Acute Respiratory Failure

proddy@clarionhospital.orgproddy@clarionhospital.org
in Denials
Anyone have any luck appealing a denial for Acute Respiratory Failure due to COPD when there weren't any ABG's done?  I did the first level of appeal with the pox 81% via EMS and O2 applied 4L, labored/difficulty breathing, no history of home O2.  He remained on 4 liters on admission, titrated between 3 and 4 liters the first couple days of his stay.  Was weaned to room air by time of discharge. 

Comments

  • hrodenberghrodenberg
    Luck is a matter of what the insurance company does.  That being said, the case you describe, with clear RA air hypoxia, documentation of signs and sx of resp distress, supplemental oxygen of 4 lpm over baseline, I would  fight that one and appeal up the food chain.  May not win...as you know, acute respiratory failure is what the insurance company says it is...but your patient sounds pretty valid to me.
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