The patient has a past medical history significant for Diabetes and recurrent cellulitis. The patient presented with left lower extremity swelling. Per the patient, roughly 3 days prior on Thursday, he woke up in the middle of the night with pain in his left foot. The pain was accompanied by a small area of redness on his left foot. By Friday morning, the redness had expanded up to his left knee and the lower left leg had also become swollen.

The health plan's determination is overturned. The inpatient stay was medically necessary. The patient at hand had taken a total of 14 doses of oral antibiotics over a three-day period prior to evaluation in the emergency department and despite dual therapy with both doxycycline and clindamycin he had continued to have progression of symptoms. In addition once admitted the patient underwent additional imaging with CT after having an abnormal plain film. Given the presence of both findings and intervention indicators present to warrant an acute inpatient stay per InterQual criteria. This patient's hospital stay does indeed warrant admission to an inpatient level of care.