This is a patient with history of constipation who was directly admitted for abdominal washout for constipation. The patient about a month prior began having intermittent vomiting. The patient was taken to the emergency department early the month prior and the abdominal x-ray showed large stool burden. The patient continued with intermittent vomiting. The patient was admitted, a nasogastric (NG) tube was placed, and GoLytely was slowly infused. The health plan's determination is overturned, in whole. Per current recommendations, if disimpaction is not achieved as an outpatient, admission for lavage via NG Tube is recommended. This patient also failed outpatient management. This patient was planned for large volumes of electrolyte solution via NGT, close monitoring of vital signs, as well as strict intake (Is) and output (Os) are of paramount importance. The inpatient level of care was medically necessary.