Diagnosis: Altered mental status.
Treatment: Inpatient stay.

The insurer denied the inpatient stay.
The health plan's determination is upheld.

The patient is a female with a history of lupus, alcohol abuse, and recurrent syncope, who presented with altered mental status. There were reports of slurred speech noted by the patient's husband. Review of system was negative for additional symptoms. The patient was admitted for possible syncope, rule our cerebrovascular accident (CVA) and alcohol intoxication. The patient was treated with intravenous (IV) fluids, thiamine, folic acid, and lorazepam.

The inpatient hospital admission was not medically necessary for this patient. The care could have been safely rendered at a lower level of care for imaging studies and supportive care.

The patient was admitted for subjective symptoms that were concerning for a stroke versus transient ischemic attack (TIA). The patient had no objective focal neurologic deficits that represented a central nervous system (CNS) etiology (NIH stroke score was zero), and imaging studies were unremarkable for acute neurologic finding. The documentation does not support an inpatient level of care since the patient was hemodynamically stable, had no electrolyte derangements and had no acute neurologic findings. In this case, a lower level of care would have been appropriate to monitor patient and rule out of a stroke and supportive care for alcohol intoxication.