Comprehensive Orthopedic Billing Services for Maximizing Reimbursement
Orthopedic billing can be complex due to the variety of services offered, including surgeries, rehabilitation, physical therapy (PT), and occupational therapy (OT). Our experience spans joint replacements, fracture care, arthroscopy, and sports medicine procedures. Our billing experts ensure that every detail is captured accurately, from pre-operative care to post-operative follow-up, maximizing your practice’s revenue while minimizing denials.
Nuances in Orthopedic Billing
Orthopedic billing covers a broad spectrum of procedures and services, each with its own unique coding and documentation requirements. Some of the key challenges include:
Surgical Procedures:
Orthopedic surgeries, such as joint replacements or arthroscopies, require precise coding to reflect the complexity of the surgery, the use of implants, and the specific anatomical site.
Rehabilitation Services (PT/OT):
Billing for physical therapy and occupational therapy involves coding for the treatment plan, therapy modalities, and ongoing patient progress. It's essential to ensure that the therapy is deemed medically necessary and is well-documented.
Fracture Care:
Billing for fracture management can vary depending on whether the treatment is operative or non-operative. Appropriate modifier usage and ensuring the global billing period is accounted for are crucial in getting the claims reimbursed correctly.
Most Used CPT Codes for Orthopedic and PT/OT Billing:
- Orthopedic Surgeries:
29881: Arthroscopy, knee, surgical; with meniscectomy (medial or lateral).
29827: Arthroscopy, shoulder, surgical; with rotator cuff repair.
27130: Total hip arthroplasty (hip replacement), with or without cement.
27447: Total knee arthroplasty (knee replacement), with or without cement.complete.
23412: Open treatment of acromioclavicular joint dislocation with internal fixation. - Fracture Care:
24515: Closed treatment of humeral shaft fracture; with manipulation.
25600: Closed treatment of distal radial fracture (Colles’ fracture) without manipulation
27502: Open treatment of femoral shaft fracture, with or without internal fixation.
- Physical Therapy (PT) and Occupational Therapy (OT):
97110: Therapeutic exercises to develop strength and endurance, range of motion, and flexibility.
97140: Manual therapy techniques (e.g., mobilization/manipulation, manual lymphatic drainage).
97530: Therapeutic activities, direct (one-on-one) patient contact (use of dynamic activities to improve functional performance).
97035: Ultrasound therapy. - Injections and Pain Management:
20610:Arthrocentesis, aspiration and/or injection of major joint or bursa (e.g., shoulder, hip, knee).
20552: Injection(s); single or multiple trigger points, 1 or 2 muscle(s).
64483:Injection, anesthetic agent and/or steroid, transforaminal epidural (lumbar or sacral).
Probable Diagnosis Codes:
- M17.11: Unilateral primary osteoarthritis of the right knee (for knee replacement).
- S52.501A: Unspecified fracture of lower end of right radius, initial encounter (for fracture care).
- S83.311A: Tear of medial meniscus, current injury, right knee, initial encounter (for meniscectomy).
- M75.121: Incomplete rotator cuff tear or rupture of right shoulder, not specified as traumatic (for shoulder surgeries).
- M25.561: Pain in right knee (for injections or arthrocentesis).
Medical Necessity in Orthopedic Billing
Medical necessity is critical when billing for orthopedic services, particularly surgeries, rehabilitation, and injections. Clear documentation is essential to prove the necessity of the procedure or therapy to the insurance payers. For example, the justification for a total knee replacement must include evidence of failed conservative treatments (e.g., physical therapy, pain management) and significant patient symptoms like decreased mobility and severe pain.
How Nellikk.ai Enhances Orthopedic Billing
Through our partnership with Nellikk.ai, we bring advanced automation and AI-powered capabilities to orthopedic practices, improving billing processes and ensuring revenue cycle efficiency:
- Improved Coding Accuracy: Nellikk.ai ensures the precise capture of diagnosis and procedure codes, automatically mapping them to relevant services and minimizing coding errors.
- Enhanced Denial Management: The platform identifies common coding issues and incomplete documentation before claims are submitted, preventing potential denials and speeding up reimbursement.
- Real-Time Insights: : With real-time analytics, our system provides comprehensive visibility into your billing performance, identifying gaps and offering actionable insights to enhance revenue.
Why We Stand Ahead of the Competition
What sets us apart is our specialized knowledge in orthopedic billing combined with our integration of cutting-edge technology through Nellikk.ai. We:
- Increase Revenue by ensuring every service is captured accurately and reimbursed promptly.
- Enhance Efficiency by automating claims submission, tracking, and error identification, freeing up your staff to focus on patient care.
- Ensure Transparency with real-time updates and detailed reporting, offering full visibility into your billing performance.
- Optimize Compliance with HIPAA and HITECH standards, ensuring the security and privacy of your patient information.
With our orthopedic billing services, supported by Nellikk.ai’s powerful capabilities, you can be confident that your practice’s financial health is in expert hands.
