The problem
Orthopedic coding packs many rules into one case. A total knee replacement opens a 90-day global period that Medicare counts as 92 days, a meniscectomy code already includes chondroplasty in the same knee, and modifiers 25, 57, 59, 78 and 79 each need their own support in the note. Our guide to common orthopedic claim denials shows where these go wrong.
Errors also carry compliance risk. OIG’s 2005 report found that 35% of modifier 25 claims Medicare allowed in 2002 did not meet program requirements, and in March 2026 OIG added a Work Plan review of E/M services paid on the same day as minor surgery without modifier 25, as our modifier 25 guide explains. Codes must reflect what the note supports.
How it works
Read the operative note: Rette’s AI agents connect to athenahealth or eClinicalWorks and read operative and clinical notes directly. Using another EHR? Ask about your EHR.
Flag gaps first: Rette flags documentation gaps in the note before coding, so codes rest on a complete record.
Suggest codes and modifiers: Rette suggests CPT and ICD-10-CM codes and modifiers drawn from the note.
Coders decide: Your coders review each suggestion and make the final call. The claim is then checked against NCCI edits and Medicare NCD and LCD rules before submission.
What you get
CPT, ICD-10-CM and modifier suggestions drawn from operative and clinical notes
Coder review built in; the final decision stays with your team
Documentation gaps flagged before coding starts
Pre-submission checks against NCCI edits and Medicare NCD and LCD rules
Built for orthopedics
Rette is built with orthopedic surgeon advisors. Orthopedic coding turns on rules like these:
Global periods: the global surgical package decides when a visit or procedure during recovery needs modifier 24, 58, 78 or 79.
Arthroscopy bundling: NCCI procedure-to-procedure edits bar reporting chondroplasty (29877) with other knee arthroscopy codes on the same knee.
Distinct services: modifier 59 and the X modifiers need a documented distinct service, such as a separate encounter or structure; opposite knees take RT and LT.
Units: for Medically Unlikely Edits, a joint and its bursae count as one unit of 20610 (major-joint injection without ultrasound guidance).
Modifier placement: modifier 25 goes on the visit, not the injection, and a mismatch can return as CO-4.
Frequently asked questions
Does Rette code claims without a coder?
No. Rette suggests CPT and ICD-10-CM codes and modifiers from the note, and your coders review them and decide what is billed. The claim is then checked against NCCI edits and Medicare NCD and LCD rules before submission, and responsibility for coding stays with your practice.
How does Rette handle modifiers such as 25, 57 and 59?
Rette suggests modifiers from what the note documents, and coders confirm them. The rules don’t change: 25 needs significant, separately identifiable visit work beyond the procedure, 57 marks a visit, on the day of or day before major surgery, that led to the decision to operate, and 59 or an X modifier needs a documented distinct service. Never add a modifier just to pass an edit.
What does Rette cost?
Pricing is confirmed on a call rather than published. If you want to see where your claims stand first, request a free denial audit, or try the free NCCI edit checks and payer policy lookup at policy.rette.ai before you talk with the Rette team.
Related guides
Read More
Coding & Modifiers
Can You Bill an E/M With Modifier 25 on an Orthopedic Injection Day?
Oct 14, 2026
Read More
Denials & Appeals
The Most Common Orthopedic Claim Denials in 2026, and How to Prevent Them
Oct 14, 2026
Read More
Medicare & Payer Updates
CY2027 Medicare Physician Fee Schedule: What It Means for Orthopedic Practices
Oct 14, 2026
Key terms
Rette reads the operative note in the EHR you already use, suggests codes and checks claims against payer and NCCI rules before submission.