Orthopedic CPT (Current Procedural Terminology) codes are a standardized set of numerical codes used to describe and document medical procedures and services provided by orthopedics. These codes are essential for healthcare providers, particularly orthopedic specialists, to communicate effectively with insurance companies, manage medical billing, and ensure accurate and timely reimbursement.
The CPT coding system was created by the American Medical Association (AMA) and is widely used across healthcare settings. It serves as a universal language for medical professionals, ensuring uniformity and consistency in documenting and billing for services. For orthopedic practices, CPT codes cover a variety of services such as surgeries, physical therapy, diagnostic tests, and other treatments related to bones, joints, ligaments, muscles, and tendons.
Essential CPT Codes for Orthopedic Billing
When it comes to orthopedic billing, understanding the various CPT codes is critical for ensuring accurate claims and proper reimbursement. Orthopedic practices must be familiar with several categories of CPT codes, as they apply to a wide range of services provided to patients. While there are numerous codes within the orthopedic surgery domain, focusing on these key categories can provide a solid foundation for orthopedic billing:
Evaluation and Management (E/M) Codes
Evaluation and Management codes (99201-99499) cover the physician’s assessment and management services. These codes reflect the complexity and time required to evaluate a patient’s condition, establish a diagnosis, and develop an appropriate treatment plan. For orthopedic specialists, these codes are often used for office visits, consultations, and follow-up care, and are essential for ensuring accurate billing for the time spent with patients.
Anesthesia Codes
Anesthesia codes (00100-01999, 99100-99140) are used to document the services rendered by anesthesiologists during orthopedic surgeries. These codes cover a wide range of anesthesia-related services, from pre-operative assessments to the administration of anesthesia during the procedure. They also encompass post-operative monitoring to ensure patient safety and recovery, making them an integral part of surgical procedures.
Surgical Procedure Codes
The surgical procedure codes (10021-69990) are among the most extensive categories in orthopedic billing. These codes represent a broad collection of surgical services, including everything from minor repairs to complex surgeries like joint replacements and spinal procedures. Orthopedic surgeons rely on these codes to document surgeries accurately and ensure proper reimbursement for the extensive services they provide.
Radiology Codes
Radiology CPT codes (7010-79999) represent the diagnostic imaging services that are often essential for diagnosing orthopedic conditions. These codes include X-rays, MRIs, CT scans, and other imaging studies that help orthopedic specialists evaluate bone fractures, joint damage, and soft tissue injuries. Proper coding of radiology services is critical for obtaining accurate payment for diagnostic tests and monitoring treatment progress.
Pathology and Laboratory Codes
Pathology and laboratory CPT codes (80047-89398) are used to report laboratory tests and pathology services related to tissue samples. For orthopedic practices, these codes may be used when lab work is required to diagnose conditions such as bone infections, cancer, or other musculoskeletal diseases. These services help orthopedic specialists make informed treatment decisions based on laboratory results.
Medicine Codes
The Medicine category (90281-99299, 99500-99607) covers a variety of medical services that don’t fall under other categories. For orthopedic practices, these codes may include injections, medication administration, wound care, and other non-surgical treatments. Whether it’s corticosteroid injections for inflammation or wound care following surgery, these codes are essential for billing services that fall outside traditional procedures.
Why Proper Use of Orthopedic CPT Codes is Crucial for Orthopedic Billing
Accurate and up-to-date CPT coding is essential for orthopedic practices, ensuring that procedures are billed correctly, and reimbursement is obtained without delay. Incorrect or missing codes can result in claim denials, delayed payments, or even audits, all of which can affect a practice’s revenue cycle.
For orthopedic specialists, working with a billing expert who understands the nuances of orthopedic procedures and CPT coding can make all the difference. Professionals in ortho billing ensure that each code is applied accurately, improving cash flow, reducing administrative burden, and allowing physicians to focus on patient care.
Top 10 Most Common Orthopedic CPT Codes
Healthcare providers use various CPT codes to bill for orthopedic services. Below are the top 10 most commonly used orthopedic CPT codes that cover a variety of procedures and services in musculoskeletal care:
CPT Code 29881 – Arthroscopy, Knee, Surgical, with Meniscectomy
This code is used for knee arthroscopy procedures that involve the surgical removal of damaged meniscus tissue. It is a common procedure for patients with meniscal tears or damage.
