
201912-123762
2020
Healthfirst Inc.
Medicaid
Central Nervous System/ Neuromuscular Disorder
Inpatient Hospital
Medical necessity
Upheld
Case Summary
Diagnosis: Weakness, dizziness, blurred vision
Treatment: Inpatient admission
The Inpatient admission was not medically necessary.
The patient is a male with a history of stroke. He presented with the complaint of generalized weakness, dizziness and blurred vision. At presentation, he had a normal neurological examination and CT brain. He was evaluated by a neurologist, and no change to his treatment regimen was recommended.
The patient presented with nonspecific complaints and a normal neurological evaluation. There were no concerning features on history, diagnostic studies or examination to suggest an acute neurological event. The patient's complaints could have been safely and effectively evaluated, monitored and treated at lower level of care. Therefore, the Inpatient admission was not medically necessary.