Eliminate billing and coding concerns with Nexus io’s orthopedic medical billing services for your specialty practice needs. Built for orthopedic practices, our team applies accurate CPT and ICD‑10 coding, manages prior authorizations, and ensures payer‑specific compliance to resolve common orthopedic billing challenges. With streamlined claim submission and denial management, we accelerate your revenue cycle. Contact us to learn how we do it.
Specialized orthopedic billing services specialize in translating complex musculoskeletal procedures like fracture repairs, arthroscopies, and joint replacements into clean, compliant claims that get paid quickly.
These orthopedic coding and billing services handle everything from initial patient registration and insurance verification to claim submission and payment posting procedures.
Compared with other medical specialties such as primary care or dermatology, orthopedics presents more complex billing procedures. As with all orthopedic treatments, multiple surgical stages, bilateral procedures, assistant-surgeon billing, and high-value implants all demand rigorous edits and real-time eligibility checks.
To stay compliant and profitable, many practices outsource to an orthopedic billing company like Nexus io, ensuring steady revenue growth.
Collection Ratio
Revenue Growth
States Served
First Pass Claim Ratio
Managing orthopedic billing and coding in-house may appear cost-effective, but the math rarely works out. Orthopedic medical billing is a complex procedure with detailed examination procedures and documentation.
It requires meticulous review of operative notes, selection from hundreds of musculoskeletal CPT and ICD-10 codes, and strict adherence to bundled and unbundled service rules.
Further orthopedic billing challenges are:
Clean Claims Rate
Reduction in A/R
Coding Accuracy Rate
Grasping orthopedic billing challenges is only half the battle. The other half demands effective and proven orthopedic revenue cycle management services. Here’s where Nexus io provides specialized support.
Our expert team of orthopedic billing consultants utilizes industry best practices to ensure coding accuracy, billing excellence, and maximum reimbursements for your practice.
Minor coding missteps can sink an orthopedic procedure claim. For instance, using the wrong 7th character in an ICD-10 injury code, over-applying laterality orthopedic billing modifiers, or omitting the T-codes in Chapter 19 all trigger costly audits.
Furthermore, pre-assigning diagnosis codes for “suspected” conditions violates payer rules, while skipping parenthetical notes in the code book often causes bundling denials. Together, these errors slow payments and inflate rework costs.
Our HIPAA-compliant orthopedic billing services hinge on meticulous documentation review.
follow-up visits and review clinical notes for symptoms and signs to assign precise ICD-10 codes. We then consult parenthetical instructions to satisfy code-specific reporting rules, keeping each claim clean, compliant, and promptly paid.
For orthopedic medical billing, our certified coders convert op-notes into exact orthopedic CPT codes, add modifiers 25, 50, 59, 62, and RT/LT, and run NCCI/MUE and LCD edits to stop bundling denials.
They track 10- and 90-day global periods, reconcile RVUs, and link UDIs or implant charges. They scrub claims for PA status, medical-necessity gaps, and frequency limits to boost first-pass acceptance and speed 835 remits.
We master CPT definitions to avoid overusing laterality modifiers. We also assign Chapter 19 T-codes accurately when complications arise, protecting every dollar of your revenue.
We provide 24/7 support for all orthopedics billing and revenue cycle services. Whether your practice performs joint replacements, fracture care, spinal procedures, or sports medicine treatments, our team ensures precise CPT and ICD-10 coding with timely and compliant claim submission.
We help reduce denials, manage surgical modifiers and global periods, and ensure accurate billing for both inpatient and outpatient orthopedic procedures. Each service aligns with payer-specific guidelines and orthopedic billing standards.
Our orthopedics billing professionals handle the complexity so you can focus on restoring mobility and improving patient outcomes.
We handle the whole revenue cycle for orthopedic subspecialties through our end-to-end orthopedic billing services.
With Nexus io handling the paperwork, each orthopedic surgeon can stay focused on patient outcomes. Our billing for orthopedic subspecialties includes:
We deploy orthopedic billing software packed with NCCI, MUE, LCD, and global-period rules. Every 837P claim is scanned before it leaves your system. The audit engine matches op-notes to CPT, ICD-10, and Chapter 19 T-codes. It checks RVUs, UDIs, and laterality modifiers.
Simulated payer edits expose over- and undercoding in real time. Clean claims go straight to the clearinghouse. Exceptions route to a senior coder for instant fixes.
Denials drop below 5%, and revenue can rise by up to 30%. All workflows remain fully HIPAA-compliant.
Facing complex orthopedic billing, surgical modifiers, or claim rejections? Our team specializes in coding for joint replacements, fracture treatment, spine procedures, and rehab services delivering clean claims, precise CPT coding, and full payer compliance to keep your reimbursements on track.
Click “Get Demo” to explore how we simplify your billing process, then fill out the form and our team will contact you within 12 hours.
Can The Nexus io work with my orthopedic EHR system?
Yes. Our orthopedic billing company integrates with Epic, Cerner, athenahealth, and more via secure HL7 / FHIR APIs. We map charge data, op-notes, and imaging feeds directly into our orthopedic billing services platform without disrupting your clinic workflow.
Are Nexus io billers trained in orthopedic billing?
Absolutely. Each coder is CPC- or CCS-P-certified and completes quarterly labs in orthopedics medical billing, covering fracture care globals, implant UDIs, and NCCI edits. Additionally, specialized teams handle spine, sports, and trauma codes to keep your submissions accurate.
Can Nexus io handle ortho surgery prior authorizations?
Yes. Our orthopedic surgery billing unit verifies medical necessity, submits PA requests, and tracks approvals for joints, fusions, biologic injections, and DME. With automated alerts, we flag expiring authorizations so cases never get delayed in the or schedule.
How does Nexus io manage denied ortho claims?
We run denial analytics to spot root causes, correct code or modifier errors within 24 hours, and file electronic appeals. Our data-driven orthopedic billing services cut denial rates below 5 % and recover lost revenue through targeted payer follow-ups.
How can I start orthopedic billing with Nexus io?
Schedule a discovery call, sign a HIPAA BAA, and share payer contracts. We import fee schedules, set up clearinghouse links, and launch your orthopedics medical billing account in 10–15 business days; with zero downtime to your front desk.
Does Nexus io check ortho patient eligibility?
Yes. Real-time and batch checks confirm coverage, deductibles, and authorization needs 48 hours before each visit. This front-end guardrail prevents costly denials and keeps your revenue cycle moving.
Nexus io is always here to assist you in exploring how our revenue cycle management services can benefit your practices and administrative staff. Reach out to us by simply filling out this quick form, and one of our billing experts will contact you in 12 hours.
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