This is a patient with a medical history remarkable for diabetes mellitus, hypertension, asthma, possibly an unknown type of cancer, ventral hernia repair, and amputation of two toes who presented to the emergency department with complaints of abdominal pain, nausea, and vomiting, which started four days before the date of admission.
The health plan's determination of medical necessity is upheld.
This patient did not have clinical signs of acute peritonitis, small bowel obstruction, acute bowel ischemia, aortic dissection, abdominal aortic aneurysm, or any other findings that would necessitate admission at the inpatient level of care.
The patient responded to the treatment provided at the emergency room (ER), and also while on the medical floor, with fast resolution of his symptoms.