Acute renal failure denial for lack of baseline creatinine

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We have received a denial for ARF in a 60 year old patient admitted for bradycardia. Creatinines were 1.76 day 1, 1.43 day 2, 1.36 day 3, and finally 1.30 on day 4. Our labs range of normal is 0.6 to 1.30 mg/dl.

The reviewer has denied the secondary dx of ARF because there was no baseline creatinine. My assertion is that the final creatinine in the normal range is the baseline. Patients don't come to the lab to have a creatinine drawn because they might be admitted to the hospital the following week.

I feel the change in the creatinine from the admission value to the discharge value meets KDIGO criteria for acute renal failure. Your thoughts are appreciated,

Michael Bushey, M.D.
 
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