Diagnosis: Hypoxemia, SOB, cough
Treatment: Continued inpatient admission
The proposed treatment was not medically necessary.

This is a patient with history of scleroderma, pulmonary hypertension with worsening shortness of breath, cough and fevers who presented to emergency room. The patient was hypoxic and required high amounts of oxygen. The patient had an elevated brain natriuretic peptide (BNP) and chest x-ray showed pulmonary edema. The patient was admitted to acute inpatient hospital level of care for the management of congestive heart failure (CHF) exacerbation. The patient was started on intravenous (IV) diuresis, as well as IV antibiotics.

The patient was admitted with acute on chronic hypoxic respiratory failure due to CHF exacerbation as well as possible pneumonia/bronchitis. The patient was treated with IV antibiotics, IV steroids, IV diuresis as well as high flow oxygen. The patient's condition slowly improved and she was titrated off high dose steroids, high flow fraction of inspired oxygen (Fio2).

For the dates of service under review, the patient was doing well and was hemodynamically stable. The patient was tolerating oral diet and was working with physical therapy. The patient was back on home oxygen requirements. The continued acute in-hospital level of care is not medically necessary.