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

The patient is a male with a past medical history of hypertension, dyslipidemia, and coronary artery disease status post prior percutaneous coronary intervention (PCI) with a total of five stents placed.

The patient presented for evaluation of new onset chest pain, right-sided, non-reproducible, non-exertional with no radiation. The patient was hemodynamically stable. The electrocardiogram (ECG) revealed no acute ischemic changes. Cardiac troponins were negative. The patient was admitted to telemetry to rule out acute coronary syndrome (ACS). No inpatient ischemic work-up was planned. The chest pain subsequently resolved. Repeat troponin was negative as well. The patient was discharged home with a plan for outpatient follow-up.

No, the inpatient admission was not medically necessary.

The patient presented with atypical chest pain. There were no acute electrocardiogram changes or increase in cardiac biomarkers. Acute myocardial infarction was ruled out by cardiac troponins, which were negative. There was no evidence of acute coronary syndrome, acute myocardial infarct (MI), decompensated congestive heart failure (CHF) or hemodynamic instability. The patient was monitored until acute coronary syndrome was ruled out and discharged with no plans for inpatient stress testing or angiography. Therefore, the medical necessity of the inpatient admission is not established and the services could have been provided at a lower level of care.