Orthopedic Billing – All You Wanted To Know! PPT
                     
ORTHOPEDIC BILLING – ALL YOU WANTED TO KNOW!
 
Did you know that 35% of the claims made in Orthopedic surgery are incorrect, and 25% of 
them get rejected? If you ask an orthopedic medical professional, they will tell you that 
orthopedic coding and billing are tedious and, in medical schools, they aren’t taught very 
well. However, when practice starts in real life, it is essential to get knowledge for getting 
paid for the services provided while dealing with the following complexities.
• Orthopedic Billing Complexities
The new ICD-10 has revised 134 codes, deleted 143, and added 264 new codes in 
orthopedic coding. Furthermore, the introduction of modifiers like XU, XE, XP, and XS is 
quite path breaking in the field, accompanied by the new rules for modifier 59. All these 
recent changes and the existing medical coding and billing practices in Orthopedic 
make the process quite complex.
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BEGIN WITH USING THE CORRECT MODIFIERS
The two-character designators used in Orthopedic billing denote how the 
procedural codes and services are to be applied for the services so the 
reimbursement can be claimed. When these modifiers are used accurately, they 
can provide an accurate and detailed medical record of the transaction. In 
orthopedics, there are two levels of modifiers, Level I and Level II. The Orthopedic 
billers and coders must have an in-depth knowledge of the modifiers and the codes 
that are suitable and permissible for a service provided. Any misuse of the modifiers 
and codes can lead to claim rejection, denial, fines, and in rare cases, even 
investigation of the practice.
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What Else? Top 5 Billing Guidelines for 
Orthopedic Practice
•  Insurance coverage verification
From the beginning, the best way to keep the Orthopedic practice efficient is by 
taking the time to understand the patient’s insurance policies and verify the aspects 
of it. It must include pre-authorization, verifying the coverage given by the 
insurance company, and the type of orthopedic medical services it covers. 
• Checking patient information
The importance of this point can never be emphasized enough, that is, checking the 
patient’s details, like the spelling of their name, date of birth, and other information 
that are easy to overlook. A simple mistake in the patient’s demographic would 
mean the practice is heading toward claim rejection or denial.
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•   On-Time Claim 
A standard procedure, process, and metrics for submitting the claim in a given time frame 
must be used to ensure no claim delays. As a practice, you must be aware of the claim 
deadlines, and the insurance companies provide a time limit to submit the claims. When 
you meet the deadline, the chances of claim denials are less, and even if a claim is 
denied, you have the time to re-check and resubmit, decreasing the chances of revenue 
loss.
• Correct coding
Payers can sometimes deny claims because the codes need to be more specific. The 
insurance companies not only require as much information as you can provide them about 
the service but also justify that the codes used are correct for the procedures. It is vital 
that orthopedic billing and coding are compliant with the new ICD-10 coding 
regulations and standards.
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ABOUT 24/7 MEDICAL BILLING SERVICES
24/7 Medical Billing Services is the nation’s leading medical billing service 
provider catering services to more than 43 specialties across the entire 50 
states. You can rely on us for end-to-end revenue cycle management. We 
guarantee up to 10-20% increase in the revenue with cost reduction of your 
practice for up to 50%. 
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CALL US TODAY :
Media Contact – 
24/7 Medical Billing Services,
28405 Osborn Road,
 Cleveland, OH, 44140
Tel: + 1 -888-502-0537
Email: [email protected]
Website: https://www.247medicalbillingservices.com/
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