THE BOTTOM LINE
Orthopedics stacks more billable events into one episode of care than almost any other outpatient specialty: an office visit, imaging, an injection, a cast, DME, and possibly a 90-day global package, all for the same patient inside a short window. Every one of those has a bundling relationship with the others.
The denials concentrate in three places: E/M visits inside a global period, joint injections billed with a same-day visit, and assistant surgeon claims on codes that were never going to pay an assistant.
That last one has a rule most reference material states backward, and it is worth reading carefully because getting it wrong means either denied claims or a case booked with an assistant who cannot be paid.
What the full playbook covers
Solo subscribers read the full playbook. Here is what it contains.
- Definitions and frequently used terms
- Global periods and the modifiers that go with them
- Joint injections
- Fracture care: three paths, not two
- Assistant at surgery, where the usual explanation is backward
- The 2026 payment picture
- Prior authorization and peer-to-peer
- DME, braces, and splints
- The denial patterns you will actually see
- Practices that prevent the denial
- Frequently asked questions
- How we work on this at ROI
- Two things worth checking this week
- Sources