Diagnosis: Atrial fibrillation
Treatment: Inpatient admission
The insurer denied the inpatient admission. The denial is upheld.

The Inpatient admission was not medically necessary.

The patient is a male. He has a past medical history significant for BPH (benign prostatic hyperplasia). He presented to the ER for complaints of palpitations associated with chest pain and diaphoresis.

The patient was found to be in atrial fibrillation with rapid ventricular rate. He spontaneously converted to normal sinus rate. His troponins were normal. The patient was started on metoprolol and was admitted to telemetry for monitoring. His prior cardiac work-up included an echocardiogram, which revealed reduced LV (left ventricle) function. During this admission, the patient remained in sinus rhythm after conversion in ER. Repeat troponin was negative, as well. 2D echo was obtained, revealing EF (ejection fraction) of 55-60%. No inpatient ischemic work-up was performed or planned during this admission. TSH (thyroid stimulating hormone) was within normal limits. The patient was started on anticoagulation with Eliquis and PRN (as needed) Metoprolol, and was discharged home with a plan for outpatient follow-up.

The patient presented for evaluation of palpitations and chest pain. He was found to have atrial fibrillation and spontaneously converted to normal rhythm. The diagnosis of an acute MI (myocardial infarction) was ruled out by cardiac enzymes, which were negative. No inpatient stress test or catheterization was planned. There was no evidence of acute myocardial infarction, ACS (acute coronary syndrome), decompensated CHF (congestive heart failure), recurrent arrhythmia or hemodynamic instability. Echocardiogram revealed preserved EF. Patient was anticoagulated with Eliquis. The clinical information provided in the record submitted for review does not support medical necessity for this admission, and the care required could have been provided at an observational level of care.