Issue
Most commonSame-day E/M billed with a procedure but no modifier 25
The denial or audit exposure
E/M denied as "included in the procedure"
How we prevent it
We append 25 only when a significant, separate evaluation is documented
Specialty billing · Orthopedics
Orthopedic Billing Services
Whether the next visit is billable turns on the modifier, not the calendar.
Get more of every surgical global, fracture, and injection paid the first time with orthopedic billing services from 247 Medical Billing Services — full-cycle coding and claims for surgeons, ASCs, and workers' comp across Medicare, commercial, and no-fault payers. A dedicated account manager, free 360° reporting dashboard, HIPAA and SOC 2 Type II security, and specialty coders since 2005.
HIPAACompliant
SOC 2Type II
Serving Since2005
Specialty-FocusedRCM
Inside the global
Modifier board · Live
Made hundreds of times a week
The ten-second coding call
24Unrelated visit inside a global
25Significant, separate same-day E/M
57The decision for surgery
58Planned, staged procedure
78Return to the OR for a complication
79Unrelated procedure in the window
Omit it and the line denies as "included in global"
And fracture care runs on two separate billing paths
the wrong choice buries payable work or invites a takeback
Chosen per encounter, against the operative note
GLOBAL FRACTURE CAREdefinitive treatment + 90 days of follow-up
ITEMISEDevaluation plus casting
Filed within 24 hoursDays in A/R < 25
We work with Orthopedic practices across the U.S.
Joint Replacement
Sports Medicine
Spine Care
Fracture Care
And More
01Lives or dies on the global package
The orthopedic coding that decides your margin
Orthopedics lives or dies on the global surgical package. The moment a major procedure is billed, a 90-day window folds every routine follow-up, dressing change, and post-op visit into that single payment — yet a staged procedure, a return to the OR, an unrelated problem, or a same-day decision for surgery stays separately payable only when the right modifier proves it.
Miss a 24, 25, 57, 58, 78, or 79, itemize a fracture that belonged in a global (or the reverse), forget the cast supply, or let an NCCI edit bundle an arthroscopy add-on, and the money either vanishes into a payment you already collected or bounces back denied.
A generalist rarely tracks these rules; we build every claim around them. Here is where an orthopedic claim is won or lost.
Won or lost 01
The global surgical package governs everything
A minor procedure carries a 10-day global and a major surgery a 90-day global, and every routine related service inside that window is already paid. Whether the next visit is billable turns on the modifier, not the calendar.
Won or lost 02
Modifiers are the whole game
A same-day evaluation that led to a procedure, an unrelated problem seen during a global, a planned staged surgery, a return to the OR for a complication — each pays only when the correct modifier tells the payer why it stands apart. Omit it and the line denies as "included in global."
Won or lost 03
Fracture care runs on two separate billing paths
You can bill global fracture care (the definitive-treatment code that covers the first 90 days of routine follow-up) or itemize an evaluation plus casting — and the wrong choice either buries payable work or invites a takeback.
Won or lost 04
Injections, imaging, and DME are distinct revenue streams
Joint injections carry both a procedure and a separately reportable drug (with its own NDC units), in-office X-ray splits into professional and technical components, and casts, splints, and braces are billable supplies. Each is routinely under-captured.
Won or lost 05
NCCI bundling edits run dense through arthroscopy and spine
Knee and shoulder scopes, multiple procedures in one session, and add-on codes all sit under column-1/column-2 edits that quietly zero out lines unless the right procedure-to-procedure logic and modifier are applied.
Won or lost 06
Workers' comp and no-fault follow their own rulebook
Separate state fee schedules, prior authorization, and specific documentation requirements make a large share of orthopedic volume behave nothing like commercial or Medicare.
