Diagnosis: utero vaginal prolapse
Treatment: inpatient hospital
The insurer denied the inpatient hospital admission. The health plan's determination is overturned.

The patient is a female with abnormal uterine bleeding and utero vaginal prolapse. Her past medical history (PMH) is significant for hypertension and obesity. She underwent a complex robotic assisted pelvic surgery including robotic assisted Supra cervical hysterectomy, bilateral salpingectomy, oophorectomy, sacral Colpopexy with mesh and rectocele repair. During the dissection, some brisk bleeding was observed and there was concern for injury to iliac vessels specifically at the level of iliac bifurcation. Although bleeding stopped, a vascular surgery consult was obtained and their recommendation was to obtain post-operative computed tomography (CT) angiogram to rule out any injury to iliac vessels. For this reason, the patient was admitted to the hospital which is the subject of this review.

Inpatient Hospital Admission medically necessary for this patient.
This patient underwent a complex lengthy robotic surgery. During the surgery, there was concern for vascular injury and vascular surgery consult was obtained. Vascular surgery recommended computed tomography (CT) angiogram post-operatively to rule out potential damage to the iliac vessels at the level of bifurcation. Although at the time of the surgery there was no significant active bleeding and the patient had intact peripheral pulses, they could not rule out injury to the iliac vessels at the level of bifurcation. In light of this information, it was reasonable to admit patient and have close follow up as an inpatient, obtain a CT angiogram to rule out the injury prior to discharge. This patient's care required an inpatient hospital admission.