Diagnosis: Dislodged PEG (feeding) Tube
Treatment: Inpatient admission
The insurer denied the inpatient admission.
The denial is upheld.

The patient is a female. She underwent an acute hospitalization. The diagnosis for the hospital stay was a dislodged PEG (percutaneous endoscopic gastrostomy) feeding tube. The patient has a history of asthma, a concussion, migraines, pseudo-seizure, adrenal insufficiency, Clostridium (C) difficile colitis, GERD (gastroesophageal reflux disease), IBS (irritable bowel syndrome), Crohn's disease on Remicade, gastroparesis and constipation.

Nausea was reported, but no emesis. The patient was observed and a PEG tube was not replaced, as the risks were felt to be too high.

No, the inpatient admission was not medically necessary. The treatment was medically appropriate, but not medically necessary at the level at which it was provided.

The patient had a dislodged PEG feeding tube. The tube was not replaced. The care was supportive in nature in its entirety. The care could have been rendered at a lower level of care.

The care as provided could have been rendered in its entirety at a lower level of care. The patient had a dislodged PEG tube, yet she did not evidence a change in mental status, high fevers, neurologic changes, hypotension, signs of sepsis, hemodynamic changes, renal abnormalities, need for NPO (nothing by mouth) status, need for invasive surgery, need for invasive monitoring or treatments, severe electrolyte dyscrasias or any other indication for an acute admission. As such, the care could have been rendered at a lesser level.