Diagnosis: Inflammatory Bowel Disease
Treatment: Inpatient Hospital Admission
The insurer denied: Inpatient Hospital Admission
The denial is upheld.

The patient is an adult male. He presented to the ER (emergency room) with LLQ (lower left quadrant) pain, nausea and vomiting x (times) 1 and diarrhea x 1.

The patient was hemodynamically stable, with a normal WBC (white blood count). His CT (computed tomography) was with colitis. He was hydrated and started on IV (intravenous) antibiotics.

The next day the patient's symptoms had improved, and his diet was advanced. He was discharged on oral antibiotics for outpatient colonoscopy.

The Inpatient Hospital Admission was not medically necessary.

The patient presented with acute abdominal pain and nausea, with an episode of diarrhea and vomiting. He was hemodynamically stable. WBC (white blood count) was normal, and CT (computed tomography) revealed pancolitis. He was started on antibiotics, and his symptoms had improved, and he was discharged for outpatient colonoscopy. As he was hemodynamically stable without multiple bloody bowel movements, and no evidence of systemic illness without tachycardia, fever, anemia or evidence of bleeding, obstruction or intractable pain, acute inpatient admission was not medically necessary. The patient could have been treated at a lower level of care.