Medicare Guidelines for Non-Cancer

 

RENAL DISEASE (A, V, & C must be present)

RENAL DISEASE (A, V, & C must be present)

  1. Acute Renal Failure

      A. Patient is not seeking dialysis or renal transplant

      B. Creatinine clearance < 10 cc/min (< 15 cc/min for diabetes)

      C. Serum creatinine > 8.0 mg/dl (3.0 mg/dl for diabetes)

 

Supportive Documentation

 

     Comorbid Conditions:

        1. Mechanical Ventilation

        2. Malignancy (other organ system)

        3. Chronic lung disease

        4. Advanced cardiac disease

        5. Advanced liver disease

·         Sepsis

·         Immunosuppression / AIDS

·         Albumin < 3.5 gm/dl

·         Cachexia

·         Platelet count < 25,000

·         Disseminated intravascular coagulation

·         Gastrointestinal bleeding

 

 2. Chronic Renal Failure

     A. Patient is not seeking dialysis or renal transplant

     B. Creatinine clearance < 10 cc/min (< 15 cc/min for diabetes)

     C. Serum creatinine > 8.0 mg/dl (3.0 mg/dl for diabetes)

 

Supportive Documentation

 

Signs and symptoms of renal failure:

  1. Uremia

  2. Oliguria (<400 cc/day)

  3. Intractable Hyperkalemia (7.0) not responsive to treatment

  4. Uremic pericarditis

  5. Hepatorenal syndrome

  6. Intractable fluid overload, not responsive to treatment

 

ICD-9 Codes that support medical necessity:

      584.5 – 584.9 Acute Renal Failure

      585 Chronic Renal Failure

      586 Renal failure, unspecified