Diagnosis: Confusion and disorientation.
Treatment: Inpatient admission.

The insurer denied the inpatient admission.
The denial is upheld.

The patient is a female who presented to the emergency ward after an episode of transient confusion. At presentation, she was at her baseline cognitive status and she had a normal neurological examination. National Institutes of Health (NIH) stroke scale score was zero. Computed tomography (CT) of the brain, computed tomography (CT) angiogram and computed tomography (CT) perfusion studies were all normal.

No, the proposed inpatient admission was not medically necessary.

The patient had an episode of transient confusion completely resolved by the time of presentation, with a normal neurological examination as well as negative neuro-imaging at presentation, including computed tomography (CT) perfusion study. The clinical assessments, monitoring, diagnostic studies and treatments could have been safely and effectively provided at a lower level of care.