Orthopedic claims carry more moving parts than most: a procedure, a global period that follows it, often hardware, and frequently more than one procedure in a single session. Each of those has its own rule, and they interact.
The global period is the one that catches practices out. A post-operative visit billed inside the global window will be denied, and the window differs by procedure rather than being a single practice-wide number.
What trips orthopedics claims up
- Global period tracked per procedure, so post-op visits aren't billed inside it
- Modifier {59} applied only where the services were genuinely distinct
- Implants and hardware billed with the invoice detail payers ask for
- Multiple-procedure reductions applied before the payer applies them for you
What we check before a claim goes out
- Global period tracked per procedure, not per practice
- Modifier 59 applied only where services were genuinely distinct
- Implants and hardware billed with invoice detail attached