Diagnosis: Abdominal Pain
Treatment: Inpatient Stay
The insurer denied the inpatient stay.
The determination is upheld.

The patient is a female who presented to the hospital with symptoms of abdominal pain and nausea. She had recently undergone laparoscopic cholecystectomy.
She has an insignificant medical history. The emergency department (ED) evaluation identified normal vital signs (heart rate of 77 beats per minute and temperature of 99.1 Farenheit). The patient had abdominal tenderness in the right upper quadrant. Her white blood cell count (WBC) count was normal and potassium level was 5.9. Her liver enzymes showed normal transaminases with a normal bilirubin. A computed tomography (CT) scan showed post-surgical changes from the cholecystectomy. There was no significant fluid collection in the gallbladder fossa, a right adnexal lesion was thought to be a fibroid. Initial treatment included intravenous (IV) fluid, antiemetics and pain medications.
The patient's pain complaints resolved without intervention. The patient had normal vital signs and tolerated a diet.

Based on the submitted clinical documentation, an inpatient stay was not medically necessary for this patient. The patient was admitted to the hospital with abdominal pain and nausea. She was status post a recent laparoscopic cholecystectomy. Her vital signs were normal at presentation. Laboratory data showed normal transaminases and bilirubin. Imaging completed with CT did not identify an acute pathology. The vital signs and white blood cell count remained normal during the period of observation until discharge. Her symptoms of abdominal pain and nausea resolved within one day of presentation.
An inpatient level of care was not medically necessary. The patient was clinically stable at the time of presentation and remained so during the period of overnight monitoring as supported by the corresponding medical records and progress notes.