We manage every one of those code families and the rule attached to it, so each service is paid to its true value — nothing swallowed by a global it doesn't belong to, nothing left uncaptured:
| Revenue stream | What it covers | What we manage |
|---|---|---|
| Surgical procedures & global periods | Major surgery (90-day global) and minor procedures (10-day global) across CPT 20000–29999 | Global tracking so related care isn't re-billed and separate care isn't lost; modifier 22 where the work truly exceeds the norm |
| Global-period modifiers | 24, 25, 57, 58, 78, 79 — the modifiers that decide what's separately payable inside a global | Each applied to documented intent (unrelated, decision-for-surgery, staged, return-to-OR, or unrelated procedure) |
| Fracture & dislocation care | Closed/open treatment, with or without manipulation; global fracture care vs. itemized E/M plus casting | The correct path chosen per encounter, with restorative vs. replacement casting billed correctly |
| Joint & soft-tissue injections | Arthrocentesis and major-joint injections (20610/20611) plus the injected drug and its J-code | Procedure, ultrasound guidance, and drug with accurate NDC-to-HCPCS unit conversion, all reported |
| In-office imaging (26/TC) | X-ray and fluoroscopy performed in the practice | Professional (26) and technical (TC) components split or billed globally to match ownership and place of service |
| Casting, splinting & DME | Cast and splint supplies and durable orthotic braces | Q-code cast supplies, splint HCPCS, and L-code braces billed alongside the procedure instead of written off |
| Multiple-procedure & bilateral rules | More than one procedure per session; bilateral and staged work | Modifiers 51, 50, RT/LT and NCCI-compliant unbundling applied so payable lines survive the edit |
Chosen per encounter, not by habit
Which fracture-care path does this encounter actually support?
Global fracture care
The definitive-treatment code
Covers the definitive treatment plus the first 90 days of routine follow-up as a single package.
PACKAGEDefinitive treatment plus 90 days
SUPPLIESCast and splint supplies still captured
RISKItemising on top invites a takeback
Itemised
Evaluation plus casting
Some cases are better billed as an evaluation plus the casting or splinting performed, rather than as a package.
E/MThe evaluation billed on its own merits
CASTINGRestorative versus replacement, coded correctly
RISKChoosing wrong here buries payable work
02Closed at the front end
Where orthopedic claims lose money
Most orthopedic losses trace to the same handful of failure points. We close each one at the front end, before it hardens into a denial or a recoupment:
Issue
Related visit or staged surgery inside a global with no modifier
The denial or audit exposure
Line denied as "bundled into the surgical global"
How we prevent it
We apply 24, 58, 78, or 79 to documented intent so separate care is paid
Issue
Fracture billed on the wrong path (global vs. itemized)
The denial or audit exposure
Underpayment or post-pay recoupment
How we prevent it
We select global fracture care or E/M-plus-casting per the encounter
Issue
Joint injection billed without the drug or with wrong units
The denial or audit exposure
Lost drug revenue or NDC-unit denial
How we prevent it
We report the injection plus the J-code drug with correct NDC-to-HCPCS units
Issue
Arthroscopy add-on or multi-procedure lines caught by NCCI
The denial or audit exposure
Column-2 bundling denial
How we prevent it
We apply the correct 59/X-modifier and highest-value procedure logic
Issue
Decision for surgery on the day of a major procedure without modifier 57
The denial or audit exposure
E/M denied as part of the global surgical package
How we prevent it
We attach 57 when the visit is the documented decision for surgery
Every one of these is preventable before submission rather than argued after the fact. Request a revenue review and we'll show you which of them is hitting your remits right now.
03It leaks in ten seconds
Outsource orthopedic billing services
Not at the front desk
Most orthopedic revenue doesn't leak at the front desk — it leaks in the ten seconds a coder decides whether a post-op visit falls inside a global, which fracture path an encounter supports, or whether an arthroscopy add-on will clear an NCCI edit.
Hundreds of times a week
Those calls happen hundreds of times a week, and an in-house biller also juggling eligibility, posting, and phones cannot win all of them. Outsource that judgment to a team that only bills surgical specialties and you shut the leak off at its source rather than chasing it on the back end.
The trade
Every claim is scrubbed and filed within 24 hours, so the surgical, injection, and imaging revenue that used to sit in a work queue starts landing in your account instead. As a professional orthopedic billing services company, we carry the coding risk your surgeons should never have to weigh between cases.
When you move the work to us
Practices typically see these numbers, month after month:
up to 0%
Fall in denials
0%
First-pass clean-claim rate
~0%
Net collections
<0
Days in A/R
~0 of 10
Worked denials overturned on appeal
0%
Client-retention rate
04Operative note to paid
What 247MBS does for your practice
Everything it takes to move an orthopedic claim from the operative or encounter note to paid, run by one certified team instead of split across vendors:
- 01Code
Orthopedic surgical & procedural coding
Operative reports translated to the correct 20000–29999 codes with the global period tracked, and modifiers 22/50/51/59 applied only where the documentation supports them.
- 02Track
Global-period & modifier management
24, 25, 57, 58, 78, and 79 matched to documented intent so every separately payable visit and staged or return-to-OR procedure inside a global actually gets paid.
- 03File
Charge capture & clean-claim submission
Surgery, injections, imaging, and DME reconciled to the note, scrubbed against payer and NCCI edits, and filed within 24 hours.
