Diagnosis: Chest pain
Issue under review: Inpatient admission
The insurer denied the inpatient admission.
The denial is overturned.

The patient is a female at the time of admission to the hospital, with a past medical history significant for hypertension (HTN), dyslipidemia, gastroesophageal reflux disease (GERD), presented to the ER with complaints of new onset chest pain. The patient was hemodynamically stable. The electrocardiogram (ECG) revealed ST depressions in inferior-lateral leads. The patient was placed in observation. Troponin was sent and was negative. The patient was referred for a stress test, which was abnormal, with evidence of ischemia. The patient was admitted for unstable angina and referred for cardiac catheterization, which revealed obstructive left circumflex lesion, which was stented. The patient was started on medical therapy for coronary artery disease (CAD) and was discharged home with a plan for outpatient follow-up.

The patient presented with new onset chest pain, suggestive of unstable angina. The ECG was abnormal, with ST depressions, consistent with ischemia. Stress test was also abnormal, with findings confirming ischemia. The patient underwent catheterization and required PCI of the culprit lesion. Given this presentation, suspicion for an acute coronary syndrome, as well as risk factors for CAD and findings on non-invasive testing, it would be consistent with the current standard of care that this patient be managed in an inpatient setting, and therefore the requested inpatient admission was medically necessary in this clinical setting.