Re: Ortho NP First Assist- Advice Needed Originally Posted by HeidiOrthoSD 
I have worked with an orthopaedic surgeon (solo physician practice) for about 18 months. I currently see patients independently in the office for initial histories and physicals, pre-op visits, post-op visits, etc. The physician has asked me to expand into the OR. Initially, he said he could do "on the job training" for me and teach me what I needed to know. I currently have privileges at the hospital where he does all his inpatient surgeries. Eventually, I want to be able to function as the First Assist and be able to bill for my services. I also have a Medicare provider number. I am in the process of dialoguing with the director of periop services about additional training/credentialing that is needed.
Does anyone have a feel for minimal training I need? I do not have previous OR experience but do have a bachelors and masters degree in nursing and am certified as a family nurse practitioner. I would appreciate any suggestions on resources to consult, etc. I have visited the AORN Web site and printed off the "Official Statement on RN First Assists."
To assist in the OR you need privileges. Depending on how your hospital credentials you need to be credentialled through nursing or through the ortho department. There are a number of issue here.
1. As an NP you can first assist and bill for the assist. No additional training is needed. You bill under your NPI with the appropriate modifier. For other insurance you bill either under your NPI or through the surgeon depending on the insurance policy.
2. Nursing has decided the certification for the OR is the RNFA. To get this you need 2000 hours of first assisting and graduation from an accepted program. Here is a list of the requirements:
http://www.cc-institute.org/cert_crnf_abou.aspx
Here are a list of the programs:
http://www.cc-institute.org/cert_crnf_prep_rnfa.aspx
NIFA has distance learning options. You already have the masters for the RNFA.
One possibility is to have the surgeon send you to the NIFA course which is one week long. This will give you the basics of first assisting. Depending on the hospital completion of the course should be enough to give you privileges to assist.
3. The other issue is the the FNP. You can look in the NP section for more discussion on this. There are a lot of FNPs doing acute care in the hospital. However, the trend nationally seems to be the ACNP. This may or may not become an issue for inpatient work depending on your state and hospital.
Finally make sure that your practice understands billing for NPs in the first assist role. There are many nuances here and many procedures do not reimburse for a first assist. Some offices are suprised with the low reimbursement (generally 14.5% of the surgeons fee). It may be more productive to have you see inpatients or outpatients, especially if you are doing high value procedures such as injections.
Here is a flier from PAOS that explains some of the issues for ortho PAs (which are probably similar to what you are dealing with):
http://www.aapa.org/gandp/issuebrief/orthosurg.pdf
Realistically the reason that you are valuable to the practice is not the first assisting. This is simply a technical task. The way that NPPs are valuable is through patient management in the clinic and on the floor. Unfortunately there is a disconnect between the floor work and the OR which is primarily where the pay comes from.
David Carpenter, PA-C
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