Diagnosis: Headache/weakness.
Treatment: Inpatient stay.
The insurer denied the inpatient stay. The health plan's determination is upheld.

This case involves a female with a history of cerebrovascular accident (CVA) and transient ischemic attack (TIA), which has left her with left-sided peripheral vision deficit, who presented to the emergency department with headache dizziness and blurriness of the vision in the left eye. The patient is chronically anticoagulated with Pradaxa. The headache started during the evening hours before admission, and 4 hours later, the patient woke up, went to the bathroom, and noted some weakness in the left lower extremity.

The inpatient hospital admission is not medically necessary for this patient. The patient can be managed at a lower level of care. There is no evidence of neurologic trauma, causing the patient's symptoms. The patient presented to the hospital with paresthesia to the left lower extremity. Extensive and advanced imaging failed to demonstrate an acute stroke, bleed, tumor, intracranial and extracranial stenosis of the arteries. As a result, there is no evidence of a neurologic emergency that would require inpatient hospitalization. This presentation could have been managed at a lower level of care, with appropriate imaging as was done, with subsequent transition to home.