Start and Stop Times need to be recorded in infusion administration
One of the issues coding professionals face when coding for infusions and drug administration is the absence of start and stop times.
According to the Centers for Medicare & Medicaid Services (CMS) Transmittal 902, hospitals are to report codes that indicate the actual time in which an infusion is administered to a beneficiary. If the start and stop times are not recorded, which happens more often than we desire, then the coder is often forced to code an IV push.
The financial impact of this default code may be of importance, especially in organizations that specialize in high-cost, chemotherapy-related anti-neoplastic infusions.
Nurses are asked to be more diligent with recording their times.In addition to the medication record or nursing notes reflecting the start and stop times, there are some other acceptable documentation approaches allowed, according to Medicare?s Part A?s Job Aids & Manuals ? Coding for Drugs and Biologicals, including:
- Record/notes indicating length of infusion after the infusion is completed;
- Record/notes indicating rate of infusion and quantity infused after the infusion is completed;
- Record/notes indicating pump times/settings and amounts infused after the infusion is completed; and
- Record/notes that enable a reviewer to accurately determine the length of time an infusion ran after the completion of the infusion.
However, these alternatives are often targets when external auditors review encounters, since they will focus their attention on how the infusion actually ran not how it was supposed to run.
To successfully achieve the documentation required, organizations should at least consider three options:
- The first option is that hospitals bite the bullet and hire infusion nurses. They start all infusions and document the start and stop times. Considering the money the hospitals are losing, they can afford infusion nurses, and they should pay them more than the regular nurses.
- The second option is to purchase infusion pumps that electronically populate the documentation and time in your electronic health record (EHR).The important thing here is to make sure that the pump technology fully integrates with the EHR.
- Assess a unique use of scribes that may be beneficial in this situation.
- The entries need to be made while both the scribe and nurse are present with the patient.
When physicians use scribes, the physician must review and sign off on the documentation created by them. This implies that the nurse attending the patient would be required to review the documentation for accuracy and sign off on the scribe?s start and stop times. If the standard operating procedure provides for nursing confirmation with documentation support from the scribe, the use of scribes may be the solution to a major coding and financial challenge.