Diagnosis: Vertigo (dizziness)
Treatment: Inpatient Stay
The health plan denied the inpatient stay.
The health plan's determination is upheld.

The patient is a female with a history of a cerebral aneurysm status post clipping who presented to the emergency room with dizziness. The patient reported multiple episodes of dizziness previously. The patient underwent a computed tomography (CT) of her head that showed no acute changes. The CT of her head showed evidence of a prior craniotomy consistent with known aneurysm clipping. The patient's dizziness improved and it was recommended that she use Meclizine for symptom control. The patient was scheduled to follow-up with neurology as an outpatient.

The requested health service was not medically necessary. An acute inpatient admission for the evaluation of dizziness was not medically necessary. The patient has a history of dizziness and was admitted to the hospital with similar symptoms. At the time of presentation, the patient had stable vital signs and laboratory data. There was no indication for an acute admission to the hospital. Although history of a cerebral aneurysm is a factor, dizziness is a common emergency department complaint and the history of an aneurysm alone cannot be used to justify an inpatient admission. The patient had no acute imaging findings and the dizziness resolved with time and the use of Meclizine. There was no stroke detected or ruptured aneurysm or emergent hypertension. There were no services provided consistent with an acute admission.