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Orthopedic billing

Orthopedic billing that masters global periods & modifiers

Surgical globals, fracture care, injections, DME and imaging each carry their own traps. Helix assigns orthopedic coders who get the modifiers and global windows right, so the surgery you perform is the revenue you keep.

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Clean-claim rate

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Avg. collections lift

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Days in A/R

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Denials overturned

The orthopedics challenge

Surgical revenue, surgical-grade coding traps

Orthopedics mixes high-value surgery with a steady stream of office visits, injections and DME. Global-period modifiers, fracture-care rules and bundling edits make it one of the easiest specialties to under-bill or trigger denials.

Helix assigns orthopedic coders, builds global-period tracking into the workflow, and scrubs every claim for the modifiers and units that decide whether a complex procedure gets paid in full.

Global-period mastery

0/10/90-day tracking with modifiers 24, 25, 57, 58, 78, 79.

Fracture & cast care

Manipulation vs. non, casting/strapping and supply codes.

Injections & DME

Joint/trigger-point injections, J-codes, braces and orthotics.

Bundling discipline

NCCI edits, -59/-XS and multiple-procedure rules handled.

Codes we capture

The orthopedic codes that get missed

Where surgery, injections and DME meet global periods, revenue leaks. We capture the procedure plus every supportable modifier, unit and supply.

orthopedics/capture.cptLive scrubbing
27447Total knee arthroplasty90-day global
29881Knee arthroscopy w/ meniscectomy-59 / -XS
20610Major joint injection/aspiration-RT / -LT
25600Distal radius fracture, closed treatmentfracture care
99213Office E/M during global period-24 / -25
L1833Knee orthosis, adjustable-RT / -LT
Representative high-frequency orthopedic codes. Helix maintains custom scrubbing edits per practice.
Denials we kill

Orthopedics' four costliest denials

CO-97 · global

E/M inside global window

Post-op visits denied as included in the surgical global when they were unrelated or staged care.

Helix fix: global-period calendar applies 24/58/78/79 to qualifying encounters.

CO-B15 · bundling

Scope add-ons bundled

Arthroscopy components stripped by NCCI edits when separate compartments warranted -59/-XS.

Helix fix: NCCI-aware scrubbing applies the correct distinct-service modifier.

CO-16 · units

J-code units wrong

Injectable drug units mis-stated, causing underpayment or denial on injection claims.

Helix fix: dose-to-unit conversion validates J-code quantities before billing.

CO-197 · auth

Surgery without auth

Scheduled procedures or advanced imaging performed without the payer's prior authorization.

Helix fix: surgical scheduling queue secures auth before the date of service.

How Helix bills orthopedics

The Helix RCM Engine, tuned for orthopedics

01

Pre-surgical auth

Authorization secured for procedures and advanced imaging.

02

Surgical coding

Procedures, fracture care and injections coded with full capture.

03

Global scrubbing

Global-period and bundling modifiers validated per claim.

04

Denial recovery

Orthopedic appeal templates and aged-A/R workdown.

Proof, not promises

What changes when orthopedic coding is done right

Summit Orthopedic Specialists
11-surgeon group · Tennessee
Global PeriodsArthroscopyDME
+24%
net collections in 6 months
22
days in A/R (from 51)
98.7%
clean-claim rate
$372K
aged A/R recovered

"Our post-op visits and scope add-ons were getting denied constantly. Helix rebuilt the global-period logic and the denials dried up."

Challenge

A high-volume surgical group losing revenue to global-period E/M denials, bundled arthroscopy components, and a backlog of aged surgical claims after rapid growth.

Solution

Helix deployed a global-period calendar with automatic modifier assignment, NCCI-aware arthroscopy scrubbing, DME unit validation, and a 90-day aged-A/R recovery project.

Outcome

Clean-claim rate reached 98.7%, A/R days fell to 22, the group recovered $372K in aged claims, and collections rose 24%.

Representative composite based on Helix engagement outcomes. Individual results vary.

VS
Valley Sports Medicine
6-provider practice · Utah
−69%
global-period denials
20
days in A/R (from 46)
"Every post-op visit used to be a fight. Now the modifiers are right the first time."

Result: $96K recovered on reworked global-period claims.

GO
Gateway Orthopedics
9-surgeon group · Missouri
+21%
DME collections
98.9%
clean-claim rate
"The brace and orthotic billing was a mess of modifier rejections. Helix cleaned it up."

Result: +$13K average monthly DME revenue.

Representative composites based on Helix engagement outcomes. Individual results vary.

Questions

Orthopedics billing FAQ

How do you handle surgical global periods?
We track each procedure's 0/10/90-day global period and apply the correct modifiers (24, 25, 57, 58, 78, 79) so visits and staged or unrelated procedures inside the global window are paid correctly.
Do you bill fracture care and casting?
Yes. We code fracture care (with/without manipulation), casting and strapping, and the appropriate supply codes, distinguishing global fracture care from E/M plus casting where allowed.
Can you bill in-office DME and injections?
Yes. We bill braces and orthotics with HCPCS and modifiers, and joint/trigger-point injections with the drug J-codes and correct units.

See what orthopedic billing should look like

Get a free audit of your global-period modifiers, surgical coding and DME, and a clear picture of the revenue you could be recovering.

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