Transcript Slide 1

Infusions & Injections
What You Should Know About Documentation
Carondelet Health Charge Compliance
(816) 655-5129
Stacie Cowell
7/17/2015
(816) 655-5267
Deb Malone
(816)655-5534
Deb Neece
IV Hydration
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IV Hydration is defined as a pre-packaged
fluid and electrolyte solutions.
 LR
 D5
½ NS w/ 20 meq KCL
 NS
 $300
for the first hour
 $150 each additional hour
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IV Infusions
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IV Infusions (IVPB) are defined as any
medication that has been mixed with a large
amount of dilutent, and hung to drip in at a
predetermined rate.
 Banana
Bag
 Antibiotics
 Other Piggy Backs
 $325
for the first hour
 $167.50 each additional hour
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IV Injections
An IV Injection can be defined as any
substance not being used as a flush, that
is pushed directly into the vein by a nurse
through a syringe.
 The nurse must actively monitor the IV
Push at the time of administration.
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IV Injections (cont)
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If medications are administered separately at
different times (e.g., 1015 and 1016) and
documented appropriately, then an IVP charge
may be charged for each administration.
If medications are documented as given at the
same time (e.g., 1015) or are given together in
the same syringe, only one IVP charge may be
charged.
 $80
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Each Time
Other Injections

Subcutaneous – SQ
 Lovenox,
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Neupogen
Intramuscular – IM
 Rocephin,
 $80
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Pain Medications, Anti-emetics
Each Time
Documentation
The “start time” is the actual time that the
medication or hydration actually started to
infuse, not when the IV is started.
 The “stop time” is the actual time that the
medication or hydration actually
stopped infusing, not when the
IV site was DC’d.
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Documentation
Ensure that you have clearly
documented if it was an IV Push (IVP) or IV
Piggyback (IVPB).
 If ordered IV or PO, ensure you have
documented which one you give.
 Documentation must prove the infusion /
injection was ordered, there is medical
necessity, and proof of administration.
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Documentation
Nurses must clearly document:
 the
name of the drug
 strength
 route of administration
 appropriate IV site
 time given
 and appropriate signature
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Documentation
Start times and stop times
are required for all IV infusions given.
This means the time the bag was hung or
the IVPB started and the time it was
completed.
Make it standard practice to enter the
start and stop times in order to receive
appropriate reimbursement.
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Documentation
A physician’s order “infuse over 1 hour” is not acceptable
as a start or stop time
Documentation that reads “Antibiotic infused over 1 hour” is
not acceptable as a start or stop time.
Use of an IV infusion pump is not a substitute for
documenting the stop time
Ensure that IV Piggyback (IVPB) and IV Push (IVP) modes
of administration are clearly differentiated
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You Must Document
Start Times When….
Hanging a New Bag
 Hanging Medications
 Returning From a Procedure
 Changing the Rate
 Restarting After a Delay
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You Must Document
Stop Times When…
Removing an Old Bag
 When the Patient Leaves for
a Procedure
 Delay in Therapy
 Changing the Rate
 When Discontinuing the
Medication
 When Saline Locking the IV
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Why Document?
It is required in order to be compliant with
Medicare rules and regulations.
 More MONEY for the hospital and your
unit.
 MONEY = Benefits = Happy Nurses

=
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Money Matters
Captured Charges
 Monthly
Averages
St. Mary’s
 $98,842
St. Joseph
 $219,225
 Total Monthly Average: $318,067
 Total
7/17/2015
Annual Average: $3,816,804
Money Matters
Average Monthly Lost Charges
 St.
Mary’s: $24,361
 St. Joseph: $50,860
Total:
$75,221
Total Average Annual Loss
$902,652
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Money Matters
Potential Earnings
 St.
Mary’s
Monthly:
$123,203
Annually: $1,478,436
 St.
Joseph
Monthly:
$270,085
Annually: $3,241,020
Total
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Annually: $4,719,456
Things to Remember
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Is there a written order?
Nurses must clearly document:
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the name of the drug
strength
route of administration
appropriate IV site (if more than 1 is present)
time given
and appropriate signature
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Document the stop time
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If giving two different medications, in separate syringes,
we may not be able to charge unless they are
documented at least 1 minute apart or given through
more than 1 documented IV site.
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Nurses Need to Remember (cont)
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Patients receiving a blood
transfusion:
 The blood transfusion is not an infusion
 If the patient is given an additional
Infusion / Injection, we can charge for it
as long as the documentation is correct
 It is required that we have start and stop
times for the blood as well.
 Blood Transfusions are billable services.
 Documentation of Normal Saline is
required.
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Questions
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Where can I document?
What if the IV goes bad?
Do I have to document on all
patients or just the ones with
Medicare?
What is the standard TKO rate?
Can I document ahead of time?
What are the legal implications
of not documenting?
Thank You!!!
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This information is complex and will take some
time to absorb.
If you have any questions please feel free to
contact any of the Charge Compliance Staff
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Stacie Cowell@ (816) 655-5129
Deb Malone @ (816) 655-5267
Deb Neece @ (816) 655-5534
Thank you for your time and attention.
7/17/2015