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

This is a male patient with a past medical history (PMH) of asthma and gout who was admitted with complaints of (c/o) sudden onset dizziness, nausea, and vomiting associated with a headache. His vital signs were unremarkable. The physical exam was notable for right-sided horizontal beating nystagmus. Lab work was unremarkable. Imaging studies included a computed tomography (CT) scan of the head which showed no acute intracranial findings. The patient was diagnosed with peripheral vertigo/benign paroxysmal postural vertigo (BPPV) and was treated with intravenous fluids (IVF), meclizine, and anti-emetics. The patient was discharged in stable condition. At issue is the medical necessity of an inpatient level of care.

The hospital stay was not medically necessary at an acute inpatient level of care. This patient presented to the emergency department (ED) with dizziness and vertigo associated with sudden onset head movement. The patient did not have any acute hearing loss, double vision, fixed neurologic deficits, severe headache, associated head trauma, fever, high clinical suspicion for central vertigo or cerebrovascular accident (CVA), cerebellar infarct or hemorrhage, vertebrobasilar insufficiency, acute suppurative labyrinthitis, intractable nausea/vomiting or inability to ambulate. All imaging performed showed no acute intracranial pathology. The patient was treated with intravenous fluids (IVF), meclizine, and anti-emetics and ultimately diagnosed with BPPV. Given the patient's clinical stability and provided interventions and clinical monitoring, these could have been safely and appropriately provided at a lower level of care.
Regarding the provided criteria, the patient did not have acute bacterial labyrinthitis, cerebellar/brainstem/cerebral ischemia or hemorrhage, vertebral artery dissection, hemodynamic instability, severe and persistent symptoms, cardiac arrhythmias, or severe neurologic findings.