Diagnosis: Cardiac/Circulatory Problems-Arrhythmia/Irregular Heart Rhythm.
Treatment: Inpatient Hospital Stay.
The health plan denied the inpatient hospital stay as not medically necessary.
The reviewer has upheld in whole the health plan's determination.

This patient presented to the hospital for catheter ablation of symptomatic premature ectopic beats; the origin of the ectopy was unclear at the time of presentation. His medical history was remarkable for hypertension, hyperlipidemia, diabetes, rheumatic fever and moderate to severe aortic insufficiency. Electrophysiologic testing revealed that the patient's ectopic beats were premature atrial beats. The focus for these beats was ablated. The procedure was uncomplicated. The patient was admitted to the hospital post-procedure and was discharged later in the day. Medical necessity for an inpatient admission is at issue.

Based on the documentation provided an inpatient level of care was not medically necessary.
The patient presented for elective catheter ablation of frequent ectopic beats. Electrophysiologic testing revealed a supraventricular site of origin for the ectopy, which was successfully ablated. The limited information provided does not indicate that his post-procedure management required an inpatient level of care. The procedure was uncomplicated, and the rhythm ablated, though symptomatic, was not life-threatening. The patient remained hemodynamically stable, recovered from sedation uneventfully and had no significant arrhythmias post-ablation. He was discharged home after six hours of bedrest and an additional hour of observation. Same-day discharge following a brief period of observation at a lower level of care after uncomplicated ablation of supraventricular arrhythmias has been shown to be safe and cost-effective. The documentation provided does not justify the need for inpatient care. The patient could have been treated at a lower level of care.