Diagnosis: Palpitations.
Treatment: Inpatient Hospital Stay.
The insurer denied the Inpatient Hospital Stay.
The determination is upheld.

This is a patient with palpitations. She was evaluated in the emergency room. Premature ventricular complexes were noted on an electrocardiogram (EKG). She complained of palpitations with activity such as running for a bus as well as at rest. She had prior stress testing and exercise frequent premature ventricular contraction (PVCs) were noted, not suppressed with exercise. She was noted to be in ventricular bigeminy on EKG at times. She took CalMag tablets with no relief of symptoms. She also had a trial of metoprolol with no improvement in symptoms.

She was referred to electrophysiology and underwent electrophysiologic testing and radiofrequency catheter ablation. The PVCs were mapped to the inferior basal right ventricle just below the tricuspid valve. The procedure was uncomplicated. She was discharged home. At issue is the medical necessity of an inpatient stay.

The requested inpatient stay was not medically necessary for this patient. The patient had an idiopathic ventricular tachycardia with focus located in the right ventricle.
She had an uncomplicated electrophysiologic study and catheter ablation. There were no post procedure complications. Hospitalization is generally at a lower level of care for an uncomplicated catheter ablation, including ventricular tachycardia (VT) ablation with right-sided ablation, based on current guidelines, referenced below. An inpatient hospitalization was not medically necessary.