Orthopedic billing: fracture care, injections, and casting supplies
Orthopedics offers a choice that many practices make unconsciously. Fracture care can be billed as a global service that includes the initial treatment and the follow-up during the global period, or as an office visit plus casting when definitive care is not being assumed. Both are legitimate, but they produce very different revenue and they cannot be mixed after the fact, and choosing the global model means later cast changes and visits are included rather than billable.
Injections and supplies generate the volume denials. Joint injections are reported by joint size and by joint, with laterality and units that payers verify against the note, and ultrasound guidance is separately reportable only when the image is documented and retained. Casting and splinting have a procedure code plus a separate supply code, and omitting the supply is pure lost revenue. Arthroscopic procedures bundle extensively within the same compartment. We code from procedure notes with laterality and units explicit, and capture supplies at the point of care.
Coding and documentation focus
- ✓Global fracture care versus visit plus casting — Assuming definitive fracture care bills a global service that includes follow-up, while non-definitive care bills a visit plus application.
- ✓Joint injections by size and laterality — Injections are reported per joint by joint size, with laterality and units that must match the procedure note.
- ✓Imaging guidance documentation — Ultrasound guidance is separately reportable only when a permanent image and interpretation are documented and retained.
- ✓Casting and splinting supplies — The application procedure and the supply are separate charges, and the supply is frequently missed entirely.
Denials we prevent on these claims
- ✓Follow-up visits billed inside a global fracture care period — resolved by choosing the billing model up front.
- ✓Injection units or laterality inconsistent with the note — reconciled before release.
- ✓Guidance billed without a retained image — flagged back to the provider.
- ✓Casting supply omitted from the claim — captured through point-of-care charge capture.
Frequently asked questions
Should we bill fracture care globally or as a visit with casting?
It depends on whether your physician is assuming definitive management of the fracture. Global fracture care pays more up front but includes the follow-up visits and cast changes during the global period, whereas a visit plus application is appropriate when another provider will manage definitive care.
When is ultrasound guidance billable with a joint injection?
When ultrasound was genuinely used to guide needle placement, a permanent image was recorded, and an interpretation is documented in the record. Using ultrasound only to survey the joint, or performing the injection by landmark, does not support the guidance charge.