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

[FireStarterRN, BSN, RN]

We just got a memo that we are now required to both sign that we gave an IV antibiotic piggyback, and then put a stop time, otherwise Medicare won't pay. Another government mandated inconvenience, if you ask me.

What idiot is making up these rules? Talk about micromanaging! Why is the government trying to weasel out of paying for things, thus undermining healthcare facilities who provide vital services to the public? I thought the government was there for the common good! Our healthcare system is nutso.

[caroladybelle, BSN, RN]

I am hopng that this info is incorrect....I am working at a government facility and have heard nothing about that.

But on most Hemo/onco inpt units, it would be virtually imposible....given the huge amounts of IVPBs that we give and the patient load in most facilities.

Though it may be required in HHC or in outpatient clinics for the purpose of accurate billing. The amount that the patient is charged is dependant on time/length of infusion for visits in many places.

[morte, LPN, LVN]

perhaps this is a miscontruing of the need for a stop DATE?

[gonzo1, ASN, RN]

I was told that you must chart that the infusion is completed and no adverse reaction. Also that you must chart follow up to meds or they won't pay.

This is easy with my facilities electronic charting because I can go back into chart at any time, click on the med given and a list pops up that says things like --pain decreased--pain unchanged, md notified---infusion completed--no adverse reaction.

So for every IV I later pop into the chart and just click on "infusion complete and then on no adverse reaction" and I'm done.

At facilities with paper charting it is a lot harder to go back on each and every med.

It won't be long before they nickle and dime us poor RNs to death. will it?

[FireStarterRN, BSN, RN]

Here is what the memo said regarding the subject:

However Medicare/Medicaid are now wanting us to put start and stop time on any and all PIGGY BACK /ANTIOBIOTICS infusion. The start time is already on the MAR (that is the time you give the piggy back/antiobiotics). What we have to do immediately is that when your PIGGY BACK/ANTIOBIOTICS is finished you put the time you stopped it on the MAR ….so in other words if you have to give a Piggy back at 1000 and it last for one hour then you put STOP 1100.

[EmmaG, RN]

oh. my. God.

[cmo421]

Just another thing for us to remember to do. I bet any amount of money that 9/10 it will be missed or someone will be going back and filling in times and reaction data. What a waste. I am thinking no one in medicare has ever held a real health care job!

[amberfnp]

We just had an "IV infusion charges" class at our facility and we were told that yes, we must document start and stop times on ALL infusions. Not only for charge purposes, but also for complete documentation/liability purposes as well.

[NRSKarenRN, BSN, RN]

Patient safety issues at stake here along with billing.

In eons ago nursing before start/stop times of infusions, patients may have received infusions for 2-3 weeks when lengthly hospitalizaion as doc forgot to stop after 10-14 days. Having done QA, its troubling when infusion suddenly stops being signed off on MAR and no notation as to WHY or what patients reaction to therapy was.

Billing regs too:

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

http://www.kansasmedicare.com/part_A/manuals/handouts/quadrant_handouts_0307.pdf

[FireStarterRN, BSN, RN]

We just had an "IV infusion charges" class at our facility and we were told that yes, we must document start and stop times on ALL infusions. Not only for charge purposes, but also for complete documentation/liability purposes as well.

I see no logical rationale for this new requirement. What would make more sense is to assume that the infusion signed for was successfully given, unless otherwise noted. Similar to giving a PO med, if the patient refused or threw up his/her pill, then we note that.

[NRSKarenRN, BSN, RN]

Reminder: all posts in Med Savy forum require moderator review prior to appearing on bb.

We are attempting to keep all medication related questions in one area so we can disseminate info cohesively rather than being scattered over board.

[caroladybelle, BSN, RN]

This will be a BIG problem on hemo/onco floors.

Most of my patients have triple lumen centrals. Not including TPN/Lipids, or PCAs, I still may be giving 5 or more IV meds per hour on many of them....and I often have 2-4 acute pancytopenic patients at a time, not including other less critical patients