PICC Lines in Radiology


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2 Posts

I was curious about current medicare reimbursement standards involving PICC line insertion. I am a RA in Texas if some of you are unfamiliar with the acronym (its relatively new) it stands for Radiologist Assistant and its an advanced practice designation of Radiologic Technology. It requires a Masters in radiology, a minimum of 500 invasive and noninvasive procedures ranging from tunneled dyalisis catheter insertion to myelograms with competency being determined by attending radiologist. There are many other educational requirements that I will not bore you all with. It appears that with my educational background I am beyond my scope in the eyes of medicare at least in regard to reimbursement for PICC insertion. I am not trying to pick a fight, I promise. Scope of practice is not deffinative as to what a individual has the knowledge or abillity to do safely. It is beuacratic hyperbolle and nothing more. One of the posters mentioned injecting IV contrast pre-flouro, don't do that if the catheter was extra-luminal it would be a big blob not a venous map, waiting until flouro is available would be much more beneficial and less risk to the patient. I also noticed a few people mention technologist were present because they knew how to run the imaging equipement. That is true but more importantly because they are licensed utilize intentionally generated radiation for medical purposes. Nursing is one aspect of medicine its important that all the others are also respected we are all on the same team. I have the utmost respect for RN's and sincere love for your dedication which is most likely why I married one. Thanks A P


369 Posts

When a RN places a picc line they can not bill for the proffesional aspect of the procedure. Currently only MD/DO/NP/CNS/PA can get a NPI which is used for billing for the proffesional component. The facility may be able to capture the technical fee I am unsure about that though.

Many places can save $$ by having a RN place a PICC line espeially for long term needs. Having to replace IVs every 72 hours or more frequent eats up a lot of time and supplies.

There are some RA programs that are still a post bac level but most are going to graduate level education.



2 Posts

J, thanks for the insight on reimbursement . I freely admit medical reimbursement is not my strength. The clarification that your explanation provided in some respects created questions in other respects. I know of many PICC agencies that are comprised solely of RN's. In a hospital setting the argument could be made that the RN is working under a physicians license. That is not the case with agency PICC services the RN's function as independent practitioners. The Board of Nursing indicates that PICC insertion is within a RN's scope of practice. Ethically speaking should the Nursing board contradict the department of health and human services designation of who is licensed to safely place PICC lines. A hospital cannot bill for technical cost in a procedure performed by a Non-licensed person (non-licensed refers to medicares policy for professional charges). If a hospital charges specific technical fees for a Professional service they have to have the qualified professional doing the procedure. I have a very good friend that does pick lines full-time with a agency he is a RN. Last year he made 120,000 logically It doesn't make sense that the hospital will happily pay very good money for a service that they are not going to bill to medicare. Seems like a fraud bomb just waiting to happen. While PICCS are realitively safe procedures they do indicate enough risk to required the patient be given informed consent. Currently a RN is not licensed to obtain informed consent in Texas, how is this obvious impossible situation resolved without a MD, DO, etc. present. Even if they were available I doubt many would get consent for a procedure that they were not performing. Thanks Everybody Happy Holidays.



11 Posts

Specializes in A little of every kind of nursing.

HELLO, I realize this might be an old topic but I am a radiology Nurse In Oklahoma and the hospital just introduced the idea of making me the PICC placement nurse also. I am thinking, is this a full time job? Should I be certified or just trained. What would be the responsiblities under this title? Could you give me some insight please?


2 Posts

Of course it's a real job. A radiologist is a physican who specializes in the interpretation of medical images such as MRI scans, CT scans, x-rays, nuclear medicine scans, mammograms and sonograms. They are specially trained to identify injury and disease in each of the body's systems, whether bone, tissue, organs or blood vessels. Radiologists may specialize in fields such as neuroradiology, angiography, cardiovascular-interventional radiology, pediatric radiology or nuclear medicine. It is not the same as a rad tech! Pleasanton Radiation Oncologist.

rkealy, BSN

45 Posts

Specializes in CCRN BSN Student FNP. Has 25 years experience.

I know in my hospital the only people doing bedside and IR piccs are the CV RAD techs hmm...anyone else heard of this?

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