Can nurses suture?

Nurses General Nursing

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KellNY, RN

710 Posts

Specializes in High Risk In Patient OB/GYN.
Aren't CNM's allowed to suture tears post-birth?
yep, definitely.

core0

1,830 Posts

i am not a billing expert by any means, i routinly get remined from my billing department that i under code visits. i used termonology of incident to since the general concept is understood but it also does allow for deligation from npp to staff asd well as from physicain to npp.

however according to medicare mas and rns are considered auxiliary personnel that can provide services under teh direction of a physician or npp. here is clarification form the cms web site q and a section

feedback how should the ordering and supervising providers be indicated when completing the cms-1500 when the service is provided incident to the service of a physician or non-physician practitioner?

answer cms issued cr 3138 to clarify and standardize the method of indicating the ordering and supervising professionals on the cms-1500 when the service is provided incident to the service of a physician or non-physician practitioner . this instruction incorporates the rule from the preamble of the proposed rule for the medicare physician fee schedule on november 1, 2001 (66 fed reg. 55267) into the cms claims processing manual that stated "the billing number of the ordering physician (or other practitioner) should not be used if that person did not directly supervise the auxiliary personnel." the update to the medicare claims processing manual located at the link below further clarifies where physician's provider information numbers and names should be reported when both an ordering provider and a supervising provider are involved in a service provided incident to a physician or non-physician practitioner . however, please note that the cms-1500 paper form is superseded by hipaa electronic formats.

reference: http://www.cms.hhs.gov/manuals

reference: http://www.cms.hhs.gov/mlnmattersarticles/downloads/mm3138.pdf

my interpretation of this is as long as the staff is working within legal guidlines for the state and under supervision of a provider the services are eligable to billed under the providers number. am i off base on my understanding here?

well i learned something. i asked a gentleman who is considered the billing guru for pa's. this was his answer:

pas, nps, rns and other office staff (medical assistant) may provide services "incident to" the physician. in addition, rns, lpns, and medical assistants can provide services "incident to" the pa. if provided "incident to" the physician, then payment is at 100%. if an rn provides services "incident to" the pa then the 85% payment is in effect.

the key issue is what the rn or lpn may do. their scope of practice under medicare is generally limited to ancillary duties such as blood pressure readings, injections, and similar services. they can not practice medicine. i don't believe that the rn is covered by medicare for suturing.

private payers can make up their own rules as to who can do what.

if a nurse provides a covered service without the involvement of the physician, pa or np, then it is billed at a level 99201 or 99211. generally, the physician, pa or np must be on site for this type of billing to occur.

looking further i found this: hhs 410.75 which describes medicare billing for the nurse practitioner. notice the bolded part. my interpretation is if there is a cpt attached you need to do it yourself. a physician may delegate this to a npp since they are medicare billers. nurses for example, cannot bill medicare (they do not have a npi). therefore you cannot bill for cpt codes under incident to. there are cpt codes for things like vaccination that nurses can bill for, but if you break out the codes you notice that there are no rvu's attached meaning that medicare is only paying for the technical component (the vaccine and the cost of giving the shot).

short answer, can nurses suture - sure (within the limits of the state scope of practice). long answer - billing for nurses (not np's or cnm or cns) who suture probably constitutes medicare fraud (other insurance can make whatever rule they want).

to the other poster on paramedics. offshore platforms exist in a medical never never land depending on if they are in us continental waters or not. this is very similar to cruise ships. there is great latitude on what can and cannot be done. also the only real issue we were discussing is billing. if a paramedic sutures this is legal (as long as it is within any applicable scope of practice). if they bill for it this would be illegal. this is how the army gets away with letting medics suture. there are no applicable scope of practice laws for medics (or its what the army says they are). this is the reason that they would generally not let nurses (lpn or rn) suture when i was in. the nurse may have a license in any number of states (you do not have to have a license in the state the post is in just have a license in the army). with suturing being outside the scope of practice in some states they chose a blanket prohibition (from what i remember).

david carpenter, pa-c

hhs 410.75 follows look at the bold section.

