Diagnosis: Hereditary hemorrhagic telangiectasia
Treatment: Inpatient Hospital Admission
The insurer denied: Inpatient Hospital Admission
The denial is upheld

The patient in this case is an adult male with hereditary hemorrhagic telangiectasia. He is noted to have a history of chronic iron deficiency anemia due to bleeding. An outpatient CBC (complete blood count) revealed a hemoglobin of 6.9 g/dl (grams per deciliter). He reported chest pressure, shortness of breath, rapid heartbeat and dizziness. He was seen in the emergency department. The patient's vital signs and physical exam were unremarkable. ECG (electrocardiogram) was done and did not reveal any ischemic changes. Given his symptoms, the patient was admitted to the hospital and treated with transfusion.
On day #2 the patient's hemoglobin was increased to 7.5 g/dl (grams per deciliter). He was seen by hematology/oncology and treated with intravenous tranexamic acid. Given ongoing bleeding, additional transfusion was recommended. He was feeling a little better than he did at the time of admission. It was noted that he had ongoing melena, but no bright blood per rectum.
On day #3 the patient was feeling better. Hemoglobin was up to 8.8 g/dl (grams per deciliter). Port placement was planned for the next day in anticipation of regularly scheduled outpatient transfusions.
The next day the patient had stable atelectasis and stable melena. He felt well. Hemoglobin was 8.6 g/dl (grams per deciliter). He was discharged to home.

The Inpatient Hospital Admission was not medically necessary.

This patient was noted to have chronic anemia due to ongoing bleeding related to hereditary hemorrhagic telangiectasia. When he was admitted, his hemoglobin was 6.9 g/dl (grams per deciliter). He was not hemodynamically unstable. He did not have any signs of acute coronary ischemia. ECG (electrocardiogram) was done and did not reveal changes of acute ischemia. While he clearly required transfusion, given the lack of hemodynamic instability, acutely worsening bleeding or active coronary ischemia, this treatment did not require acute care inpatient admission.