
201908-119788
2019
Empire BlueCross BlueShield HealthPlus
Medicaid
Skin Disorders
Inpatient Hospital
Medical necessity
Overturned
Case Summary
Diagnosis: Guttate psoriatric lesions
Treatment: Inpatient stay
The acute inpatient admission was medically necessary.
Summary:
The patient has a history of psoriasis, and presented with increased leg swelling, and pain.
In the ER, the patient's vitals were as follows: Temperature-36.9, Pulse-155, Respiration Rate-18, Blood Pressure-123/80. On general examination, the patient was NAD (no acute distress). Examination of the patient's CVS (cardiovascular system), chest, and abdomen were normal. Examination of the patient revealed widespread guttate psoriatric lesions, erythematous lesions with circumferential scaling, tender to touch, leg lesions are more coalesced with scaling with yellowish thin discharge from both calves, foul smelling.
This patient should have had inpatient admission and for the following reasons:
1) She had systemic signs of infection (high WBC count and tachycardia), which is indication for admission according to the Infectious Diseases Society of America guidelines (1).
2) The patient failed outpatient therapy and MRSA infection was suspected. Again, these are indications for admission according to the Infectious Diseases Society of America guidelines (1).