Diagnosis: Syncope.
Treatment: Inpatient admission.

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

This patient is a male who was found down and admitted with altered mental status and hyperglycemia. In the emergency room, the patient's blood pressure (BP) was 139/100, temperature was 101.3, heart rate was 148, and respiratory rate was 22. The patient's glucose was 545 milligrams per deciliter (mg/dL). Calculated osmolality was 289. Glycated hemoglobin (A1C) was 16.1%.

The patient was treated for sepsis possibly due to bullosis diabeticorum. He was treated with Vancomycin and Zosyn. He was given hydralazine for his blood pressure (BP) of 198/107. The patient was treated with subcutaneous insulin.

Yes, the proposed inpatient stay was medically necessary.

The requested inpatient stay was medically necessary. This patient was admitted with marked hyperglycemia after being found down. Given his syncope episode, which was complicated by fever at the time of presentation and marked hyperglycemia, he required admission. He also had multiple fluid filled bullae. He was appropriately initiated on antibiotics for possible sepsis and blood and urine cultures were taken. He had ongoing confusion. He also had persistent hyperglycemia with glucose values up to 422 milligrams per deciliter (mg/dL) and glucose of 376 milligrams per deciliter (mg/dL). Therefore, the requested inpatient stay was medically necessary.