Diagnosis: Arthrogryposis-renal dysfunction-cholestasis syndrome.
treatment: Inpatient stay.
The insurer denied the inpatient stay.
The health plan's determination is upheld.

The patient is a male who has multiple medical problems as a result of arthrogryposis-renal dysfunction-cholestasis syndrome. He had a number of prior hospitalizations for gastrointestinal and renal complications, including electrolyte derangements such as hypernatremia due to polyuria and hypocalcemia. He is on multiple medications. His nephrologist determined that he required a central venous catheter (port placement) due to poor intravenous (IV) access, need for frequent blood draws and prior hospitalizations for dehydration. The port placement was scheduled and he was pre-admitted to the nephrology service for IV hydration and calcium correction while nothing by mouth (NPO) awaiting surgery.

The inpatient hospital admission was not medically necessary.

The patient was medically complex, but clinically stable when evaluated by nephrology prior to admission and when admitted pre-operatively. Labs showed some abnormalities. The nephrology note suggests that most of the abnormalities were stable, chronic issues (modest anemia, presumably due to renal disease, for which he was on Epogen; modest elevations of blood urea nitrogen (BUN) and creatinine consistent with chronic renal disease; mildly low albumin consistent with chronic gastrointestinal (GI) disease and failure to thrive; mild transaminitits consistent with chronic GI disease; and modestly low ionized calcium at 0.94 (consistent with chronic diseases). The only issues identified to manage pre-operatively were the need for intravenous fluids while NPO awaiting surgery and calcium correction. These two interventions can be performed at a lower level of care. There is no evidence that there were clinical issues that arose that would meet acute inpatient criteria.