Can a NP perform plastic surgery?

Specialties NP

Published

What is the difference between a cosmetic procedure and a surgical procedure?

Can a NP inject your buttocks with silikon 1000 to make it bigger?

A woman showed me a picture of her new booty and said a NP at a "spa clinic" gave her these butt shots of silikon 1000.

Not exactly true. Post-mastectomy breast reconstruction is purely cosmetic, yet most insurance companies do cover it.
Just about all (US) health insurance compnies HAVE to cover post-masectomy reconstruction, it's a Federal law (tossing this out there because so many women [and healthcare providers] are unaware of this).

Under WHCRA, group health plans, insurance companies and health maintenance organizations (HMOs) offering mastectomy coverage also must provide coverage for certain services relating to the mastectomy in a manner determined in consultation with your attending physician and you. This required coverage includes all stages of reconstruction of the breast on which the mastectomy was performed, surgery and reconstruction of the other breast to produce a symmetrical appearance, prostheses and treatment of physical complications of the mastectomy, including lymphedema

http://www.dol.gov/ebsa/publications/whcra.html

This law also applies even if the reason for the masectomy was not cancer or if the masectomy was done under a different insurance plan (no dodging it as a pre-existing condition).

Up Vote Up Vote ×
Not exactly true. Post-mastectomy breast reconstruction is purely cosmetic, yet most insurance companies do cover it.

Caused by cancer/pre-cancer + genetic markers....not ego or pure preference. Big difference :)

Up Vote Up Vote ×
Specializes in OB-Gyn/Primary Care/Ambulatory Leadership.
Caused by cancer/pre-cancer + genetic markers....not ego or pure preference. Big difference :)

Yes, I realize there is a difference. Someone stated that insurance companies don't cover any cosmetic procedure, and I was simply giving an example of one cosmetic procedure that they do indeed cover. That's it. Period. No judgment call or malignment of post-mastectomy breast surgery.

Up Vote Up Vote ×
Depends on the state. In most states, NPs can indeed practice on their own, complete with prescriptive authority.

In many states they can practice on their own, however the prescriptive authority is defined by the state,what they are or are not allowed to prescribe..

Up Vote Up Vote ×
Specializes in ACNP-BC, Adult Critical Care, Cardiology.
Depends on the state. In most states, NPs can indeed practice on their own, complete with prescriptive authority.

Though the numbers will likely grow in years to come, there are less than half of the 50 states and DC (AK, AZ, CO, DC, HI, IA, ID, MD, ME, MT, NM, OR, RI, UT, WA, WY and recently ND and VT) where NP's can practice without any physician involvement and that includes completely independent prescriptive authority. I wouldn't say "most states" at this point. All states allow NP's to practice as providers and prescribe with varying legislative provisions for physician involvement except for the aforementioned states and DC where no physician involvement is necessary.

http://www.nejm.org/doi/full/10.1056/NEJMp1012121

http://nurse-practitioners-and-physician-assistants.advanceweb.com/News/Front-Center/Progress-Toward-NP-Independent-Practice.aspx

Up Vote Up Vote ×
Specializes in ACNP-BC, Adult Critical Care, Cardiology.
Not exactly true. Post-mastectomy breast reconstruction is purely cosmetic, yet most insurance companies do cover it.

You can call it whatever you want but I draw the line with the word "reconstruction"...that is NOT a purely cosmetic reason.

Up Vote Up Vote ×
Specializes in Level II Trauma Center ICU.
NPs, in general, cannot operate. They are not trained or licensed to do so. A NP can also be a RNFA in which they can assist in surgery. PAs are trained in surgery and operate collaboratively with physicians in the OR (usually being a 1st assist) although can take the lead when the PAs supervising physician allows it.

Your statement is incorrect. I know NPs who assist surgeons in surgery in the same manner as PAs. NPs can be trained in surgery during clinicals and fellowships.

Up Vote Up Vote ×
Your statement is incorrect. I know NPs who assist surgeons in surgery in the same manner as PAs. NPs can be trained in surgery during clinicals and fellowships.

I never said NPs don't do surgery, I just said that they are not trained to do so, or at least I have never found a NP program that contains a surgery course. I have also never found a PA program that didn't have a surgery course/rotation. Typically, NPs do not perform surgery where PAs do. Typically, PAs operate more independently than PAs do. There are always exceptions.

Up Vote Up Vote ×
Specializes in ACNP-BC, Adult Critical Care, Cardiology.
A prosthetic limb helps a person walk or grasp/hold things. A prosthetic breast (especially when they create a nipple and tattoo on the aereolae) is indeed purely cosmetic. That's not a value judgment, it's just a statement of fact. Prosthetic breasts serve no purpose but aesthetic. There's nothing WRONG with that, nor do I in any way judge women who choose them. But it is a cosmetic procedure that most insurance companies cover.

