Podiatrists may perform procedures related to their scope of practice as defined below:
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To everyone that wants to throw the typical SDN cold bucket of water on someone for doing something above and beyond what is necessary in podiatry, I would just ask you to consider that the only way the profession evolves/advances is by a mechanism similar to this.
To the OP, I commend you for reaching to the limits of the scope of practice (or perhaps even challenging it) and advancing your own knowledge and capabilities.
Here’s some commentary and advice:
1. Doing an NCV study is probably in scope in almost every state. This is a non-invasive test.
2. Doing an EMG is probably in scope in most states with a treatment-based law as long as you’re using it to diagnose a problem that is in scope. There might be some specifics here, since it is an invasive test. In some states, you might even be justified in adding upper extremity EMG and NCV as long as you’re ruling out a systemic neuropathy vs one localized to the lower extremity.
3. I don’t know that a state board will give you any valuable information and could only harm you. State boards are mostly precedent-driven if something is not clearly spelled out in the law. What that means, is that they can only really respond with a clear answer if the state board has previously ruled on a complaint related to a similar issue. Therefore, if you ask for an answer in writing, you will either get something nebulous or even harmful, even though it would technically be in-scope. I recommend not asking the state board officially and instead just back channel with someone on the board and let them know what you’re doing and your rationale. Based on what I read in VA (and I was actually once licensed there), I would feel comfortable with performing the NCV and EMG.
4. When I was in residency in NY, we actually convinced my director Dr. Michael DellaCorte to buy an NCV-only device. We learned how to use it by watching a DVD (it was 2005) in DellaCorte’s basement and practiced on each other. DellaCorte and I tested each other’s tibial nerve with a shock intensity of 3 (which was ridiculously painful). But we held it together. Then when Nick Bevilacqua wasn’t looking, we set it to 10 and tested him. I think you could hear the scream at the neighbors’. So be careful with sensate patients! We used the device a lot in practice.
5. Just because you have the scope and knowledge, doesn’t mean you’ll actually get paid for the codes. DellaCorte got rejected on about 50% of his claims. Some payers restrict certain codes by specialty. So make sure to do prior auths although “Prior authorization is not a guarantee of payment.” (Who doesn’t love that phrase!!)
So … keep advancing brother (or sister)
And this how an Aussie would do it, colorful language included:
