Denial for AKI "after optimal hydration"

rmalcolm@cvph.orgrmalcolm@cvph.org
in Denials

Hello,

I'm fairly new to denial appeals, just started about 6 months ago and I'm having some success but lately I've been receiving an increase in denials for acute kidney injury with the auditor using the logic that "after optimal hydration" the patient's creatinine did not meet clinical criteria and thus acute kidney injury. For example: a patient comes in with Creatinine of 2.1 and it improves over the next 48 hours to 1.5, 0.9, 0.86; then was discharged with a creatinine of 0.72 a few days later. They are saying that the creatinine at 0.86 was the first lab results "after optimal hydration" and that in using that number, the patient does not meet the x1.5 criteria with the baseline of 0.72. There are no previous labs to use to support otherwise. They reference KDIGO and Rifle. I've attempted a couple of times now to point out that the KDIGO criteria has no mention of "optimal hydration" but with no luck. Has anyone else run into this and had any luck or can help me with some guidance.

Much appreciated!!

Rebekka

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Comments

  • 1915267119152671

    You are absolutely correct that there is no requirement in KDIGO that its criteria on applies after the AKI's underlying cause has been addressed. Since you are correct, then it is the payer that is fraudulently misinterpreting these criteria as to promise healthcare and not pay for it. The only solution I know is to refer this to your legal department since the payer's misapplication of Coding Clinic, 4th Quarter, 2016, page 147 to 149 is pre-empted by HIPAA and receive their direction as to what your facility's approach will be today and with contracting in the future.

  • holly.young52holly.young52

    I have just received a denial for the use of "AKI" stating "documented abbreviation AKI that is not recognized as a standard or accepted medical abbreviation and therefore is considered vague." They are stating a query should have been done for clarification.

    I am searching for internal organizational documentation for approved abbreviations. No luck so far. Has anyone experienced this before? Talk about physician query fatigue!

    Any help would be appreciated!

    Holly Young

  • AAGraczaAAGracza
    edited September 5

    Rebekka,

    I suggest citing the Kidigo literature, there is no requirement for a the creatinine to stay high after hydration. Hydration is the treatment, and if your creatinine is still high, that may indicate ATN. If you have access to Pinson and Tang, they have a denial just as you do as an example and how to fight it.


    Holly Young, This is a widely accepted abbreviation and a denial on it is just beyond unscrupulous. I would give them the professional references below.


    Per Up To Date

    image.png


    From the Nationall kidney foundation page -

    image.png

    Also from the MERCK manual.

    image.png


    Hope this helps.

    Thanks

    Adelaide

  • cgoeweycgoewey

    We too are receiving audits/denials for AKI using the same reason - stating AKI should be diagnoses after fluid resuscitation. We are appealing but not having a lot of success so far. We are referencing KDIGO criteria and that fluid resuscitation is part of the treatment for AKI. We will keep fighting.


    Cindy

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