Wiki Pre-Op Clearance

[laurap]

We have an NP who preformed and billed a pre-op clearance. After the service was done the patient rescheduled the surgery and the NP had to clear the patient a second time about a month and a half later. Can the second pre-op be billed as a consult since it was not our NP's fault that the surgery was rescheduled and she did the work again?

Laura L. Porter, CPC
Jamestown Area Medical Associates

 

[LLovett]

Was the first one truly even a consult or just done because they had to be cleared before having surgery?

If the pre-op was truly a consult the first time that means there was a request. In order to bill another consult you would have to have another request. It doesn't sound like that is what took place.

If all the requirements are not met for a consult then you need to bill an established visit.

Laura, CPC

 

[FTessaBartels]

Surgeon or PCP?

Is the NP part of the surgeon's practice? Or in the PCP's practice?

If you are the PCP office and the reason for pre-op clearance was routine requirement of the hospital you do not have a consult.

If you are the surgeon's practice, I would consider this part of the global surgical package.

F Tessa Bartels, CPC, CEMC

 

[laurap]

More Information on Original Post

The NP is part of our Internal Medicine practice. The surgeon requested both pre-op clearances and all the requirements for a consult were met for both visits. Can anyone help?

Laura L. Porter, CPC
Jamestown Area Medical Associates

 

[LLovett]

The fact that the surgeon asked again for pre-op clearance leads me to believe this does not meet the requirements for a consult either time, but is in fact a rountine screening process.

http://www.cms.hhs.gov/transmittals/downloads/R782CP.pdf

G. Consultation for Preoperative Clearance
Preoperative consultations are payable for new or established patients performed by any physician or qualified NPP at the request of a surgeon, as long as all of the requirements for performing and reporting the consultation codes are met and the service is medically necessary and not routine screening.

Just my opinion though,

Laura, CPC

 

[Allison L. Wickham]

Hi.

As long as you have a request from the surgeon for "surgical clearance" you can bill a Consultation. As far as determining the "Medical Necessity" of the service I would leave that up to the carrier. Bottom line is that the surgery will not hapen unless the patient has received clearance.