Diagnosis: Gout
Treatment: Inpatient admission
The proposed inpatient admission is not deemed medically necessary.
This male patient with a medical history pertinent for diabetes mellitus, hyperlipidemia and gout presented to the ER for further evaluation/management of left foot and first toe pain and swelling. Intake vitals were afebrile, hemodynamically stable with no evidence of febrile temperature, malignant hypertension, profound hypotension, severe tachycardia or hypoxemia on room air. Examination was notable for erythema, edema and tenderness to palpation of the left first toe; the rest of examination was non-focal with no significant abnormalities noted including no evidence of acute cardiopulmonary abnormalities or findings consistent with sepsis/bacteremia. Laboratory testing was without critical findings including no evidence of acute end organ damage.
The medical records indicate that this patient was admitted to the inpatient medical service in stable condition where he received treatment for gout flare with indomethacin, colchicine and steroids. He responded well to the prescribed therapies and was subsequently discharged in stable condition.
There is no evidence of intensification of services throughout the course of this patient's hospital stay. Hence, the patient's care could have been safely furnished in a less intensive setting without adversely affecting patient's safety or outcome. For these reasons, the proposed treatment of inpatient admission is not deemed medically necessary.