Health Information Management

Tip of the week: Don't make assumptions about duration for drug infusion therapy

APCs Insider, May 2, 2008

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When it comes to drug infusion therapy, it is not acceptable to make assumptions about duration solely based on the method of administration, what you know about the duration of the infusion, or the medical efficacy or safety of administration time or methods. This holds true even for drugs that are given as infusates.

Without an explicit stop time, an outside reviewer may not be able to validate what you know about certain drugs and methods of administration from a clinical perspective. Official sources consider it a best practice to have start and stop times. With this information, a reviewer would be able to definitively validate the duration time for infusions.

You may be able to make the case that you can only infuse certain drugs for a specified period of time. However, without a stop time, how can a reviewer know whether it was a short-duration infusion or an infusion greater than 90 minutes (in which case you would be allowed to report the additional hour code)? Without a stop time on the record, the reviewer could argue that the infusion was stopped early and is not allowable for that code set. Our recommendation is to have clearly documented start and stop times for all infusions.

(The above tip was excerpted from the April issue of APC Answer Letter)



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