Diagnosis: Seizures
Treatment: Inpatient admission
The insurer denied the inpatient admission.
The denial is upheld.

This is a female with a history of alcohol use disorder and alcohol induced seizure who presented after a seizure. She had been binge drinking.

Vital signs (VS) were as follows: 99.1, 65, 17, 134/93, and 100%. Exam was remarkable for moderate tremulousness and left lower rib discomfort. Clinical Institute Withdrawal Assessment (CIWA) was 15 down to four. Labs revealed the following: white blood cell (WBC) 3.7, hemoglobin/hematocrit (H/H) 12.1/35.4, and platelets (PLT) 186. Head computed tomography (CT) showed no acute disease (NAD). Cervical (C) spine CT showed NAD. Electrocardiogram (EKG) revealed sinus bradycardia.

The patient was admitted. Plan of care included CIWA protocol. The patient was complaining of headache. She was tolerating by mouth (PO). CIWA was eight. She was considered for Librium taper. Plan for right upper quadrant (RUQ) ultrasound (US) for elevated bilirubin. he patient had a posterior headache and left upper quadrant discomfort, tongue fasciculations and mild tremulousness. CIWA was nine. The patient was cleared for discharge.

No, the proposed inpatient admission was not medically necessary.

This patient was admitted after presenting with an alcohol-induced seizure. The patient did not have active comorbid conditions. The patient was hemodynamically stable and afebrile. She did not have tachycardia or arrhythmia. She did not have persistent vomiting, delirium, seizures, or gross tremor. Labs were unremarkable. The patient was admitted with plan for CIWA protocol. The patient remained hemodynamically stable. She was not scoring high on CIWA protocol. The patient was clinically stable and did not have findings of severe alcohol withdrawal. She did not have symptoms that required an acute inpatient level of care. She had not failed management in a lesser level of care. The requested inpatient admission was not medically necessary.