Diagnosis: Seizures.
Treatment: Inpatient admission.

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

The patient is a female with a history of seizure disorder who presented to the emergency ward with the complaint of seizure and abdominal pain. At presentation, her neurological evaluation was normal. Her computed tomography (CT) of the head showed no acute abnormality. She was started on Keppra and admitted for further evaluation. Her electroencephalography (EEG) and magnetic resonance image (MRI) were both interpreted as normal. The patient was diagnosed with intermittent porphyria and breakthrough seizures and discharged on Keppra.

No, the proposed inpatient admission was not medically necessary.

The patient had a history of seizure disorder and was not maintained on any anticonvulsant therapy. Shortly after her presentation, she was at her baseline neurological status. Her diagnostic studies were all negative and she was stabilized on an anticonvulsant regimen within 24 hours without any recurrent spell after presentation. The diagnostic studies, clinical evaluation, monitoring and treatment could have been safely and effectively managed at a lower level of care.