Required IV documentation for Reimbursement?

[crobe79526]

I am a clinical coordinator on a med/surg unit and a co-chair of our Professional Development Council in our hospital. We currenlty use McKesson for our computerized charting (which I'm sure is not being utilized in the correct way). Currently our nurses chart IV's in 3 different areas, which become a pain and compliance is decreasing. I recently discovered that not all the units in the hospital chart their IV information the same and I'm looking into making changes and I need HELP!!!

I was wondering if anyone knows the IV documentation requirements from Joint Commission and CMS that are required to get documentation? Or If you have McKesson can you tell me how your nurses are documenting?

Thank you,

C

[Reno1978, BSN, RN]

We use McKesson and on the patient assessment screen there is a section for IV Access/Lines that we use to document where IVs, Central Lines, Arterial Lines, Sheaths are, their condition, interventions, etc.

[d'cm]

What I think you may be referring to is Interqual criteria (which is owned by McKesson). This is medical necessity criteria based on Severity of Illness (SI) and Intensity of Service (IS). IVs are typical IS. It depends on what is in the IV and or how often it is given that determine if IS is being met. Insurance companies (including CMS in rare retrospective review) however are using Milliman more than Interqual. The Joint regs have nothing to do with reimbursement per se.

[3rdcareerRN]

Medicare reimburses based on diagnosis-related group, rather than on individual charge items for a patient (such an IV catheter). ( see http://www.cms.hhs.gov/AcuteInpatientPPS/01_overview.asp ) So I am not sure you are pursuing a question that has a direct answer.

You might clarify with the hospital's revenue-cycle / billing department, specifically the coding supervisor. That person should be able to answer any medication-specific reimbursement question and what documentation is required. After all, the coder must ensure the item is documented in the medical record before it can be coded for reimbursement.

However, as an informatics person, I applaud your efforts to standardize how the EMR is used.