Diagnosis: Venous malformation of the posterior right thigh
Treatment: Inpatient Hospital Stay
The insurer denied the Inpatient Hospital Stay.
The determination is overturned.

The patient has a several year history of a venous malformation of the posterior right thigh. He had a sclerosing direct stick embolization procedure performed using sodium tetradecyl sulfate (STS) foam.
His past medical history showed a history of leg pain. Magnetic resonance imaging (MRI) confirmed vascular malformation. Pertinent past medical records note findings of Klippel-Trenaunay syndrome. Past surgery history was reviewed, medications and lab work noted. He was discharged with appropriate medications.

The requested health service/treatment with Inpatient Hospital Admission was medically necessary for this patient.
Klippel-Trenaunay Syndrome (KTS) or Klippel-Trenaunay-Weber Syndrome refers to bony and/or soft tissue overgrowth, and slow-flow venous/lymphatic malformations. The cause is unknown. The venous malformations in KTS can be quite extensive and involve bones, joints, muscles, as well as the skin and fat. The major veins of the limb themselves can also have issues with venous reflux and this can cause pooling of blood. This leads to high pressures within the compartments of the limb and increases the likelihood of debilitating pain particularly with walking, exercise or prolonged standing. When symptoms worsen, direct stick embolization of the underlying venous malformation can be performed in multiple sessions. This can help reduce symptoms significantly. Treatment of the more superficial components of the venous system in patients with KTS can be safely performed with significant improvement in symptoms. The patient's treatment was standard of care. The diagnosis of KTS is unusual and the planned treatment is necessary under general anesthesia where it is impossible to know if symptomatic complications have arisen, with the potential for post-procedure issues being significant. Patient care included continuous monitoring and access site management of the right leg. Furthermore, there is an increased risk of infections as well as clotting of the veins after the procedure along with the potential for muscle or nerve damage. Therefore, this required admission for evaluation and ongoing treatment. This would be appropriate at the inpatient level of care.
If the patient needed further therapy prior to discharge, it could easily be arranged.