Maximize surgical revenue with fracture coding precision, implant billing expertise, global period management, and modifier accuracy for complex procedures.
Orthopedic and surgical practices face the most complex coding challenges in healthcare: fracture management requiring anatomical precision, multiple procedure bundling rules, implant and device billing, global period tracking, and modifier accuracy for bilateral and staged procedures. Denial rates run 18-20% higher than primary care due to coding complexity and payer scrutiny. IntegraRCM protects your surgical revenue with orthopedic-certified coders, implant tracking systems, bundling expertise, and specialized denial management—ensuring every surgical dollar is captured and defended.
Anatomical precision required for site-specific codes, open vs. closed fractures, and displacement levels
Separate billing for hardware, tracking implant costs, and matching device codes to surgical procedures
Distinguishing related vs. unrelated visits during 10/90-day global periods to prevent bundling denials
Correct modifier usage for bilateral procedures, staged surgeries, and multiple approach combinations
Supporting surgical decisions with imaging results, conservative treatment failures, and clinical indicators
Managing PA requirements for joint replacements, spinal procedures, and high-cost orthopedic surgeries
Specialists trained in fracture coding, anatomical precision, and musculoskeletal procedure classification
Automated device code matching, cost reconciliation, and separate billing for hardware components
Real-time tracking of 10/90-day windows with automated modifier application for unrelated services
Correct modifier usage for bilateral, multiple, and staged procedures to maximize compliant reimbursement
Clinical documentation review linking imaging, conservative treatment, and surgical indications
Orthopedic-specific templates and clinical evidence packages for coding and bundling disputes
Orthopedic and surgical practices use specialized clinical and billing platforms designed for operative workflows and implant tracking. We adapt to your system configuration, including:
Targets vary by procedure mix, payer contracts, and implant volume. We baseline KPIs during onboarding and define SLAs aligned to your surgical revenue priorities.
Eligibility Verification & Prior Authorization
Surgical Documentation & Implant Tracking
Fracture & Procedure Coding with Modifiers
Pre-Submission Bundling & Modifier Review
Payment Posting & Implant Cost Reconciliation
Denial Appeals & Global Period Management
Coding precision + modifier expertise + global period tracking = protected surgical revenue.
| Operational Area | Before IntegraRCM | After IntegraRCM |
|---|---|---|
| Fracture coding accuracy | Generalist coders struggle with anatomical precision, laterality, and displacement levels | Orthopedic-certified coders ensure >96% fracture code accuracy |
| Implant & device billing | Missing device codes and failure to separately bill expensive hardware components | Automated implant tracking and device code matching for complete billing |
| Global period management | Routine follow-ups billed separately causing bundling denials and recoupments | Real-time global period tracking with automated modifier application |
| Multiple procedure bundling | Incorrect modifier usage causing downcoding and lost reimbursement on complex cases | Bundling expertise with correct -50, -59, -LT, -RT modifier application |
| Denial recovery rate | Coding and bundling appeals delayed or abandoned due to complexity | Specialized orthopedic appeal templates improve overturn rates |
Reduces denials from 19% to 6% and recovers $1.2M annually through coding precision
A regional orthopedic group with sports medicine, spine, joint replacement, and hand surgery specialties was experiencing a 19% initial denial rate, primarily from fracture coding errors, incorrect modifier usage on bilateral and multiple procedures, global period violations, and missing implant billing. The in-house billing team lacked specialized orthopedic coding expertise, and appeals were rarely successful due to inadequate clinical documentation packaging.
Initial claim denial rate reduced through coding precision and modifier expertise
Fracture coding accuracy rate, eliminating anatomical and laterality errors
Annual recovery in previously denied surgical claims through specialized appeals
Captured in missed implant billing through automated device tracking
Global period compliance achieved, eliminating bundling recoupments
Reduction in A/R through faster claim submission and fewer denials
Note: Results vary by procedure mix, payer contracts, and surgical complexity. We baseline KPIs during onboarding and report progress against SLAs.
| Model | Description | Best For |
|---|---|---|
| Performance-Based (% of Collections) | Fee based on monthly collections (typically 5-9% for surgical complexity), aligning incentives for maximum recovery | Single-specialty orthopedic groups, ambulatory surgical centers |
| Dedicated Surgical Coding Team | Specialized team of orthopedic-certified coders dedicated to your practice workflows and payer rules | Multi-surgeon groups, hospital-employed orthopedic departments with high surgical volumes |
| Hybrid Support + Credentialing | Base retainer for core RCM services + surgeon credentialing, contract negotiation, and PA management | Growing practices adding surgeons, groups expanding to new payer networks |
Each engagement begins with onboarding: baseline KPI audit (denial rate by category, fracture coding accuracy, global period compliance, implant billing capture), workflow mapping, system integration, and SLA definition aligned to your surgical revenue goals.
Most orthopedic practices see measurable improvement within 60-90 days as coding accuracy increases and bundling expertise matures, with sustained denial rate reduction as appeal processes and global period tracking optimize.
Orthopedic and Surgical revenue cycle management (RCM) is the specialized process of managing complex fracture coding, implant and device billing, global period tracking, multiple procedure bundling, modifier accuracy, prior authorization for surgical procedures, claim submission, payment posting, denial management, and A/R follow-up for musculoskeletal procedures and surgical services.
Orthopedic practices face 18-20% higher denial rates compared to primary care due to complex fracture coding requiring anatomical precision, multiple procedure bundling rules, implant and device billing requirements, global period management, modifier accuracy for bilateral procedures and staged surgeries, and prior authorization requirements for high-cost procedures. Specialized coding expertise is essential.
Yes. We align workflows to Epic (OpTime and Resolute for surgical billing), Cerner PowerChart Surgery, Modernizing Medicine EMA Orthopedics, athenahealth, AdvancedMD, and other orthopedic practice management platforms—adapting to your surgical scheduling, implant tracking, and procedure-specific billing requirements.
Our system tracks all surgical procedures with 10-day and 90-day global periods in real-time. When patients present during the global window, we automatically apply appropriate modifiers (-24, -25, -57, -79) for unrelated services to ensure compliant billing and prevent bundling denials. This eliminates manual tracking errors and recoupment risks.
We integrate with your OR documentation and supply chain systems to automatically track implant usage, match device codes to surgical procedures, ensure separate billing for expensive hardware components, and reconcile implant costs against reimbursement. This captures revenue that many practices miss and protects margins on high-cost devices.
Most orthopedic practices see measurable improvement within 60-90 days. Fracture coding accuracy improvements show impact immediately in first-pass acceptance rates. Global period compliance and modifier expertise reduce bundling denials within the first billing cycle. Specialized appeal processes compound over subsequent months, driving sustained denial rate reduction and revenue recovery.
We'll review a sample of surgical procedures, evaluate fracture coding accuracy, assess modifier usage and bundling compliance, measure global period adherence, identify implant billing gaps, analyze denial patterns, and provide a revenue protection baseline with recommendations for coding excellence, bundling expertise, and denial prevention.
Assessment reports are typically delivered within 10 business days.