Maximize reimbursements for fracture care, arthroscopy, joint replacement, and surgical procedures with orthopedic billing specialists who understand global periods, modifier rules, and bundling edits that commonly cause denials in musculoskeletal billing.
Orthopedic billing is defined by surgical global periods, fracture care complexity, and arthroscopy bundling rules that change annually. A missed global period modifier, an incorrectly bundled arthroscopic code, or an undocumented fracture management service can cost your practice thousands in denied or underpaid claims. RCMAXIS orthopedic billing specialists hold CPC certifications and are trained exclusively in musculoskeletal coding — including NCCI edits and payer-specific orthopedic policies.
Open vs. closed treatment, initial vs. subsequent encounter, and manipulation vs. without manipulation — fracture care coding has multiple decision points that affect reimbursement significantly. We ensure all fracture and dislocation codes are correctly assigned based on documentation, body site, and treatment method.
Knee, shoulder, hip, and wrist arthroscopy procedures involve complex bundling rules — you cannot unbundle arthroscopic and open procedures performed at the same site during the same session. RCMAXIS coders navigate NCCI edits and CCI bundles to correctly code all arthroscopic services while capturing all separately billable components.
Total and partial hip, knee, and shoulder arthroplasty claims require precise coding of the prosthesis type, approach, and any simultaneous procedures. RCMAXIS manages the full surgical episode from pre-operative documentation review through post-operative global period claim management.
Orthopedic surgeries carry 10- or 90-day global periods during which post-operative visits are included in the surgical fee — unless separately billable. We track every patient's global period, correctly apply modifiers 24, 25, and 57 when services fall outside the global, and prevent unnecessary bundling of legitimate post-op visits.
Orthopedic surgeries and advanced imaging (MRI, CT) require prior authorizations from most commercial payers. RCMAXIS submits, tracks, and escalates all prior auth requests — coordinating peer-to-peer reviews when necessary — so surgical schedules aren't disrupted by coverage delays.
Bundling denials, medical necessity disputes for elective procedures, and global period timing disputes are the top denial types in orthopedics. RCMAXIS identifies patterns, corrects root causes, and submits targeted appeals with clinical documentation — recovering revenue that generic billing companies write off.
Our certified orthopedic coders stay current with NCCI edits, annual CPT updates, and payer-specific musculoskeletal coverage policies to ensure accurate code selection on every claim.
Orthopedic practices routinely lose revenue to global period errors, NCCI bundling disputes, and under-coded fracture care. RCMAXIS eliminates these leaks with specialty-specific expertise.
All coders are CPC-certified with specific training in musculoskeletal CPT codes, NCCI edits, and the AMA's orthopedic coding guidelines. We understand the difference between separately billable services and included components — and we code accordingly every time.
We maintain a real-time global period tracker for every surgical patient — flagging post-operative visits that fall outside the global, ensuring modifier -24, -25, -57, and -58 are applied correctly, and preventing lost revenue from improper bundling of unrelated services.
Monthly reports break down collections by procedure type, denial reason, and payer — giving orthopedic practice managers actionable intelligence to identify high-denial procedure types, track improvement over time, and benchmark performance against industry standards.
Full HIPAA compliance across all data handling — encrypted transmission, signed BAAs, role-based access controls, and regular third-party security audits protect patient data and keep your orthopedic practice audit-ready.