Orthopedic Surgery Billing Services

Orthopedic surgery billing combines the two hardest problems in surgical revenue: long global periods and multi-procedure operative sessions. Most major orthopedic operations carry 90-day global periods, so three months of follow-up care is bundled into one payment, and a single session can involve joint replacement, arthroscopy, fracture work, and hardware, each with its own coding and modifier rules. A missed modifier or a wrong laterality turns a high-value case into a denial.
MedPlus RCM provides medical billing, coding, credentialing, and denial management for orthopedic surgery practices, built around joint, spine, and sports surgery coding.

Orthopedic surgery billing challenges

Global periods dominate orthopedic revenue. A total knee replacement (27447) or total hip replacement (27130) carries a 90-day global period, so routine post-operative visits and standard wound care for three months are included in the surgical payment and must not be billed separately. Separate billing inside the window is allowed only for genuinely distinct work: an unrelated condition with modifier 24, a planned staged procedure with modifier 58, a complication requiring a return to the operating room with modifier 78, or an unrelated procedure with modifier 79.
Laterality and multiple procedures are the second challenge. Joint work is inherently sided, so RT and LT modifiers, or modifier 50 for a bilateral procedure, must match the operative report exactly, and payer preference between the two approaches varies. Multiple procedures in one session need modifier 51 where it applies, but never on an add-on code or a modifier 51 exempt code, and distinct procedures that payers would otherwise bundle need modifier 59 with operative documentation proving they were genuinely distinct. Arthroscopy coding adds its own bundling rules, since diagnostic scopes and related interventions on the same joint are frequently bundled together.
Documentation and authorization complete the picture. Joint replacement claims need the prosthesis, the laterality, and whether the case is primary or revision stated clearly. Fracture care must distinguish open treatment from closed treatment with manipulation, since billing the wrong one is a classic orthopedic error. Elective joint and spine cases need prior authorization secured before surgery, and implant and device documentation must be complete, since implants are handled separately from the professional service code.

What MedPlus RCM handles for orthopedic surgery practices

  • End-to-end medical billing. Charge entry, claim scrubbing, submission, payment posting, and patient billing, the full cycle.
  • Medical coding. Certified coders assign current ICD-10, CPT, and HCPCS codes matched to your documentation and specialty.
  • Provider credentialing and enrollment. End-to-end enrollment with commercial payers, Medicare, and Medicaid, plus re-credentialing maintenance.
  • Denial management and recovery. Every denial investigated to root cause, corrected, and appealed with documentation.
  • A/R recovery. Aged and outstanding balances audited and pursued, including balances already written off where the appeal window is still open.
  • Financial reporting. Clean claim rates, collections, denial patterns, and A/R aging visible by payer and provider.
    We serve orthopedic surgery practices of every size, from solo surgeons to multi-surgeon groups, across all 50 states.

Results orthopedic surgery practices can check

MedPlus RCM maintains a 99% clean claim rate and keeps client accounts receivable under 30 days. Pricing is a performance-based percentage of successfully collected revenue: if you don’t get paid, we don’t get paid. We are 100% HIPAA compliant, and onboarding takes 2 to 4 weeks depending on practice size, with no disruption to your daily cash flow.

Frequently asked questions

Can post-operative visits be billed after a joint replacement?
Routine post-operative visits inside the 90-day global period are included in the surgical payment and are not billed separately. Only distinct work qualifies, such as an unrelated condition with modifier 24 or a staged procedure with modifier 58.
When is modifier 59 appropriate in orthopedic surgery?
When two procedures that payers would normally bundle were genuinely distinct, such as work on different anatomical sites in the same session, and the operative documentation proves it. Using it without documentation support is a compliance risk.
How is bilateral joint work billed?
With modifier 50 for a bilateral procedure, or with RT and LT modifiers on separate lines, depending on the payer’s stated preference. The approach must match the payer’s policy for that claim.
What documentation does a joint replacement claim need?
The prosthesis used, the laterality, and whether the case is primary or revision, plus complete implant documentation. Missing any of these is a common denial cause.
How long does it take to switch our billing to MedPlus RCM?
Onboarding takes between 2 and 4 weeks depending on practice size, including data migration and payer clearinghouse setup.
What does MedPlus RCM charge?
A performance-based percentage of successfully collected revenue. If you don’t get paid, we don’t get paid.

Get a free financial audit

Find out where your orthopedic surgery practice is losing revenue. Request a free financial audit and our specialists will review your claims, denials, and A/R.
Request your free financial audit