Specialty billing / Orthopedic
Orthopedic practices run a clinic, an imaging suite, a procedure room and an operating room schedule, each with its own billing rules. Fracture care carries a global period that starts in the office, injections and imaging performed the same day face bundling edits, and a large share of the volume arrives through workers compensation with entirely separate requirements.
0
Years in revenue cycle
48h
Claim filing window
30d
Target days to payment
HIPAA
Compliant by design
Where it breaks
Restorative fracture care codes include a global period covering follow-up visits and casting. Billing an office visit for each subsequent check after applying fracture care produces denials, while billing only visits forgoes the higher-valued global code.
Joint injections performed with ultrasound or fluoroscopic guidance have specific bundling rules, and some guidance is included in the injection code. Billing guidance separately where it is bundled draws edits on a routine, high-volume service.
Comp carriers require claim numbers, adjuster contacts, work status reports and often state-specific forms. Missing any of these stalls payment indefinitely, and the account ages without ever appearing as a formal denial to work.
In office-based procedures, implants, braces and durable supplies may be separately reportable depending on payer and setting. Practices dispensing braces without checking coverage and supplier requirements absorb the inventory cost.
Frequently billed
Representative codes only. Actual coding follows current CPT/HCPCS guidance and payer policy.
Denials we prevent
FAQ
Bill restorative fracture care when the provider assumes responsibility for the fracture through healing, including follow-up visits and casting within the global period. Bill an evaluation and management visit with casting supplies when the patient is being stabilized and referred elsewhere for definitive care. Decide once and document which model applies.
It depends on the code. Some injection codes include imaging guidance in their descriptor, in which case separate reporting is bundled and denied. Others permit a separate guidance code when the guidance is performed and a permanent image is retained with an interpretation. Checking the specific code pairing before billing avoids recurring edits.
Missing administrative detail rather than clinical disagreement. Comp carriers need the claim number, the adjuster, the date of injury, authorization for the specific treatment, and periodic work status reporting on the state's form. Collecting all of it at the first visit is far easier than reconstructing it after the account has aged.
Sometimes, and it depends on the payer, the item, and whether your practice meets supplier requirements for that plan. Some payers require a separate supplier enrollment even for items dispensed by the treating physician. Verifying before stocking inventory prevents dispensing equipment that cannot be billed.
We submit with the clinical evidence payers actually evaluate: documented conservative treatment and its duration, imaging findings, functional limitation, and pain affecting daily activity. Most denials at this stage are about missing conservative care history rather than disputed surgical indication, so we confirm that record before submitting.
Other specialties
Next step
Send us your specialty, claim volume and current billing setup. We will come back with a proposal you can act on.
