Continued denial for ABLA- Clinically validated but decision upheld
The clinical findings do not reflect Acute post hemorrhagic anemia coexisted during the hospital course. Lab results: 6/6/18 Hgb 9.3, 6/6 PN VS stable, Labs results 6/7 Hgb 8.4, order of iron supplements but not documented as given prior to discharge.
This was only part of the clinical picture despite their accessibility to the entire medical record:
(1) Patient w/ EBL of 250ml
(2) Post-op HR: 102-106
(3) New Order for Type and Screen
(4) New order for Niferex 150mg QD, administered by the nurse and documented as given X1 (not given day of discharge)
(5) Pre-op H & H: 11.4 & 34.7, POD #1 H & H : 9.3 & 27.8 POD #2 H & H: 8.4 & 24
(6) Supporting physician documentation in PN:
Active Comorbidities: Post-op Anemia secondary to acute blood loss
We included 2016 "Strategies for Management of Post-operative Anemia in Elective Orthopedic Surgery" which stated that the best practice transfusion threshold was 8g/dl or less or when symptomatic (E.g. tachycardia unresponsive to fluid resuscitation) and otherwise additional strategies such as use of oral iron therapy.
We wrote the appeal letter and it came back denied again.
What am I missing??