Documentation for IV Fluids

debra.stewart@halifaxregional.comdebra.stewart@halifaxregional.com
in CDI Talk Archive
I have been asked from our outpt coder to please have Providers document the reasons for iv fluids. We have not had to query for this before. With DRG payments, etc. is there a need to query for iv fluids? I know some are stated like dehydration, renal failure, chf w/restrictions, but they are asking for ALL iv fluids to have the providers state specifically why they ordered it. Any help/thoughts are appreciated on this.

Comments

  • rmhosler1rmhosler1
    edited May 2016
    This is not the practice at our institution. I am anxious to see what
    others say.



    Mary A Hosler MSN, RN
    Clinical Documentation Specialist
    Alumnus CCRN
    McLaren Bay Region
    1900 Columbus Ave.
    Bay City, Michigan 48708
    (989) 891-8072
    mary.hosler@mclaren.org
  • Unknown
    edited May 2016
    good morning what a dumb question
  • tpeytontpeyton
    edited May 2016
    this is not something we do

    Tracy M Peyton RN, CCDS
    Bradford Regional Medical Center
    Upper Allegany Health Systems
    116 Interstate Parkway
    Bradford, PA 16701
    814-558-0406
  • laura.bohls@prairielakes.comlaura.bohls@prairielakes.com
    edited May 2016
    I’m sorry but I can’t let that comment go. This is supposed to be a forum where we can ask others for help/opinions. When you send comments like that it might make a person regret asking for help. If you don’t have anything constructive to add, maybe don’t add anything. I know in the past I had posted a question and a couple of the responses I received made me feel like it was a stupid question and it took me a long time to post again.

    Laura Bohls, RN CDS
    Prairie Lakes Hospital
  • tpeytontpeyton
    edited May 2016
    Laura thanks for saying that...I have had the same thing happen to me before.



    Tracy M Peyton RN, CCDS
    Bradford Regional Medical Center
    Upper Allegany Health Systems
    116 Interstate Parkway
    Bradford, PA 16701
    814-558-0406
  • lsipos@monument.healthlsipos@monument.health
    edited May 2016
    Laura

    Amen…..some of our programs are in their infancy and we look here for guidance-not knowing what rules we are often relegated by-or what standards other institutions are in practice with. ☺

    Juli Bovard RN CCDS
    Rapid City Regional Hospital
  • kbenson@uwhealth.orgkbenson@uwhealth.org
    edited May 2016
    Agreed. Come on people...
  • rmhosler1rmhosler1
    edited May 2016
    I actually thought he meant it was stupid for the coders to ask the question. If that wasn't the case, then I am very disappointed.



    Mary A Hosler MSN, RN
    Clinical Documentation Specialist
    Alumnus CCRN
    McLaren Bay Region
    1900 Columbus Ave.
    Bay City, Michigan 48708
    (989) 891-8072
    mary.hosler@mclaren.org
  • debbie.kooledebbie.koole
    edited May 2016
    Actually, there is a reason to address the need for IVF. Outpatients (ED and OBS) are billed for each hour of fluid and each injection, if they aren’t part of the procedure. Denials are based on necessity or lack of documented necessity. I used to have to add up all of the hours and number of injections for the hospital OBS patients. It was a nightmare. I never worried about necessity, but I did hear about it from the ED billers and the denial people.

    Debbie Koole RN, MBA, MSN, CDS
    602 870-6060 Ext 6803
    602 320-6564 Cell
  • yuliyafishyuliyafish
    edited May 2016
    Would this be helpful?
    http://www.cgsmedicare.com/kyb/pubs/news/2012/0512/cope18821.html

    We are not reviewing outpatient yet, so no direct experience.
  • rmhosler1rmhosler1
    edited May 2016
    I don't think my comment came out how it was meant and wish to apologize. There are no stupid questions from anyone, in my opinion. Just to clarify.
  • katysuegood@gmail.comkatysuegood@gmail.com
    edited May 2016
    This is what I was thinking. You said this was an OUTPATIENT coder, correct? I am assuming she is asking you to query for OUTPATIENT records? Makes sense to me then. I don’t have any experience with OP and we do not review these records but it’s my understanding they need an indication as well as start/stop times.

    Katy Good, RN, BSN, CCDS, CCS
    Clinical Documentation Program Coordinator
    AHIMA Approved ICD-10CM/PCS Trainer
    Flagstaff Medical Center
    Kathryn.Good@nahealth.com
    Cell: 928.814.9404
  • debra.stewart@halifaxregional.comdebra.stewart@halifaxregional.com
    edited May 2016
    Yes it was an OP coder, but she said for all charts, but just got and email from her clarifying only OBS patients, we do not review out patient charts, so I’m still confused, does it need to done for OBS also?


