Diagnosis: Otitis externa
Treatment: Inpatient Hospital Stay
The insurer denied the Inpatient Hospital Stay.
The determination is upheld.

The patient had ear pain and had been treated with oral Augmentin. He returned to the emergency room (ER) with ear pain. He was seen by ear, nose, and throat (ENT). His exam revealed mastoid tenderness and edematous ear canal. A computed tomography (CT) scan demonstrated left otitis externa and minimal fluid in mastoid on the left. The patient was diagnosed with otitis externa and ear drops were recommended. He was admitted. He was treated with intravenous (IV) Ciprofloxacin which was transitioned to by mouth (PO) antibiotics.
At issue is the medical necessity of an inpatient stay.

The inpatient stay was not medically necessary.
The patient was diagnosed with otitis externa. He did not have clinical mastoiditis. His vital signs were stable and he was not toxic appearing. Otitis externa is typically treated on an outpatient basis with topical antibiotic drops and possible oral antibiotics. Hospital admission is not standard of care for this diagnosis. This patient could have been managed at a lower level of care. Intravenous (IV) antibiotics and hospital admission are not needed. Therefore, an inpatient stay was not medically necessary.