AKI / ARF Denials (Not clinically supported)
We've been getting several denials for ARF/AKI that are not clinically supported by changes in Cr as cited by the auditor (cases also did not meet with UOP).
Does anyone have a written policy (for coders) to address this -- ie, guidance to not code if there is not clinical support in the record? Any other ideas on how to address (in addition to physician education)?
I am wondering if this might be an acceptable approach -- our coders struggle with this. They can clearly see that the clinical support is not there, but there is strong documentation trend and discussion of hydration to address the issue.
Don
Donald A. Butler, RN, BSN
Manager, Clinical Documentation
PCMH, Greenville NC
dbutler@pcmh.com
Does anyone have a written policy (for coders) to address this -- ie, guidance to not code if there is not clinical support in the record? Any other ideas on how to address (in addition to physician education)?
I am wondering if this might be an acceptable approach -- our coders struggle with this. They can clearly see that the clinical support is not there, but there is strong documentation trend and discussion of hydration to address the issue.
Don
Donald A. Butler, RN, BSN
Manager, Clinical Documentation
PCMH, Greenville NC
dbutler@pcmh.com
Comments
H&H and no blood transfusions). Any guidance would be greatly
appreciated.
Gina Spatafore, RN
Clinical Documentation Integrity Specialist
Waterbury Hospital
203 573 7647
(more than likely), we have the same problem with BC denying ARF,
depending on which auditor is reviewing which facility. The NY auditor
uses the RIFLE criteria, he uses this criteria irregardless if the
providers documents why the patient won't meet criteria ......... we
appeal these and generally they are approved.
The PA auditor prefers the AKIN criteria .......... not as many denials,
but or coding staff have the issue of taking anything documented by the
provider ........ so we will clarify with the provider if we feel it
doesn't meet criteria ............. it is such a time consuming process
............... this is what we as a facility came up with:
Acute Renal Failure:
VS
Acute Renal Insufficiency:
Trend Creatine through stay; if creatine level is elevated on admission
and returns to baseline with in 24 hrs, they have insufficiency secondary
to condition IE: dehydration, stricture, etc….
Acute Renal Failure:
Creatine increase of 0.5 over baseline, for greater than 24hrs
And
Treatment with IVF greater than 100cc/hr, or documentation of why rate is
lower IE: CHF, etc
And
Diagnosis to support acute renal failure IE; dehydration, sepsis, poisons,
BPH, etc
Thank You,
Susan Tiffany RN, CCDS
Supervisor Clinical Documentation Program
Guthrie Healthcare System
"Twenty years from now you will be more disappointed by the things you
didn't do than by the ones you did do. So throw off the bowlines. Sail
away from safe harbor.Catch the trade winds in your sails. Explore. Dream.
Discover." Mark Twain
Patsy Fowler RN, MSN, CCDS
Certified Clinical Documentation Specialist
Marion Regional Medical Center
PO Box 1150
Marion, SC 29571
Office 843-431-2044
Cell 843-431-2863
Fax 843-431-2475
Google AKI RIFLE and you should find some very good clinical articles.
Risk 1.5 x baseline Cr (50% rise)
Injury 2.0 x baseline Cr (100% rise) (or for a baseline Cr of 4, any rise of 0.5)
Failure
Loss
ESRD
Depending on the overall clinical picture, we consider query at the Risk level, and don't hesitate at the Injury level.
AKIN (AKI Network) is similar, ie based on Cr changes, but presupposes adequate fluid resuscitation/hydration before looking at net Cr shifts to support the diagnosis, which is more complicated for the CDI.
Don
source?
Kelley Walrath
Documentation Specialist Coordinator
BSN - CCDS
352-671-2589 or x8426
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As far as coders not coding what isn't supported in the record, our coders apparently were instructed to code whatever the physician writes, whether it's clinically supported or not. Then it became my job to try to make the data fit the diagnosis or get the diagnosis changed. That is a very, very hard job. I have been pushing very hard for our coders to be allowed to leave off a code if I feel it is prime to be challenged and lost on appeal. So now if they ask me about a questionable diagnosis and we agree that it's extremely weak, they will leave it off.
Renee
Linda Renee Brown, RN, CCRN, CCDS
Clinical Documentation Specialist
Arizona Heart Hospital
1. Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P, and the ADQI
workgroup: Acute renal failure – definition, outcome measures, animal
models, fluid therapy and information technology needs: the Second
International Consensus Conference of the Acute Dialysis Quality
Initiative (ADQI) Group.
Crit Care 2004, 8:R204-R212. PubMed Abstract | BioMed Central Full Text |
PubMed Central Full Text
urine output (UO)
Thank You,
Susan Tiffany RN, CCDS
Supervisor Clinical Documentation Program
Guthrie Healthcare System
email: tiffany_susan@guthrie.org
"Twenty years from now you will be more disappointed by the things you
didn't do than by the ones you did do. So throw off the bowlines. Sail
away from safe harbor.Catch the trade winds in your sails. Explore. Dream.
Discover." Mark Twain
Theresa Woods, RN, MSN
Jennings American Legion Hospital
1634 Elton Road
Jennings, La 70546
Phone: 337-616-7297
Fax: 337-616-7096
twoods@jalh.com
normal volume status / adequate fluid resuscitation?
Don