Diagnosis: Asthma.
Treatment: Inpatient stay.
The insure denied the inpatient stay.
The health plan's determination is upheld.

This case involves a patient with known asthma, multiple emergency department (ED) visits and multiple admits, including 2 Pediatric Intensive Care Unit (PICU) stays, who was admitted to the pediatric floor. In the ED, he received, intravenous (IV) magnesium sulfate, and IV steroids. Following admission, he was placed on albuterol via nebulizer q (every) 3h (hours), oral steroids, and IV fluids. Albuterol was changed from nebulizer q3h to q4h. Per the notes, he had equal air entry bilaterally, scattered rhonchi, no acute distress, normal breath sounds, and/or bilateral expiratory wheezes. Per the notes, IV fluids were started for spitting after coughing.

The inpatient hospital admission is not medically necessary for this patient.

Based on the records provided, there was not decreased breath sounds with tight chest, and no signs of respiratory distress. The patient was reported to be comfortable on room air and has normal pulmonary effort. The oxygen saturations were all above 92% on room air. The patient received by mouth (PO) steroids. IV fluids were given overnight for excessive cough with post-tussive spitting. Per the history and physical (H&P), the patient was not seen by the attending physician, as the parent refused them access. The patient was only seen by the resident, and later, a consultant. Although this patient had severe symptoms in the ED and had previous PICU admissions, he did not exhibit any more signs or symptoms of respiratory distress in the hospital. There were no examination findings inpatient that supported the frequency of breathing treatments that are generally reserved for the inpatient setting. A lower level of care would have been appropriate.