Diagnosis: Ovarian Cancer.
Treatment: Inpatient hospital stay.
The insurer denied the inpatient stay as not medically necessary. The determination is upheld in whole.

The patient has a Stage II yolk sac tumor who presented to the operating room for resection of a pelvic mass and lysis of adhesions, performed laparoscopically. The patient was admitted to the hospital after the procedure and discharged home the following day.

The surgical procedure performed was done laparoscopically and it is defined as an ambulatory or outpatient operation. Per the medical records reviewed, the procedure was uncomplicated, it did not require conversion to a laparotomy and the patient was able to ambulate, void, and tolerate an oral diet and oral pain medications after the surgery and remained afebrile with stable vital signs. Thus, there were no medical conditions or events to justify inpatient level of care after the surgery. This service of inpatient hospital stay is not standard of care, is not supported by peer reviewed literature and it is not supported by professional organizations and thus, it was not medically necessary. The patient could have received treatment at a lower level of care.