Diagnosis: Seizure-like activity
Treatment: Inpatient admission
The insurer denied the inpatient admission.
The denial is upheld.

The patient is a female with a history of depression and post-traumatic stress disorder. She presented to the emergency ward with seizure-like activity. She was not post-ictal after the spell.

At presentation, the patient's neurological examination was normal, and CT (computed tomography) brain and cervical spine showed no acute findings.

No, the inpatient admission was not medically necessary.

At presentation, the patient had a normal neurological examination and diagnostic work-up. The patient had a single spell. The spell lacked emblematic features of generalized seizure such as tongue, bite incontinence or post-ictal confusion or lethargy. Given these factors, the diagnostic studies, clinical evaluation, treatment and monitoring could have safely and effectively been provided at a lower level of care.