Down-coding IV

[hmorrison]

Hi! We are having an ongoing discussion in our hospital regarding the down-coding of an IV (without documented start/stop times) to an IV push. Does anyone know of a precedent in this regard, and/or can anyone advise as to their current practice (and how you came to whatever decision you've made)? Thanks in advance!!

 

[OCD_coder]

Yes, if the stop time is not documented you code a push. Then provide education to the nurse who performed the documentation/infusion of the revenue loss.

This has been the policy as every oncology practice and ER facility I have been involved with.

 

[lsolway]

If the MAR says- Route : Intravenous - but no stop time, you would code it as a push, even though documentation states Intravenous? I was doing that, then spoke with our consultant that said "push" would need to be documented to code it... unless of course the stop time was documented at < 16 minutes.

 

[SharonCollachi]

AAPC Has an article here that states, in part:
Time Requirements: One of the biggest obstacles when coding drug administration is the common lack of documentation; start and stop times must be clearly and completely documented in the medical record by the clinician. The start time is normally well documented, but the stop time is quite often omitted. Check with your payer to see their requirements for these situations; some will accept a code for an IV push even if a stop time is not documented, while others will not. In general, an IV push code may be used for an infusion lasting 15 minutes or less (again, check with your payers for clarification). In drug administration terms, “one hour” means any infusion lasting between 16 and 90 minutes. Only when an infusion lasts longer than 90 minutes can you code the “additional hour” code. “Each additional hour” means increments greater than 30 minutes over the initial hour. Do not include time spent keeping veins open (see Table 3 for examples).

 

[thomas7331]

I've worked for employers that have done this both ways. I think there is a valid argument to support either way, and have not seen an authoritative source that specifically says it must be one or the other, so I think it's a policy that every practice needs to decide for themselves. My own opinion is that if the documentation clearly shows that the drug was in fact administered and given via IV route, coding a push is supported (although I also agree that it's important that education and feedback be given to get this corrected). I'm not sure how a payer could legitimately argue that if the drug was actually administered, that there should be no administration charge paid at all simply because the stop time was not recorded.