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

This patient is a male with a history of alcohol dependence and withdrawal who presented to the emergency department (ED) for evaluation of alcohol withdrawal. The patient complained of tremors, nausea, tactile hallucinations and being anxious. Also, he had intermittent left-sided chest pain.

Vital signs (VS) were as follows: 97.4, 76, 20, 112/96, and 99%. Exam was remarkable for diaphoresis. Labs revealed the following: complete blood count (CBC) and basic metabolic panel (BMP) were within normal limits (WNL), troponin was less than (<) .015, and alcohol (EtOH) was 260. Electrocardiogram (EKG) showed sinus rhythm, lateral infarct. The patient was admitted. Plan of care included Clinical Institute Withdrawal Assessment (CIWA) protocol.

The patient's vital signs were stable (VSS); there was no acute distress (NAD). There were no hallucinations. Troponins were negative three times (x3). Disposition after CIWA protocol. CIWA was 5. Disposition after CIWA completed.

No, the proposed inpatient admission was not medically necessary.

This patient was admitted after presenting with possible alcohol withdrawal. The patient was hemodynamically stable and afebrile. He did not have tachycardia or arrhythmia. He did not have persistent vomiting, delirium, seizures, or gross tremor. The patient also complained of chest pain. Troponin was negative. Labs were remarkable for elevated alcohol level. The patient was admitted with plan for CIWA protocol. The patient remained hemodynamically stable without signs of alcohol withdrawal. The patient was not scoring high on CIWA protocol. The patient was clinically stable and did not have findings of severe alcohol withdrawal. He did not have symptoms that required an acute inpatient level of care. He had not failed management in a lesser level of care. The requested inpatient admission was not medically necessary.