Wiki Decision for SX & Pre-Op Clearance Same Day?


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Hi all,

I need some help directing an ortho practice I work with.

They have been billing 2 E/M codes per day;
1. the PT sees the physician who makes a decision for surgery and bills an E/M code with modifier 57
2. the PT sees an NP within the practice, who bills for a "medical clearance" with a different DX (Z01.81x). The NP obtains the records from the PT's PCP and she reviews them. It is not clear to me how much of the evaluation the NP is doing vs. how much she is looking over the records sent by the PCP.

On the face of it, this seems like double dipping. I don't feel right with the NP's billing of "medical clearance" but am butting heads with the physicians at the practice. Their argument is that a PCP can bill for "medical clearance" and since it's a different diagnosis code, the NP can as well. Also clouding it is that the NP is using records from the PCP. Is there any situation in which the NP could bill for the clearance portion after the surgeon has already made the decision for surgery? Does Global play into this, or because the “medical clearance/pre-op” is being done for a different DX, is it excluded?

Trying to find up to date articles about this has proven difficult. Any advice this forum can offer would be much appreciated! I'll add more details as I get them.

Thank you!