CPT Code 23472 – Arthroscopic Rotator Cuff Repair
Used for the arthroscopic repair of a torn rotator cuff in the shoulder. This minimally invasive procedure is common for patients suffering from shoulder injuries.
CPT Code 27130 – Total Hip Arthroplasty (Hip Replacement)
This code is applied for total hip replacement surgery, commonly performed to treat severe arthritis, hip fractures, or degenerative hip conditions.
CPT Code 99213 – Office Visit, Established Patient, Level 3
This code represents an office visit for an established patient, typically used for routine evaluations and management of ongoing orthopedic conditions.
CPT Code 25500 – Open Treatment of Distal Radius Fracture
Used for the open treatment of fractures in the distal radius (wrist area), typically requiring surgical intervention to realign and stabilize the bone.
CPT Code 22612 – Arthrodesis, Spinal Fusion, Anterior or Posterior
This code is used for spinal fusion surgeries, where vertebrae are fused together to stabilize the spine, often performed for patients with degenerative disc disease or spinal instability.
CPT Code 64721 – Neuroplasty, Median Nerve (Carpal Tunnel Release)
Commonly used for carpal tunnel release surgery, this code covers the neuroplasty of the median nerve to treat carpal tunnel syndrome, relieving compression in the wrist.
CPT Code 27447 – Total Knee Arthroplasty (Knee Replacement)
This code is used for total knee replacement surgery, performed to replace a damaged knee joint due to arthritis or injury.
CPT Code 99204 – Office Visit, New Patient, Level 4
Used for new patient visits requiring a detailed history, examination, and moderate to high complexity decision-making, often for initial orthopedic consultations.
CPT Code 29877 – Arthroscopy, Shoulder, Surgical
This code is used for shoulder arthroscopy procedures that may include debridement, repair, or stabilization of joint structures within the shoulder joint.
Orthopedic CPT Codes List (100 CPT Codes Commonly Used)
Orthopedic practices use a wide range of orthopedic surgery CPT codes to bill for diagnosis, treatment, and follow-up care. To make things simple, here are 100 commonly used CPT codes in orthopedic surgery, grouped into 5 main categories.
Fracture and Dislocation Care CPT Codes
Orthopedic specialists often treat fractures and dislocations. These CPT codes cover services for closed and open treatments across different bones.
| CPT Code | Description |
| CPT 21310 | CPT code 21310 is used for closed treatment of nasal bone fracture. |
| CPT 21320 | CPT code 21320 is used for closed treatment of nasal fracture with manipulation. |
| CPT 21330 | CPT code 21330 is used for open treatment of nasal fracture. |
| CPT 21335 | CPT code 21335 is used for open treatment of nasal fracture with stabilization. |
| CPT 21400 | CPT code 21400 is used for closed treatment of mandible fracture. |
| CPT 21401 | CPT code 21401 is used for open treatment of mandible fracture. |
| CPT 21450 | CPT code 21450 is used for closed treatment of maxillary fracture. |
| CPT 21451 | CPT code 21451 is used for open treatment of maxillary fracture. |
| CPT 23500 | CPT code 23500 is used for closed treatment of clavicle fracture. |
| CPT 23515 | CPT code 23515 is used for open treatment of clavicle fracture. |
| CPT23600 | CPT code 23600 is used for closed treatment of shoulder dislocation. |
| CPT 23605 | CPT code 23605 is used for closed treatment of shoulder dislocation with anesthesia. |
| CPT 23615 | CPT code 23615 is used for open treatment of shoulder dislocation. |
| CPT 24500 | CPT code 24500 is used for closed treatment of humeral shaft fracture. |
| CPT24505 | CPT code 24505 is used for open treatment of humeral shaft fracture. |
| CPT 24640 | CPT code 24640 is used for closed treatment of radial head fracture. |
| CPT 24650 | CPT code 24650 is used for open treatment of radial head fracture. |
| CPT 25600 | CPT code 25600 is used for closed treatment of distal radial fracture. |
| CPT 25605 | CPT code 25605 is used for closed treatment of distal radial fracture with manipulation. |
| CPT 25607 | CPT code 25607 is used for open treatment of distal radial fracture with fixation. |
Joint Repair and Replacement CPT Codes
These codes apply to surgeries such as arthroplasty and joint reconstruction, which are very common in orthopedic practice.
