Orthopedic billing done right. Every Case.
Surgical coding, implant billing, global period management, fracture care, prior authorizations — orthopedic billing has more high-stakes moving parts than almost any other specialty. Theiatrics manages all of it with the precision your practice demands and the revenue outcomes you deserve.
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Orthopedic Billing Is High-Stakes. One Coding Error Costs Thousands.
Orthopedic surgery generates some of the highest per-claim reimbursements in medicine — which means billing errors, undercoding, and missed charges carry a financial impact that dwarfs most other specialties. A single coding error on a total joint replacement claim can mean thousands of dollars in underpayment. A missed implant charge can cost even more. And an incorrectly managed global period can trigger billing compliance issues that affect your entire practice.
Orthopedic billing sits at the intersection of surgical procedure coding, implant and hardware HCPCS billing, fracture care classification, global period management, and — for many practices — workers' compensation and personal injury billing. Each of these areas has its own rules, its own modifiers, and its own potential for costly errors. Few billing companies have the depth of knowledge to handle all of them correctly at the same time.
Orthopedic surgeons also operate across multiple settings — office, ambulatory surgery center, and hospital — each with separate billing streams that need to be coordinated without duplication or omission. Missing a professional fee billing opportunity because it was assumed the facility handled it, or duplicating a charge that was already captured, are both real risks in multi-setting orthopedic practices.
Theiatrics has built specific, deep expertise in orthopedic revenue cycle management. We know the CPT code families for every major joint and procedure, the HCPCS codes for implant categories, the global period rules by procedure type, and the modifier logic that unlocks billing outside the global window.
Orthopedic Billing for Every Practice Setting
Orthopedic Surgeons
General orthopedic, joint replacement, trauma, and spine surgeons — we handle every procedure type in your operative schedule with surgical-grade coding precision.
Sports Medicine Physicians
Office visits, arthroscopic procedures, injection billing, and concussion management — sports medicine has its own billing profile and we know it thoroughly.
Multi-Physician Orthopedic Groups
Scalable billing operations across large provider rosters — with per-surgeon reporting, consistent coding quality, and coordinated ASC and hospital billing.
Spine Surgeons & Neurosurgeons
Spinal fusion, disc procedures, and decompression billing requires level-specific coding and payer-specific medical necessity documentation — we handle both accurately.
Ambulatory Surgery Centers
ASC facility fee billing coordinated with orthopedic surgeon professional billing — preventing both missed charges and duplicated claims across every surgical case.
Workers' Comp-Heavy Practices
If workers' compensation and personal injury cases make up a significant share of your volume, we build a billing workflow specifically designed for that payer mix and authorization environment.
Complete Orthopedic Billing Services
Surgical Procedure CPT Coding
We select the precise CPT code for every orthopedic procedure — arthroplasties, arthroscopies, spinal fusions, fracture repairs, and soft tissue procedures — based on operative notes, anatomical site, and technique documented by the surgeon.
Implant & Hardware HCPCS Billing
Joint replacement components, bone screws, plates, rods, and spinal hardware each require specific HCPCS codes and payer-specific billing rules. We capture every implant and charge correctly — nothing gets left unbilled.
Fracture Care Coding
Fracture care requires selecting the right code based on bone, fracture type, and treatment method — closed, open, or percutaneous fixation. We apply the correct fracture care CPT codes consistently across every case and every payer.
Global Period Management
We track every patient’s global period, identify which visits fall inside and outside it, and apply the correct modifiers (-24, -25, -57, -58, -79) to protect both your compliance and your revenue during the post-surgical window.
Prior Authorization Management
Orthopedic procedures — especially joint replacements, spinal surgeries, and advanced imaging — almost universally require prior authorization. We submit, track, and appeal every authorization so your surgical schedule isn’t held up by payer delays.
Denial Management & Appeals
High-value orthopedic claims face aggressive denial tactics from payers — medical necessity disputes, coding downgrades, and bundling edits. We analyze and appeal every denial with the surgical documentation payers require to reverse their decision.
Workers' Compensation Billing
Workers' comp orthopedic billing involves state-specific fee schedules, separate authorization processes, and distinct forms. We manage the entire workers’ comp workflow — including injury documentation, authorization, billing, and follow-up.
ASC & Hospital Billing Coordination
When you operate at an ambulatory surgery center or hospital, we coordinate professional and facility fee billing to ensure complete reimbursement — and prevent both gaps and duplications that cost practices money on every surgical case.
Revenue Analytics & Reporting
Monthly reports on collection rates by payer and procedure type, denial trends, global period tracking, AR aging, and surgical volume analytics — giving you full financial visibility without digging through payer portals yourself.
Global Period Expertise
Global Periods Are Where Most Orthopedic Practices Lose Revenue and Create Compliance Risk — Simultaneously
Correctly navigating the 90-day global period requires knowing exactly which visits are bundled, which are exceptions, and which modifier unlocks separate billing.
The global surgical package is one of the most misunderstood concepts in orthopedic billing. When a major orthopedic procedure is performed, Medicare and most commercial payers consider the surgical fee to include all routine pre-operative care the day before surgery, intraoperative services, and all routine post-operative follow-up within the 90-day global period.
That sounds straightforward — until you realize how many orthopedic scenarios fall outside the standard rule. A patient who develops a complication during the global period. A second unrelated procedure performed during the same window. A new injury in a patient still in the global period for a prior surgery. A physician who didn't perform the surgery now providing post-operative care. Each of these requires a different modifier — and billing without the right one creates either a compliance risk or a lost payment.
Theiatrics tracks every patient's global period across every surgical case, identifies which visits are exceptions, and ensures the correct modifier is applied on every claim. We also proactively identify visits that should be billed but aren't — recovering revenue that most practices simply leave in the global window.
