Orthopedics
Revenue Yield
Stop losing revenue on complex coding audits and modifier adjustments. Partner with Apex experts trained specifically in orthopedics guidelines.
Common Billing Challenges in Orthopedics
Practicing medicine requires your full focus. Unfortunately, navigating payer-specific guidelines, bundling edits, and coding specificity often causes clinical revenue to get delayed or written off.
Navigating global surgical packages and postoperative care split modifiers.
Accurately billing for orthopedic implants, hardware, and external fixators.
Frequent denials for physical therapy and injections billed on the same day as E/M.
Compliant Modifiers
Orthopedics claims require precise documentation and correct modifiers to justify reimbursement under strict NCCI guidelines.
Staged or related procedure during the post-op global period of the initial surgery.
Unplanned return to the operating room for a related procedure during the global period.
Unrelated E/M service by the same physician during a post-operative global period.
Why General Billing Fails
- •Failing to document postoperative complications to justify unrelated E/M codes
- •Using outdated codes for joint reconstructions and spine surgeries
- •Missing prior authorizations for DME, physical therapy, and MRI scans
- •Incorrect billing of assistant surgeon modifiers (-80, -82, -AS) on complex surgeries
Interactive Claim Pipeline
Click on each workflow phase to inspect our protocols, software rules, and certified check systems.
Surgery Pre-Authorization
Verifying surgery codes, implants, and assistant needs.
We obtain auths for the primary CPT codes, planned implants, and assistant surgeons to ensure comprehensive payer coverage.
Phase Protocols
Frequently Asked Questions
Ready to Optimize Your Orthopedics Yield?
Let us conduct a complimentary review of your billing records and codes to identify hidden leaks and contract underpayments.