x-ray interpretation

[Jeremy G]

Nurse Practitioners ordering Radiological Studies and interpretation of such tests”

I have been researching a topic for quite sometime. I am from Georgia and have spent most of my nursing and NP career in orthopedics. I am also a Certified Surgical First Assistant (CSFA) and love working in the OR with ortho cases. I am blown away that current Georgia law mentions that I cannot interpret a simple orthopedic X-ray when the law clearly states that I can order an X-ray. I don't have a problem with the law not allowing me to interpret an MRI (but I can read knees and shoulders quite well) just saying. My current practice has never hire an NP and I am new to them. I do the same PA job role and there are questions that come up about billing for interpreting X-rays. Currently, what I do is see a patient, order x-rays, interpret them, and then develop a plan of care. When I dictate my exam I interpret the x-ray in my note and then enter the phrase Today's x-rays were reviewed with Dr. XYZ.” You get the point. So, then next is how to bill this. I don't see anything wrong with me dictating the interpretation when I put reviewed with my MD.” Which reviews most of my charts anyway. The way I understand coding is the E&M will be billed under the NP's npi# and the technical component gets billed with the MD npi#. Is this correct?

Also, from my understanding this is the same scenario for the PAs. Correct? If so, then all midlevels in our office should add the phrase Today's x-rays were reviewed with Dr. XYZ”.

Also, why would there be hundreds of accredited NP CMEs that are about Interpreting Radiological Studies” if APRNs and not allowed to interpret these”. Not sure how AANP or ANCC can authorize and accredit a company offering a course that is not within the APRN scope of practice?

Also, what is the ONCB doing about advocating for APRNs who are certified in the Orthopedic Specialty? I was actually ONC certified but let it expire. I do plan to take the ONP-C eventually. However, this and other certifications need to be more than just an accomplishment”. They need to affect change in scope of practice and mean something to our State Boards and Insurance companies.

These are some statements from the Georgia Composite Medical Board on the Nurse Protocol Agreement:

(3) Identify the parameters under which delegated acts may be performed by the advanced practice registered nurse, including without limitation the number of refills which may be ordered, the kinds of diagnostic studies which may be ordered, the extent to which radiographic image tests may be ordered, and the circumstances under which a prescription drug order may be executed. In the event the delegating physician authorizes the advanced practice registered nurse to order an X-ray, ultrasound, or radiographic imaging test, the nurse protocol agreement shall contain provisions whereby such X-ray, ultrasound, or radiographic imaging test shall be read and interpreted by a physician who is trained in the reading and interpretation of such tests; a report of such X-ray, ultrasound, or radiographic imaging test may be reviewed by the advanced practice registered nurse; and a copy of such report shall be forwarded to the delegating physician, except that such provision for an ultrasound shall not be required for an advanced practice registered nurse acting within his or her scope of practice as authorized by Code Sections 43-26-3 and 43-26- 5;

(9)"Life-threatening" means an emergency situation in which a patient's life or physical well-being will be harmed if certain testing is not performed immediately.

(10) "Nurse protocol agreement" means a written document mutually agreed upon and signed by an advanced practice registered nurse and a physician, by which document the physician delegates to that advanced practice registered nurse the authority to perform certain medical acts pursuant to this Code section, and which acts may include, without being limited to, the ordering of drugs, medical devices, medical treatments, diagnostic studies, or in life-threatening situations radiographic imaging tests. Such agreements shall conform to the provisions set forth in subsection © of this Code section.

(11) "Order" means to prescribe pursuant to a nurse protocol agreement which drug, medical device, medical treatment, diagnostic study, or in life-threatening situations radiographic imaging test is appropriate for a patient and to communicate the same in writing, orally, via facsimile, or electronically.

(15) "Radiographic imaging test" means a computed tomography, magnetic resonance imaging, positron emission tomography, or nuclear medicine.

I appreciate any comments as there is always much to learn about scope and billing ethics.

Jeremy G., MSN, ANP-BC, RN, CSFA

[Jules A, MSN]

You need to get in touch with your state NP organization's lobbyist. In my experience the state organizations can have tremendous power. Hopefully Georgia is one of the states with organized, motivated NPs.

[core0]

here is the direct quote from the rule:

"If the delegating physician authorizes the APRN to order an X-ray, ultrasound or radiographic imaging test, the nurse protocol agreement shall contain provisions whereby such tests shall be read and interpreted by a physician who is trained in reading and interpretation of such tests and provide that a copy of such report shall be forwarded to the delegating physician. However, such provision for an ultrasound shall not be required for an APRN acting within his or her scope of practice as authorized by Code Sections 43-26-3 and 43-26-5;"

This doesn't exist in the PA practice act so doesn't apply. I would check with either the board of nursing or the NP organization United Advanced Practice Registered Nurses of Georgia

on how the rule is interpreted. One way is the final product (ie the final report) has to be done by a physician. It doesn't prevent you from looking at and acting on a preliminary version. In the hospital for example we act on CXR and don't have to wait for the read. To bill the final read has to be done by a radiologist and we are not allowed to perform a final interpretation or bill for the interpretation.