Wiki NPP Nurse Practioner Licensing

[tera828@yahoo.com]

Is it within Licensing Guidelines for a NPP (PRNA) to interpret & sign off on 51798 PVR Bladder Scan (technically a radiology code) when NO Physician in office performed by back office (LPN/MA) for diagnostic purposes in office? Is this something that will be denied in an audit and is it billable this way?

 

[thomas7331]

Nursing scope of license is determined by state law, so you would need to look at your particular state's nursing regulations and/or contact your local state board of nursing to get the answer to this question. Also, specific payers may have reimbursement policies as to what codes they will pay to certain provider types, although I believe that the government payers will align with the state requirements.

I would note, however, that this particular code, although it does make use of radiological technology, is a simple measurement of bladder volume and is not an imaging study that requires interpretation skills. On the Medicare fee schedule, 51798 is a technical component only code, so the reimbursement is entirely for the practice's cost of test itself and not for the interpretation, so I don't believe there should be any issue with this being billed by any provider type.