Diagnosis: Acute Coronary syndrome

Treatment: Inpatient Admission

The insurer denied the Inpatient Admission. The denial was upheld.

This is a middle aged female who presented to the emergency department in mid-2019 with left arm pain that had been present an extended period of time. She had a history of hypertension and hyperlipidemia. She had an EKG, which revealed normal sinus rhythm, tall R waves and deep T wave inversions in the lateral leads. Her chest x-ray revealed stable elevation of the right hemi-diaphragm and new mild right tracheal deviation. The computed tomography scan of the chest confirmed questionable thyroid hypodensity with trace left pleural effusion, mild left perihilar pulmonary infiltrate, and a 4 mm left lung nodule. The nuclear stress testing was normal and transthoracic echocardiography revealed normal left ventricular ejection fraction (LVEF 55-60%) and severe concentric left ventricular hypertrophy. She was evaluated by endocrinology who recommended thyroid ultrasound as an inpatient or outpatient. The nuclear stress testing on 5/7/19 was normal and transthoracic echocardiography revealed normal left ventricular ejection fraction (LVEF 55-60%) and severe concentric left ventricular hypertrophy. She was discharged home for further outpatient follow up.

There is no evidence that this patient required an acute inpatient level of care to determine that her left arm pain was not related to acute coronary syndrome.

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