Diagnosis: Appendicitis
Treatment: Inpatient stay
The insurer denied the inpatient stay.
The health plan's determination is upheld.

The patient is a male with a past medical history (PMH) of asthma who presented with acute appendicitis with free fluid. He had a white blood cell (WBC) of 18 and transaminitis. The original plan was for antibiotic management, however, he was still in pain so underwent a laparoscopic appendectomy. His operative report indicates there was no gangrene or perforation. He was discharged to home. The inpatient admission is under review.

The inpatient hospital admission was not medically necessary. The patient required intravenous (IV) antibiotics and IV fluid hydration, and nausea treatment. This could be delivered in most centers at a lower level of care.
Level II evidence from NSQIP (National Surgical Quality Improvement Program) in pediatric patients concludes: Outpatient management following appendectomy in children is possible with low morbidity and readmission rates. Comparison with other NSQIP-Pediatric centers suggests an opportunity to generalize this practice with considerable savings to the health care system.