Diagnosis: Dyspnea

Treatment: Inpatient admission, medication, oxygen therapy, monitoring

The insurer denied the inpatient admission. The denial was upheld.

The patient is a male who was admitted to the hospital with complaint of Dyspnea. The patient had been recently discharged from the hospital with Azithromycin, steroids and bronchodilators, but was not compliant with his medications. Vital signs at presentation were temperature 99.1 F, heart rate 135, respiratory rate 45, and blood pressure 125/105. Oxygen saturations were 92 %. Arterial blood gas (ABG) was PH 7.388, PCO2 44, PaO2 73, and HCO3 25. White blood cell count was 14.2 K and cardiac enzymes were negative. Chest x-ray was within normal limits. EKG showed Sinus Tachycardia with no acute changes. Flu and Respiratory Syncytial Virus (RSV) testing was negative. The patient was treated with intravenous (IV) Steroids, and Bronchodilators. The patient was placed on bilevel positive airway pressure (BiPAP). He improved with treatment in the Emergency Department (ED) and was taken off BiPAP but later needed to be placed back on BiPAP as he became tachypneic again. The History & Physical note from later that day stated patient was in no acute distress. There was no use of accessory muscles noted. Mild scattered wheezing was noted with some decreased air entry bilaterally. The patient was continued on steroids, bronchodilator treatment.

Based on the patient's presentation and subsequent course it appears this patient did not require acute hospitalization. He could have been placed on Observation status while diagnostic testing and treatment were initiated. The patient improved after treatment in the ED. He was afebrile and hemodynamically stable. There was no evidence of Pneumonia. The patient remained stable overnight and was discharged home on oral steroids and other maintenance inhalers.

The carrier's denial of coverage for the inpatient admission is upheld. The medical necessity is not substantiated.