- -24 Unrelated E/M visit during global period — different diagnosis from surgical case
- -25 Significant, separately identifiable E/M on same day as procedure
- -57 Decision for surgery — E/M visit within global period of major surgery leads to surgical decision
- -58 Staged or related procedure during global period — planned at time of original surgery
- -79 Unrelated procedure during global period — new, unrelated surgical event
- -78 Return to OR for related complication during global period
- -76 Repeat procedure by same physician — medically necessary repetition
- Major Surgery: 90-Day Global Period Total joint replacements, spinal fusions, and most major orthopedic reconstructions carry a 90-day global period. All routine follow-up during this window is bundled — but documented complications, new diagnoses, and unrelated services can be billed with the correct modifier.
- Minor Procedures: 10-Day Global Period Arthrocentesis, trigger point injections, and other minor orthopedic procedures carry a 10-day global period. Understanding which CPT codes carry which global period is the first step — applying the right billing logic is the second.
- Zero-Day Global ("XXX") Procedures Some orthopedic procedures carry no global period — meaning each service is billed independently with no bundling of follow-up. Correctly identifying these and billing accordingly is another area where revenue gets missed without experienced billing support.
- Multi-Surgeon and Covering Physician Scenarios When a covering physician provides post-operative care for another surgeon's patient, or when co-surgeons share a procedure, specific modifiers apply. We handle split billing, co-surgery, and assistant surgeon billing correctly across every case configuration.
Why Theiatrics
Orthopedic Billing Needs Depth. Not Just Billing Software.
The orthopedic billing market is filled with companies that can submit a claim. Very few have the coding depth to read an operative note on a complex spinal fusion, identify the correct CPT code family, add the right implant HCPCS charges, apply the appropriate modifier, and coordinate billing across the professional and facility fee streams — all without triggering a compliance risk or missing a dollar of reimbursement.
That's what orthopedic billing actually requires. And it's the standard we hold ourselves to on every case we handle.
Our orthopedic billing specialists train on surgical procedure coding, operative anatomy, global period rules, and implant billing at a level that most general billing companies simply don't prioritize. When a payer downgrades your arthroplasty code or denies a prior authorization for spinal surgery, our team knows exactly how to build the appeal — with the clinical rationale and documentation the payer needs to reverse the decision.
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Orthopedic Surgical Coding Specialists Our coders train on surgical operative notes, orthopedic anatomy, and procedure-specific CPT families — not general medical coding applied to surgery.
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Global Period Tracking Built In We track every patient's global period from surgery date and apply the correct modifier logic — protecting compliance and capturing every billable exception.
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Implant Charge Capture Protocol We've built a specific workflow for capturing implant charges from OR logs and applying the correct HCPCS codes — one of the largest and most consistently missed revenue sources in orthopedic billing.
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Workers' Comp & PI Expertise Dedicated workflows for workers' compensation and personal injury billing — separate from standard health insurance and managed with the specific knowledge those payers require.
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Performance-Based Pricing Our fee is a percentage of collections — completely aligned with your outcome. Better billing means better results for both of us, on every case.
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No Long-Term Contracts Month-to-month only. We earn your business by delivering measurable revenue improvement — and you're never locked into a commitment that doesn't serve you.
Coding Expertise
Orthopedic Surgical Coding Requires a Specialist — Not a Generalist with a Codebook
Orthopedic surgical CPT codes span a broad range of joints, techniques, and approaches — and the difference between one code and the next can be a matter of hundreds to thousands of dollars per case. Correct code selection depends on reading the operative note carefully, understanding anatomical terminology, and knowing which surgical approaches correspond to which CPT families.
Arthroscopic versus open, partial versus total, primary versus revision — each distinction carries a different code and a different reimbursement. Spinal procedures add additional complexity with laterality, level, and approach considerations that require coders who understand orthopedic anatomy, not just billing software.
Joint Procedures-
27447Total Knee Arthroplasty Primary total knee replacement — one of the highest-volume orthopedic codes
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27130Total Hip Arthroplasty Primary total hip replacement including any implant approach
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23472Total Shoulder Arthroplasty Glenohumeral joint replacement — anatomy-specific coding required
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29881Knee Arthroscopy w/ Meniscectomy With or without meniscal shaving — additional code for lateral compartment work
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29827Shoulder Arthroscopy w/ Rotator Cuff Repair Full thickness rotator cuff repair — distinct from partial thickness codes
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29862Hip Arthroscopy with Femoroplasty FAI correction — requires specific documentation of impingement type
Beyond surgical CPT codes, orthopedic billing requires accurate implant billing and fracture care coding — two areas where errors compound across high patient volumes.
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1Closed Fracture Treatment (No Surgery) Manipulation with casting or splinting — codes vary by bone and whether manipulation was performed (e.g., 27750 closed tibial shaft fracture without manipulation, 27752 with manipulation).
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2Open Fracture Treatment (Surgical Exposure) Surgical opening of the fracture site for reduction and fixation — distinct code family from closed treatment, higher reimbursement, requires operative documentation.
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3Percutaneous Skeletal Fixation Pin or screw fixation without opening the fracture site — a distinct treatment category with its own CPT codes often confused with open treatment.
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4Fracture Aftercare vs. Fracture Care Initial fracture care includes immobilization and management. Subsequent visits for cast changes may bill separately — distinction matters for global period and payer rules.
Find Out How Much Revenue Your Orthopedic Practice Is Missing
Our free revenue audit reviews your surgical coding patterns, global period compliance, implant charge capture, and denial rate — and shows you in plain terms exactly what more precise orthopedic billing is worth to your practice.
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