Diagnosis: abdominal pain.
treatment: inpatient stay.
The insurer denied the inpatient stay.
The health plan's determination is upheld.

The patient is a female who initially presented to the emergency department with concerns for abdominal pain and diarrhea. Pertinent history included ruptured ectopic pregnancy status/post (s/p) mini exploratory laparotomy and palpitations followed by an outpatient cardiologist. The patient was placed in the hospital thereafter with an impression of dehydration and proctocolitis. Treatment plan included intravenous fluids, clear liquid diet, cultures, empiric Zosyn, and consultations.

No, the inpatient hospital admission was not medically necessary. Evaluation and management could have been performed at a lower level of care. In this particular situation, the patient had a history of ruptured ectopic pregnancy status/post (s/p) mini exploratory laparotomy and presented with abdominal pain and diarrhea. An extensive evaluation was performed which found the patient to be afebrile, hemodynamically stable, without significant laboratory abnormalities, and with radiographic findings suggestive of proctocolitis. Treatment plan included intravenous fluids, symptom management, and additional diagnostic testing. Gastroenterology consultation was obtained who recommended discontinuation of antibiotics and performed a flexible sigmoidoscopy that was unremarkable. Multiple consultations were obtained, including neurology and cardiology, for dizziness and palpitations who essentially recommended outpatient follow-up. Following observation, the patient did not have a documented significant pathological process present that could only be managed at an acute inpatient level of care.