The MAR Explained: How to Code Infusion Therapy & IV Push in Epic
- Alexis Wilkinson CPC
- Feb 5
- 4 min read
Updated: Feb 7
If you’ve ever opened the MAR in Epic and thought “there is no way I’m supposed to code all of this,” you’re not alone. The MAR can feel chaotic, multiple dates, multiple routes, start and stop times everywhere, and way more information than you actually need.
The truth is: most of the MAR is noise. The skill isn’t memorizing medications — it’s learning how to filter the MAR based on the encounter timeframe and CPT hierarchy. Once you understand that, infusion and IV push coding starts to make sense.
This guide breaks it down step by step using a real-world ED to observation scenario.
What the MAR Is and Why It Matters for Coding
The Medication Administration Record (MAR) documents what medications were given, how they were given, and when. For facility coding, the MAR is critical because drug administration CPT codes are time-based and hierarchy-driven.
One important thing to know right away:When you’re in the MAR inside Epic, infusion orders appear before the actual administration records. That means you almost always have to scroll past the orders to get to the information that matters for coding.
Heads up — if you stop too early, you will miss administrations.
Understanding the Encounter Timeline (This Comes First)
Before you even think about CPT codes, you need to anchor yourself to the patient’s status and dates.
In this example: Find the MAR here<-----
ED services: 01/04
Observation services begin: 01/05 at 06:39
Inpatient admission date: 01/09
These dates matter because they define what we are allowed to charge. Even though medications may appear in the MAR across many days, only outpatient dates apply to outpatient drug administration coding.
For this scenario, we focus on 01/04 and 01/05 and disregard anything outside that timeframe.
ED and Observation: Same Encounter, Different Departments
This is one of the most misunderstood concepts in infusion coding.
Even though the ED and observation are separate departments, they are both considered outpatient services. From a drug administration standpoint, they are treated as one continuous outpatient encounter.
That means:
An initial infusion code billed in the ED carries into observation
You do not reset initial codes just because the patient status changes
However, ED charges and observation charges remain separate departmental charges
So while the charges don’t roll together, infusion and injection coding rules absolutely cross departments.
Big Picture: Drug Administration Code Groups
Drug administration codes fall into two main groups:
Infusion Therapy
96365 – Initial infusion therapy
96367 – Additional sequential infusion therapy
IV Push
96374 – Initial IV push
96375 – Additional sequential IV push
96376 – Repeat IV push of the same drug
Only one initial code may be reported per encounter per vascular access site.
What “Initial” Actually Means
This is where coders get tripped up.
Initial does NOT mean:
First medication given
First documented in the MAR
Most clinically important drug
Initial means:The primary service based on CPT hierarchy
CPT Hierarchy
Infusion therapy
IV push
Injection (IM/SQ)
If infusion therapy occurs at any point during the encounter, 96365 becomes the initial service, even if an IV push happened first.
Time order does not override hierarchy.
Infusion Therapy Coding Rules
96365 – Initial Infusion Therapy
First infusion therapy reported for the encounter
Covers up to 1 hour
Reported once per encounter per access site
96367 – Additional Sequential Infusion Therapy
Used when:
A different substance is administered
Given sequentially, not at the same time
Occurs after the initial infusion
Key reminders:
Must be a different substance
Cannot overlap in time
Must be medically necessary
IV Push Coding Rules
96374 – Initial IV Push
Used only when no infusion therapy is reported
First IV push of the encounter
If infusion therapy is billed, 96374 is not allowed
96375 – Additional Sequential IV Push
Used when:
A different drug is administered
Given after the initial IV push
96376 – Repeat IV Push (Same Drug)
Used when:
Same drug
Same route
Given again
At least 30 minutes apart
Not scheduled dosing
Not reported when:
Less than 30 minutes apart
Continuous or scheduled therapy
Real MAR Example: How to Pull What Matters
The MAR contains:
Oral meds
Held doses
Scheduled inpatient meds
Imaging contrast
Nebulizers
Patches
Most of this is not relevant to infusion and IV push coding.
Your job is to:
Filter by date
Filter by route
Apply CPT hierarchy
Assign codes based on sequence and timing
This is why MAR review is a skill — not memorization.
Common MAR Coding Mistakes
These are the mistakes that cause denials and audits:
Resetting initial infusion codes in observation
Coding IV push initial when infusion therapy occurred
Counting oral or scheduled meds
Missing additional sequential infusions
Ignoring the ED when reviewing observation services
If the ED gave an initial infusion, that decision affects everything that follows.
How to Train Your Eyes When Reviewing the MAR
New coders struggle because the MAR looks overwhelming. The fix isn’t speed — it’s focus.
Train your eyes to:
Look for IV routes
Identify start and stop times
Spot new substances
Ignore anything outside the encounter timeframe
Once you do that, the MAR stops being chaotic and starts being logical.
Final Takeaway
Infusion and IV push coding isn’t about finding the first med in the MAR. It’s about understanding:
Encounter status
CPT hierarchy
Sequence
Timing
Medical necessity
When you approach the MAR with that mindset, the codes fall into place.
This is the difference between guessing and knowing why your code is correct.
If you want more real-world coding education like this, visit WeAreMedicalCoders.com — built by coders, for coders.
Comments