Diagnosis: Persistent hypotension.
Treatment: Inpatient Hospital Admission.
The insurer denied: Inpatient Hospital Admission.
The denial is upheld.

The patient is an adult female. Her past medical history includes lupus, DVT (deep venous thrombosis) and POTS (postural orthostatic tachycardia syndrome). She presented in transfer from another hospital with persistent hypotension. She had presented to the other hospital with failure to thrive.
The patient's vital signs were stable. Her blood pressure was 143/73. Her exam was unremarkable. She was admitted with plan for Cardiology evaluation. Midodrine was continued.
She was noted to have POTS (postural orthostatic tachycardia syndrome) on the day after admission with supine systolic 115 and standing systolic 86. The plan was to continue midodrine and fludrocrotisone. Three days later, the patient's blood pressure was 87/55. She was tolerating medications. The plan was for discharge to rehab. The day after, the patient was feeling well. Her blood pressure was 90/62. The plan was to
continue current management. Staff were looking for placement for the patient. On the following day, the patient was awaiting rehab placement.

The requested Inpatient Hospital Admission was not medically necessary.

This patient with history of POTS (postural orthostatic tachycardia syndrome) was admitted for Cardiology evaluation due to persistent hypotension. Evaluation showed blood pressure consistent with POTS (postural orthostatic tachycardia syndrome). There was no significant change from baseline. Oral medication regimen had already been established with no significant change. During hospital stay, she was monitored for oral intake. Discharge was delayed pending placement. During this hospital stay, the patient was clinically stable. She was not receiving intervention that required an inpatient level of care. Inpatient hospital admission was not medically necessary.