Orthopedic coding software for in-house billing teams should make your coders faster and your claims cleaner without taking the work away from them. Mira pre-codes every orthopedic encounter from the note, audits it before submission, and sends only the exceptions to your team. It maps CPT and ICD-10, assigns modifiers like -LT, -RT, -25, -59, and -79, and checks every claim against several layers of orthopedic-specific rules for bundling, modifiers, global periods, and payer requirements. Your coders review a short queue of flagged claims, each with the reason and the supporting documentation, instead of building every claim from scratch.
If you want Mira to run your entire revenue cycle instead, see Mira RCM. This page is for practices that keep their own coders and billers.
Who This Is For
Many orthopedic practices have good reasons to keep billing in house. Their coders know the surgeons’ habits, the local payers, and the history behind every write-off. What they lack is time. A coder with 150 charts a day cannot give each one the attention a total joint or a multi-procedure arthroscopy deserves.
Mira is built for that team. It does the first pass on every chart and the audit on every claim. Your people make the calls that need judgment.
The Problem With Coding Every Chart From Scratch
Orthopedics has some of the most rule-dense coding in medicine. A single clinic day can include:
- Laterality. A missing -LT or -RT is one of the most common avoidable denials.
- Bundling. Arthroscopic procedures in the same compartment often bundle under the CMS NCCI edits, and -59 has to be earned by the documentation.
- E/M with a procedure. A visit plus a knee injection (CPT 20610) needs a separately identifiable E/M to support -25.
- Global periods. A 90-day global after a total knee (CPT 27447) changes how every follow-up is billed. CMS explains the rules in its Global Surgery Booklet.
- Diagnosis specificity. Primary osteoarthritis of the right knee is M17.11, not an unspecified code.
Experienced coders know every one of these rules. Under volume, a few still slip through, and they show up weeks later as denials and rework.
How Pre-Coding and Pre-Submission Audit Work
| Step | What Mira does | What your team does |
|---|---|---|
| 1. Pre-code | Reads the note and suggests CPT, ICD-10, and modifiers, each tied to supporting documentation | Nothing yet |
| 2. Audit | Checks bundling, modifiers, global periods, and payer rules | Nothing yet |
| 3. Flag | Sends claims with denial risk or missing documentation to one review queue, with the reason | Reviews and decides |
| 4. Submit | Releases approved claims per your workflow | Approves per your rules |
| 5. Defend | Drafts appeals with clinical evidence from the encounter | Reviews and sends |
Clean claims move without extra touches. Your coders spend their time on the claims that actually need a coder.
Orthopedic Coding Audit: What Gets Checked
Modifier audit
| Modifier | When it applies in orthopedics | What Mira checks |
|---|---|---|
| -LT / -RT | Procedure on one side | Side documented in the note and on the claim |
| -50 | Bilateral procedure in one session | Both sides documented |
| -25 | Separately identifiable E/M on a procedure day | E/M work distinct from the procedure decision |
| -59 | Distinct service that would otherwise bundle | Documentation supports the distinction |
| -79 | Unrelated procedure during a global period | New problem, not a complication of the original surgery |
Global period audit
Mira tracks each procedure’s global period from the CMS physician fee schedule. A routine post-op visit inside the global is not billed as a new E/M, and an unrelated problem during the global gets the right modifier.
E/M level audit
Mira appends a structured Medical Decision Making justification to every note: diagnoses addressed, data reviewed, and risk. That is the framework auditors use for E/M levels. Practices using Mira capture Level 4 visits at 73%, compared with a 32% industry average for orthopedics, with documentation to support each one.
Coding Intelligence vs. Outsourced RCM
| Mira coding intelligence | Mira RCM (outsourced) | |
|---|---|---|
| Who codes | Mira pre-codes; your coders approve | Mira’s team runs coding end to end |
| Who submits | Your billers | Mira |
| Denials and appeals | Mira drafts; your team sends | Mira handles |
| Best fit | Practices with an established billing team | Practices that want billing off their plate |
Both run on the same orthopedic coding engine. Practices can start with one and move to the other.
Rolling Out Alongside Your Coders
Your coders do not change systems or give up control. In the first weeks, they review every Mira suggestion next to their own coding. Where Mira and your coders disagree, we look at the documentation together and tune the rules to your surgeons and payers. Once your team trusts the suggestions on routine claims, they move to reviewing exceptions only.
Your lead coder decides when that switch happens, by claim type. Many teams start with E/M visits and injections, then add surgical claims once they have seen Mira handle global periods and multi-procedure arthroscopy.
Results
| Metric | With Mira |
|---|---|
| Denial reduction | ~56% |
| Clean claim rate | ~85% |
| Claim submission | Within 24 hours |
| Average annual savings | $216K+ |
Works With Your Notes and Your EHR
Mira codes from the encounter note, whether your surgeons write it in the EHR or use Mira Scribe. Mira integrates natively with Epic, athenahealth, ModMed, eClinicalWorks, NextGen, and DrChrono, and builds new EHR integrations in one to four weeks.
Our free orthopedic CPT reference, ICD-10 musculoskeletal reference, and modifier guide are open to any coder.
Next Step
Book a demo and bring ten recent claims your team found hard, including one that was denied. We will run them through Mira side by side with your coders.