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Infusions & Injections What You Should Know About Documentation Carondelet Health Charge Compliance (816) 655-5129 Stacie Cowell 5/25/2017 (816) 655-5267 Deb Malone (816)655-5534 Deb Neece IV Hydration 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 5/25/2017 IV Infusions 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 5/25/2017 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. 5/25/2017 IV Injections (cont) 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 5/25/2017 Each Time Other Injections Subcutaneous – SQ Lovenox, Neupogen Intramuscular – IM Rocephin, $80 5/25/2017 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. 5/25/2017 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. 5/25/2017 Documentation Nurses must clearly document: the name of the drug strength route of administration appropriate IV site time given and appropriate signature 5/25/2017 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. 5/25/2017 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 5/25/2017 You Must Document Start Times When…. Hanging a New Bag Hanging Medications Returning From a Procedure Changing the Rate Restarting After a Delay 5/25/2017 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 5/25/2017 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 = 5/25/2017 Money Matters Captured Charges Monthly Averages St. Mary’s $98,842 St. Joseph $219,225 Total Monthly Average: $318,067 Total 5/25/2017 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 5/25/2017 Money Matters Potential Earnings St. Mary’s Monthly: $123,203 Annually: $1,478,436 St. Joseph Monthly: $270,085 Annually: $3,241,020 Total 5/25/2017 Annually: $4,719,456 Things to Remember Is there a written order? Nurses must clearly document: the name of the drug strength route of administration appropriate IV site (if more than 1 is present) time given and appropriate signature Document the stop time 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. 5/25/2017 Nurses Need to Remember (cont) 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. 5/25/2017 Questions 5/25/2017 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!!! 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 Stacie Cowell@ (816) 655-5129 Deb Malone @ (816) 655-5267 Deb Neece @ (816) 655-5534 Thank you for your time and attention. 5/25/2017