Infusions & Injections

1. Infusions & Injections What You Should Know About Documentation Carondelet Health Charge Compliance (816) 655-5129 (816) 655-5267 (816)655-5534Stacie Cowell Deb Malone Deb Neece

2. 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

3. 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

4. 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. IV Injections (cont) • Ifmedications 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 sametime (e.g., 1015) or are given together in the same syringe, only one IVP charge may be charged. • $80 Each Time

6. Other Injections • Subcutaneous – SQ • Lovenox, Neupogen • Intramuscular – IM • Rocephin, Pain Medications, Anti-emetics • $80 Each Time

7. 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.

8. 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.

9. Documentation Nurses must clearly document: • the name of the drug • strength • route of administration • appropriate IV site • time given • and appropriate signature

10. 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.

11. 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

12. You Must Document Start Times When…. • Hanging a New Bag • Hanging Medications • Returning From a Procedure • Changing the Rate • Restarting After a Delay

13. You Must DocumentStop 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

14. 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 =

15. Money Matters Captured Charges • Monthly Averages • St. Mary’s • $98,842 • St. Joseph • $219,225 • Total Monthly Average: $318,067 • Total Annual Average: $3,816,804

16. Money Matters Average Monthly Lost Charges • St. Mary’s: $24,361 • St. Joseph: $50,860 • Total: $75,221 • Total Average Annual Loss • $902,652

17. Money Matters Potential Earnings • St. Mary’s • Monthly: $123,203 • Annually: $1,478,436 • St. Joseph • Monthly: $270,085 • Annually: $3,241,020 • Total Annually: $4,719,456

18. 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.

19. 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.

20. Questions • 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?

21. 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.