Diagnosis: Vaginal Bleeding
Treatment: Inpatient Hospital Stay
The insurer denied the Inpatient Hospital Stay.
The determination is upheld.

The patient has a history of uterine fibroids and abnormal bleeding with chronic anemia. She presented to the emergency room for vaginal bleeding and abdominal pain. Her hemoglobin was 5 and a computed tomography (CT) scan showed a fibroid uterus. She was admitted as an inpatient for the anemia and provided 3 units of red blood cells. She was also provided tranexamic acid for her bleeding. She was discharged to home in good condition. At issue is the medical necessity of an inpatient stay.

The requested health service/treatment of inpatient stay was not medically necessary for this patient.
The patient had severe anemia and the transfusion was appropriate, however, there are no documents provided to support the need for inpatient admission. The patient had chronic anemia secondary to uterine bleeding, however, she had no other medical condition that would require acute inpatient admission. She was provided the transfusion and discharged home in good condition the following day. She could have been treated at a lower level of care. She did not require inpatient monitoring. There was no evidence of cardiovascular changes, collapse or concerns. She had chronic anemia with compensation and no loss of consciousness or neurological concerns. She had no comorbid conditions that would complicate her treatment such as hepatic, renal or pulmonary failure. There was no surgery scheduled or continued concerns.