Diagnosis: Urinary tract infection
Treatment: Inpatient Hospital Services

Summary: This patient with an unclear past medical history except for recent urinary tract infection (UTI), self- treated with cranberry juice, presented to the emergency department (ED) with complaints of fever, chills, and rigors. Vitals on presentation included: Temperature max-103 F, Blood Pressure-123/67, Pulse-73, Respiratory Rate-119, Oxygen saturation-96% on Room Air. Laboratory values were notable for the following: White Blood Count (WBC)-5.8 (32% bands), Hemoglobin-14.1, Hematrocrit-43.6, creatinine-0.89, glucose-112; urinalysis showed small leukocyte esterase, negative nitrite. The patient was empirically started on intravenous (IV) antibiotics (azithromycin and ceftriaxone) for possible UTI. Chest x-ray was negative. Urine culture grew Escherichia coli. The patient refused antibiotics and signed out against medical advice.

The insurer has denied coverage for the inpatient hospital admission as not medically necessary. The denial was reversed.

According to the medical records, the patient presented with symptoms suggestive of an infection. Urinalysis and urine culture confirmed a UTI. He had high fever, tachycardia and although a "normal" absolute WBC, he had elevated bands. Moreover, the patient failed outpatient management (seen at Urgent Care), but refused antibiotics. Based on above findings, in an unpredictable patient with unclear medical history, hospital admission was medically warranted for administration of IV antibiotics and further diagnostic management to rule out sepsis.