Orthopedic claims get denied at a higher rate than almost any other specialty — not because the care is unusual, but because the coding rules for global periods, implants, and multiple procedures are some of the most complex in medicine.
Global Period Mistakes
Most orthopedic procedures carry a 90-day global period covering routine post-op care. Billing a separate E/M visit during that window — without modifier 24 to show the visit was unrelated to the original procedure — is one of the most common denial triggers in the specialty.
Multiple Procedure Reductions Done Wrong
When more than one procedure is performed in the same session, payers apply a multiple procedure reduction to the lower-valued codes. Billing without accounting for this, or sequencing the codes in the wrong order, leads to either a denial or a payment that’s wrong but goes unnoticed for months.
Implant and Hardware Coding Errors
Implant costs are often billed separately from the surgical procedure, but only under specific payer rules and only with the right documentation of the device used. Missing the implant invoice or HCPCS code in the claim package is a frequent, fixable cause of underpayment.
Laterality and Site-Specificity Errors
ICD-10 requires laterality — left, right, or bilateral — for most orthopedic diagnoses. A claim missing or mismatching laterality between the diagnosis and procedure code is an easy automatic denial, and one of the most preventable.
Bundled Imaging and Injections
X-rays and injections performed during the same visit as a related procedure are often bundled under NCCI edits. Billing them separately without proper modifier justification triggers the same kind of denial covered under general NCCI errors.
The Fix
Orthopedic coding needs staff who specifically know global periods, multiple procedure rules, and implant documentation requirements. Generalist coders without ortho-specific training will hit these issues repeatedly because the same template gets reused across patients.
What OmniBridge Actually Does
We run the parts of the revenue cycle most practices struggle to staff well: medical coding, claims submission, denial management, and full RCM — built specifically for US physician practices, on a performance-based fee.
If you want to see where your practice currently stands, request a free billing audit and we’ll show you your actual clean claim rate and days in A/R before you commit to anything.
