Diagnosis: Cardiac/Circulatory.
Treatment: Inpatient Hospital.

The insurer denied inpatient stay.
The denial is overturned.

The patient is a male with a past medical history significant for anxiety, hyperlipidemia, and psychological disorder who presented with complaints of chest pain. The chest pain started one day before the presentation. It was described as cramping, intermittent. He denied associated symptoms including dyspnea, nausea, diaphoresis, palpitations, dizziness, or lightheadedness. By the time the patient was seen by the admitting physician, the chest pain resolved. The patient had no other complaints. He was started on a heparin drip. In the hospital, the patient was seen by a cardiologist. According to the consultation note, the patient had negative cardiac markers and unremarkable electrocardiogram (EKG). It was mentioned that a coronary computed tomography (CT) angiogram was attempted, however, the computed tomography angiography (CTA) portion was deferred secondary to an elevated calcium score. Subsequently, the patient was transferred for cardiac catheterization.
The cardiac catheterization revealed that the patient had a normal left ventricular ejection fraction. There was severe mid circumflex (LCx) stenosis. The patient underwent successful percutaneous coronary intervention (PCI) of the mid-LCx. The patient had occluded proximal right coronary artery (RCA). During the hospital stay, the patient remained in stable clinical condition. He was discharged home with a recommendation to follow up with cardiology service in order to have staged PCI as an outpatient.

The requested health service/treatment of inpatient stay was necessary for this patient.
The patient presented with symptoms suggestive of unstable angina and was appropriately started on a heparin drip. The patient required a rule-out of the acute coronary syndrome and an angiogram with PCI. Based on the clinical symptoms and results of cardiac catheterization, this patient had unstable angina in the setting of significant coronary artery disease.
Based on the current standards of care, the severity of the patient's condition and the complexity of the services provided completely justified the acute inpatient level of care.