Orthopedic billing combines high-dollar procedures with complex coding requirements, making it both lucrative and risky. Common pitfalls include incorrect modifier usage for bilateral procedures, missing opportunities for injection billing, and inadequate documentation for complex surgeries.
The biggest money-losers are usually modifier mistakes: using -50 instead of -RT/-LT for bilateral procedures, missing -59 for distinct procedural services, and incorrect global period management for follow-up care. These errors can cost thousands per case and trigger payer audits.
Success formula: Master your most common procedure codes and their modifier requirements, implement robust documentation templates for complex cases, and stay current with payer-specific policies for orthopedic procedures. The investment in proper coding education pays for itself with the first few claims that avoid denials.