Accurate orthopedic coding is essential for both compliance and practice revenue. With frequent CPT updates, complex surgical procedures, strict payer rules, and extensive bundling requirements, even minor coding errors can result in denials, delayed payments, or audits. This orthopedic CPT codes cheat sheet gives orthopedic providers, coders, and orthopedic billing teams a quick, reliable reference to the most commonly used codes, key coding categories, and essential documentation rules. Whether you’re managing office visits, injections, arthroscopy, joint replacements, or spine surgery, this guide helps ensure correct coding, reduced claim rework, and improved reimbursement accuracy.
Why Orthopedic CPT Codes Matter?
Orthopedic CPT codes are the Current Procedural Terminology codes used to describe evaluation, management, procedures, and surgical services performed by orthopedic clinicians. Payers use these codes to determine payment; they also trigger edits, bundling rules, global periods, and medical necessity reviews. Getting orthopedic CPT codes right reduces denials, prevents audits, and supports efficient orthopedic medical billing workflows.
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Types of Orthopedic CPT Codes
Orthopedic practices use several categories of CPT codes. Understanding these types helps ensure documentation and bundling rules are properly matched and improves orthopedic billing accuracy.
- Evaluation & Management (E/M) codes
Office visits, consultations, hospital visits (e.g., 99202–99205, 99212–99215). E/M rules changed in recent years; document medical decision-making (MDM) or time per payer rules.
- Injections & Procedures
Joint injections, aspirations (e.g., 20610 for arthrocentesis/injection when performed). These are commonly subject to NCCI edits and payer-specific requirements in orthopedic medical billing.
- Arthroscopy & minimally invasive surgery codes
Shoulder and knee arthroscopies (e.g., codes in the 298xx range). These codes often bundle intraoperative services with work.
- Open reduction / internal fixation and fracture care
ORIF, internal fixation, external fixation (CPT ranges 20000–29999 for musculoskeletal procedures).
- Joint replacement/arthroplasty codes
Total knee (27447), total hip (27130), and related revisions. These carry global surgical periods and hospitalization components.
- Spine surgery codes
Decompression, fusion, disc procedures (22010–22899 range). These have complex bundling and global period rules.
Most Commonly Used Orthopedic CPT Codes
| Codes | Procedures / Services |
|---|---|
| 99202–99205 | New patient office visits |
| 99212–99215 | Established patient office visits |
| 20610 | Major joint injection/aspiration (knee, shoulder, hip) |
| 29881 | Knee arthroscopy with meniscectomy (medial OR lateral) |
| 29888 | Arthroscopic ACL reconstruction |
| 29827 | Arthroscopic rotator cuff repair |
| 29826 | Arthroscopic subacromial decompression |
| 23412 | Open rotator cuff repair |
| 27130 | Total hip arthroplasty |
| 27447 | Total knee arthroplasty |
| 27486 | Revision total knee (one component) |
| 27245 | ORIF proximal femoral fracture |
| 27506 | ORIF tibial shaft fracture |
| 20936 | Autograft for spine surgery |
| 22840 | Posterior non-segmental spinal instrumentation |
| 63030 | Lumbar laminotomy/discectomy |
| 64415 | Brachial plexus nerve block |
| 77002 | Fluoroscopic guidance for needle placement |
| 73562 | Knee X-ray (3 views) |
| 72100 | Lumbar spine X-ray (2–3 views) |
CPT Codes for Orthopedic Surgery
Here are commonly reported CPT codes for orthopedic surgery and categories providers should know:
| Procedure Type | Codes / Notes |
|---|---|
| Total joint arthroplasty | 27447 (total knee), 27130 (total hip) |
| Arthroscopy | Codes in the 298xx range for knee and shoulder arthroscopies |
| Rotator cuff repairs / shoulder procedures | Commonly reported codes, such as 23410 |
| Injections / aspirations | 20610 (arthrocentesis/injection), plus codes for tendon sheath injections |
| Fracture care / fixation | ORIF and fixation codes across 20000–29999; ranges and specifics depend on bone/site |
Essential Documentation and Coding Rules Every Orthopedic Provider Should Know
Accurate orthopedic CPT codes depend on clear documentation, correct modifier use, and awareness of payer rules. Providers play a critical role in preventing denials by ensuring the following basics are met:
- Be specific in procedure notes: Document the indication, exact steps performed, laterality (RT/LT), approach (open vs. arthroscopic), implants or grafts used, and key intraoperative findings. Vague notes often lead to undercoding or denials.
- Document E/M services correctly: For office and hospital visits, record medical decision-making (MDM) or total time according to current E/M guidelines.
- Link every CPT to an ICD-10 diagnosis: Each procedure must be supported by a specific, site-appropriate diagnosis code that establishes medical necessity.
- Understand global period rules: Many orthopedic surgeries carry 0-, 10-, or 90-day global periods. Routine post-operative visits are usually bundled and not separately billable unless clearly unrelated.
- Use modifiers only when justified: Apply RT/LT for laterality and Modifier 59 or X{E,S,P,U} modifiers only when documentation supports a distinct service. Incorrect modifier use increases audit risk.
- Watch for bundled services: NCCI edits prevent billing of procedures that are typically bundled together, especially in arthroscopy and injections. Always review edits before submitting multiple services on the same day.
- Confirm prior authorization: Joint replacements, spine procedures, advanced imaging, and implants often require payer approval. A lack of prior authorization often results in automatic denials.
- Handle complex and new procedures carefully: Unlisted and Category III codes require detailed operative reports and may not be covered by all payers. Verify coverage before billing.
- Document implants and supplies thoroughly: Include implant type, manufacturer, and device identifiers when required by payer or registry guidelines.
Final notes
Getting orthopedic CPT codes right is a team sport: surgeon documentation, trained coders, front-desk prior-auth workflows, and regular updates from AMA/AAOS/CMS keep revenue flowing and reduce audit risk. If your practice hasn’t run a coding audit in the last 12 months, prioritize one small documentation fixes often recover larger sums and prevent future denials.
