Stop times for IV piggybacks now required on MAR?(by Medicare)

IV DOCUMENTATION/TIME

Q1) If an IV infiltrates in the middle of an infusion, there will be two
start/stop times. Which set of start/stop times is used to determine

the time of the infusion?

A1) For documentation purposes, both the start (start time before and

after the IV infiltrates) and stop times (stop times when IV infiltrates
and at the conclusion of the infusion) should be recorded.
When billing an infusion administration service, the provider should
add the total time the IV was infusing (excluding the time between the
infiltrate and the restart) to determine the appropriate code(s).
For example, an IV begins infusing at 9:00 a.m. At 10:00 a.m. the
site infiltrates and the IV infusion is restarted at 10:30 a.m. The IV
continues to infuse until 12:30 p.m.
The total time of this infusion would be 3 hours (1 hour from 9:00
a.m. to 10:00 a.m. plus the 2 hours after the IV infusion is restarted
(10:30 a.m. to 12:30 p.m.). The facility would not bill for the 30
minutes from when the IV infiltrated to when it was restarted.
(1/2006)

Q2) In our medication administration and clinical pharmacy process, the IV

piggyback medications have an administration time noted on the bag
and all of our IV medications are administered via a pump so the
infusion time is very prescriptive and controlled. Will this meet the
documentation requirement if the nurse notes on the Medication
Administration Record (MAR) the actual start time and that the MAR
notes the prescribed rate (i.e. “infuse over 30 minutes”)?

A2) Per CMS IOM 100-4, Chapter 4, §230 Hospitals are to report codes

according to CPT instructions. CPT instructions are to use the actual
time over which the infusion is administered to the beneficiary for
time-specific drug administration codes. This would indicate hospitals
should not include their reporting time that may elapse between
establishment of vascular access and initiation of the infusion.

Wheatlands Administrative Services 10

A CMS Contracted Intermediary

It is this intermediary’s interpretation that the actual infusion

start and stop times should be documented.

CPT ASSISTANT November 2005 states:

Initial IV infusion codes 90760, 90765, 96413 are reported for initial
infusion whish is greater than 15 minutes up to 1 hour. 90761,
90766, 96415 may be used to report infusions that are at least 30
minutes beyond the initial hour.
(update 3/2007)

Q3) For an injection that takes one minute, is the start/stop time still

required?

A3) CPT instructions state that the actual time is required only when the

infusion time is a factor in the CPT descriptor.
(updated 3/2007)

Q4) If a patient is receiving an IV infusion for hydration and the stop time

is not documented in the record, how should that be coded?

A4) If the medical record clearly indicates that IV fluids were initiated and

infusing (e.g. nurses notes indicate bag is infusing), then it would be
appropriate to submit CPT code 90760 (Intravenous infusion,
hydration, initial)
It would not be appropriate to bill this service using CPT code 90774
(Therapeutic, prophylactic or diagnostic injection (specify substance or
drug) intravenous push, single or initial substance/drug). Added 3/2007