Orthopedic medical billing covers everything from fracture care and joint injections to major joint replacement and arthroscopic surgery, and it’s a specialty defined by global periods — many orthopedic codes bundle an entire episode of follow-up care into one fee, and billing outside those rules is one of the most common sources of denials and compliance risk. TBC Solutions provides dedicated orthopedic billing so practices get paid correctly the first time.
Why Orthopedics Billing Is Different
- Fracture care codes often bundle an entire treatment episode — including follow-up visits and cast changes — into a single global fee, and billing a follow-up visit separately when it’s already bundled is a common, costly error.
- Major procedures like total hip (27130) and total knee (27447) replacement carry 90-day global periods, requiring modifiers -58, -78, and -79 to correctly bill any related or unrelated procedure performed during that window.
- Bilateral and multiple-site procedures (modifier -50, plus site modifiers -RT/-LT) are common in orthopedics and require precise documentation to avoid claims being flagged as duplicate.
- Orthopedic visits frequently include same-day imaging (X-ray codes in the 73xxx range) and DME (braces, casts) — both billed under different rules than the primary procedure, and both easy to under-bill if not tracked deliberately.
Our Orthopedics Medical Billing Services
Charge Entry & Coding
Accurate CPT/ICD-10 coding by coders trained specifically in this specialty’s code sets and payer edits.
Claims Submission & Scrubbing
Every claim is scrubbed against payer-specific edits before submission to catch errors before they become denials.
Denial Management & Appeals
Denied claims are tracked, corrected, and appealed — not just resubmitted blind.
Payment Posting & Reconciliation
Payments are posted and reconciled against contracted rates to catch underpayments, not just track deposits.
Credentialing & Payer Enrollment
We handle payer enrollment and re-credentialing so billing isn’t interrupted by lapsed enrollment.
Patient Statements & Support
Clear, accurate patient statements and support fielding billing questions, reducing patient billing complaints.
Reporting & Analytics
Regular, transparent reporting on collections, denials, and days in accounts receivable — no black-box billing.
Common Orthopedics Billing Challenges We Solve
Global period conflicts on fracture care
Billing a follow-up visit separately when it’s already bundled into a fracture care global fee is one of the most common — and most preventable — sources of denied and recouped claims in orthopedics.
Modifier errors on major joint procedures
Related and unrelated procedures performed during a 90-day global period after joint replacement require specific modifiers (-58, -78, -79); getting this wrong causes both denials and compliance exposure.
Bilateral and multi-site procedure documentation
We apply correct modifier combinations (-50, -RT, -LT) with supporting documentation so bilateral or multi-site procedures aren’t flagged as duplicate claims.
Under-billed same-visit imaging and DME
Same-day X-rays and DME (braces, casts) are billed under separate rules from the primary procedure and are frequently missed; we track both as part of standard claims review.
Our Process
- Free Practice Audit: We review a sample of your recent claims, denial patterns, and current billing workflow at no cost and with no obligation.
- Onboarding & EHR/PM Integration: We integrate with your existing EHR/practice management system — no need to switch software.
- Coding & Claims Submission: Claims are coded and submitted using the specialty-specific rules covered in this document.
- Denial Management: Denied claims are corrected and appealed promptly, with root-cause tracking so the same denial doesn’t recur.
- Reporting & Optimization: Ongoing reporting identifies further revenue opportunities as your practice and payer mix evolve.
Why Practices Choose TBC Solutions for Orthopedics Billing
- Coders trained on this specialty’s specific code sets, modifiers, and payer edits — not generalist billing applied to every specialty the same way.
- HIPAA-compliant handling of all patient and claims data, from intake through reporting.
- Transparent, regular reporting — you always know what was billed, what was paid, and what’s outstanding.
- A dedicated point of contact, not a rotating support queue.
Frequently Asked Questions
How do you avoid denials from orthopedic global periods?
We track the specific global period assigned to each procedure — from bundled fracture care to 90-day joint replacement periods — so follow-up visits and related procedures are billed with the correct modifiers instead of being denied.
Do you bill for bilateral procedures correctly?
Yes — bilateral and multi-site procedures require specific modifier combinations and supporting documentation, which we apply as standard practice to avoid duplicate-claim flags.
Can you bill for same-visit X-rays and DME?
Yes. Same-day imaging and durable medical equipment like braces and casts are billed under separate rules from the primary procedure, and we track both so they aren’t missed.
Do you work with both surgical and non-surgical orthopedic practices?
Yes — from sports medicine and pain management-adjacent orthopedic practices to high-volume joint replacement surgery centers.
What does the onboarding process look like?
A free practice audit, followed by EHR/practice management integration, coding review, and a transition period where we work alongside your current process before fully taking over.
How is reporting handled?
You get regular, transparent reporting on claims submitted, denials, collections, and days in accounts receivable — no black-box billing.
Get Started
Ready to stop losing revenue to preventable orthopedic billing denials? Book a Free Orthopedic Billing Audit with TBC Solutions.