Diagnosis: Seizure
Treatment: Inpatient Hospital Stay
The insurer denied Inpatient Hospital Stay.
The determination is upheld.

The patient presented to the hospital after a seizure at home. Her family called emergency medical services and she was transported to the hospital. Her seizure aborted spontaneously at home. She was briefly postictal. On arrival to the emergency room, she was treated with levetiracetam. The patient was admitted to the hospital for further evaluation. She had a negative computed tomography (CT) scan of the head and a negative magnetic resonance imaging (MRI) scan of the brain for an acute ischemic process. The patient underwent an electroencephalogram (EEG) that showed occasional left mid to posterior temporal sharp waves and occasional burst of generalized sharp and slow waves. Given the abnormality on the EEG, continuation of levetiracetam was recommended. She was discharged with outpatient neurology follow-up.
At issue is the medical necessity of an inpatient stay.

The requested inpatient admission is not medically necessary. The patient presented to the hospital after one seizure. She did not have any further seizures in the emergency room or during the hospitalization. While the patient did have a postictal state, the period was brief and resolved within the observation time frame. The patient did not have persistent altered mental status or a new neurologic deficit such as motor weakness in an arm or leg. Additionally, there were no significant cardiac, imaging, or laboratory findings suggesting an underlying cause of the seizures that required correction or intervention during hospitalization. The patient did have epileptiform activity on EEG suggesting a diagnosis of epilepsy. The patient was treated with levetiracetam and discharged on this medication for outpatient follow-up. None of the services required an acute inpatient admission due to rapid improvement during the observation period, lack of multiple seizures, and lack of a malignant etiology (cerebral hemorrhage, increased intracranial pressure, etc) that would benefit from hospitalization.