Diagnosis: Abdominal distension; Abdominal pain.
Treatment: Inpatient admission.

The insurer denied the inpatient admission.
The denial is upheld.

The patient is a male.

A brief summary of the hospital stay is as follows:

(Admission History and Physical) Two-to-three-week history of worsening abdominal distension and abdominal pain. He was seen in in the ED (Emergency Department). CT (computed tomography) scan showed abdominal distention and ileus. Surgery consulted with no acute issues. GI (gastroenterology) consulted and recommended admission for inpatient care. The plans included IV (intravenous) fluids; routine monitoring.

(Progress note) Clinically stable and discharged home.

No, the Inpatient Admission was not medically necessary.

As documented in the clinical notes, this patient had worsening abdominal distention and was admitted for inpatient care. During the hospital stay, the patient received IV (intravenous) fluids, but not any other acute intervention. The patient was clinically stable on the second day and then discharged home. There was no documentation for suspected acute intra-abdominal process, ascites requiring acute treatment, severe diarrhea, severe dysphagia, gastroparesis, encopresis or severe fecal impaction or any other acute issues. Thus, the inpatient admission was not medically necessary.