Diagnosis: Chest pain and dyspnea.
Treatment: Inpatient admission.
The insurer denied the inpatient admission.
The denial is overturned.

The patient is a male. At the time of admission to the hospital, he had a past medical history significant for hypertension (HTN), dyslipidemia, and coronary artery disease (CAD) diagnosed by computed tomography (CT) angiogram, with a finding of severe left anterior descending (LAD) stenosis. The patient presented to the emergency room (ER) with recurrent chest pain with associated dyspnea. The patient was hemodynamically stable. Given the recent diagnosis of coronary artery disease (CAD), as well as new onset chest pain, the patient was admitted for suspected unstable angina. He was referred for cardiac catheterization and was found to have no obstructive coronary artery disease (CAD). He was diagnosed with pericarditis and was discharged home on anti-inflammatory medical therapy.

Yes, the proposed inpatient admission was medically necessary.

The patient presented with new onset chest pain, suggestive of unstable angina. The patient had multiple risk factors for coronary artery disease (CAD), as well as a known history of coronary artery disease, which was diagnosed by coronary computed tomography (CTA), with a finding of severe left anterior descending (LAD) stenosis and was therefore referred for cardiac catheterization. Given the presentation, as well as clinical suspicion for an acute coronary syndrome/unstable angina, she would not be an appropriate candidate for an emergency department (ED) chest pain observation unit, and it would be consistent with the current standard of care that this patient be managed in an inpatient setting. Therefore the requested inpatient admission was medically necessary in this clinical setting.