Diagnosis: Possible Seizure/Head Bobbing
Treatment: Inpatient admission
The insurer denied the inpatient admission.
The denial is overturned.

The patient is a male. The patient has history of abnormal head movements with singular head bobs/head drops approximately twice a week. These incidents became more frequent and lasted for longer periods of time. The patient was then seen by a neurologist and underwent an EEG (electroencephalogram), which was negative. The patient's episodes persisted but not as frequently.

The patient was brought to the emergency room on the advice of his neurologist after two episodes of vomiting, which were not associated with head movement episodes, as well as almost falling over while brushing his teeth. Exam in the emergency room was essentially unremarkable.

The patient was admitted for further management and workup, including neurology consult and video EEG (electroencephalogram). According to the Discharge Summary, there were no further acute events, and the parents reported no head drops or abnormal movements since he was admitted. His vital signs remained stable and he remained without fever and without neurological deficits throughout his admission. The patient was placed on video EEG monitoring for 48 hours, and this showed diffuse theta slowing, occasional bilateral generalized amplitude spike or poly-spike wave discharges in sleep, but no seizures were confirmed. Discharge diagnosis was listed as seizure. The patient was prescribed Depakote and was to follow-up with his neurologist in three weeks.

Yes, the Inpatient stay was medically necessary.

The patient had drop attacks suggestive of seizures. Atonic seizures manifesting with loss of tone in the neck and body and legs are manifestations of seizure disorder and are especially dangers due to high risk of trauma during the falls. Routine EEG (electroencephalogram) did not discover the nature of the patient's illness. Therefore, inpatient video EEG (electroencephalogram) was medically necessary to capture the actual events and/or to capture prolonged interictal activity, to make an appropriate diagnosis, either of nonepileptic spells or of seizures. Such diagnosis was made, based on the EEG (electroencephalogram) slowing and presence of spikes, and medication was started, improving patient's health and lowering the likelihood of any further seizures. Therefore, the treatment is medically necessary by virtue of being generally accepted, appropriate for the patient's condition, and having substantial potential to improve the patient's health.

The patient was suspected to have a severe case of epilepsy, known as atonic seizures/drop attacks. Outpatient evaluation failed to determine the diagnosis. Therefore, inpatient admission with video EEG (electroencephalogram) was medically necessary to make an appropriate diagnosis and to decide about antiepileptic management.