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Thread: Physician orders or protocol required?

  1. #1

    Question Physician orders or protocol required?

    AAPC: Back to School
    Same story as many...I'm new to oncology. I'm in an outpatient setting.

    1. Does the administration of two drugs to be be infused concurrently (96368) require physician orders documented in the chart? Or, if it can be based off a protocol, should a copy of the protocol be found in the patient's chart?

    2. Same questions for the "mainline" of Normal Saline or D5W (or any other soln used as a "mainline" I suppose) to TKO while the drugs are infusing.

    I am looking at chart documentation and it looks like the nurses just know what to do. There are no physician orders or protocols to be found. ???

  2. #2
    Join Date
    Apr 2007
    Bettendorf, IA


    The number one rule of coding and billing is make sure your charges match documentation. If there's no signed order from the physician in the chart for that specific day of that specific treatment, the treatment shouldn't happen. Before charging anything out, require the docs to provide orders and protocols.
    All administration of drugs should follow what's been ordered by the physician, so drugs being infused concurrently should only be done so if that's how the doc ordered them. The mainline of normal saline should be written into the protocol/order as well. You can't charge for the time the saline is running while other drug is being given, however if there's hydration being given before or after the drug admin, and the saline that's being given alone has been ordered to be given as hydration, you can charge for your hydration time.
    Whatever you do, require documentation for everything!

  3. #3


    So let's say the nurses documents start/stop times, the drugs administered and how much in the chart notes, we are still supposed to check the physicians orders on top of the documentation? I just started coding for infusion and find it so time consuming, so I am double checking here to see what others have to say. I would think checking the orders to ensure the nurse is following the physicians orders on every infusion service is a compliance issue between the nurses and the physician, and should not be required for the coder, but my manager say's otherwise so I am taking so long to code. Any insight would help.


    Dana CPC

  4. #4
    Join Date
    Apr 2007
    Columbia, MO


    Standing orders must be signed by the physician and a copy in the chart, it should not be that hard to find it in the chart. In the infusion unit we had the nurses reference the date of the order in their notes so everyone knew which set of orders they were following and for what diagnosis, especially thoses with mulitple metastisis and treatments. Then we could flip back tothat date and verify the order. So all of the infusions would begin with ... Per physician order of xx/xx/xx patient here for treatment of xxx.xx.

    Debra A. Mitchell, MSPH, CPC-H

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