Over the past few years, I have been talking to the insurance medical directors my peer to peer reviews.
Here are some of the clinical indicators that could support inpatient status for patient admitted with congestive heart failure and one could use these during peer to peer reviews potentially to help in overturning the denials.
(1) Hemodynamic instability which did not improve during observation time.
(2) Electrolyte abnormalities which are severe and persistent beyond observation time.
(3) Arrhythmias which needs immediate attention.
(4) CHF caused by acute MI.
(5) Assisted ventilation whether invasive or noninvasive was required.
(6) Patient is unable to void or ambulate due to severe edema/anasarca.
(7) Ongoing shortness of breath beyond observation time.
(8) Creatinine going up while treating the CHF with diuresis.
(9) new onset CHF requiring inpatient ischemic evaluation on our titration of medications.
Please add as a comment if you no more not could help support inpatient status for a patient admitted with congestive heart failure.