AI-Powered Orthopedic Billing Services | Sterling Global Solution

THE PROBLEM

Global periods and bundling rules turn routine claims into denials.

✕RT/LT or bilateral (50) modifiers missing or mismatched against the operative note

✕Follow-up visits billed inside a 90-day global period without the modifier (24/58/78/79) that gets them paid separately

✕Arthroscopy-family codes bundled under NCCI edits but billed as if they were separate procedures

✕DME (braces, walking boots) and RTM billed like a routine office charge instead of through their own coding rules

Sterling tracks the global clock and the modifier, not just the code.

Our AI is tuned to orthopedics' modifier and bundling logic, not a generic office-visit filter.

✓ RT/LT/50 laterality checked against the operative note before the claim goes out

✓ Global-period modifiers (24/58/78/79) applied based on staged, unrelated, or complication status

✓ NCCI bundling edits checked per arthroscopy compartment before 59/XU is applied

✓ DME (HCPCS L-codes) and RTM (CPT 98975–98981) billed through their own coding logic

WHERE THE MONEY LEAKS

The rules that decide reimbursement.

Orthopedic procedure volume is shifting to ASCs fast, CMS's 2026 update moved 285 procedures off the inpatient-only list, and MedPAC reports total knee and hip arthroplasty volume in ASCs grew 27.6% and 28.7% from 2023 to 2024. Site-of-service and facility-fee coding accuracy matters more every year.

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Laterality & Bilateral Modifiers

RT, LT and 50 on procedures like joint arthroplasty (CPT 27130, 27447) and fracture care, missing or mismatched laterality is one of the most common denial triggers.

RT/LT/50

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Global Period & Staged Procedures

90-day global periods on major procedures. Modifier 58 for planned staged returns, 78 for unplanned complications, 79 for truly unrelated procedures, 24 for unrelated E/M.

24/58/78/79

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NCCI Bundling on Arthroscopy

Component arthroscopic procedures bundle into the more extensive primary procedure unless performed in a genuinely distinct compartment and documented accordingly.

NCCI edits

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DME, Orthotics & RTM Billing

Braces and walking boots billed through HCPCS L-codes with LCD medical-necessity documentation; remote therapeutic monitoring billed on its own 20-minute time increments.

DME + RTM

HOW WE WORK YOUR CLAIMS

Built for orthopedics' modifier and bundling rules.

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Verify

Eligibility, prior authorization, and global-period status confirmed before the visit.

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Scrub

RT/LT/50, global-period modifiers, and NCCI bundling edits validated against the operative note.

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Document

Medical necessity, laterality, and staged-vs-unrelated documentation attached before submission.

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Collect

Clean claims submit same-day; global-period and bundling denials get root-cause analysis by claim type.

FAQ

What orthopedic practices ask first.

Why do orthopedic claims get denied for missing modifiers?

RT/LT laterality and bilateral (modifier 50) are required on most orthopedic procedure codes. Omitting them, or mismatching them against the operative note, is one of the most common denial triggers, especially on joint arthroplasty and fracture-care codes.

How do global surgical periods affect orthopedic billing?

Major procedures like fracture care and joint arthroplasty carry a 90-day global period. Follow-up E/M and additional procedures during that window need the correct modifier, 24, 58, 78, or 79, depending on whether the service is unrelated, planned/staged, or an unplanned complication. Without it, the payer bundles the service into the original payment.

What's the difference between billing arthroscopy procedures separately vs. bundled?

NCCI edits bundle many component arthroscopic procedures into the more extensive primary procedure performed in the same compartment. They're only billable separately, with modifier 59 or XU, when performed in a genuinely distinct compartment with documentation to support it.

Do you bill DME and remote therapeutic monitoring (RTM) for orthopedic practices?

Yes. DME such as braces and walking boots is billed through its own HCPCS L-codes with medical-necessity documentation, and RTM (CPT 98975–98981) is billed on its own time-based monthly cycle, both handled separately from routine visit coding.

AI-Powered Orthopedic Billing & RCM