Understanding Why Given in Epic Does Not Automatically Indicate Billable Status | EPIC Given vs Billable

Why “Given” in Epic Does NOT Automatically Mean Billable

Excellent and crucial question. This gets to the very heart of your role as a charge capture specialist. In Epic (and most EHRs), the status "Given" is a clinical documentation point, not a billing trigger. It means the medication was administered to the patient, but it does not mean it meets all the complex rules for professional or facility billing.

Here’s a breakdown of why "Given" doesn't equal "Billable," focusing on your ER/OBV setting:

1. The "Given" Status is Clinically Focused EPIC Given vs Billable

• Purpose: Tells the care team, "This task is complete. The patient received this." It's for safety, documentation, and care coordination.

• Billing Blind Spots: It contains none of the billing-specific information you need:

  • Duration? "Given" doesn't tell you if an infusion ran for 10 minutes or 2 hours.

  • Hierarchy? "Given" doesn't tell you if this was the first infusion service of the encounter.

  • Medical Necessity? "Given" doesn't indicate if the drug was for a billable therapeutic purpose or an incidental/non-covered use.

  • Route/Technique? "Given" for an IV medication doesn't specify if it was a push or an infusion.

2. Common Scenarios Where "Given" ≠ Billable

Here are specific examples you will encounter daily:

A. Hydration as a Vehicle (The #1 Issue)

• Epic Shows: "NaCl 0.9% 1000 mL - Given"

• The Reality: This fluid bag was hanging solely as the vehicle to piggyback an antibiotic (e.g., Rocephin).

• Billing Rule: The fluid is bundled into the administration of the drug (CPT 96365). You cannot separately bill hydration codes (96360/96361).

• Your Action: You must link the fluid to the medication. If it was the diluent, it's not separately billable.

B. Infusion Duration < Minimum Time

• Epic Shows: "Vancomycin 1000 mg in 250 mL - Given"

• The Reality: The medication was infused over 10 minutes (perhaps due to an adverse reaction).

• Billing Rule: An IV infusion requires a minimum of 16 minutes to be billable (15 min is bundled into the initial service; minute 16 starts the clock). A 10-minute "infusion" is coded as an IV Push (96374), not an infusion (96365).

• Your Action: You must find the stop time or duration. "Given" alone is useless for coding.

C. Incidental or Non-Covered Medications

• Epic Shows: "Sterile Water 10 mL - Given" (used to flush an IV line).

• Epic Shows: "Normal Saline 3 mL - Given" (used to reconstitute a powdered drug).

• Billing Rule: These are supply items, not separately billable drugs. They are part of the cost of providing the service.

• Your Action: Recognize common supplies and exclude them.

D. Violation of Infusion Hierarchy

• Epic Shows:

  • "Levofloxacin 500 mg in 100 mL - Given" (start time 08:00, duration 60 min)

  • "Normal Saline 500 mL - Given" (start time 08:15, duration 120 min)

• The Reality: The antibiotic is the initial infusion service (96365). The NS started 15 minutes later and ran concurrently.

• Billing Rule: You can only bill one "initial" infusion per encounter. The concurrent hydration is bundled as it serves as the vehicle for the sequential antibiotic line.

• Your Action: You must audit start times. "Given" on two items doesn't tell you their relationship. This scenario would only bill 96365 for the antibiotic.

E. Duplicate Billing from Standing Orders

• Epic Shows: "Diphenhydramine 25 mg IV - Given" (at 10:00 for itching).

• Also in Epic: "Diphenhydramine 25 mg IV - Given" (at 10:30 as a premedication for a blood transfusion).

• Billing Rule: If both administrations are within the same encounter, the second may be considered part of the transfusion administration service (CPT 36430) and not separately billable as a drug push (96374).

• Your Action: Review context and purpose. Two "Given" statuses for the same drug don't automatically mean two billable units.

3. What You MUST Verify Beyond "Given"

Your job is to be a detective. For every item marked "Given," you need to find:

1. Start and Stop Times (or Duration): This is non-negotiable for infusions/hydration.

2. Route and Method: "IV Push over 2 min" vs. "IV Infusion over 30 min" are different CPT codes.

3. Order Context: Was the fluid ordered as "maintenance" or as a "piggyback vehicle"?

4. The "Story" of the Encounter: Use the MAR (Medication Administration Record) View or Timeline View in Epic. You need to see the sequence of events.

   • What was hanging first?

   • What was running concurrently?

   • Was there a separate IV access site?

Actionable Workflow for Epic Charge Capture

1. Use "Given" as your STARTING list, not your final list.

2. Open each "Given" item and drill down to the flowsheet details or chart review to find:

   • Infusion Rate (mL/hr)

   • Volume Infused

   • Start/Stop Times

3. Reconstruct the Timeline: Mentally (or on paper) line up all IV services by start time.

4. Apply the Rules: Hierarchy (initial/sequential/concurrent), bundling (vehicle fluids), and medical necessity.

5. If documentation is missing (e.g., no stop time), you must query the nursing staff or follow your facility's protocol for missing data. You cannot assume billable duration.

"Given" tells you what happened clinically. Your expertise applies the billing rules to determine if and how it gets coded. Treating "Given" as an automatic billable event is the fastest path to claim denials, audits, and compliance issues. Your value is in knowing the difference.