Wiki Risk Level Of IV Push/Infusion - MDM

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sdifuh278652

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Hello,

Does the level of risk in MDM of an IV push or IV infusion vary from drug to drug? Or is it high risk every time?

For example,

IV push/infusion of Lasix (not a scheduled drug) - high risk

IV push/infusion of Ativan (Schedule 4 drug) – high risk

IV push/infusion of insulin (Schedule 4 drug) - high risk

IV push/infusion of fentanyl (Schedule 2 drug) - high risk

Parenteral controlled substances are listed as high risk in MDM, so any drug not administered through the alimentary canal could be considered high risk in spite of the risk or morbidity or mortality of the drug itself. According to IV Push Medication Administration: Making Safe Choices; Choosing Best Practice - Journal of Emergency Nursing, “The significant risk for patient injury and death related to IV medication errors is well known.”
 
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Hi there, the risk is going to vary based on the patient's condition and the drug used. The treating provider must "show their work" (MDM) in the note. That includes for parenteral controlled substances, even though the chart lists them as an example under high risk. From the CPT Manual:

Parenteral controlled substances: The level of risk is based on the usual behavior and thought processes of a physician or other qualified health care professional in the same specialty and subspecialty and not simply based on the presence of an order for parenteral controlled substances.
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Therefore it is not accurate to say the designation of one type of parenteral drug as potentially high risk means all parenteral drugs are high risk.

If a provider's documentation isn't clear, the coder needs to go back to the provider. If the provider's documentation is consistently lacking in detail, that's a call for more training.
 
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Hello, thank you for your reply. What about drugs that are on the high alert list? If they are administered at less than, equal to, or greater than the typical dose, could that automatically be high risk? "Parenteral controlled substances" as per the CPT guidelines include all drugs, and like you said, some could be low, moderate, or high risk. Would high alert drugs be at least moderate risk, if not high risk, every time? https://www.ismp.org/sites/default/files/attachments/2018-08/highAlert2018-Acute-Final.pdf If they are on a list for high alert, wouldn't we as coders default to high risk whether on IV push, infusion, or by pill, automatically?
 
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Hi, to keep things simple: The provider must document the risk. The idea of a coder automatically defaulting to any specific level of risk without supporting documentation from the provider isn't supported by any guideline or policy I've seen.

Also I will point this out:

Parenteral controlled substances" as per the CPT guidelines include all drugs
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This example specifically mentions controlled substances. That is not "all drugs."
 
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