Diagnosis: Asthma Exacerbation.

Treatment: inpatient hospitalization.

The insurer is denied coverage for inpatient hospitalization.

The denial is overturned.

This male patient has a history of eczema and asthma.

He was noted to have wheezing, prolonged expiration and retractions which did not respond to treatment in the emergency room (ER) with prednisone, continuous albuterol and magnesium sulfate. The decision was made that he would require inpatient pediatric treatment for status asthmaticus. Since there was no inpatient pediatric service at the facility the child was transferred by ambulance to another hospital for admission. In the ER , he had a pulse oximeter reading of 93% (percent) and he was noted to have an increased respiratory rate of 40. His viral respiratory panel was positive for rhinovirus. When his respiratory symptoms did not improve with treatment in the ER, the decision was made to admit him with a diagnosis of status asthmaticus for ongoing treatment with albuterol every 2 hours.

The patient was treated appropriately in the ER for a cough, wheezing and respiratory distress. He had been treated in the ER with continuous albuterol, prednisone and magnesium sulfate. Following treatment in the ER he continued to have ongoing respiratory distress with persistent wheezing, prolonged expiration and increased work of breathing.

It was appropriate and consistent with the standard of care to admit him to the hospital for ongoing treatment with albuterol every 2 hours with a diagnosis of status asthmaticus. He continued to be in respiratory distress with a pulse ox of 93% and was not stable enough to be discharged home. The admission was medically necessary.

Based on the above, the medical necessity for the inpatient hospitalization is substantiated. The insurer's denial is overturned.