Diagnosis: Vaginal Bleeding.
Treatment: Inpatient Hospital Stay.

The insurer denied the Inpatient Hospital Stay. The determination is upheld.

The patient had vaginal bleeding and presented to the emergency department. Her exam was normal except for blood in the vagina. Vital signs were normal. Her hemoglobin was 7.2 and she was not pregnant. She was admitted as an inpatient and received 2 units of packed red blood cells. She was discharged. Her hemoglobin at discharge was 8.7. At issue is the medical necessity of an inpatient stay.

The requested health service/treatment of inpatient stay was not medically necessary for this patient.

The patient had vaginal bleeding with anemia; however, an inpatient stay was not medically necessary. She could have received treatment with her transfusion in the emergency department or under extended monitoring without the need for high-level inpatient monitoring. She received most of her transfusion before admission. She could have received her transfusion at a lower level of care. She had no abnormal vital signs or cardiovascular instability. She had a history of obesity; however, she had no other significant morbidities. She had no lung, renal or hepatic damage. Except for the anemia, the lab results were normal, and she was discharged less than 24 hours later. She did not receive surgery or other treatments that would require admission.