Hi all !
I am reaching out to see what other teams are doing as far as documentation goes. Until recently, when a PICC was placed at the bedside using ultrasound and 3CG, we printed out the confirmation of the EKG waveforms to be scanned into the medical record, and placed a note. If an xray was needed, we placed a note as well with the reading from the radiologist. All other related documenation, such as vein used, max barrier, blood return, etc. was done on a flow sheet.
We were notified at the beginning of the year that to get reimbursed for PICC or Midline insertion (ultrasound guided peripheral insertion for that matter ) that we needed to have a picture of the proposed vessel, the needle entering the vessel, and finally the catheter residing IN the vessel. The 3 CG was still printed as well.
Has anyone else moved to this form of documention? I can understand the picture of the proposed vessel, but the other 2 steps? If we have 3CG, isn't that confirmation the catheter is in the vessel? We do PICCs and Midlines by ourselves, it is very difficult to obtain all this while trying to keep your eye on the needle, the patient, and your surroundings. Not to mention that alot of the time you can't actually see it!! We use Bard products, so attempting to do this using the Powerglide is near impossible, just because of the way the insertion process is.
Anyone else doing this?
From my understanding we are not reembursed for VAD placement as hospitals are reembursed in lump sums for the reason for admission. Total hysterectomy is $x, whether that requires a picc not.
You should have a second person to help you keep sterile field and assist when needed. They could assist with snapping required pictures. While some extra work, it might save your butt one day as long as you’re doing everything you should.
You are totally correct. For inpatients, the facility is paid a predetermined fee, by diagnosis (DRG for Medicare) or number of covered lives (HMO). So what you "charge" does not bring in additional revenue for your hospital. But you should be using some type of tracking system for what you do as this has an impact on your department's budget. A percentage is allocated to your budget based on what "charges" you submit.
Outpatients are billed differently and they do bring in additional revenue.
Also agree that you should have an assistant. Support for this is found in recommendations to complete a procedure checklist. This has to be done during the procedure, not after or before. So a second person is necessary.
In the original post, the question about US photos is correct. But this is probably referring to the professional fees charged by only MD, NP, and PA. RN cannot charge these professional fees. You do need documentation that the photo can bring in case there is ever any question about the vein you entered. Tip location is documented by either an ECG or chest xray.
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Thank you Lynn, I appreciate the input. The more I read into it and the CPT codes they gave us for reference, I thought it was directed toward physician inserted PICCs. For now we are going to do the initial ultrasound image of the vessel and PICC tip confirmation. I suppose someone will tell us if they think we are doing it wrong. It is still being debated....