Diagnosis: Transient Ischemic Attack

Treatment: Inpatient Admission

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

This is an elderly male who presented to the emergency department in mid-2019 with complaints of dizziness. It is reported that the patient's daughter stated that while the patient was eating breakfast, he was feeling dizzy and lightheaded as if he was going to pass out. She stated that he appeared pale, diaphoretic, and had a slurred speech for 5 to 10 minutes during the described episode. It was noted that upon arrival the patient had no further complaints and was feeling better. He had a history of hyperlipidemia and hypertension. His physical examination revealed he was alert and oriented, and was able to follow commands, but was having difficulty speaking. The patient's laboratory studies revealed no significant abnormalities. A Computer Axial Tomogram scan of the brain was performed which did not reveal any acute intracranial hemorrhage or acute appearing territorial infarction. He had a chest x-ray that showed mild air trapping without focal lobar lung consolidation. The patient was admitted and received intravenous fluids. Physical therapy evaluated the patient and noted that the patient was feeling better and denied any further complaints of dizziness. He was discharged home with physical therapy and home health care in place.

According to referenced literature a patient may be admitted to inpatient services when there is evidence of acute bacterial labyrinthitis, cerebellar, brainstem, or cerebral ischemia or hemorrhage, hemodynamic instability, severe persistent vomiting, and severe new neurologic findings requiring inpatient services or evidence of cardiac arrhythmias of immediate concern. Within the documentation none the above was present. It was noted the patient presented with complaints of dizziness prior to presentation however, upon presentation the symptoms resolved.

Based on the above, the medical necessity for the inpatient admission is not substantiated. The insurer's denial is upheld.