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A Complete Guide To Top CPT Codes And Modifiers For Orthopedic Billing Services

Dec 29

Orthopedic physicians specialize in the treatment of musculoskeletal issues. Orthopedic physicians specialize in treating a range of conditions with medication and surgery. They may also do other procedures like bone grafting or limb lengthening when necessary.

Orthopedic physicians work closely with other medical professionals and sometimes with physical therapists to treat patients. Some of their treatments include broken bones, arthritis, degenerative diseases, and joint replacement surgery.

Orthopedic surgery is a type of medical treatment that can be used to treat injuries and diseases of the musculoskeletal system. In addition, they can help alleviate pain and disability caused by injuries, congenital deformities, or conditions that affect the musculoskeletal system. However, the medical billing process is complex, and many factors must be considered when paying your bill. This article will discuss the CPT code for orthopedic surgery and CPT modifiers used in medical billing services provided by healthcare professionals specializing in this area of medicine.

What is Medical Coding?

Coding assigns codes to medical procedures, services, and supplies. Healthcare providers use coding to document the type of procedure performed and the time spent on each procedure. The procedure code (PC) represents a specific method for performing an operation or administration; it does not necessarily indicate whether or not you had a successful outcome from your treatment plan.

For example: if you have had surgery for knee replacement surgery, then you would likely be given one or more PC codes like this one: Knee Replacement Surgery

Many insurers require that they see documentation showing what kind of surgery was performed before they will pay out benefits based on your claim submission form (CBF). However, suppose there aren't enough details about how much time was spent doing each step to document them all together correctly. These details might be left out entirely, leaving some confusion about how much work went into achieving those results!

What are CPT Codes?

CPT stands for Current Procedural Terminology, the most widely used medical coding system in the United States. The American Medical Association (AMA) publishes this extensive list of codes yearly, updated every few years as new procedures become available or requirements change. A medical billing company will help you to understand the allocation of CPT codes according to the ICD-10 system.

What is the purpose of CPT Codes?

CPT codes are used by healthcare providers, insurance companies, and government agencies to report medical procedures and medical billing so that patients can receive proper reimbursement from their insurers or other sources of payment (such as Medicare.)

What is the role of CPT modifiers in Medical Billing?

Modifiers are used to provide additional information about a procedure or an item that was provided to a patient. Modifiers can be used in the main procedure code and the procedure's CPT code to show that a distinct factor has changed the procedure. They can impact reimbursement, but they are also the reason for claims not playing correctly. 

Modifiers are codes that allow providers to show the extent of a procedure or service. They can be used to increase reimbursement for services provided by your practice, but they must be used correctly.

Level I modifiers: Level I modifiers have numerical variable digits and are referred to as CPT Modifiers. Every year, the American Medical Association updates each level. Moreover, these CPT modifiers are used to add to or modify care descriptions in order to offer patients with more information about treatment or particular service that was rendered.

Level II modifiers: HCPCS Level II Modifiers are two-digit (Alpha/Alphanumeric characters) modifiers that fall within the range of AA to VP. The Centers for Medicare and Medicaid Services (CMS) regularly updates these modifiers.

Primary CPT Codes of Orthopedic Surgery

  • Evaluation and Management: 99201 – 99499
  •  Anesthesia: 00100 – 01999; 99100 – 99140
  •   Pathology and Laboratory: 80047 – 89398
  •  Medicine: 90281 – 99199; 99500 – 99607
  • Surgery: 10021 – 69990
  • Radiology: 70010 – 79999

CPT Codes for Hand Surgery

There are many types of hand surgery, like tendon repair, total wrist arthroplasty, etc. Hand/wrist arthroplasty with implants or prostheses is used to treat a common carpometacarpal joint injury or osteoarthritis at one of its joints. Tendon lengthening involves the removal of part or all of an extrinsic muscle from an intrinsic muscle group to allow release from a tight contracture. The procedure may involve one or both hands and can be performed on either side at any elbow but above wrist level.

CPT codes for hand surgery include:

 CPT – 11760 – Repair of Nail Bed

  • CPT – 25215 – Carpectomy; all bones of the proximal row
  • CPT – 64721 – Neuroplasty (carpal tunnel release)

Carpal Tunnel Release – 64721

  • "Neuroplasty and transposition; median nerve at the carpal tunnel."
  • Endoscopic Carpal Tunnel Release – 29848

Modifiers in Orthopedics Billing Services:

There are many different kinds of modifiers used in orthopedic surgery. Some modifiers are listed below:

  •  Modifier-50 for bilateral procedure
  •  Modifier-51 for multiple procedures
  •  Modifier-52 for reduced procedure
  •  Modifier-58 for Staged or related procedure or service by the same physician during the postoperative period
  •  Modifier-58 for Distinct procedural service
  • Modifier-73 for Discontinued outpatient hospital/ASC procedure before the administration of anesthesia  
  •  Modifier-74 for Discontinued outpatient hospital/ASC procedure after the administration of anesthesia
  •  Modifier-76 for Repeat procedure or service by the same physician
  •  Modifier-77 for Repeat procedure or service by another physician
  •  Modifier-78 for Return to the OR for a related procedure during the postoperative period
  •  Modifier-79 for Unrelated procedures or services by the same physician during the postoperative period
  •  Modifier-RT & -LT for Right Side and Left Side
  •  Modifier-TC for Technical component.



We hope you've enjoyed learning about orthopedic billing. It might seem like the most intimidating type of medical billing, but it doesn't have to be! With some practice and a little intuition, you can get the hang of CPT codes and modifiers—and make sure that your patients receive the care they need. So it is a good idea to get good medical billing services. U control medical billing provides a complete set of solutions to orthopedic medical needs. We aim to ensure you can give the best care possible and excellent customer service.

We understand that every case of orthopedic billing is different, and its needs are different as well. That's why we offer expert services to our clients. This way, you can pay monthly instead of quarterly or yearly if that makes sense for your business model or budgeting process.