Cardiology Coding Alert

Question: I just read the article "3 Steps Will Bolster Your Supervision Level Know-How" in the December 2006 Cardiology Coding Alert. The "Step 3" portion stated that basically the supervision requirements pertained only to techs/nurses. If an NP or PA were to perform a diagnostic test, as long as it was within their scope of practice, am I correct to interpret that there are no supervision requirements?

Maine Subscriber

Answer: According to Medicare rules, nurse practitioners (NPs), clinical nurse specialists (CNSs) and physician assistants (PAs) may not function as supervisory physicians under the diagnostic tests benefit.

Example: If your cardiologist is out of the office, your NP cannot perform a stress test (93015, Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; with physician supervision, with interpretation and report).

But when these practitioners personally perform diagnostic tests as provided under §1861(s)(2)(K) of the Act, the supervision rules do not apply, and they may perform diagnostic tests pursuant to state scope-of-practice laws and under the applicable state requirements for physician supervision or collaboration.

You Be the Coder and Reader Questions were prepared with the assistance of Jim Collins, ACS-CA, CHCC, CPC, CEO of the Cardiology Coalition and compliance manager for several cardiology groups around the country; and reviewed by Jerome Williams Jr., MD, FACC, a cardiologist with Mid Carolina Cardiology in Charlotte, N.C.