Orthopedic Billing

Orthopedic billing and revenue cycle presents a unique set of challenges. Many internal and external billing teams struggling with every piece of the billing process.

Male doctor and nurse discussing over notes on clipboard in clinicIf your practice is struggling with orthopedic billing, Coronis is here to help. 

Overview of Orthopedic Billing

Orthopedic billing covers a wide scope of services and procedures. Orthopedic medical billers are required to know coding, understand the billing process, and know the payor specific guidelines.  In order to be proactive and receive revenue without delay, the Orthopedic biller/coder is responsible to code the procedures and diagnosis codes and works closely with the providers to educate and to obtain specific answers in order to code correctly.  Submitting claims, posting payments, following up on rejections or denials, confirming accurate payment and billing patients are also processes followed by the Orthopedic billers.

Outline of the Orthopedic Billing Process

Office charges:

Completed through EHR/EMR

  • E/M coding:
    • Report based on components of history, exam, and medical decision making.
  • In-office procedures:
    • Injections
    • X-rays
  • Documentation:
    • New Injury/problem; exacerbation of a previous injury/problem; unanticipated change in the condition; change in treatment plan.


  • Operative Report is sent electronically through Ebridge.
  • Coder codes the OP Report with procedure codes and Diagnosis Codes
  • The OP report with the procedure codes and the DX Codes is then loaded to ebridge for the Charge entry team to enter.

            After charge posting:

  • The claim is billed electronically
    • Rejections are worked on a daily basis through the Charge entry team.
  • Payments are posted and any ansi/reason codes are posted
  • If denied, the AR team will work on the denials
  • If Paid, confirm payment is correct
  • Any co-pay, co-ins or deductible is sent to the patient via statements, emailed statements or hard copy statements.

Eligibility and Verification

There are many medical reimbursement policies, be proactive in verifying benefits and coverage, including if prior authorization is required.  For Medicare, if the services are not covered the patient needs to sign an Advanced Beneficiary Notice (ABN).


Similar to other specialties, orthopedic coding has it's challenges. Coding denials can be common in orthopedics and often are a result of poor documentation. Best practice is to code based on documentation not reimbursement which can cause issues when doctors are not documenting thoroughly. Many providers fail to document key pieces of information which can result in missed opportunities for reimbursement. Coding guidelines are constantly changing as are payor guidelines and many doctors and internal teams struggle to keep up. Holding regular education sessions for not only coders and billers but also for providers is crucial.

Common Orthopedic Coding Errors

Accounts Receivables and Denials

With growing deductibles and reduced timely filing timelines, orthopedic practices are getting hit from many angles and it's taking a huge toll on their accounts receivables. For many practices, they do not have the bandwidth to stay on top or AR and fight to win claims. It is not uncommon to see one or two attempts to resolve a claim and then write it off. This has a huge impact on a practice's cash flow and revenue. Practices are hemorrhaging money as a result of poor AR follow up making it critical to have a clear process in place for follow up.

Preventable Ortho Denials

Best Practices for Patient Collections

Patient is contacted by email prior to their follow up appointment to inform they have a balance; this should be collected in the office.

  • 2 statements sent to patient
  • Email as a final attempt
  • Balance over 1,000.00 a call is placed as a final attempt
  • send client for approval.
  • Approved accounts are forwarded to the collection agency.