The patient has a past medical history of hypertension and diabetes admitted on 1/18/19 with chest pain that was at rest and with exertion. Vital signs were normal. A chest x-ray was normal. An electrocardiogram (ECG) was reported as not acute.

The health plan's determination is upheld. The inpatient stay was not medically necessary. There was not a severe catheterization related complication (i.e. severe bleeding, cerebrovascular accident (CVA)), or supporting evidence for an acute coronary syndrome such as elevated cardiac biomarkers or an abnormal ECG. As such, criteria for an inpatient level of care were not met. This patient could have been cared for at a lower level of care.