| CPT Code | Description |
| CPT 27130 | CPT code 27130 is used for total hip replacement (arthroplasty). |
| CPT 27132 | CPT code 27132 is used for conversion of previous hip surgery to total hip arthroplasty. |
| CPT 27134 | CPT code 27134 is used for revision of total hip arthroplasty with both components. |
| CPT 27137 | CPT code 27137 is used for revision of total hip arthroplasty with acetabular component only. |
| CPT 27138 | CPT code 27138 is used for revision of total hip arthroplasty with femoral component only. |
| CPT 27440 | CPT code 27440 is used for arthroplasty of knee with prosthesis (unicompartmental). |
| CPT 27441 | CPT code 27441 is used for arthroplasty of knee, femoral component only. |
| CPT 27442 | CPT code 27442 is used for arthroplasty of knee, tibial component only. |
| CPT 27443 | CPT code 27443 is used for arthroplasty of knee, patellofemoral component. |
| CPT 27445 | CPT code 27445 is used for revision of total knee arthroplasty, femoral component. |
| CPT 27446 | CPT code 27446 is used for revision of total knee arthroplasty, tibial component. |
| CPT 27447 | CPT code 27447 is used for total knee replacement (arthroplasty). |
| CPT 27486 | CPT code 27486 is used for revision of total knee arthroplasty, one component. |
| CPT 27487 | CPT code 27487 is used for revision of total knee arthroplasty, both components. |
| CPT 29888 | CPT code 29888 is used for arthroscopically aided ACL reconstruction. |
| CPT 29889 | CPT code 29889 is used for arthroscopically aided PCL reconstruction. |
| CPT 29894 | CPT code 29894 is used for arthroscopy, ankle with limited synovectomy. |
| CPT 29895 | CPT code 29895 is used for arthroscopy, ankle with partial synovectomy. |
| CPT 29897 | CPT code 29897 is used for arthroscopy, ankle with extensive debridement. |
| CPT 29898 | CPT code 29898 is used for arthroscopy, ankle with excision of osteochondral defect. |
Arthroscopy and Endoscopic Procedure CPT Codes
Arthroscopy is widely used in orthopedics to diagnose and treat joint issues. These CPT codes represent common arthroscopic procedures.
| CPT Code | Description |
| CPT 29805 | CPT code 29805 is used for shoulder arthroscopy, diagnostic. |
| CPT 29806 | CPT code 29806 is used for shoulder arthroscopy, capsulorrhaphy. |
| CPT29807 | CPT code 29807 is used for shoulder arthroscopy, repair of SLAP lesion. |
| CPT 29820 | CPT code 29820 is used for shoulder arthroscopy, synovectomy. |
| CPT 29821 | CPT code 29821 is used for shoulder arthroscopy, complete synovectomy. |
| CPT 29822 | CPT code 29822 is used for shoulder arthroscopy, limited debridement. |
| CPT 29823 | CPT code 29823 is used for shoulder arthroscopy, extensive debridement. |
| CPT 29824 | CPT code 29824 is used for shoulder arthroscopy, distal claviculectomy. |
| CPT 29825 | CPT code 29825 is used for shoulder arthroscopy, lysis of adhesions. |
| CPT 29826 | CPT code 29826 is used for shoulder arthroscopy, decompression. |
| CPT 29827 | CPT code 29827 is used for shoulder arthroscopy, rotator cuff repair. |
| CPT 29828 | CPT code 29828 is used for shoulder arthroscopy, biceps tenodesis. |
| CPT 29830 | CPT code 29830 is used for elbow arthroscopy, diagnostic. |
| CPT 29834 | CPT code 29834 is used for elbow arthroscopy, removal of loose body. |
| CPT 29835 | CPT code 29835 is used for elbow arthroscopy, synovectomy, partial. |
| CPT 29836 | CPT code 29836 is used for elbow arthroscopy, synovectomy, complete. |
| CPT 29837 | CPT code 29837 is used for elbow arthroscopy, debridement, limited. |
| CPT 29838 | CPT code 29838 is used for elbow arthroscopy, debridement, extensive. |
| CPT 29840 | CPT code 29840 is used for wrist arthroscopy, diagnostic. |
| CPT 29844 | CPT code 29844 is used for wrist arthroscopy with synovectomy. |
Spine Surgery and Back Procedure CPT Codes
Orthopedic surgeons also treat spinal conditions. These CPT codes are used for laminectomy, fusion, and related back procedures.
