Diagnosis: Paroxysmal atrial fibrillation
Treatment: Inpatient admission

The insurer denied the inpatient admission. The denial is upheld.

The patient is a male with a history of paroxysmal atrial fibrillation who presented to the hospital for elective redo left atrial catheter ablation. Following successful electrophysiologic study with catheter ablation, the patient had an uncomplicated post-operative course and was discharged home the following day.

No, the inpatient admission was not medically necessary.

This patient presented to the hospital for an elective electrophysiologic (EP) study and ablation of atrial fibrillation. According to hospital records, the ablation was successfully performed without complication. Observation following ablation was unremarkable and no post-operative issues were noted. The patient was discharged home the following day. In this case, there were no clinical reasons for hospital admission and the patient could safely be managed at a lower level of care. In two multicenter registry studies looking at healthcare utilization after EP study catheter ablation, more than 80% of patients undergoing ablation were hospitalized for a single day, regardless of age or co-morbidity. (Reference 1) Another study demonstrated that patients undergoing atrial fibrillation ablation procedures could be safely discharged on the same day. (Reference 2) The current standard of care in an uncomplicated atrial fibrillation ablation is to manage patients at a lower level of care.