Sepsis and Acute respiratory failure - calculated versus ABG P/F ratios
UHC (our favorite insurance company) is now stating that we cannot use calculated P/F ratios for Acute respiratory failure or Sepsis diagnoses but need to do an ABG on these patients. Anyone else having this issue and found a work around yet? We rarely do ABGs in my hospital system as it does not change management. Using VBGs has been more helpful but is useless for P/F ratios.
- Janel
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We are experiencing the same issue as our hospital uses VBGs most of the time. I believe we are going to appeal these to the highest level and hopefully get some Peer to Peer discussions happening.
Cindy
I work for a competing payor. I recommend looking at Pinson and Tang or ACP Hospitalist for Acute Respiratory Failure. These are oft cited references in the industry. If you appeal although you meet the criteria in these journals (or other peer-reviewed journals) and fail, then appeal to an IRE if you can. But, have your "ducks in a row" -- don't appeal every denied respiratory failure just because. Finally, the hospital needs to have a standard definition so that all the providers are documenting based on that reference. This has worked well for Sepsis-3 in many facilities.