    Debra Stewart RN, BSN
    Clinical Documentation Specialist
    Sentara/Halifax Regional Hospital
    South boston, va. 24592
    (434)-517-3317 Work
    (434)-222-9884 Cell
  • debra.stewart@halifaxregional.comdebra.stewart@halifaxregional.com
    edited May 2016
    Thank you all for your responses and the instance support, and about the question and first response, and thanks for the apology!! I was getting a little worried here!! Because I do need help like most of us in this job with all the new documentation requirements coming at us!! I was not at all trying to imply the coder was stupid or asked a stupid request either!! After all we are in this together: CDS, Coders. I figured it had to be a reason to address the need, but I just don’t understand All of a Sudden why? Been doing this for 4 years here and have never queried for that. Thank you Debbie for your reply, I had heard that too. We have not been reviewing all OBS, OP charts so now we are trying to see OBS and I guess this is why she asked us to look at this. So it seems the consensus is that most of CDS do not query for IV fluids reasons to be documented, because actually with most of our In-Patients we would have to query on 80% or more for the provider to document reason for fluids. The coder stated she did not always know why fluids were given other than if they documented dehydration-she is not medical.

    Debra Stewart RN, BSN
    Clinical Documentation Specialist
    Sentara/Halifax Regional Hospital
    South boston, va. 24592
    (434)-517-3317 Work
    (434)-222-9884 Cell
  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    edited May 2016
    IV fluids do not affect the MS-DRG assignment as IV fluids are not a procedure affecting DRG assignment. (Could, however, help a CDI uncover a condition such as shock or ARF).

    As several stated already, reason for IV fluids are pertinent in the outpatient setting. Coding of infusions and injections is very, very detailed in regards to start/stop times, units, indications, et al.



    Paul Evans, RHIA, CCS, CCS-P, CCDS

    Manager, Regional Clinical Documentation & Coding Integrity
    Sutter West Bay
    633 Folsom St., 7th Floor, Office 7-044
    San Francisco, CA 94107
    Cell: 415.637.9002
    Fax: 415.600.1325
    Ofc: 415.600.3739
    evanspx@sutterhealth.org
  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    edited May 2016
    It has been a long time since I have had to review Observation cases, but it is my understanding the charging for devices/supplies is a part of this process. That is probably why the coder is asking for this information. However, given the volume of IV fluids administered, this seems impractical.

    Someone else with current OBS experience may be able to offer insight.

    Paul Evans, RHIA, CCS, CCS-P, CCDS

    Manager, Regional Clinical Documentation & Coding Integrity
    Sutter West Bay
    633 Folsom St., 7th Floor, Office 7-044
    San Francisco, CA 94107
    Cell: 415.637.9002
    Fax: 415.600.1325
    Ofc: 415.600.3739
    evanspx@sutterhealth.org
  • katysuegood@gmail.comkatysuegood@gmail.com
    edited May 2016
    OBS is coded as an OP record using CPT for procedure codes.

    Katy Good, RN, BSN, CCDS, CCS
    Clinical Documentation Program Coordinator
    AHIMA Approved ICD-10CM/PCS Trainer
    Flagstaff Medical Center
    Kathryn.Good@nahealth.com
    Cell: 928.814.9404
  • ssalinasssalinas
    edited May 2016
    I believe she is referring to OBS as in Outpatient Observation, not Obstetrics. Outpatients are billed with CPT codes and certain codes require specific diagnosis in order to be paid. IV fluids are not covered unless the physician documents dehydration or something similar. There are national and local coverage determinations so you (or someone) should check what they are in your area.

    In regards to the comment about a ‘stupid question’ – Don’t care if it was referring to the question being posted or the coder asking it, it was an inappropriate response in my humble opinion. I know that I have been reluctant to ask questions at times based on less offensive responses that have been posted. Both beginners and experienced CDIs and coders can learn a lot from this forum and it would be a shame to inhibit members from asking questions.

    Sharon Salinas, CCS
    Barlow Respiratory Hospital
    2000 Stadium Way, Los Angeles CA 90026
    Tel: 213-250-4200 ext 3336
    ssalinas@barlow2000.org
  • katysuegood@gmail.comkatysuegood@gmail.com
    edited May 2016
    If anyone has any ‘stupid questions’, feel free to send them my way. I have asked MANY so I don’t judge ☺

    Katy Good, RN, BSN, CCDS, CCS
    Clinical Documentation Program Coordinator
    AHIMA Approved ICD-10CM/PCS Trainer
    Flagstaff Medical Center
    Kathryn.Good@nahealth.com
    Cell: 928.814.9404
  • debra.stewart@halifaxregional.comdebra.stewart@halifaxregional.com
    edited May 2016
    That is what I thought, thanks for all your help!

    Debra Stewart RN, BSN
    Clinical Documentation Specialist
    Sentara/Halifax Regional Hospital
    South boston, va. 24592
    (434)-517-3317 Work
    (434)-222-9884 Cell
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