Can RNs conduct cardiac stress tests?

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Question:

Can an RN be the primary conductor and supervisor of a cardiac stress test without the MD in the room but with an MD on site?

thanks so much for your help! :nurse:

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I don't have a good answer for you, but I will definitely be watching this thread. There has been talk at the office I work at (large doctor's group practice) about just this thing. We've not gotten a good answer back from the state board of nursing yet. Will be interesting to see what they say.

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Specializes in ICU, M/S,Nurse Supervisor, CNS.

I don't have an exact answer, but I do know that when I had my cardiac stress test done a few years ago, I never even saw the doctor. He was physically in the office, but I never saw him and to this day wouldn't know him if he walked by me. (I got the results from his office nurse and my primary doctor who referred me.) There were two people in the room with me conducting the test, but I honestly can't remember if they were nurses or techs.

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At my hospital we have an APRN conduct the stress test. The test is done in our Cardiology dept with cardiologist around but not required (i think) to be present in the room. I hope this helps.

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Specializes in ICU.

I've served as Practice Manager/Administrator for cardiology offices for 15 years---no, RNs can not supervise stress tests, as least from a Medicare and Medicaid standpoint. Other carriers tend to follow CMS guidelines. Aside from the nuclear tech doing the study, a PA/NP can supervise, but the physician MUST be physically present in the office suite---aka "Direct Supervision". Depending on where you are, there may be a "Personal Supervision" requirement, where the doc must supervise personally. In fact, the CPT codes (93015-93018) are billed by the physician for the stress test itself (not the nuclear portion) and specify physician supervision---they can not meet this requirement if non-billable staff are actually doing it. Billing for it otherwise is fraudulent. Our NP used to supervise the actual test while the docs saw patients, and the NP would bill out the supervision, while the doc billed the other codes (technical and professional). This worked for her since she also collected a percentage of her billings aside from salary.

Also, from a pt safety perspective, ie code, its better all around if the doc is available. Hope this helps!

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Specializes in Acute Care.

When I was in nursing school, I spent a day watching people run on the treadmill with just an RN in the room and me.

(It was a boring boring boring day!)

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Specializes in ICU.

Here's a link that talks a bit more about supervision of diagnostic studies:

http://www.physiciansnews.com/law/298vukmer.html

Cheers!

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The answer is yes. Printing off something from a blog is not good enough, though. You are arguing with someone, right? Here is how to win the argument. Get ready to follow the bouncing links. The first link is a rather exhaustive study by the ACC and is the reason the rule changed in 2000. http://circ.ahajournals.org/cgi/content/full/102/14/1726 The juicy sentence in there (It is in Section 1) reads "In most patients, exercise testing can be safely supervised by properly trained nurses, physician assistants, exercise physiologists, physical therapists, or medical technicians working under the direct supervision of the physician, who should be in the immediate vicinity or on the premises or the floor and available in case of emergency situations." However, Medicare the ACC is not. So, what makes it okay for them? You go to PFS Relative Value Files and download the most current RVU table, which will be in .csv format and should automatically open in Excel. Column heading in column AF on the 2011 table reads "Physician Supervision of Diagnostic Testing." Drop down to 93015 (GXT) and note that it says "2" which means there is a level 2 requirement for physician supervision. There are a bunch of these but the first three cover everything you ever wanted to know. I call them (1) Elvis is around (2) Elvis is in the building and (3) Elvis is in the room. They actually read:

1 = Procedure must be performed under the general supervision of a physician. 2 = Procedure must be performed under the direct supervision of a physician. 3 = Procedure must be performed under the personal supervision of a physician.

As you can see, if you have looked in your handy dandy downloaded RVU table, 93015 is an Elvis is in the building procedure. Most practices require ACLS, but that is their druthers. One thing to remember, and I won't go into much detail, is that state PA and NP boards sometimes let midlevels be Elvis in the building, but Medicare doesn't.

Love,

James

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Question:

Can an RN be the primary conductor and supervisor of a cardiac stress test without the MD in the room but with an MD on site?

thanks so much for your help! :nurse:

I have seen it done-those nurses have been supervised and trained heavily by MDs for that to happen though.

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Specializes in ER.

I worked at a hospital where they did stress tests without a crash cart. I can't imagine why you'd need a doctor, or even a nurse, if there was no crash cart. Jump on buddy, and good luck to ya, if you stay upright you pass.

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:eek:

I worked at a hospital where they did stress tests without a crash cart. I can't imagine why you'd need a doctor, or even a nurse, if there was no crash cart. Jump on buddy, and good luck to ya, if you stay upright you pass.

:eek::eek::eek::eek::eek:

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