Diagnosis: Weakness.
Treatment: Inpatient Hospital Admission.

The insurer denied Inpatient Hospital Admission. The denial is upheld.

This elderly female presented with weakness and vomiting. She was recently diagnosed with COVID. She had decreased oral (PO) intake and had not gotten out of bed. The patient's vital signs were stable, and she was afebrile. Her oxygenation was 99% (percent) on room air. Her exam was unremarkable. The pertinent abnormal labs were as follows: COVID positive and creatinine 1.29. Chest x-ray showed no acute disease. Electrocardiogram (EKG) showed sinus bradycardia.

The patient was admitted with a diagnosis of weakness. On the next day, the patient's vital signs were stable. There were no overnight events. Her diet was advanced. There was no need for treatment for COVID. Acute kidney injury improved. Her blood pressure medications were being adjusted. On day number two, there was no significant change. On day number three, the patient was discharged.

The proposed treatment is not medically necessary.

This patient was admitted with weakness secondary to COVID infection. The health plan denied coverage because the patient did not meet criteria for Musculoskeletal Disease, Neurology, and Viral Illness. The patient was hemodynamically stable. Oxygenation was normal on room air. The patient did not have altered mental status. Labs were remarkable for acute kidney injury. The patient did not have severe electrolyte abnormalities. Imaging was negative for pneumonia. The patient was admitted and received supportive care. Renal function rapidly improved. The patient was able to tolerate oral intake. She was medically stable. She had not failed an observation level of care. Acute inpatient admission was not medically necessary.