Diagnosis: Respiratory System - Asthma.
Treatment: Inpatient Hospital.
The insurer denied inpatient stay.
The denial is overturned in whole.

This is the case of a female who presented to the emergency department (ED) with cough, congestion, rhinorrhea, and shortness of breath. Symptoms were worsening for 2 days prior to presentation despite patient's mother giving albuterol. There were no fevers, vomiting, diarrhea, or chest pain. Social history notable that patient and mother are currently residing in a shelter.
ED vitals temperature (T) 37 Celsius (C), heart rate (HR) 123-138, respiratory rate (RR) 32-34, blood pressure (BP) 103/66, oxygen (O2) sat 90% on room air. Exam was notable for tachypnea with decreased breath sounds, wheezes, and rhonchi. Albuterol given without obvious effect. The patient was started on 2 liters (L) oxygen (O2). Flu, respiratory syncytial virus (RSV), and Coronavirus disease 2019 (COVID) tests were negative.
Chest x-ray showed left basilar opacity consistent with (c/w) probable atelectasis. The patient was given Duonebs (albuterol/ipratropium) and prednisolone. The patient was admitted to the hospital for further management.
At issue is whether the medical necessity for the inpatient stay.

The requested inpatient stay was considered medically necessary for this patient. This previously healthy patient presented with acute wheezing and respiratory distress. She was treated for acute asthma exacerbation and required initiation of oxygen therapy for oxygen saturation levels that dropped to 90%. Additional complexity to this patient's care includes housing instability with current shelter placement for the family, thus creating uncertainty of outpatient follow-up.
This patient required treatment for acute asthma exacerbation, including supplemental oxygen for hypoxemia. Her medical status improved quickly upon admission to enable progression to discharge.