Diagnosis: Dental abscess
Treatment: Inpatient hospital stay
The insurer denied the inpatient hospital stay.
The health plan's determination is overturned.

The patient is a girl who presented with swelling and pain of her chin. She was well until several days prior to presentation, when a friend at school accidentally hit her chin. She developed swelling at that time with some redness. Afterwards, the swelling progressed and the pain worsened, particularly with eating, drinking, and speaking. She took acetaminophen at home with no relief. The pain progressed to a 10 out of 10 in intensity, and therefore she was brought to the emergency department for care.

Inpatient hospital admission was medically necessary for this patient.

This is a patient who presented with a significant odontogenic infection. If unrecognized and untreated, these infections are potentially serious since they can spread contiguously into the deeper fascial spaces of the head and neck. For patients with pyogenic odontogenic infections, parenteral therapy is appropriate along with intravenous fluids to maintain hydration status and pain control. Inpatient hospitalization was necessary for these treatments, as well as expert consultation with surgical intervention.