- 04Resolve
Certified orthopedic coding
Coders handling fracture-care path selection, injection-plus-drug capture, and NCCI edit resolution inside the same workflow.
- 05Appeal
Denials and appeals worked to root cause
From "bundled into global" reversals to authorization and medical-necessity appeals, every denial traced and re-filed.
- 06Recover
Aged A/R recovery
Old claims pursued relentlessly across Medicare, commercial, workers' comp, and ASC facility payers.
- 07Run
End-to-end revenue cycle management
The full cycle owned from eligibility through payment posting, with reporting that shows exactly where every dollar sits.
If you'd rather keep orthopedic billing and coding services under one roof, that's the model — certified coders and billers on one team, sharing the same operative note, instead of handing claims between companies.
Revenue review
Price the missed modifiers draining your remits.
A certified orthopedic specialist puts a dollar figure on the missed modifiers, mis-billed fracture care, and aged A/R draining your remits.
- In-global visits tested against the right modifier
- Fracture encounters checked against both billing paths
- Injections, imaging and DME reconciled for under-capture
HIPAA & SOC 2 Type II
Back within one business day
No long-term lock-in
Request a Revenue Review
Tell us about your practice.
An orthopedic billing specialist will reach out within one business day.
Thanks — we've got it.
An orthopedic billing specialist will reach out within one business day.
05Fluent in the global-period rulebook
247MBS vs. a general biller
A general billing company learns orthopedics on your claims. An orthopedic billing company that already lives in the global-period rulebook shows up fluent — and the gap shows up on the remittance:
Capability
General billing company
247MBS
Surgical global-period tracking (10 & 90-day)Everything else hangs off it.
No
Yes
Modifiers 24 / 25 / 57 / 58 / 78 / 79The whole game.
Limited
Full
Global vs. itemized fracture-care selectionTwo separate billing paths.
No
Yes
Injection + drug (NDC-to-HCPCS units) captureMedication revenue left on the table.
No
Yes
In-office imaging split (26 / TC)Matched to ownership and place of service.
No
Yes
Casting, splinting & DME supply billingRoutinely written off instead.
No
Yes
Arthroscopy & multi-procedure NCCI editsColumn-2 edits zero out lines quietly.
No
Yes
Workers' comp & no-fault fee schedulesA large share of orthopedic volume.
Rarely
Yes
Dedicated account manager & live dashboardEvery claim, denial and dollar.
Sometimes
Always
06Setting and subspecialty
Who we bill for
The rules shift with the setting and the subspecialty, and we bill each one to the detail it demands:
Orthopedic surgery groups & multi-specialty practices
High surgical volume where global periods, modifiers, and multiple-procedure edits have to line up on every operative claim.
What decides the moneyGlobals, modifiers and multi-procedure edits
Sports-medicine & arthroscopy practices
Knee and shoulder scopes where NCCI bundling and add-on logic decide how many lines survive. See sports medicine billing for the wider MSK book.
What decides the moneyHow many lines survive the edit
Spine & joint-replacement surgeons
Major procedures with long globals, staged bilateral work, and dense authorization requirements.
What decides the moneyLong globals and staged bilateral work
Hand, foot-and-ankle, and fracture-care specialists
Encounters that hinge on the global-vs-itemized fracture decision and on casting and splinting capture.
What decides the moneyThe path choice and the supply capture
Physiatry, sports injection & non-operative clinics
Joint and soft-tissue injections, drug capture, and in-office imaging as core revenue. Chronic and interventional cases sit alongside our pain management billing services.
What decides the moneyDrug capture and the imaging split
Ambulatory surgery centers
Facility claims that depend on clean, first-pass coordination with the surgeon's professional billing. See ambulatory surgery center billing.
What decides the moneyFacility and professional claims in step
07No hole in cash flow
Switching is a handoff, not a project
Changing billers should never open a hole in cash flow, and with us it doesn't.
Your systems stay
We work inside your existing practice-management and EHR systems, so nobody relearns a platform.
Every panel in parallel
Credentialing and payer-enrollment review — commercial, Medicare, and workers'-comp panels — run in parallel while your claims keep going out the door, and a named account manager leads the transition from day one.
Live in weeks
Most orthopedic practices are fully live within a few weeks.
The denial drop and the faster A/R turn up in the first cycles, not a quarter later.
08Coders who read operative notes for a living
Medical Billing for Orthopedic Practices
Every surgical global, fracture, and injection paid at full value the first time.
