This is a patient with a past medical history significant for hypertension, peripheral artery disease with stents to the distal superficial femoral artery (SFA), mid superficial femoral artery (SFA) and popliteal arteries, obesity, and tobacco dependence, who presented with a chief complaint of chest pressure. She reported that the pressure radiated to her back and both shoulders, was associated with shortness of breath and intermittent dizziness and palpitations.The health plan's determination of medical necessity is upheld in whole.
This patient who had several risk factors for acute coronary syndrome and presented with chest pressure was appropriate for a lower level of care of care and stress testing. In the absence of laboratory or EKG evidence of ischemia or other process such as dissection, pulmonary embolism, malignant arrhythmia, pericardial effusion, or other process requiring inpatient care, admission at the acute inpatient level of care was not medically necessary.