Diagnosis: Musculoskeletal/Orthopedic.
Treatment: Skilled Nursing Facility.

The insurer denied skilled nursing facility. The denial is upheld.

The patient is a male with right foot osteomyelitis. He was admitted to a skilled nursing facility. It was noted that intravenous (IV) antibiotics were required, and he obtained wound care every Thursday. The health plan denied skilled nursing facility as the patient did not meet criteria. The subject under review is the medical necessity for the skilled nursing facility.

No, the requested skilled nursing facility stay was not medically necessary nor appropriate for this patient. The patient did not have any skilled needs.
The patient is a male who was admitted to a hospital related to right foot osteomyelitis. He was subsequently admitted to a skilled nursing facility. The patient was medically stable. He was not requiring any IV antibiotics. He was seen by a wound team once a week and dressing changes were not more than once a day. The patient was more than ready to be discharged to a lower level of care since, despite being non-weight bearing (NWB) to his right lower extremity (RLE), he was ambulating over 100 feet with rolling walker and stand by assist (SBA) with wheelchair following via hopping and was also SBA for bed mobility, transfers, toileting, car/tub-shower transfer and lower extremity dressing. He was independent over 150 feet with wheelchair mobility, upper extremity activities of daily living (ADLs), hygiene/grooming and feeding.