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

This male with a history of alcohol abuse presented to the emergency room for evaluation of alcohol withdrawal. He was reported to be confused.

Vital signs were as follows: temperature 97, pulse 75, respiratory rate 20, blood pressure 154/97.
Exam at admission was unremarkable. Laboratory results were as follows: Sodium 142, potassium 3.8, blood urea nitrogen (BUN)/creatinine 8/.8, white blood cell (WBC) count 7.06, hemoglobin/hematocrit (H/H) 14.3/42.1, Platelets 246. EtOH (ethyl alcohol) 76. Ammonia 35. Urine toxicology test positive for THC (Tetrahydrocannabinol). A chest x-ray had no abnormality detected (NAD). Electrocardiogram (EKG) showed sinus tachycardia.

The patient was admitted with alcohol withdrawal syndrome. Plan of care included IVF (Intravascular Fluid) and CIWA (Clinical Institute Withdrawal Assessment for Alcohol) protocol. The patient remained hemodynamically stable with no signs of acute withdrawal.

No, the inpatient admission from was not medically necessary.

This patient was admitted for alcohol withdrawal. He did not have active comorbid conditions and was hemodynamically stable and afebrile. He had tachycardia, but no arrhythmia. He did not have persistent vomiting, delirium, seizures, or gross tremor. Electrolytes were stable. The patient was admitted with plan for IVF (Intravascular Fluid) and CIWA (Clinical Institute Withdrawal Assessment for Alcohol) protocol. There were no signs of sever alcohol withdrawal during the hospital stay. 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. Withholding the treatment would not reasonably be expected to affect the patient's health adversely.