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201907-118914

2019

United Healthcare Plan of New York

HMO

Central Nervous System/ Neuromuscular Disorder

Inpatient Hospital

Medical necessity

Upheld

Case Summary

Diagnosis: Seizure
Treatment: Inpatient admission
The acute inpatient admission from 05/16/2019 through 05/18/2019 was not medically necessary.

The patient is a male with a history of seizure disorder who presented to the emergency ward with confusion after a seizure. He received parenteral phenytoin and was admitted for prolonged post ictal confusion.

The next day, the patient was no longer confused, and he had no recurrent seizures.

The patient was restarted on phenytoin and had returned to his baseline neurological status. He did not require acute inpatient care and management could have been achieved at a lower level of care.

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