Hypertension
Inpatient hospital

This is a female with history of hypertension and obesity who presented to the emergency department (ED) with complaint of sudden onset of epistaxis. Initial vital signs were blood pressure (BP) 180/104, pulse 70, resp 20, pulse oximetry 100% on room air, and temp 99.6 F. Physical examination showed bilateral nostril packing with 2+ pedal edema. Abnormal lab values included glucose 136, anion gap 16. An electrocardiogram (EKG) showed normal sinus rhythm with t-wave inversions in V3-V6. Chest x-ray showed probable slight bilateral dependent atelectasis. The patient was admitted and seen by Cardiology, ear, nose, and throat (ENT) and critical care. She was treated with nasal packing and blood pressure medications. The patient was discharged home with outpatient follow-up. In question is the medical necessity of the inpatient admission.

The health plan's determination is upheld. The Inpatient hospital admission was not medically necessary. Although the patient presented with hypertensive urgency and nasal bleeding, this was well controlled while the patient was in the emergency department. The nasal bleeding was controlled with anterior packing and the blood pressure was under control with medications administered in the ED. Further care consisted of a Cardiology consult, echocardiogram and blood pressure monitoring. The blood pressure remained stable and outpatient follow-up was recommended by Cardiology. There were no inpatient clinical needs that met criteria for inpatient admission.