How to use the PRN Billing Feature (Precision Billing) for Medications?
Modified on: Fri, 4 Dec, 2020 at 9:57 AM
PRN billing can be a very useful tool, particularly if you want to be able to titrate treatments within a dose range for your patients. If you create a Medication parameter, it will use the PRN Billing feature regardless of Picker type (Numeric, Initial). This means that all the numeric figures input in the cell will affect the quantity of the medication indicated in the Billing report (please find more details HERE). However, it is required to understand how their entry into the cell correlates with how the medication is displayed on the flowsheet. Please read the below information to avoid billing mistakes when entering numerical values to the flowsheet for Medications:
For example - Let’s take 2 mg/ml Hydromorphone for Barney, our 10kg patient, and set it to send billing per Total (ml). The DVM has chosen to dose Barney at 0.1 mg/kg, thus it gives us a total dose of 1 mg to be given, which is a total volume of 0.5ml:
In this case, after the execution:
The Billing report will contain: 0.5 ml as the Total dose calculated (if initials are added to the cell) and a precise dose of 0.3 ml entered manually for execution:
However, if we choose to display the same medication on the treatment sheet as Total (mg):
After the same execution, the Billing Report view will be changed:
In this case, if the numeric value entered to the cell indicates to Smart Flow that we gave 0.3 mg in total (not ml as in the example above). Then this dose is recalculated from mg to ml, and results in - 0.15 ml in the Billing Report.
Finally, if we keep the original dose of 2 mg/ml Hydromorphone but chose to display it on the flowsheet as a Dosage of 0.1mg/kg:
This time when we execute the treatment with the 0.3 numeric value in the cell, Smart Flow takes this as a dosage of 0.3 mg/kg. There is an automatic calculation for Barney's results i.e this dosage is equal to 3 mg (or 1.5 ml) of 2 mg/ml Hydromorphone, so Smart Flow sends 1.5 ml to the bill:
In summary, it is worth mentioning that to avoid incorrect billing it's critically important to always check which option on the flowsheet is selected for a particular medication, and ensure that the entered numerical value has the same unit (mg/kg, mg, ml):
And that the given dose is calculated in ml for billing:
If we want to indicate that we only gave half the dose of 2 mg/ml Hydromorphone to Barney each time, we would need to enter the values in the cell as follows:
Total (ml) volume in ml must be shown on the flowsheet: we should enter 0.25 ml as that is half the volume of 0.5 ml dose, and 0.25 ml will show up on the billing report.
Total (mg) volume in mg must be shown on the flowsheet: we should enter 0.5 mg which is half of the 1 mg dose, and 0.25ml will show up on the billing report.
Dosage in mg/ml shown on the flowsheet: we should enter 0.05 mg/kg dosage (half of the 0.1 mg/ml), and the billing charge will be 0.25 ml.
So after the execution of any of the below:
We will get the below expected results in the Billing Report:
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