Diagnosis: ENT.
Treatment: Inpatient hospital stay.
The health plans determination is upheld in whole. The inpatient hospital stay was not medically necessary.

The patient has a right sided cholesteatoma and had a tympanomastoidectomy. There were no peri-operative complications as well as no operative complications. Patient was admitted for intravenous (IV) antibiotics administration due to concern for complications like meningitis post operatively. The patient was discharged the following day. There is no documentation of intra-operative or peri-operative complications where IV antibiotics were needed. There was no documentation that patient had an active infection at the time of surgery.
IV antibiotics or any type of post-operative antibiotics have not been shown to be beneficial for ear surgery (see Patel). A Cochrane review concluded " There is no strong evidence that the large scale use of prophylactic antibiotics in clean and clean-contaminated ear surgery is helpful in reducing postoperative complications such as wound infection, discharge from the outer ear canal, labyrinthitis and graft failure." Additionally, meningitis is exceedingly rare in ear surgery. If there is no violation of the tegmen tympani and/or dura (as there was no violation per the operative report) the risk of meningitis is near zero.
In summary, there was no medically indicated reason for an inpatient admission for IV antibiotics based on the documentation provided. It is not considered standard of care to give IV antibiotics after a tympanomastoidectomy surgery. Therefore, medical necessity for an inpatient admission is not established.