Orthopedic Medical Billing

A third of orthopedists’ report spending at least ten hours per week completing paperwork and administrative tasks, which contributes to burnout.

As a branch of medicine, orthopedic surgery or orthopedics treats conditions related to the Musculoskeletal System, which includes bones, joints, ligaments, tendons, and muscles.

Complexities in Orthopedic Billing

The field of orthopedic medical billing encompasses a wide range of healthcare services and procedures. It is essential for orthopedic medical billers to have a solid understanding of coding, the billing process, and the insurance specific guidelines. As part of being proactive and receiving revenue as quickly as possible, the Orthopedic Billing/Coding Specialist is responsible for coding procedures and diagnosis codes and works closely with providers to obtain specific answers.

Coding Issues:

Many doctors and internal teams struggle to keep up with the constantly changing medical coding guidelines, as well as payor guidelines. Providing regular education sessions is crucial for both professional coders and billers, as well as for providers.

Similar to other specialties, orthopedic billing codes are based on criteria established by the ICD-10-PCS. With these specific codes, medical billing specialists can bill the appropriate procedures to the patient’s insurance company, creating a more unified billing and coding process. When providing expert coding services, it is important to be familiar with standard CPT and ICD-CM diagnosis codes, as well as supply codes that adhere to CMS guidelines.

Procedures involving tendon and ligament injuries

The procedures involving the tendons and ligaments, such as a PLC reconstruction, are significantly different. Repair procedures for those parts, which typically requires submitting orthopedic surgery claims, would begin “0L” and “0M,” respectively. This includes:

The code for a tendon repair in the right lower arm could be coded as one of the following: 0LQ50ZZ, 0LQ53ZZ, or 0LQ54ZZ, depending on the approach being used.
The code for a ligament repair to the right lower arm could be coded as one of the following: 0MQ50ZZ, 0MQ53ZZ, or 0MQ54ZZ.

Character Designation

For procedures, the character structure is as follows:

The first character designates the section in which the procedure falls in the ICD-10.
The second character denotes the body system that is being affected by the procedure.
The third character is determined by the root operation (main objective) of the procedure.
The fourth character is established as the character that specifies which body part is being affected by the procedure.
The fifth character defines the approach of the procedure.
The sixth character outlines the device being used.
The seventh character provides any other qualifying information pertinent to the procedure in order to make the coding process as simple as possible.

Account Receivable and Denials:

Growing deductibles and shortened filing timelines are putting a strain on orthopedic practices' accounts receivables (AR). For many orthopedic physicians, it is difficult to stay on top of AR and fight to win claims. The process of resolving medical claim denials often involves one or two attempts before the claim is written off. The impact of this on a practice's cash flow and revenue cycle is significant. Poor AR follow-up cost practices a great deal of money, disrupting the revenue cycle, which necessitates the establishment of a clear process for follow-up.

Eligibility and Verification:

There are a number of medical reimbursement policies, so it is important to take proactive measures to verify insurance coverage, including if prior insurance authorizations are required. In the case of Medicare, if the services are not covered, the patient must sign an Advanced Beneficiary Notice (ABN). The reimbursement policies of many leading commercial carriers, including United Health and the Blue Cross Group, can make processing medical bills more challenging. In light of this, it is imperative that medical billing companies take the time required to negotiate successfully with commercial carriers if necessary.

WMB Solution to Orthopedic Billing and Coding Issues:

As part of our Orthopedic billing service, we handle patient scheduling, coding, and submitting claims. We also handle denials and rejections, compliance charting and coding, payer adjustments and paybacks, as well as bill collection. Due to our process effectiveness, clients tell us that our services increase their revenue so much that they do not consider them a cost.

Utilization of the right technology:

With long surgical procedures and long follow-up schedules, it is essential that every patient encounter is accurately documented and billed. The ability to customize ortho-specific templates streamlines documentation by allowing the user to document from any web browser.

Administrative efficiency:

Practice management software that is intuitive relieves you and your staff of administrative burdens. When you are evaluating your patients with the latest scoping technology, why do you use cumbersome, outdated software for managing appointments, storing patient profiles, and billing?

Expert Orthopedic Billing and Coding Team:

As medical billing guidelines continue to evolve under CMS/AMA/AAPC/ACA, our billing and coding professionals stay current to meet these challenges. Along with following up on unpaid or partially paid claims regularly, handling rejections, and appealing insurance denials in accordance with the billing guidelines, we pursue every dollar owed.

Expert AR Management:

As a company, we are proud of our ability to successfully pursue the difficult task of obtaining payment for old and aging claims for our clients. Our firm believes that every single dollar our clients provide is worth every single cent. By utilizing an aggressive AR management system and a professional AR team, we pursue those old and aging claims our clients have lost hope of collecting.

Fast and Easy Access to Customer Support:

WMB recognizes the importance of prompt and easy communication between the billing company and the client. Our team of experienced and professional Customer Support representatives ensures that there is no lag in communication. You will be able to reach a dedicated Support representative by telephone, email, or text message at any time.

Our expertise in Orthopedics includes but is not limited to:

Foot and Ankle Surgery

Trauma Surgery

Spine Surgery

Pediatric Orthopedic Surgery

Hip and Knee Surgery

General Orthopedics

Bone Health Center

Sports Medicine

Shoulder and Elbow Surgery

Orthopedic Oncology

Hand Surgery

Osseo-integration Clinic

Our billing services for Orthopedic can increase your revenue and relieve you of the distractions and stress related to billing so that you can concentrate on your patients.

You are under no obligation, so request a free AR analysis today!

1-(888) 816-6676

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