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Orthopedics Medical Billing and Coding – The Quintessence Advantage

Orthopedics is a branch of medicine that regularly sees a constant stream of patients and is ever busy. Running an orthopedic practice means that you should have the right balance of managing the business and working on your clinical expertise to actually succeed. Many orthopedic practitioners focus extensively on their clinical processes and not so much on the business, constantly struggling to break even or succeed financially. Orthopedic medical billing and coding is a service that helps regulate the business part of an orthopedic practice, clinic, or department, supporting the practice to improve its revenues and grow as a brand.

Why is it not a smart move for medical practitioners to handle billing and collections?

Now, if you run a small practice, you may be tempted to handle the medical billing and collections yourself. This also makes sense since you can save money spent on hiring an internal team or a third-party medical billing and coding team to help you out.

However, the problem is with balancing both the practice and the business. While doctors already face the risk of work burnout, asking them to also look into the business side of it is unfair. Unless a person is an expert handling billing and coding, they will not be able to justify the job.

A large healthcare provider may consider having an internal team to handle billing and coding instead of getting help from an RCM third-party company. This may work as long as the team is equipped to work independently and consists of people with the right experience and expertise.

We did talk about the pros and cons of having your own medical billing and coding team vs. hiring a third-party service provider some time back. Do check that out to know more.

Common challenges faced while billing and coding for an orthopedic practice

Recent surveys say that about 35% of orthopedic surgery claims are incorrect and 25% are rejected. With such a large rejection rate, no wonder most practices find it unable to be consistently profitable. Here are some of the challenges faced while handling medical billing and coding for an orthopedic practice.

  1.   Complexities in coding – Orthopedic procedures, especially those done for accidents and physical trauma, can involve multiple procedures. That is why the coding part gets more complicated. There are multiple modifiers you have to use while coding for different procedures. For instance, when a patient receives a removable foot insert, using the modifier KX is necessary to prevent payer rejections. Many practices forget /don’t know about this and face reimbursement denials. Also, let’s assume a person comes with multiple fractures due to an injury and needs different surgical procedures. Medical billing and coding experts have to know that all the first procedures will have to be grouped as initial encounters.
  2.   Billing challenges – Orthopedic billing greatly depends on the documentation collected from the minute the patient steps in to after discharge. The billing department has to work closely with the physicians, getting the right documents at every step. If your billing team is not clear about what is wanted, then there is a high chance the claim gets rejected, stating a lack of supportive documentation. Do note that this is the first step to actually recording all the procedures that were performed. If this is not done right, then overbilling/underbilling may occur.
  3.   Constant changes with ICD-10 regulations – This is a challenge faced by the entire medical billing and coding, to be fair. There are constant changes in the ICD-10 regulations and keeping up with these changes themselves takes a considerable part of the time and effort put by a biller or a coder at work. Unless the coders and billers have the right skills, these changes will lead to increased rejection rates.

How can an RCM company like Quintessence help?

Quintessence is a HIPAA and SOC II Type II compliant organization that handles end-to-end RCM solutions for practices and medical billing and coding service companies. We understand how critical the medical billing and coding process is for any healthcare provider. Even with impeccable service, a subpar backend team can cause such institutions to struggle moving forward.

Our team of billers and coders understand the process completely and help clients handle gaps in their RCM processes. We are backed by AI tools that automate most processes and can spot errors early on during the billing and coding processes.

70% of our clients work with us on a contingency model, so they don’t have to pay for services that didn’t match with the promised SLA. Our team takes over your entire RCM process, starting from patient data management to coding, payments, and receivables management.

Our analytical reports are inclusive and data-driven and include details like collection ratios, baseline reports, CPT Volume Analysis, charge liquidation, denial trends, and so on.

As your medical billing and coding partner, you will get access to most of our tools that can help enhance your backend system and offer a competitive advantage.


Orthopedics is a department where the smallest of billing omissions or coding errors can lead to high losses in revenues. Your doctors and the internal team work really hard, and their time needs to be monetarily matched without flaws. Here is where a medical billing and coding company like Quintessence can help. Have you conducted an internal audit to see your critical values like the reimbursement rate, denials rate, and charge volumes? Comparing these values with those of your competitors will tell you your backend gap.

Do get in touch with Quintessence to know how we can change things for the better. We partner with our clients and back them up, helping them grow, expand, and make a difference in the healthcare industry.