Indicators and limitations of coverage and/or necessity

Medicare Qualifications

Patients will be considered to be in the terminal stage of renal disease (life expectancy of six months or less) if they meet the following criteria.

Acute renal failure 1, 2 and 3 must be present; factors from 4 will lend supporting documentation)

1. The patient is not seeking dialysis or renal transplant
2. Creatinine clearance <10 cc/min (<15 cc/min. for diabetes)
3. Serum creatinine >8.0 mg/dl (>6.9 mg/dl for diabetes)
4. Comorbid conditions:
5. Mechanical ventilation
6. Malignancy (other organ system)
7. Chronic lung disease
8. Advanced cardiac disease
9. Advanced liver disease
10. Sepsis
11. Immunosuppression/AIDS
12. Albumin <3.5 gm/dl
13. Cachexia
14. Platelet count <25,000
15. Disseminated intravascular coagulation
16. Gastrointestinal bleeding

Chronic renal failure 1, 2 and 3 must be present; factors from 4 will lend supporting documentation

1. The patient is not seeking dialysis or renal transplant
2. Creatinine clearance <10 cc/min (<15 cc/min. for diabetes)
3. Serum creatinine >8.0 mg/dl (>6.9 mg/dl for diabetes)
4. Signs and symptoms of renal failure:
5. Uremia
6. Oliguria (<400 cc/day)
7. Intractable hyperkalemia (>7.0) not responsive to treatment
8. Uremic pericarditis
9. Hepatorenal syndrome
10. Intractable fluid overload, not responsive to treatment