Diagnosis: Hidradenitis suppurativa.
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 hidradenitis suppurativa, with prior history of surgical wound debridement, who presented to the hospital, as the surgical wound opened up. She reported no fevers chills or significant pain. The patient was taking ciprofloxacin on admission. She has undergone multiple excisions of hidradenitis, in numerous body locations.

The inpatient hospital stay is not medically necessary for this patient. This is a patient, who appears to have Hurley stage II hidradenitis suppurativa. This is a chronic and recalcitrant condition that typically requires multiple excisional procedures. In this presentation, the patient has a recurrence of a lesion in the left groin, as well as dehiscence of the wound, from a previously excised hidradenitis in the left inframammary region. These were addressed surgically. The operation was without complications, and the patient was discharged the following day. This type of presentation is typically accomplished under a lower level of care. There is no sign of systemic illness; there is no sepsis; and the patient is hemodynamically stable. The intraoperative cultures showed coagulase-negative staph, which is a skin contaminant, and Proteus mirabilis. The patient was appropriately covered with Cipro before coming into the hospital. This patient did not require skin graft placement or wound vacuum-assisted closure (VAC). As a result, the inpatient stay is not medically necessary.