Diagnosis: Ischemic systolic heart failure with reducedejection fraction (40-45%), hypertension (HTN), and atrial fibrillation.
Treatment: Inpatient admission.
The insurer denied the inpatient admission.
The denial is upheld.

The patient is a male with a history of ischemic systolic heart failure with reduced ejection fraction (40-45%), hypertension (HTN), and atrial fibrillation. He presented to the hospital for an elective catheter ablation of atrial fibrillation and atrial flutter. He underwent uncomplicated pulmonary vein isolation and cavotricuspid isthmus atrial flutter ablation and was discharged home the following day.

No, inpatient hospital admission following uncomplicated ablation of atrial fibrillation and atrial flutter is not medically necessary.
This patient presented to the hospital for an elective electrophysiological study and ablation. According to hospital records, the ablation was successfully performed without complication. Observation following ablation was unremarkable and no post operative issues were noted. The patient was discharged home the following day.

In this case, there were no clinical reasons for hospital admission and the patient could safely be managed at a lower level of care. In two multicenter registry studies looking at healthcare utilization after electrophysiological study catheter ablation, more than 80% of patients undergoing ablation were hospitalized for a single day, regardless of age or co-morbidity. (Reference 1) Another study demonstrated that patients undergoing atrial fibrillation ablation procedures could be safely discharged on the same day. (Reference 2) The current standard of care in an uncomplicated atrial fibrillation ablation is to manage patients at a lower level of care.