Diagnosis: Dysfunctional uterine bleeding and endometriosis
Treatment: Inpatient admission
The insurer denied the inpatient admission.
The denial is upheld.

The patient is a female with a history of dysfunctional uterine bleeding and endometriosis, as well as multiple sclerosis (MS), status post (s/p) previous ovarian cystectomies, as well as rectosigmoid resection and ileostomy. The patient underwent a robotic-assisted total hysterectomy, lysis of adhesions and right salpingectomy, as well as bladder cystectomy. She underwent the surgery and was discharged.

No, the proposed inpatient admission was not medically necessary.

The proposed treatment is not medically necessary since there are no data that outcomes after robotic assisted hysterectomy including lysis of adhesions are better if patients are admitted after the procedure. This is deemed to be an ambulatory procedure and the patient did not have any conditions that would render inpatient level of care after it to be medically necessary. Specifically, the patient did not require conversion to laparotomy, the patient did not have any underlying medical conditions that would require inpatient level of care after the procedure, the surgery was not complicated, and the patient was able to ambulate, void, and take oral medications, and an oral diet. Thus, the patient did not have any conditions that required inpatient level of care. Inpatient level of care in this case is not supported by peer-reviewed literature, it is not standard of care and is not supported by professional organizations.

The patient did not have any conditions that required inpatient level of care. Inpatient level of care in this case is not supported by peer-reviewed literature, it is not standard of care and is not supported by professional organizations.