A Complete Breakdown of The MAR In EPIC

This page is to teach coders

This confuses a lot of coders, so let’s clear it up.

Even though Epic shows medications continuously in the MAR, billing rules do not follow the MAR. They follow patient status.

ER and Observation

Both are considered outpatient services
From a billing perspective, they are part of the same outpatient encounter
Because of this:
- Drug administration services continue
- CPT hierarchy carries forward
- Initial infusion codes do not reset in observation

Inpatient Admission

* This page breaks down the MAR in EPIC. To learn the guidelines that govern infusion and injection coding.

How to Filter the MAR

Filtering is the process of stripping away non-billable events to find the "billable heart" of the record.

Identify Service Transitions: Determine exactly when the patient moved between levels of care, such as the move from the ED on 01/04 to Observation on 01/05.
Separate by Route: Focus strictly on intravenous (IV), IVPB, and subcutaneous routes.
Ignore Pharmacy-Only Items: Oral medications and nebulizations are typically charged by the pharmacy and do not count toward administration hours.
Exclude Non-Charges: Filter out items explicitly marked as "No Charge" or medications billed by other departments like Radiology.

Facility billing follows a "Top-Down" approach to identify the primary service for the encounter.

Rank by Complexity: The most complex drug administered is your "Initial" service for the day.
The Single Initial Rule: Only one initial code, such as 96374 for a push or 96365 for an infusion, is reported per encounter.
Sequence Matters: Once the initial drug is set, additional drugs are coded as Sequential or Concurrent.
Time-Based Downgrades: If an infusion does not meet the 16-minute requirement, it is downgraded to an IV Push in the hierarchy

Hydration is frequently adjusted or ignored by auditors based on specific clinical data.

The "Keep Open" Rule: Hydration cannot be billed if the rate is used only to keep the line open, typically anything under 250 mL/hr.
Rate Verification: Auditors look for rates like 100 mL/hr as a sign that the hydration is not a stand-alone therapeutic service.
Hierarchical Bottom: Hydration is always the lowest priority and is only billed as an "initial" service if no other therapeutic drugs were given that day.

An auditor looks for documentation gaps to ensure the record is compliant.

Verify Stop Times: If a medication like Vimpat is missing a stop time, an auditor must bill it as an IV Push (IVP) because the duration cannot be proven.
Apply the 16-Minute Threshold: For an infusion to be valid, it must last at least 16 minutes.
Identify Short Durations: A drug like Vancomycin given for only 13 minutes is automatically billed as an IVP, regardless of the drug type.
Monitor Daily Resets: Auditors check that the billing logic follows the patient through different dates of service and status changes.