Denial for AKI "after optimal hydration"


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!!


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