Diagnosis: Urinary Tract Infection (UTI).
Treatment: Inpatient admission.
The insurer denied the inpatient admission.
The denial is overturned.

The patient is a female. She was admitted through the ER (emergency room) with a diagnosis of acute pyelonephritis. She had renal calculi treated with a percutaneous nephrostolithotomy. She had been managed at home with Cipro and Bactrim. CT (computed tomography) imaging had left renal calculi up to 14 mm (millimeters). Vitals were Tmax (maximum temperature) 101.4 Fahrenheit, pulse 88 per minute, blood pressure 118/64 mmHg (millimeters of mercury). IV (intravenous) Levaquin was started.

Day two, she was treated with IV (intravenous) antibiotics. The urine culture grew streptococcus species.

Day three, the patient was discharged home.

Yes, the Inpatient admission was medically necessary.
The patient had previous urologic surgery (e.g., stent placement). She had renal calculi treated with a percutaneous nephrostolithotomy.

Admission is indicated for 1 or more of the following: Hemodynamic instability, Altered mental status that is severe or persistent, Persistence or worsening of clinical findings (eg, fever, pain, dehydration, vomiting) despite observation care treatment (ie, remain too severe to allow treatment at lower level of care), Parenteral antibiotics needed beyond observation care treatment (eg, patient cannot take oral medication, known or suspected pathogen resistance to oral agents), Pregnancy of 24 weeks' gestation or beyond (if pyelonephritis) Immunocompromised state (eg, AIDS [acquired immune deficiency syndrome], chronic systemic corticosteroid use), Urinary system finding that requires invasive procedure, or places patient at increased risk for systemic illness (eg, hypotension), or delayed recovery as indicated by 1 or more of the following:Ureteral obstruction (eg, stone), Bladder emptying significantly impaired (eg, neurogenic bladder, bladder outlet obstruction), Renal or perinephric abscess Emphysematous pyelonephritis, Granulomatous pyelonephritis, Pyelitis Pyonephrosis, Previous urologic surgery (eg, stent placement), Anatomical abnormality (eg, of collection system, ureters, reflux), Transplanted kidney, Acute renal failure Need for IV (intravenous) hydration support (eg, inability to maintain oral hydration) despite observation care treatment.

As the patient had previous urologic surgery, the inpatient admission was medically necessary.