
How do you handle workers' compensation billing?
Our workers' comp team operates as a separate workflow. We manage state-specific fee schedules (all 50 states), lien filings, attorney correspondence, and independent medical exam (IME) coordination — all as part of your standard service.
Do you handle ASC and hospital-based billing separately?
Yes. We bill ASC facility fees, hospital outpatient facility fees, and professional fees as separate workflows with the appropriate place of service codes, facility-specific modifiers, and implant reporting requirements for each setting.
What's your experience with bilateral procedures and modifier 50?
Bilateral modifier rules vary significantly by payer. We maintain a payer-specific bilateral matrix for each of your carriers and apply modifier 50, RT/LT, or the double-line method as required — never guessing when real rules are available.
Ready to Capture Every Orthopedic Dollar?
Start with a free orthopedic billing assessment. We'll identify your implant gaps, global period risks, and denial patterns.
Get Free Orthopedic Assessment