Diagnosis: Transient Ischemic Attack
Treatment: Inpatient Hospital Stay
The insurer denied the Inpatient Hospital Stay.
The determination is upheld.

This is a female patient who was admitted to the hospital with a chief complaint of "left arm heaviness". The patient denied any other neurologic deficits on presentation to the emergency department. She was admitted to the hospital for evaluation of a transient ischemic attack. On presentation to the emergency room, she had normal vital signs and normal laboratory studies. A computed tomography (CT) scan of the head and computed tomography (CT) perfusion scan of the head were unremarkable. A magnetic resonance imaging (MRI) scan of the brain was performed during the hospitalization which was negative for an acute ischemic stroke. The patient's medical history was significant for hypertension and atrial fibrillation. She was instructed to continue with rate control and Eliquis for secondary stroke prevention. The patient was subsequently discharge from the hospital. At issue is the medical necessity of an inpatient stay.

The patient was admitted to the hospital from the emergency room for evaluation of a transient ischemic attack. Transient ischemic attack is treated in observation status in the United States. This entity is defined as neurologic symptoms that resolved within 24 hours. The patient was noted to have some mild right arm heaviness on presentation. No clinically significant weakness was noted on the examination. On admission, the patient had normal vital signs, imaging, and laboratory studies. The MRI of the brain was negative for acute stroke. The patient did not have any significant cardiac arrhythmias, receive treatment for a stroke or transient ischemic attack. The patient was continued on all home medications for the treatment of hypertension, atrial fibrillation, and hyperlipidemia. The patient improved during the observation timeframe. There are no findings to support an acute inpatient admission for treatment of this patient's transient ischemic attack.