Diagnosis: Anemia
Treatment: Inpatient admission
The insurer denied the inpatient admission.
The denial is upheld.

The patient is a female. She was sent to the emergency department by her primary physician for severe anemia with a hemoglobin of 6g/dl (grams per deciliter). She had some intermittent dizziness and headache but no other symptoms. She was noted to have recently had a hemoglobin in the 7-8g/dl (grams per deciliter) range prior to being found to have a hemoglobin of 6g/dl (grams per deciliter).

The patient was admitted. She was treated with one unit packed red cell transfusion. She was also treated with intravenous iron (Venofer) as she was found to have iron deficiency anemia. Pelvic ultrasound was done and revealed polycystic ovaries. Abdominal ultrasound was done and revealed mildly prominent spleen. She was discharged.

No, the Inpatient admission was not medically necessary.

This patient was found to have worsening anemia with a hemoglobin of 6g/dl (grams per deciliter). However, she did not have active bleeding and also had no hemodynamic instability. She was treated with single unit transfusion and also treated with intravenous iron. She was discharged after a two-day hospital stay, and during her hospital stay there were no other active medical issues documented. At the time of admission she had mild symptoms related to her anemia and no evidence of hemodynamic instability. She did not require acute care inpatient admission for treatment of her anemia and could have been safely managed in the outpatient setting.