Understanding Epic's Medication Administration Record (MAR) for Billing and Coding

The High-Stakes Translation from Clinical Care to Understanding Epic's Medication Administration Record (MAR) for Billing and Coding

In an integrated Electronic Health Record (EHR) like Epic, clinical documentation actions have direct and immediate financial consequences. At the center of this dynamic is the Epic Medication Administration Record (MAR)—a document that is frequently misunderstood by revenue cycle professionals. Far from being a simple checklist of medications given, the MAR is a complex clinical dataset where a single click can trigger a charge, and a missing data point can result in revenue loss or compliance exposure.

Because Epic bills upon administration, any gaps, inaccuracies, or misinterpretations in MAR documentation can lead to denied claims, lost charges, or audit findings. This guide provides medical coders with a strategic, defensible framework for reviewing the Epic MAR—not as a billing sheet, but as clinical evidence that must be analyzed, validated, and translated into compliant charge capture.

To do that effectively, coders must first understand what the MAR was designed to do—and what it was not.

The Coder’s Dilemma: The MAR Is a Clinical Tool, Not a Billing Sheet

The MAR exists to support patient safety and clinical workflow, not billing convenience. Epic’s medication workflows—especially those integrated with IV smart pumps—are designed to reduce medication errors, improve clinical outcomes, and streamline nursing documentation. The involvement of medication safety integration nurses and clinical informatics teams underscores this reality.

Billing is a secondary downstream function, not the MAR’s primary purpose. This disconnect is the root cause of many potential billing issues seen when the MAR is treated as a standalone charge document. The key mindset shift for coders is this: the MAR supports billing, but it does not replace critical documentation review and analysis.

This becomes especially important when automated documentation is involved.

Automated vs. Manual Documentation

Epic leverages bidirectional IV smart pump interoperability, enabling auto-programming and auto-documentation between infusion pumps and the EHR. While this reduces manual data entry, it is not universal and is intentionally excluded from certain high-risk or high-acuity scenarios.

Scenarios requiring manual documentation include procedural and perioperative areas such as anesthesia, endoscopy, cardiac catheterization labs, interventional radiology, and dialysis; emergency transport between facilities; trauma resuscitations and code blue events; rapid response team activations; blood product administration; and rapid fluid resuscitation using gravity infusions or pressure bags.

A quiet or incomplete MAR in these settings does not mean no billable services occurred. It usually means the documentation lives elsewhere. The MAR is never a standalone source of truth.

Documenting Advanced Medication Administration in Epic

Once coders recognize that the MAR is a clinical record—sometimes populated through automation, sometimes entered manually—it becomes essential to know how advanced medication administrations are captured in Epic.

Medications aren’t always given as scheduled. Delays, holds, and overrides happen frequently in acute care settings. Here’s how Epic users typically document these scenarios:

• Scheduled Administrations: Nurses scan the patient’s wristband and the medication barcode to confirm timing and dosing. The action logs directly onto the MAR.

• Overdue or Missed Doses: If a scheduled dose isn’t administered as planned, staff must document the rationale. This might mean marking the dose as “not given” and selecting an appropriate reason—whether the medication was held for clinical assessment, the patient was unavailable, or another circumstance intervened.

• Held Medications: Any medication intentionally withheld, say, due to a change in vital signs or lab results, is logged as “held” with documentation supporting the clinical rationale.

• Override Pulls: In urgent moments, medications may be removed from automated dispensing cabinets (like Pyxis or Omnicell) without using the standard barcoding workflow. These are documented through specific MAR workflows, often with additional review and follow-up to ensure accurate charge capture later.

• Using the Brain and Barcode Workflows: Epic’s “Brain” workflow consolidates scheduled, overdue, and held medications, making it easier for clinicians to review the full administration picture at a glance.

Each scenario must be thoroughly reviewed by coders. The why behind missed or variably timed doses often lives in MAR comments, audit trails, or nurse documentation—and this context is critical for defensible billing.

Coders should approach these advanced documentation cases as clinical stories, not just administrative line items. Knowing when to dig deeper ensures that the charges reflect actual care delivered, no matter how complex the route or situation.

Finding the Right MAR View in Epic

Before analyzing charges, coders must ensure they are viewing the correct MAR display. This is typically accessed under Chart Review through Flowsheets or under Medications by selecting the MAR.

Coders should avoid summary “given/not given” views and instead use detailed options such as MAR with Details, MAR Timeline, or the IV Summary. Required display elements include start and stop times, infusion rate, volume infused or remaining, and route and method such as IV push, IV piggyback, or IV infusion. Without these elements, compliant IV coding is not possible.

The Principle of Corroboration: Why the MAR Is Never Enough

Auditors expect claims to be supported by a cohesive clinical story across multiple documentation sources. A charge supported only by the MAR is indefensible.

Orders establish provider intent and must align with MAR administration. Flowsheets often contain critical data such as vitals, titration changes, and infusion adjustments that are not visible on the MAR. Clinical notes from nurses and providers explain the clinical rationale, patient response, complications, or early discontinuation. A high-cost medication appearing on the MAR without narrative support elsewhere represents a significant compliance risk.

The 5-Step MAR Dissection Process for IV Charge Capture

Once the correct MAR view is confirmed and corroborating documentation is identified, coders should apply a consistent analysis process to every IV medication and fluid.

Step 1: Identify True Billable Administrations

Focus on IV pushes, IV piggybacks, IV infusions, and IM or subcutaneous injections. Exclude oral, topical, inhaled medications, flushes, reconstituting agents, and PRN medications that are not linked to a procedure or billable service.

Step 2: Determine the Drug and Actual Dose Given

Coders must bill what was administered, not what was ordered. For example, if Vancomycin 1 gram in 250 mL was ordered but only 125 mL was infused, only 500 mg was given. The billed units must reflect the actual dose administered and be mapped to the correct HCPCS J-code.

Step 3: Determine Route, Method, and Duration

Duration drives infusion coding. Coders must confirm whether the medication was given as an IV push, piggyback, or infusion and identify start and stop times. If a stop time is missing, the rate and volume may allow duration calculation. If duration cannot be verified, assumptions are not permitted and a query is required per facility protocol.

Step 4: Apply Infusion Hierarchy and Bundling Rules

All IV services must be placed on a timeline. There is no one way to create the timelinE. Personal I brake it up into groups of administration and then by day. To get a complete visual of how I break it down check out "The MAR" on our webpage or click here.

Step 5: Final Medical Necessity and Payer Review

Services must be reviewed against diagnosis and payer-specific rules. Emergency department hydration may be billable for intoxication, magnesium sulfate is billable for pre-eclampsia, and IV fluids during routine labor may be bundled. Medical necessity must always be defensible.

High-Risk MAR Scenarios That Demand Extra Scrutiny

Certain medication scenarios require heightened attention, including titratable infusions with undocumented rate changes, early discontinuation due to reactions or infiltrations, automated MAR entries without supporting clinical notes, and encounters flagged for manual review by autonomous coding systems. If automation identifies a case as non-standard, it warrants careful human analysis.

Accurate documentation in the Epic Medication Administration Record (MAR) is critical for patient safety, compliance, and reimbursement accuracy. As we’ve discussed above, capturing the right details — including time, route, dose, and clinician verification — helps reduce clinical and coding errors in infusion and medication administration workflows.

For further clinical context on safe medication administration practices and evidence-based standards, you may find this resource helpful: https://pmc.ncbi.nlm.nih.gov/articles/PMC10757236/