Not to try to beat a dead horse but there is a difference between the field of "Cosmetic Surgery" and "Plastic Surgery". The nature of the two disciplines are not interchangeable.

Per the FAQ's from the American Academy of Cosmetic Surgery website:

"Cosmetic surgery is a unique discipline of medicine focused on enhancing appearance through surgical and medical techniques. Cosmetic surgery can be performed on all areas of the head, neck and body. Because treated areas function properly but lack aesthetic appeal, cosmetic surgery is elective".

"Plastic surgery is defined as a surgical specialty dedicated to reconstruction of facial and body defects due to birth disorders, trauma, burns, and disease. Plastic surgery is intended to correct dysfunctional areas of the body and is reconstructive in nature".

Many surgical procedures performed by Plastic Surgeons are covered by insurance but none of the procedures performed by Cosmetic Surgeons are. Breast reconstruction after mastectomy is an example of a procedure performed by Plastic Surgeons. Breast augmentation to improve the appearance of the female form is an example of a procedure performed by Cosmetic Surgeons. Plastic Surgeons are qualified to practice Cosmetic Surgery.

http://www.cosmeticsurgery.org/patients/faqs.cfm

Up Vote Up Vote ×
Specializes in Level II Trauma Center ICU.
I never said NPs don't do surgery, I just said that they are not trained to do so, or at least I have never found a NP program that contains a surgery course. I have also never found a PA program that didn't have a surgery course/rotation. Typically, NPs do not perform surgery where PAs do. Typically, PAs operate more independently than PAs do. There are always exceptions.

UAB has a dual ACNP program that trains the NP to practice as first assist. There are many job postings for ACNPs and/or PAs to function as first assist for cardiothoracic and orthropedic surgeons and neurosurgeons (check out indeed.com). I know several FNPs who were trained as first assist by ortho surgeons during their clinical rotations. You may not "typically" see this but it is happening. You are claiming these are "exceptions" while it could be the that you are just not informed.

Up Vote Up Vote ×
Specializes in Critical Care.
A prosthetic limb helps a person walk or grasp/hold things. A prosthetic breast (especially when they create a nipple and tattoo on the aereolae) is indeed purely cosmetic. That's not a value judgment, it's just a statement of fact. Prosthetic breasts serve no purpose but aesthetic. There's nothing WRONG with that, nor do I in any way judge women who choose them. But it is a cosmetic procedure that most insurance companies cover.

It is replacing a body part that has to get cut off/out. To me that is the same thing. You can function with only one leg or arm just fine, I've seen many of my patients do it.

Up Vote Up Vote ×
Specializes in Anesthesia, Pain, Emergency Medicine.

Forever,

No offense intended but you are not even an RN yet, much less a NP. I would carefully consider you words and make sure they are back up by facts.

I do minor surgery all the time. I drain abscesses, remove various growths and cysts.

I even utilize the OR and c-arms to do various pain related procedures.

BTW, NP do not have to be RNFAs. I worked with many FNPs who first assist in the OR.

Q. Can a nurse practitioner bill as a first assistant at surgery? Are there specific educational requirements in order to qualify to be a first assist as an NP?

A. Medicare pays for assistant-at surgery services under both the hospital inpatient prospective payment system and the physician fee schedule. Payments under the physician fee schedule are limited to a few health professions. Nurse practitioners are permitted under Medicare to receive payment as first assistants in surgery.

Medicare makes a single payment to hospitals for all the services, including assistant-at-surgery services, that a hospital provides to a beneficiary while an inpatient. The inpatient PPS pays predetermined fixed amounts for groups, or bundles, of services, designed to provide incentives to control spending by rewarding efficiency. Medicare also makes payments under the Medicare physician fee schedule for assistant-at-surgery services performed by physicians and members of certain nonphysician health professions whose members assist. These nonphysician health professionals-primarily physician assistants, nurse practitioners, and clinical nurse specialists-are allowed to bill Medicare under the physician fee schedule.

There is no widely accepted set of uniform requirements for experience and education that the health professionals who serve as assistants-at-surgery are required to meet. The health professions whose members provide assistant-at-surgery services have varying educational requirements. No state licenses all the health professionals who serve as assistants-at-surgery.

For assistant at surgery services, payment equals 80 percent of the lesser of either the actual charge or 85 percent of the physician's fee schedule amount paid to a physician serving as an assistant at surgery. A physician serving as an assistant at surgery receives 16 percent of the physician fee schedule amount. The NP allowance is 85 percent of the 16 percent (13.6 percent of the physician fee schedule). The assistant surgery (AS modifier) must be submitted with the claim.

NPs, in general, cannot operate. They are not trained or licensed to do so. A NP can also be a RNFA in which they can assist in surgery. PAs are trained in surgery and operate collaboratively with physicians in the OR (usually being a 1st assist) although can take the lead when the PAs supervising physician allows it.
Up Vote Up Vote ×
+ Add a Comment