
201906-118495
2019
Fidelis Care New York
Medicaid
Cancer
Inpatient Hospital
Medical necessity
Upheld
Case Summary
Diagnosis: Prostate Cancer
Treatment: Inpatient admission
The inpatient admission was not medically necessary.
While hospitalization was indicated, the patient's care did not require an acute inpatient level of care. The patient was afebrile and clinically stable. He was on clear diet. The use of pain medications and IV antibiotics, as well as JP and Foley care, can be safely and appropriately be administered at a lower level of care. With an uncomplicated post-op stay of less than 48 hours, an acute inpatient level of care was not required because care could have been provided at a lower level of care. A benefit of laparoscopic surgery is a quicker recuperation than open surgery.