Diagnosis: Depression/Obsessive-Compulsive Disorder/OCD.
Treatment: Inpatient Behavioral Health Level of Care, Child or Adolescent.

The health plan denied the Inpatient Behavioral Health Level of care, child or adolescent. The reviewer has upheld in whole the health plan's determination.

The patient was admitted to inpatient behavioral health level of care. Prior to admission the patient was impulsive with possible mania. The patient had not been sleeping for 4 days. The patient was diagnosed with major depressive disorder (MDD), obsessive-compulsive disorder (OCD), attention deficit hyperactivity disorder (ADHD), body dysmorphia and post-traumatic stress disorder (PTSD). As of the first date in question the patient had improved. The patient was not suicidal, homicidal, psychotic, or manic. The patient was not sexually inappropriate. The patient was medication compliant with no side effects to medications. There were no other imminent risk concerns.

The requested health service/treatment of Inpatient Behavioral Health Level of Care, Child or Adolescent is not medically necessary for this patient for the dates of service in question. The patient had no suicidal ideation with a plan, homicidal ideation with a plan or command hallucinations. There was no physical aggression and no other acute concerns that required around the clock monitoring. The patient had improved and did not have emotional or medical concerns that required 24-hour level of care monitoring. A serum level of Lithium could have been managed at a lower level of care.