| CPT Code | Description |
| CPT 22551 | CPT code 22551 is used for cervical discectomy with fusion, single level. |
| CPT 22552 | CPT code 22552 is used for cervical discectomy with fusion, each additional level. |
| CPT 22600 | CPT code 22600 is used for arthrodesis, cervical, posterior approach. |
| CPT 22612 | CPT code 22612 is used for arthrodesis, lumbar, posterior approach. |
| CPT 22630 | CPT code 22630 is used for arthrodesis, lumbar interbody technique. |
| CPT 22633 | CPT code 22633 is used for arthrodesis, lumbar combined technique. |
| CPT 63005 | CPT code 63005 is used for laminectomy, cervical, single segment. |
| CPT 63012 | CPT code 63012 is used for laminectomy, cervical, each additional segment. |
| CPT 63017 | CPT code 63017 is used for laminectomy, thoracic, single segment. |
| CPT 63030 | CPT code 63030 is used for lumbar laminectomy with nerve root decompression. |
| CPT 63035 | CPT code 63035 is used for lumbar laminectomy, each additional segment. |
| CPT 63042 | CPT code 63042 is used for re-exploration lumbar laminectomy. |
| CPT 63047 | CPT code 63047 is used for lumbar laminectomy with spinal stenosis. |
| CPT 63048 | CPT code 63048 is used for lumbar laminectomy, each additional segment. |
| CPT 63056 | CPT code 63056 is used for laminectomy, removal of intradural lesion. |
| CPT 63057 | CPT code 63057 is used for laminectomy, intradural lesion, each additional segment. |
| CPT 63267 | CPT code 63267 is used for excision of intradural spinal tumor, cervical. |
| CPT 63268 | CPT code 63268 is used for excision of intradural spinal tumor, thoracic. |
| CPT 63270 | CPT code 63270 is used for excision of intradural spinal tumor, lumbar. |
| CPT 63271 | CPT code 63271 is used for excision of intradural spinal tumor, sacral. |
Other Common Orthopedic Procedures CPT Codes
Besides fracture, joint, arthroscopy, and spine codes, orthopedic practice includes other services such as tendon repair, amputation, and hardware removal.
| CPT Code | Description |
| CPT 20600 | CPT code 20600 is used for arthrocentesis, small joint. |
| CPT 20605 | CPT code 20605 is used for arthrocentesis, intermediate joint. |
| CPT20610 | CPT code 20610 is used for arthrocentesis, major joint. |
| CPT 20680 | CPT code 20680 is used for removal of implant, deep. |
| CPT 20930 | CPT code 20930 is used for allograft for spine surgery. |
| CPT 20931 | CPT code 20931 is used for structural allograft for spine surgery. |
| CPT 20936 | CPT code 20936 is used for autograft, spine surgery. |
| CPT 20937 | CPT code 20937 is used for bone graft with microvascular technique. |
| CPT 20938 | CPT code 20938 is used for autograft, local, for spine fusion. |
| CPT 25260 | CPT code 25260 is used for repair of wrist tendon. |
| CPT 25265 | CPT code 25265 is used for reconstruction of wrist tendon. |
| CPT 25310 | CPT code 25310 is used for tendon transfer of forearm. |
| CPT 25400 | CPT code 25400 is used for repair of hand tendon. |
| CPT 25405 | CPT code 25405 is used for tendon transfer in hand. |
| CPT 27570 | CPT code 27570 is used for manipulation of knee joint under anesthesia. |
| CPT 27600 | CPT code 27600 is used for repair of Achilles tendon. |
| CPT 27650 | CPT code 27650 is used for repair of flexor tendon, leg. |
| CPT 27750 | CPT code 27750 is used for amputation of leg, through femur. |
| CPT 27752 | CPT code 27752 is used for amputation of leg, re-amputation. |
| CPT 27759 | CPT code 27759 is used for amputation of lower leg, below knee. |
Modifiers in Orthopedic Billing
Modifiers are essential in orthopedic billing to provide additional details about procedures, ensuring accuracy in coding and reimbursement. They help clarify changes in the procedure, such as the complexity, location, or multiple services performed, ensuring correct payment for orthopedic services.
