The patient with history of hypertension and kidney stones presented for an elective percutaneous nephrolithotomy. Intraoperative findings include a left staghorn calculus. After the procedure the patient was put on an inpatient status and was managed with intravenous (IV) fluids, IV antibiotics and monitoring. Follow-up computed tomography (CT) scan showed no stones. The Foley catheter and nephrostomy tube were discontinued. There were no intraoperative or postoperative complications. The patient had an uneventful hospital stay and was discharged. The health plan's determination is upheld.

An inpatient stay was not medically necessary for this patient.
The majority of patients who undergo transurethral resection of prostate can be discharged within 24 hours of the procedure. The procedure was an elective scheduled procedure. The patient did not have any significant risk factors which increased risk of post-operative complications. The post-operative course was essentially normal without any significant complications or issues with pain control. The patient could have been managed at a lower level of care status given the patient's clinical presentation and post-operative course. A lower level of care status is safe, effective, and a generally accepted standard, and would be the most appropriate treatment option. Admission status may be changed anytime during a lower level of status if the patient requires continuing services and monitoring, and if the patient's condition is severe enough to require inpatient treatment.