Orthopedic billing without the global-period guesswork.
Orthopedic groups lose revenue to same-day E/M denials (modifier 25 and 57), services bundled into global periods, DME documentation gaps and surgical claims that need an appeal. We code to the global-period rules and appeal what payers bundle incorrectly.
Where ortho revenue goes missing.
Same-day E/M and procedures
Modifier 25 needs a significant, separately identifiable E/M; modifier 57 marks the decision for major surgery. Payers deny both when the note doesn't show it.
Global period bundling
Post-op visits are included in the global package, but unrelated problems and complications may not be. Without the right modifier (24, 79, 78) they're bundled away.
DME and injection supplies
Braces and injected drugs need specific documentation and codes, and are frequently denied or underpaid.
The lines that decide your reimbursement.
Orthopedics is a modifier specialty: most denials come from the global-period rules.
Read more
| Code / modifier | What it covers | What goes wrong |
|---|---|---|
| Modifier 25 | Significant, separately identifiable E/M on the day of a minor procedure | E/M note doesn't stand apart from the procedure |
| Modifier 57 | Decision for surgery (day before or day of a major procedure) | Missing, so the E/M is bundled into the global |
| Modifiers 24 / 79 / 78 | Unrelated E/M, unrelated procedure, related return to OR during the global | Not used, so services are bundled away |
| 20610 / 20611 | Major joint arthrocentesis/injection without / with ultrasound guidance | Ultrasound documented but not billed, or vice versa |
| J-codes | Injected drugs (corticosteroids, viscosupplements) | Units don't match dose administered |
| L-codes | Orthoses and DME | Medical necessity and fitting documentation missing |
Code descriptions are summarized. Always check the current CPT descriptor, NCCI edits and payer policy.
Strategy backed by experienced specialists.
Strategy & Direct Client Partnership led by Rohit Pandey, backed by a dedicated team of credentialed medical coders (AAPC/AHIMA) and seasoned AR follow-up specialists.
How we work with your team
- We work inside your PM/EHR (eClinicalWorks, NextGen, AdvancedMD and others) under a HIPAA BAA.
- We act as a secondary recovery team on aging AR and complex appeals, alongside your staff.
- Weekly collection reporting to practice leadership.
- 6–7% of net collections; 10% only on No Surprises Act IDR wins.
Orthopedics billing questions
When is modifier 25 allowed?
When the provider performs a significant, separately identifiable E/M service on the same day as a minor procedure, beyond the usual pre- and post-procedure work. The note should make the separate problem and work clear.
What's the difference between modifier 25 and 57?
Modifier 25 applies to minor procedures (0 or 10-day global). Modifier 57 applies when the E/M results in the decision to perform a major surgery (90-day global) the same day or the day before.
Do you bill DME for orthopedic practices?
Yes, including the documentation and supplier requirements payers apply to braces and other orthoses.
10 minutes. One screen. Your numbers.
A short Google Meet with Rohit to look at where your revenue stalls and whether contingency recovery makes sense for your practice. No software change, nothing to pay up front.