This is a case of a patient with no major medical history, who presented to the emergency department, with complaints of aphasia. The patient's last known normal state was 19 hours prior; the patient woke up with aphasia, right upper and lower extremity weakness, worsening over time. The patient was not taking any medications at the time of the presentation. A rapid response was activated, and the patient was sent for a computed tomography (CT) scan of the brain with CT perfusion and angiogram. The patient's patient's brain MRI, which showed acute to subacute infarct in the posterior limb of the left internal capsule. The the health plan's determination of medical necessity is overturned in whole.
The requested health service treatment of inpatient medical stay is necessary for this patient.This patient presents to the hospital with typical signs and symptoms of acute stroke, with weakness in the right upper and lower extremity, facial droop, and dysarthria. The symptoms persisted and did not resolve immediately.This type of presentation is typically managed under inpatient status. A lower level of care was not appropriate.in this case.The patient's admission based on Milliman Care Guidelines (MCG) criteria for acute ischemic stroke, the patient satisfies the criteria, for hospitalization under the inpatient status.