Digestive System
Inpatient hospital

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

The patient is a woman with a history of gastritis, depression, marijuana use and anxiety who presented to the emergency department with abdominal pain, nausea and vomiting for the past two hours. She reported using marijuana earlier that day. She denied other drug use. She had reportedly experienced cyclical vomiting due to marijuana use. This resulted in multiple emergency department visits over the past few months. Vital signs showed blood pressure 140/85, heart rate 54, temperature 97.4 Fahrenheit, and respiratory rate 20. On physical exam, the abdomen was tender in the epigastric region. Labs showed white blood cell (WBC) 11.6,. Hemoglobin 12.0, platelets 255, sodium 142, potassium 4.3, creatinine 0.73, and calcium 10.3. Imaging of the abdomen was negative for obstruction and free air. The patient was admitted for suspected marijuana hyperemesis.

The inpatient stay was not medically necessary. The patient did require further management for marijuana hyperemesis, and received several agents including Zofran, Reglan, and Haldol. However, she was hemodynamically stable, had no severe electrolyte abnormalities, and had no other suspected cause of her abdominal pain such as bowel obstruction or inflammatory bowel disease. Her care did not need to be provided at the acute inpatient level of care. A lower level of care was appropriate.