I have information from 2008 that a major hospital in Portland is charging $104 for each PICC/ CVC dressing done by an IV nurse. Is anyone getting reimbursement for this? Is anyone else changing for this aside from the biopatch and sorbaview? Is anyone charging for the statlock?
We bill on our inpatients but have added statlock and biopatch in the kit. We charge a kit fee through order entry in our meditech module in the patiants chart. We are getting reimbursed but just for the kit not our time.
The nice thing is we are at least capturing the cost of the components, charging and charting at the bedside in each room while we are rounding.
Jose Delp RN BSN
Clinical Nurse Manager IV Team
Upper Chesapeake Health
Jose Delp RN BSN
CliClinical Nurse Manager IV Team
Upper Chesapeake Health
So along this same line, the hospital where I am located currently, is charging for PICCs but not Midlines as they say there is no reimbursement for this "since they are essentially longer peripheral lines"....not even the kit. Is this the case in other hospitals out there?
Trish Jean RN BSN
The last hospital I worked at charged the same for a midline as a PICC. It is a little cheaper for the patient because they don't pay for an X-ray or the reading of an x-ray. At this hospital we also charge the same for a midline as a PICC although we would never do a midline on purpose unless a PICC would not pass correctly. Due to the probabilty that the patient will be changed to an antibiotic requiring a PICC, and also for blood draws, a PICC is far superior. If you don't get paid for a midline, I suggest you only do PICC lines since they are the same amount of time. Also, at the hospital I used to work for we didn't bother stocking midlines since we could trim a PICC to be a midline and then we didn't have to have more lines in stock.
Michelle Todd, CRNI--Head PICC Nurse, Vibra Specialty Hospital of Portland [email protected]
Michelle Todd, CRNI--Head PICC Nurse, Vibra Specialty Hospital of Portland [email protected]
Sorry Michelle, I have to seriously disagree with you on this one. The choice of catheter must be based on the needs of the patient, not what you can or can not "charge" for them. These so-called charges are usually not resulting in the actual reimbursement of what is billed anyway due to capitated fee structures for most patients. Choosing a PICC when a midline will work for the prescribed therapy is asking for additional complications because the longer catheter exposes a greater length of vein to damage. Also, I would issue a strong warning about altering any product in such a manner that it significantly alters how it is used such as taking a PICC and cutting to a midline. This is also asking for problems when the nurse sees the external label on the catheter stating "PICC" but the tip is in a midline location. Very high risk situations from both of these and factors that any good expert will be looking for when a case is review for lawsuit purposes. Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
www.hadawayassociates.com
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
Yes Lynn, I totally agree about the trimming issue. When I first came to this hospital, they were trimming PICCs to make as Midlines. We have since stopped that practice. Off-label use and risk of mis-use d/t confusion way too great.
Where I came from, we did not use Midlines. In practice, I find very few patients that this is appropriate for these days, so many on Vanc. and others that exceed limits of Midline. The service is offered where I work now, but use is trending down as we are educating as to the proper uses for midline (not just a line that you can get quicker than a PICC)
Most re-imbursement is DRG and capitated fee related, but I was wondering how folks were accounting for their time when inserting Midlines if no charge is being generated.
Thanks
Trish
Ann Zonderman, BSN, JD, CRNI, LHRM
I would like to add a legal prospective...How do you document legitimately for this? Also if you billed for a PICC, but actually placed a midline... and a law suit was filed for a related problem - How do you think the Court would react when you say you placed a PICC to be sure to get paid.
Besides the horror of a law suit, the issue of "billing fraud" and falsifying documentation.... may well impact the outcome of the case.
Ann Zonderman, BSN, JD, CRNI
At my hospital, we charge for the dressing change and charge for the Statlock. The dressing change charge is a charge for our time and the Statlock is a supply charge.
Thank you all for your input. Lynn, I was meaning that we charged the same for a midline as a PICC. We do not call it a PICC though. It is just the same amount of money billed. Also, we label all dressings with neon labels that say either PICC or Midline. When you purchase a midline cath from BARD Groshong, it looks exactly the same except the hub. So, unless you labeled the dressing, it would still look nearly the same. We have the midline hubs that we place on the cath if they are a midline as well. As far as the needs of the patient, it seems that I just don't have any patients that fit the criteria for a midline. None of them are on Ancef, which is one drug that I consider appropriate for a midline. None of them are just on IV fluids. In the past when a midline was placed for home antibiotics over 2 weeks, you could be sure they would be back to get a new catheter before the therapy was over due to leaking at the site, of course from phlebitis at the tip. And so many times I have had doctors that ordered ancef and then changed to vancomycin after the midline was in. Frequently, the patient was already at home and then we would see them back for chemical phlebitis of course. So as far as the patient's needs, I just don't think highly of midlines any more although I used to place them frequently for 10 days of inpatient pain meds and fluids. It really does seem like a hospital could refuse to place midlines if they were not paid for them. They could just place lots of PIVs instead, or do a PICC. Unfortunately, the heath care system today does force us to not always do what we feel may be best for the patient, and in a lot of other things besides infusion therapy. Please write back.
Michelle Todd, CRNI--Head PICC Nurse, Vibra Specialty Hospital of Portland [email protected]
Michelle Todd, CRNI--Head PICC Nurse, Vibra Specialty Hospital of Portland [email protected]
Lots of PIVs would cost far more than 1 midline, so that is not the answer. A few catheters are not stamped with the type of catheter on the external portion but most are. I think there are numerous patients that can benefit from a midline but strongly believe that it requires an infusion nurse specialist to make that assessment.
Lynn Hadaway, M.Ed., RN, BC, CRNI
www.hadawayassociates.com
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
Kathy Kokotis
Bard Access Systems
First off there is no HCPCS/CPT code for dressing change so you can bill but no one will pay it. As there is no code. Now a patient without insurance will get stuck paying it as they have no negotiator. No insurance company will recognize this and Medicare is DRG based.
For a midline there is also no billing code so it cannot be billed as well.
That being said one can always charge internally for paper trail but realize no monies are received at all from any payor but the self insured or non insured for a dressing change or midline.
kathy
Kathy Kokotis
Bard Access Systems