Joint Replacement EHR and AI Medical Billing Software

Joint replacement surgeons need the whole story of conservative care before payers approve surgery. XEHR documents it visit by visit and carries it into the approval and the claim.

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Chart · Office visit

Lastname, Firstname M. Sample patient · DOB 01/01/1980 · Commercial

Eligible

BP128/82

HR72

BMI26.4

Temp98.6

Progress noteAI Scribe draft

Right knee pain for 3 years, worse on stairs; injections no longer help.

M17.11 Unilateral primary osteoarthritis, right knee

ReviewSign note

Diagnosis carried to the claimM17.11

THE HARD PARTS

What makes joint replacement billing hard

Proving conservative care

Payers want documented months of therapy, injections and medicines before approving a joint replacement.

Revisions with long histories

Revision surgery depends on the earlier implant and operation, which are often in outside records.

Outcome measures

Joint replacement programs report function scores before and after surgery.

WHERE THE WORK HAPPENS

How joint replacement care is delivered and billed

Adult reconstructive surgeons perform hip and knee replacements and revisions in hospitals and, increasingly, in surgery centers. Clinic visits, x-rays and injections are billed on the professional claim; surgery is billed with the facility place of service and a 90-day global period. Payers and bundled payment programs watch outcomes, readmissions and the documentation of conservative care.

What payers check on joint replacement claims

Joint replacement approval usually requires documented conservative treatment, imaging findings and functional limits.
Osteoarthritis codes carry laterality and whether one or both joints are affected.
Revision surgery is coded with the complication of the earlier implant.
Joint replacement carries a 90-day global period that includes routine follow-up.
Implant status codes are reported for patients with an existing artificial joint.

Common joint replacement diagnoses ICD-10-CM

M17.11	Unilateral primary osteoarthritis, right knee
M16.12	Unilateral primary osteoarthritis, left hip
M17.0	Bilateral primary osteoarthritis of knee
T84.031A	Mechanical loosening of internal left hip prosthetic joint, initial encounter
Z96.651	Presence of right artificial knee joint
M87.051	Idiopathic aseptic necrosis of right femur

Examples only. The provider chooses the code that matches the documented diagnosis, and XEHR checks it against the note and the payer's rules before the claim goes out.

A VISIT ON XEHR

A joint replacement visit, start to payment

1
Document the trial

Each visit records pain, function, imaging and the conservative treatment tried.
2
Request approval

The prior authorization is prepared from the conservative care timeline and imaging.
3
Operate and record the implant

The operative note records the approach and implant details.
4
Bill and follow outcomes

The claim carries the side and setting; global period visits and function scores are tracked.

How XEHR helps

From the joint replacement visit to the payment

Conservative care in one timelineTherapy, injections and medicines are recorded so the approval request is built from the chart.
Earlier implants on fileOutside operative notes and implant records are filed to the patient.
Scores capturedFunction scores are recorded in structured fields before and after surgery.
AI that waits for youThe AI drafts notes and prepares claims; your providers sign and your billers approve.

Claim · CMS-1500

Sample claimLastname, Firstname M. · DOS 03/04/2026

Scrub passed

Scrubbed
Submitted
Accepted
Paid

Service	Dx	Units	Charge
Office visit	E11.9	1	145.00
A1c test	E11.9	1	28.00
Total			173.00

ERA postedPayment applied, no re-keying

Agentic AI for joint replacement

AI medical billing for joint replacement practices

XEHR is an agentic EHR: AI agents do the administrative work around every joint replacement visit, and your team approves what matters. How agentic AI works

Before the claim leaves

The claim-check agent looks for

Joint replacement approval usually requires documented conservative treatment, imaging findings and functional limits.
Osteoarthritis codes carry laterality and whether one or both joints are affected.
Revision surgery is coded with the complication of the earlier implant.
Joint replacement carries a 90-day global period that includes routine follow-up.

Around the visit

Agents run on their own

Coverage checked before each joint replacement visit
The visit note drafted for the provider to sign
Insurance payments matched and posted
Open claims tracked, denials read and appeals drafted

People decide

Your team stays in charge

Providers sign every note
Billers approve every claim and appeal
Staff submit prior authorizations
Any check can be overridden, with a reason

BUYER'S GUIDE

Questions to ask before you choose a joint replacement EHR

Ask every vendor, including us. The answers show whether a system was built for joint replacement work or only adapted to it.

Ask us on a demo

Can conservative care across many visits be pulled into an approval request?
Are implant details recorded in the operative note?
Can function scores be recorded before and after surgery?
Can revision surgery be coded with the earlier implant complication?
Can outside operative notes be filed to the patient?

QUESTIONS

Joint Replacement practices ask us

Does XEHR help get joint replacements approved?

Yes. The conservative care history is documented across visits and used to prepare the request.

Can XEHR track joint replacement outcomes?

Yes. Function scores are recorded before and after surgery for comparison.

Does XEHR handle revision surgery records?

Yes. Earlier operative notes and implant details are kept in the patient record.

Can XEHR bill joint replacements done in surgery centers?

Yes. The claim carries the facility’s place of service, whether hospital or surgery center.

Does XEHR support joint replacement in surgery centers?

Yes. The claim carries the surgery center’s place of service.

Can XEHR track readmissions after joint replacement?

Yes. Admissions after surgery are recorded in the patient record.

Can physical therapy progress be kept with the surgical record?

Yes. Therapy reports are filed to the patient record.

How much does XEHR cost for a joint replacement practice?

Pricing is published: $189 per provider per month for the Clinical plan, $449 per provider per month for the Practice Suite with billing, or 2.5% of collections for RCM as a Service. Month-to-month, with a BAA on every plan. See pricing.

How long does it take a joint replacement practice to go live?

Small practices are usually live in 2 to 4 weeks, including setup, data migration and training. We agree the plan with you before you sign.

Related specialties

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See XEHR set up for joint replacement

A 30-minute walkthrough on a live test environment, with your specialty's templates and billing.

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