NP performing lumbar spine epidural and facet inj's ?

[lakewood77]

I'm wondering if any NP's are performing spinal injections either in an office or hospital setting? The injections would be done using fluoroscopy.

I work in a large neurosurgery practice and a few of the neurosurgeons routinely perform these injections on their patients. There is a growing interest amongst the NP's to perform these procedures as well. This would be addressed in a collaborative practice agreement with the surgeon.

A few questions that arise--

1. Any legal pitfalls that need to be addressed prior??

2. How would the NP bill for these procedures?

3. Did anybody run into opposition from BON? (I live in Georgia)

4. Any issues with payors?

5. What kind of documentation did BON require to prove competency?

Any advice or guidance is greatly appreciated.

Thanks!!

[nomadcrna, DNP, CRNA, NP]

I do ESIs and joint injections. Some of my colleagues offer full service pain service.

No practice agreement needed as I am in an independent practice state.

2. Normal billing just as you would for any procedure.

3. Perfectly legal in my practice states. Can't speak for Georgia.

4. None

5. Mine was included in school but I know of other NPs that start at a paid clinic and are taught. There are also some post graduate courses.

I'm wondering if any NP's are performing spinal injections either in an office or hospital setting? The injections would be done using fluoroscopy.

I work in a large neurosurgery practice and a few of the neurosurgeons routinely perform these injections on their patients. There is a growing interest amongst the NP's to perform these procedures as well. This would be addressed in a collaborative practice agreement with the surgeon.

A few questions that arise--

1. Any legal pitfalls that need to be addressed prior??

2. How would the NP bill for these procedures?

3. Did anybody run into opposition from BON? (I live in Georgia)

4. Any issues with payors?

5. What kind of documentation did BON require to prove competency?

Any advice or guidance is greatly appreciated.

Thanks!!

[lakewood77]

Thanks for your reply. How long did it take before you felt comfortable doing esi's ?

[Corey Narry, MSN, RN, NP]

I don't do spinal injections. However, I work in an ICU and we do perform procedures here such as intubations, invasive lines, and moderate sedation for procedures. Even in states where the NP is not independent, it is not difficult to do procedures as long as rules are followed. Most BON's do not address procedures specifically in their Nurse Practice Act. As a general rule, if an NP works in a specialty where procedures are commonly done, it is acceptable for NP's to be trained in those procedures. For instance, in our institution, Heme/Onc NP's do bone marrow biopsies, Thoracic Surgery NP's do chest tubes, Pulmonary Transplant NP's do bronch's. Georgia specifically do not have provisions banning NP's from performing procedures in their practice act.

To answer your questions:

1. Legal pitfalls: all procedures carry a risk to the patient. You must explain these when getting consent. Complications can happen but as long as you followed standard protocol and observed all the safety checks required for the procedure itself, you should not be held legally accountable. Negligence and incompetence are different - those you can really get in trouble for. One can not stress enough the need for malpractice coverage.

2. Billing would be the same as how physicians do it. The procedure note itself is used for billing and describes the indications, findings, safety checks, and steps carried out in the actual procedure. The surgeons are already doing that I'm sure so you'll just need to follow their template.

3. As I mentioned most BON's don't specifically address procedures. If all Georgia requires is a collaborative agreement, all you need to do is make sure these are included in that document. I practice in California where our state has specific rules on procedures. Our BRN requires details on procedures we do including who trained us, how we were trained, and who the physician responsible for each NP is. It's all in our Standardized Procedures document.

4. Generally payors will reimburse for procedures done by NP's.

5. Again most BON's typically do not get into the details (exceptions are maybe California and Maryland, there could be others). What you need to concern yourself with is institutional credentialing and privileging. If you will be doing these in a hospital setting, you must get approval from Medical Affairs. The Joint Commission also requires that NP's and PA's who perform "medical" acts be credentialed under Medical Affairs and these are looked into during TJC visits. Follow your institutional policy. Our hospital requires that all PA's, NP's, CRNA's, and CNM's log procedures in our computerized system. Depending on the type of procedure, a certain number of cases must be supervised by a physician and the succeeding ones can be done independently once competence is assured.

[lakewood77]

Thanks!! Your reply is extremely helpful.

[PainARNP]

You looking for an Experienced NP to get you started? PM me.

[ggoodman]

Hello I am working in  Pain management and completing other injections   My supervising physician and I are getting a C-ARM.  Were discussing training me to do epidural and facet injections.  I was wondering if you guys would talk to me bout the training credentialing process.  Please PM me.  I live in N. Florida.  Trying to identify rules regulations which would cover this.  

[Mcpeak7]

I live in Georgia and work in PM. I wanted to know if NP's can do ESI's after receiving additional training?