Diagnosis: Possible stroke
Treatment: Inpatient admission
The insurer denied the inpatient admission.
The denial is upheld.

The patient is a female. She presented the emergency ward with right hemibody numbness, intermittently for one month. She had a NIH (National Institutes of Health) stroke scale of 4. She was admitted for possible stroke. Her MRI (magnetic resonance imaging) was negative.

No, the Inpatient admission was not medically necessary.
The patient presented with right hemibody numbness for one month. The possibility that this was an acute stroke or recurrent TIA (transient ischemic attack) was low (Mendelson and Prabhakaran). The diagnostic studies were negative. The neurology consult, diagnostic studies, monitoring and treatment could have been safely and effectively provided at a lower level of care.