Orthopedics
Orthopedic Billing Services Powered by AI Agents
Achieve precision in orthopedic medical billing and coding with our AI agents trained on procedure-specific CPT/ICD codes, complex surgical guidelines, ASC vs hospital billing rules, and intricate orthopedic workflows.
What Is Orthopedic Billing and Coding?
Orthopedic billing and coding involves turning musculoskeletal encounters (injuries, injections, imaging, and surgery) into clean, payable claims.
Coders assign precise ICD-10-CM codes with laterality and correct seventh characters, choose the right CPT codes for services like fracture care or injections, and apply modifiers per NCCI and payer rules.
Billers then verify coverage and authorizations, scrub and submit those claims.
Complex Procedure Coding
Orthopedic procedures often involve multiple anatomical sites, implants, and staged surgeries requiring precise CPT codes and modifiers.
Impact: Delayed payments for fracture repairs
Thorough Documentation of Surgical Details
Detailed operative reports must capture procedure specifics like implant types, laterality, and surgical approach.
Impact: Coding errors and payer requests for additional records
Prior Authorizations for High-Cost Implants
Many orthopedic surgeries require prior authorization for expensive implants and durable medical equipment.
Impact: Failure to secure timely approvals
Our Expertise in Orthopedic Billing and Coding
Amy: AI Medical Coder for Orthopedic Care
- Codes orthopedic visits with precise CPT, ICD-10, and modifier combinations
- Applies specific rules for implants, fractures, and surgical approaches
- Flags missing laterality, implant details, and surgical complexity
- Audits charts for common errors in high-volume workflows
- Provides line-by-line rationale for every code to ensure accuracy and transparency
Mark: AI Medical Biller for Orthopedic Care
- Verifies eligibility across Medicare, Medicaid, and commercial payers
- Validates orthopedic codes and modifiers before claim submission
- Submits claims and handles charge entry directly in your billing software
- Reads ERAs and scans paper EOBs post payments
- Continuously learns from pediatric denial patterns to prevent future rejections
Adam: AI Denial Manager for Orthopedic Care
- Checks claim status in real-time across different payers using portals, chatbots, and aggregators
- Makes AI-driven calls to payers, navigating IVRs and live agents
- Uses customizable call scripts tailored to orthopedic scenarios such as joint replacement pre-authorizations and post-op follow-ups
- Manages both outbound and incoming calls
- Provides call recordings, summaries, and actionable recommendations for unresolved orthopedic claims
Future-proof your Healthcare RCM with AI Workforce
Schedule a Call with Us to Discuss Your Needs
Email: info@combinehealth.ai
