Diagnosis: Skin Disorders
Treatment: Inpatient Hospital Stay

Diagnosis: Skin Disorders-abscess
Treatment: Inpatient Hospital Stay
The health plan denied the inpatient stay as not medically necessary. The reviewer has upheld in whole the health plan's determination.

This is a healthy patient who presented to the emergency department (ED) with a 3-day history of cellulitis and abscess at a port-site incision status/post (s/p) laparoscopic ovarian cystectomy 2 years earlier. This was the second infection that she experienced at this site. On physical examination, her vital signs were normal. She was afebrile, and not tachycardic. She had a 3 centimeter (cm) indurated area with fluctuance that was tender to palpation. Her white blood cell (WBC) count was normal at 10. Ultrasound showed a 2.6 x 1.1 cm abscess while a computed tomography (CT) scan showed it to be 2.9 x 1.3 x 1.3 cm without extension to the peritoneal cavity. She was admitted, started on antibiotics, and underwent bedside incision and drainage of approximated 5 cubic centimeter (cc) of purulent fluid. On hospital day 1, her WBC count was 7.3 and on hospital day 2, it was 6.9. She was discharged to home with antibiotics with a discharge diagnosis of cutaneous abscess of the abdominal wall.

No, admission at the acute in-patient level of service was not medically necessary for this patient. This was an uncomplicated cutaneous abdominal wall abscess that could have been managed at a lower level of care. A lower level of care would have been appropriate with bedside incision and drainage performed, and discharge to home on oral antibiotics, as occurred in this situation. A lower level of care would have been safe and effective for this patient.