Diagnosis: Ovarian Torsion.
Treatment hospital admission.
The insurer denied coverage for hospital admission.
The denial is upheld.

The patient presented to the emergency room with abdominal pain. There was a concern for ovarian torsion. The patient underwent a laparoscopic detorsion with ovarian cystectomy. The procedure was uncomplicated. She was discharged later that day.

The patient presented with severe abdominal pain, an ovarian cyst and findings suggestive of torsion. She underwent an uncomplicated laparoscopy.
A laparoscopy is an ambulatory procedure.

According to Milliman Care Guidelines, Inpatient and Surgical Care, Laparoscopic Gynecologic surgery, including myomectomy, oophorectomy, and salpingectomy, laparoscopic procedures are ambulatory procedures. Inpatient stay may be needed for:
1)Older patients (> 65)
2)Conversion to abdominal procedures
3)Surgical complications
4)Comorbidities.

This patient did not have any of these criteria. Her procedure was uncomplicated. There was no evidence of any injury to other organs. She was tolerating oral intake and voiding adequately.

Please note that a laparoscopic procedure is an outpatient procedure and includes appropriate postoperative monitoring and an overnight stay if required.
Based on the above, the inpatient admission was not medically necessary.

The health care plan acted reasonably and with sound medical judgment and in the best interest of the patient.

The hospital admission is not considered medically necessary for this patient.

The insurer's denial of coverage for hospital admission is upheld. Medical necessity is not substantiated.