Our orthopedic medical billing runs on coders who read operative notes for a living: they know the second a follow-up falls inside a global, when a fracture belongs on the itemized path, and when an injection and its drug both have to be reported, so the routine work never re-bills into a takeback and the separately payable work never gets written off against a global it never belonged to. The payoff shows on the remittance — fewer bundling surprises, a first-pass clean-claim rate near 99%, and revenue that reflects the work your surgeons actually did. From high-volume joint-replacement groups to single-surgeon sports-medicine clinics, orthopedic medical billing this disciplined scales without letting margin leak in the ten-second coding calls that happen hundreds of times a week. Request a revenue review
- INSIDEThe second a follow-up falls inside a globalSo routine work never re-bills into a takeback.
- PATHWhen a fracture belongs on the itemised pathChosen per encounter, not by default.
- BOTHWhen an injection and its drug both reportWith the correct unit conversion.
- APARTWhat stands apart from the globalAnd never gets written off against it.
09On results, not promises
Choosing an Orthopedic Billing Services Provider
Sign the orthopedic billing services provider that already lives in the global-period rulebook rather than learning it on your claims, and the leaks close before they start.
- Decides between global fracture care and itemised castingPer encounter, not by default.
- Captures injection drugs with the correct unit conversionsSo the medication revenue is not left behind.
- Clears arthroscopy bundling edits as routineThe exact call a generalist stumbles on.
- Brings certified orthopedic coders, not general billersWith denial and A/R teams who speak surgical billing.
- Gives transparent reporting you can open any day of the monthAnd a named account manager instead of a ticket queue.
- Can be weighed on results, not promisesThe clean-claim rate and the A/R turn tell the real story.
10Nothing changes except the results
Outsource Orthopedic Billing — What Outsourcing Looks Like With Us
What changes hands
Outsource orthopedic billing to 247MBS and your surgeons operate while the surgical revenue lands where it belongs, on time — nothing about your day changes except the results. You keep your practice-management system, your front desk, and your workflow; we take over coding, scrubbing, submission, denial work, and A/R behind the scenes.
Outsourcing orthopedic billing services means every operative, injection, and imaging line is scrubbed against payer and NCCI edits and filed within 24 hours, denials are worked to root cause, and days in A/R hold under 25 well past the first quarter — with a dashboard showing exactly where each dollar sits.
Orthopedic billing services outsourcing trades hiring, training, and software overhead for a specialist team and a predictable, transaction-based cost, and the handoff is mapped so cash flow never dips. Ready to shut the leak off at its source? or call +1 888-502-0537.
Behind the scenes, ours
- Coding
- Global tracking
- NCCI scrubbing
- Submission
- Denial work
- Aged A/R
24 HOURSEvery operative, injection and imaging line filedMAPPEDThe handoff planned so cash flow never dipsVISIBLEA dashboard showing where each dollar sits
We track every 10- and 90-day global against the operative note and apply the right modifier to each subsequent service — 24 for an unrelated visit, 58 for staged or related surgery, 78 for a return to the OR, 79 for an unrelated procedure — so separately payable care gets paid and routine follow-up isn't re-billed into a takeback.
Whichever the encounter supports. Global fracture care includes the definitive treatment plus the first 90 days of routine follow-up, while some cases are better billed as an evaluation plus casting. We choose per patient and capture the cast and splint supplies either way.
Yes. We bill the arthrocentesis or major-joint injection, any imaging guidance, and the injected drug with its J-code and the correct NDC-to-HCPCS unit conversion — so the medication revenue is captured, not left on the table.
Yes. Workers' comp is a large part of orthopedic volume, and we manage its state fee schedules, prior authorizations, and carrier-specific documentation as routine rather than letting those claims stall in A/R.
We do. Certified orthopedic coders and billers work as one team, so global-period logic, modifier selection, fracture-care paths, and claim submission all stay aligned instead of being split across two vendors.
Most practices are live within a few weeks. We bill from your existing practice-management and EHR setup, run credentialing and enrollment review in parallel, and assign a dedicated account manager on day one.
global periods·the surgical modifiers·fracture paths·workers' comp
Ready to get more of your orthopedic claims paid the first time?
Whether you're a solo surgeon, a large multi-specialty orthopedic group, a sports-medicine clinic, or an ASC, our orthopedic billing services protect every surgical global, every fracture, every injection, and every imaging and DME line. Outsource orthopedic billing services to a team that treats global periods, the surgical modifiers, and workers' comp as routine — and put the revenue you're leaving on the table back where it belongs.
Prefer email? sales@247medicalbillingservices.com