The patient presented to the emergency department (ED) complaining of intermittent chest pain for one week. An electrocardiogram (ECG) showed no ischemic changes. Troponin was negative. The patient was seen by Cardiology who recommended urgent catheterization and was admitted. Cath showed a 99% left anterior descending (LAD) stenosis which underwent successful drug-eluting stenting (DES). The patient was observed uneventfully overnight and discharged. The inpatient stay is under review.

The health plan's determination is upheld. The inpatient stay was not medically necessary. The patient had an urgent diagnostic catheterization and coronary intervention for unstable angina. The cath was successful and the patient tolerated the procedure well. It was reasonable and appropriate to monitor the patient for several hours after the procedure. However, it was very likely that the patient would be ready for discharge with 8-23 hours after the procedure. Thus, the patient could have been observed at a lower level of care without the need for a full inpatient admission.