Orthopedic Medical Billing Services: Injections, DME, and Global Periods
Orthopedic practices juggle procedures, injectable drugs, durable medical equipment, and workers' comp rules — each billed differently.
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Why orthopedic billing has more moving parts
A single orthopedic visit can involve a procedure, an injected drug, a brace or DME, and sometimes a non-standard payer like workers' comp — each billed under different rules in the same encounter. See orthopedic billing considerations.
Where orthopedic claims get denied
- Injections and the drugs used in them bill separately from the procedure and need correct units and NDC data
- Durable medical equipment (bracing, L-codes) often needs its own authorization and documentation of medical necessity
- Post-operative global periods bundle follow-up visits into the original procedure, and billing a visit separately inside that window gets denied
- Workers' compensation and auto-insurance claims follow entirely different submission and payment processes than standard medical claims
What a global period actually restricts
Related follow-up visits within the global period (commonly 10 or 90 days) aren't separately billable unless specific modifiers apply showing the visit is unrelated to the original procedure.
What to check before outsourcing orthopedic billing
| Area | Risk if missed | What to ask a billing service |
|---|---|---|
| Injection/DME billing | Units or NDC errors → denial | How do you handle injection and DME billing and authorization? |
| Global period tracking | Follow-up visit billed and denied | How do you track global period dates per procedure? |
| Workers' comp claims | Submitted like a standard medical claim → rejected | Do you have a specific process for workers' comp and auto claims? |
Questions to ask
- Ask how they track global period dates per procedure, not just per patient
- Ask whether they have a specific process for workers' comp and auto claims, which pay and appeal differently
- Ask how they bill DME and whether they handle the separate authorization it often needs
Orthopedic billing leans heavily on coding and charge entry accuracy and persistent AR recovery for workers' comp and auto claims. A billing audit can show where global-period or DME claims are already being lost.
Frequently asked questions
Yes, but only with a modifier showing it's unrelated to the original procedure or for a specific documented reason — not as a routine follow-up.