Common Modifiers in Orthopedic Billing
Some of the most common modifiers used in orthopedic billing are:
Modifier 50 – Bilateral Procedure
Modifier 50 indicates that a procedure was performed on both sides of the body in the same session. It ensures proper reimbursement for surgeries like joint replacements on both limbs.
Modifier 51 – Multiple Procedures
Used when multiple procedures are performed during a single session. This modifier signals to insurers that more than one procedure was done, often with reduced reimbursement for subsequent services.
Modifier 58 – Staged or Planned Procedure
Modifier 58 shows that a procedure was planned or staged as part of a treatment plan. It helps insurers understand that multiple surgeries were anticipated and part of a planned series.
Modifier 59 – Distinct Procedural Service
Modifier 59 indicates that a service was distinct or separate from other services on the same day. It ensures appropriate reimbursement for unrelated procedures performed together.
Modifier 62 – Two Surgeons
Modifier 62 is used when two surgeons work together to perform different parts of a complex surgery. This modifier ensures each surgeon is properly reimbursed for their contribution to the procedure.
Modifier 78 – Unplanned Return to Operating Room
Modifier 78 is applied when a patient unexpectedly returns to the operating room due to complications. It clarifies that the return surgery is related to the original procedure and should be reimbursed accordingly.
Modifier 22 – Increased Procedural Services
Modifier 22 indicates that a procedure was more complex than usual, requiring extra time or effort. This modifier helps justify additional reimbursement for unusually difficult procedures.
Modifier 26 – Professional Component
Modifier 26 is used when the professional component of a service (such as interpretation of imaging) is billed separately. It ensures reimbursement for the physician’s work in interpreting tests or procedures.
Modifier 27 – Multiple Encounters
Modifier 27 indicates that a patient had more than one encounter on the same day. This modifier allows proper billing for multiple services provided during different sessions on the same day.
Maximizing Reimbursement with Orthopedic CPT Codes
Maximizing reimbursement in orthopedic billing requires a strong understanding of the correct use of CPT codes. These codes are essential for accurately documenting procedures and services provided to patients, ensuring proper insurance reimbursement. Orthopedic practices face unique challenges due to the complexity and variety of musculoskeletal procedures, but with the right strategies, they can significantly optimize their revenue cycle. Below are key strategies to help maximize reimbursement with orthopedic CPT codes.
Accurate Coding of Services
The foundation of maximizing reimbursement is ensuring that all services are correctly coded. Accurate use of CPT codes reflects the specific procedures performed and ensures that your practice is reimbursed for the full scope of services rendered.
Identify the right codes
Make sure to use the correct CPT code for the procedure performed. For instance, using the appropriate arthroscopy or joint replacement code ensures that the level of complexity is reflected.
Include modifiers when necessary
Modifiers add important details to CPT codes, such as whether a procedure was bilateral (performed on both sides of the body) or if it was more complex than expected. This helps clarify billing and can result in appropriate reimbursement.
Utilizing Accurate Evaluation and Management (E/M) Codes
Orthopedic providers often see patients for follow-up visits or consultations that require appropriate E/M coding. Ensuring that these codes accurately reflect the level of care provided can significantly impact reimbursement.
Document thoroughly
For established and new patient visits, document the history, examination, and decision-making process. Proper documentation supports the level of service coded and avoids underbilling.
Use higher-level codes
If the visit involves high complexity or extensive work, don’t under-code. For instance, if a significant amount of time is spent on a consultation or managing a complex case, coding at a higher level (e.g., CPT 99214 or 99215) can result in increased reimbursement.
