APRN role in specialty clinic

[cgonzalezy]

Does anyone know if the APRN should see initial consults in a special area? or should the initial visit and evaluation be completed strictly by the attending physician? This is for a private practice in Texas. I am currently reviewing Texas Board of Nursing guidelines, but have not found anything specifically addressing my question. Any constructive feedback would be greatly appreciated. Thanks

[JeanettePNP, MSN, RN, NP]

if the attending wants to bill under his/her name (incident to) then the initial visit must be completed by the attending. If you are billing under your own name there is no reason you can't see the patient initially.

I work in a specialty and when we see new patients I usually take the h&p and then the attending will speak to the patient and make the plan of care. At this point unless it's a complex case I can usually make the plan of care for new patients myself but patients feel better that they were seen by a specialist, not an NP.

[PG2018]

A lot of "specialists" have the NP or PA see the patient first to assess/gather information. It's pretty commonplace.

[rnsrgr8t]

I work in a specialty practice and do both. I have my own group of patients with a particular diagnosis that I handle myself primarily (new and f/u patients). I also can work with my attendings and do the H&P and see the patient with the attending as well. Just depends on the day and what the needs are in my division. Most of my work is seeing my own patients on my own.

Billing is an issue too. I work in a high volume practice so the attendings I work with do not miss the RVU's of the patients I see. They may get better reimbursement if billed under the MD rather than the NP so if they want you to bill incident to, then they need to see them first as a new patient. My group decided that the difference in reimbursement having me see my patients completely independently was negligible. When I first started 10 years ago, they saw the new patients with me and then I saw the f/u's myself and billed incident to. Over the years, I just started seeing everyone myself. I see kids with voiding dysfunction and they take a lot of time and honestly my attendings do not have time to see them in their busy, regular clinics. For me, they allow me 45 minutes to see them and I can take my time and in the end it works better. I prefer to be independent so I am happy they let me do it that way. What does your practice want you to do?