Cardiac
Inpatient hospital

Diagnosis: Chest pain
Treatment: Inpatient stay
The insurer denied the inpatient stay. The health plan's determination is upheld.

The patient is a female with a past medical history of myocardial infarction who presented to the emergency department (ED) with complaints of chest pain with radiation to the left jaw since the night prior to presentation. It comes and goes every two minutes. (By different note, there was no radiation and the quality of pain was achy). Her pain was intermittent and sharp.

The Inpatient Hospital Admission was not medically necessary for this patient. The patient presented with atypical chest pain. She reported history of MI, however, that was not confirmed. The patient had normal vitals, physical examination, labs and electrocardiogram (ECG). She was stable, but the plan was to observe her overnight. The patient refused to stay. Her condition upon presentation was stable and she did not meet criteria for inpatient admission. She should have been managed at a lower level of care. Even if the patient stayed overnight, the likelihood of her qualifying for inpatient stay would be very low.