Leverage Modifier Codes
Modifiers are essential for clarifying situations that deviate from standard procedures, ensuring that claims are processed correctly. Proper use of modifiers can help practices obtain additional reimbursement for complex cases.
Modifier 50 (Bilateral Procedures)
If a procedure is performed on both sides of the body, this modifier ensures proper reimbursement for both sides. For example, performing joint replacements on both knees can significantly increase reimbursement.
Modifier 22 (Increased Procedural Services)
For cases where a procedure is more complex or takes more time than usual, modifier 22 can indicate that the work was above and beyond the usual scope, allowing for increased payment.
Billing for Post-Operative Services and Complications
Post-operative care is often essential in orthopedic procedures, especially after major surgeries like joint replacements. Ensure that any follow-up visits or additional procedures related to complications are properly coded and billed.
Use the correct follow-up codes
Make sure to code for all follow-up services (e.g., physical therapy or additional consultations) as separate services, when applicable.
Modifier 78 (Unplanned Return to Operating Room)
If a patient needs to return to the operating room due to complications, modifier 78 ensures that the return surgery is recognized as part of the original surgical episode, allowing for appropriate reimbursement.
Focus on Timely and Accurate Claim Submission
Timely submission of claims is critical to maximizing reimbursement. The longer claims take to process, the more likely they are to face delays or denials. Ensure that claims are submitted quickly and that they contain all the necessary information to avoid rejection.
Verify codes before submission
Double-check the CPT codes and modifiers before submitting claims to reduce the chances of errors. Automated claim scrubbing tools can also help ensure accuracy.
Appeal denied claims
If a claim is denied, don’t hesitate to appeal with correct documentation and codes to ensure proper reimbursement. An orthobilling expert can assist in navigating this process.
Stay Updated on CPT Code Changes in Orthopedic Billing
CPT codes are periodically updated to reflect advances in medical technology and treatment. Staying informed about changes ensures that your practice continues to use the most accurate and up-to-date codes.
Review annual CPT updates
Every year, the AMA publishes updates to CPT codes. Familiarize yourself with these changes and ensure your billing practices are aligned.
Attend coding workshops
Participate in coding education workshops or webinars focused on orthopedic billing to keep your staff updated on the latest practices.
Monitor Payer Contracts and Reimbursement Policies
Different insurance companies may have varying reimbursement rates and policies for orthopedic procedures. Understanding these nuances is key to maximizing reimbursement.
Negotiate better rates
If you notice discrepancies or underpayment for specific services, discuss these issues with payers to negotiate higher reimbursement rates.
Understand payer policies
Some insurers may have specific guidelines or restrictions related to orthopedic procedures. Familiarizing yourself with these policies can help avoid denials and maximize payments.
Conclusion
Orthopedic billing involves a wide range of orthopedic surgery CPT codes, from fracture care to joint replacements and spine surgeries. Understanding the correct CPT code is key to proper reimbursement and smooth claim processing. By grouping the most common orthopedic CPT codes into clear categories, healthcare providers can improve documentation, reduce denials, and stay compliant. A reliable billing partner can also help practices save time, reduce stress, and boost revenue.
Ready to simplify your billing? Contact us today to partner with a trusted orthopedic billing expert.
FAQs
Let’s answer to your questions:
How often are orthopedic CPT codes updated?
Orthopedic CPT codes are updated yearly by the AMA. Staying current with changes helps providers bill accurately and avoid claim denials.
What are global periods in orthopedic billing?
Many orthopedic CPT codes come with a global period, which means post-operative care is bundled with the surgical payment and cannot be billed separately.
Can modifiers be used with orthopedic CPT codes?
Yes. Modifiers like 25, 50, 51, and 59 are often applied in orthopedic billing to show additional or distinct services performed during the same encounter.
What is the difference between CPT and ICD-10 codes in orthopedics?
CPT codes describe the procedures performed (like fracture repair), while ICD-10 codes in orthopedics explain the diagnosis (like femur fracture). Both are required for claims submission.
Why do orthopedic claims often get denied?
Orthopedic claims are denied mostly due to coding errors, missing documentation, incorrect modifiers, or lack of medical necessity. Accurate coding and detailed notes reduce denials.