(d) services and supplies incident to a

nurse practitioners' services. medicare

part b covers services and supplies (including

drugs and biologicals that cannot

be self-administered) incident to a

nurse practitioner's services that meet

the requirements in paragraph © of

this section. these services and supplies

are covered only if they--

(1) would be covered if furnished by a

physician or as incident to the professional

services of a physician;

(2) are of the type that are commonly

furnished in a physician's office

and are either furnished without

charge or are included in the bill for

the nurse practitioner's services;

(3) although incidental, are an integral

part of the professional service

performed by the nurse practitioner;

and

(4) are performed under the direct supervision

of the nurse practitioner

(that is, the nurse practitioner must be

physically present and immediately

available).

(e) professional services. nurse practitioners

can be paid for professional

services only when the services have

been personally performed by them and

no facility or other provider charges,

or is paid, any amount for the furnishing

of the professional services.

(1) supervision of other nonphysician

staff by a nurse practitioner does not

constitute personal performance of a

professional service by a nurse practitioner.

(2) the services are provided on an

assignment-related basis, and a nurse

practitioner may not charge a beneficiary

for a service not payable under

this provision. if a beneficiary has

made payment for a service, the nurse

practitioner must make the appropriate

refund to the beneficiary.

[63 fr 58908, nov. 2, 1998; 64 fr 25457, may 12,

1999, as amended at 64 fr 59440, nov. 2, 1999]

core0

1,830 Posts

yep, definitely.

CNM's are non physician providers under medicare guidelines for providers and can suture. As far as I know any NPP can suture (and bill for it). The question (as I interpret it) was can RN's (or LPN's) suture. The answer is depends on your state. For the answer on billing for this see my other post.

David Carpenter, PA-C

PANurseRN1

1,288 Posts

Specializes in Day Surgery/Infusion/ED.

Suturing? No thanks, I have enough to do already.

rigmedic

74 Posts

I am an offshore medic, currently 45 miles offshore from a third world country. I suture all the time. After I finish nursing school, get my BSN and then my CNOR and RNFA perhaps I can suture onshore also. LOL:lol2:

platon20

268 Posts

Of course NPs can suture. But for RNs to suture is dangerous. They dont teach that in RN school and 99% of them are not trained to do it. I have NEVER seen a doc let an RN suture anybody in the ED. Its always an NP that does it.

puggymae

317 Posts

Specializes in OB, NP, Nurse Educator.

I am a family practice NP and I can suture.

niccikatie

58 Posts

Specializes in Ambulatory | Management | Informatics.

I know that my daughter was seen in an ER and the 'suture nurse' sutured her wound and the MD came in at the end to check everything out. Im not 100% sure if she was an RN or an NP. This is in MN.

Also, on the subject of billing. I'm an RN in an ENT office. As an RN, I can see post op patients and 'bill' (post ops have global days, so they're included in the cost of the surgery) for them even if I'm the only one to see a pt. Usually, I do first post ops where packing or suture removal is required. I have to dictate a note into our EMR and fill out an MSR to accurately document the visit. We can also bill for 'nurse only' visits if the pt needs something that is in the scope of our practice such as a wound check or nasal packing removal.

pghfoxfan

221 Posts

Sorry so late to this discussion but... I have wondered this for many years in PA

7 years ago, the RNs In the Electrophysiology Lab, sutured (closed) pacemaker and ICD pockets while the Doctor dictated or was writing orders. There were 4 of us. 3 different Doctors supervised us till they felt we were competent. Again, the Doctor was still in the room. About 3 years ago, we hired an RN who did not want to suture, and went to administration saying that it was against the PA nurse practice act. NO ONE could find in ANYWHERE that it was against the Nurse Practice Act. Our Administration finally told us to stop suturing since it was a "gray area". IMO, It would be ridiculous for us to become an RNFA just to suture 2 layers of the skin 2-3 inches long and for only pacemakers or ICDs .

reeta

9 Posts

Specializes in general.

In my hometown you ll never see any GP suturing, the registered nurses do their job.

HappyNurse2005, RN

1,640 Posts

Specializes in LDRP.

CNM's suture perineal lacerations....

kachidekuyua

22 Posts

Specializes in industrial and hospital nursing.

I have done it before in a lacerated wound and during circumscision, but I was under Doctor's supervision and guidance.. I don't know about legalities but the doctor was the one who signed on the procedure I have done. I think I'm safe doing it...

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