EMR and Medical Billing: A Guide for Orthopedics Coding


The operations of medical practice are complicated and often difficult let alone an orthopedics medical practice. You have to see patients, keep up with the medical journals and handle the administrative aspect of the orthopedics medical practice.

In addition, you need to handle the running of the electronic medical record system as an orthopedic, and doing so is the proper way to break down and lose focus on what needs to be done.

Orthopedic or Sports medicine as alternatively called faces several challenges and tasks every day. This includes working with patients and leading them through therapy, increasing productive outputs ad patient attention.

Now, following the adverse increase in patient calls, there is a need for orthopedics to use EMR for orthopedics and tools that aids their practice and offer optimal care without issues and hitch.

Required Elements of Orthopedic EMR software

Anyone who desires to obtain a great knowledge and in-depth understanding of how the EMR work needs to learn about the several elements and features of the feature. This will go a long way to aid the person in choosing the best EMR software for orthopedics.

First, we need to be sure that the orthopedics EMR software has the following key elements :

Precise Templates

Orthopedics Electronic Medical Record Software needs to have innate templates to detect symptoms and diagnose the signs that specialists interact with on a daily basis.

This reduces the possibility of monopolizing tasks and monotony of assignment of tasks and makes things simpler to run the healthcare organization. These defined templates for Orthopedics include:

  • Procedures for the knee
  • Pain in the back
  • Procedures in the back
  • Shoulder process
  • Disorders such as Lumbosacral disorders
  • Carpal tunnel
  • Elbow process
  • Pain in the neck

Managing workflow

Working in orthopedics calls for recording data, and providing support and care for patients. The EMR system for orthopedics should be capable of managing and maintaining documents that contain all the workflow of orthopedics for easy access and retrieval.

Specific codes for ICD/CPT 

When the International Classification of Diseases and Current Procedural Terminology changes or updates its necessary codes and updates the list of new diseases including what class they fall into, the EMR software should be familiar with them and keep up with the updates.  This also makes it easier for billing to take place and be transferred to the billing office in charge.

Compatibility with Photo and Machine

Most orthopedics depend on testing images as well as using machines for their tasks. EMR software rests heavily on the compatibility of orthopedics with MRI, EMG, and X-rays including other formats of the diagnostic image.

Data Import

The core function of Electronic Health Record software (EMR) involves importing data automatically from the Electromyography (EMGs) tracking and keeping a record of the patient’s medical history.

Managing compensation

Handling compensations with insurance companies is a core duty of the EMR, especially for accidents and work sites for disabled patients. There is a need for Orthopedists and their teams to handle the management of files and charts for their patients. The EMR system also makes the management of compensation easy for the attorneys.

Dashboard for Orthopedics

Every dashboard managed by Top Orthopedics needs to feature an updated real-time dashboard where the orthopedics are able to see the individual charts, records, billing process, and scheduling processes of the patients. The dashboard is also helpful in time-saving and multiple tabs management.

Choose the best Orthopedic EMR Software

Having narrowed the possible eligible vendors for the EMR orthopedic software, there are also other further considerations to be put in place, this includes:

The design of the EMR System

When it comes down to choice, it is usually between the installation of the EMR software in your computer server and the cloud server for easy access via the internet.

Some orthopedics and physicians also demand a secure system server on their computers since it aligns with HIPAA compliance rules and demands. On the other hand, some doctors prefer to have direct access to their data anywhere that they find themselves.


It is a known fact that some EMR software vendors often supply their services to be best suited for large medical practices than smaller organizations. The EMR software is also designed and constructed to attend to a limited number of users bearing scalability and customer support in mind. So, always keep in mind the size of your practice before choosing an EMR software vendor.


Most orthopedics often demand for certification before making their purchase from the vendor. Most of the important certification includes the popular Office of the National Coordinator for Health Information Technology–Authorised testing bodies (ONC-ATCB). This organization is responsible for ensuring that the EMR vendor meets the compliant objectives of the HIPAA.

What Orthopedic billing is about

Quick question for you-are you aware that most percentages of the insurance claims in the orthopedics are often incorrect while the rest are rejected? So, in real life despite the fancy aspect of orthopedics which is mostly taught in school, it is important for physicians to acquire knowledge of the services that they will be paid for.

The complexities of Orthopedic billing

The new International Classification of Diseases (ICD-10) incorporates the introduction of modifiers such as XS, XP, and XU. accompanies by the laws of modifier 59. This includes the existing coding and billing aspects in the orthopedics and this makes the process a complex one.

Using the right modifiers

The two characters often denoted in the procedural services and codes are often applied for the insurance services so that their refunds can be easier and claimed faster. These modifiers, when used correctly provide an accurate and detailed recrd of the medical transaction.

There are two levels of modifiers in orthopedics, which are level I and Level II. It is expected for these orthopedic coders and billers to have an in-depth understanding of the suitable codes and modifiers that are required for the provided service.

Additionally, the misuse of the codes and orthopedic modifiers often leads to rejection of the insurance, fines, and investigation of the medical practice if necessary.

Top 5 Billing Guidelines for Orthopedic Practice

There are simple guidelines that must be followed in order to adhere to the complicated and complex structure of Orthopedic billing and coding. The guidelines can help to reduce the denials of insurance claims and also increase the management of the revenue system as listed below:

Verification of Insurance coverage

Starting from the beginning, the most possible method of keeping and adhering to the practice of the Orthopedic system efficiently is taking the time to understand the insurance policies and verifying the different aspects that are involved in it.

This includes pre-authorization which is about verifying the insurance company coverage and the manner of service that the orthopedic medical services will be covering.

In total, this helps and assists the orthopedic medical practice to interpret and understand the kind of reports that the insurance company will receive and ensure that the insurance also covers the insurance services to be offered.

Check the information of the patient

Checking patient information is the emphasis and important and always emphasized to include tiny details such as the rightful name of the patient, their date of birth, address, and other information that the insurance company may require.

One major mistake which most practice makes is with the demographic positioning of the patient. This mistake in itself often leads to the rejection of a claim or denial of such.

The most efficient way to ensure that the details on the received form from the patient are to pass the form through the admin staff.

Insurance claim real-time

One of the most required procedures for submitting insurance claims is to ensure that the required time frame is met with. Orthopedic medical practices need to ensure that they meet the deadline of the insurance companies.

Meeting this deadline increases the chances of approving the insurance claims and reduces the chances of rejecting the insurance claims as well.

Right orthopedic coding

The insurance companies or payers can easily deny the insurance claims if the codes are not specific enough. The companies in charge of insurance do not only demand as many details as you need to provide in order to justice the codes that are used for the insurance procedures. It is equally important for these orthopedic billing and coding to comply with the ICD-10 rules, standards, and regulations.

Getting and working with the right partner

Orthopedic coding practices involve changing rules and regulations, coding practices, and keeping up with other updates within the orthopedic practice insurance.

It is important to train the staff in the house so that you don’t have to spend more time, money, and resources on hiring hands that will offer these services.

Another way of ensuring that there is an accurate on-track cycle of revenue is with experts who handle the 24/7 medical billing services and needs.

These experts need to have experience in orthopedic coding and billing including increasing their experience and upgrading the revenue.

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