Diagnosis: central nervous system (CNS) lymphoma
Treatment: inpatient hospital admission
The insurer denied inpatient hospital admission.
The health plan's determination is overturned.

This is patient with diagnosis of human immunodeficiency virus (HIV) infection, central nervous system (CNS) lymphoma (diffuse large B cell), status post high dose methotrexate, followed by R-VP (rituximab, cyclophosphamide, vincristine, prednisone) regimen and high dose therapy with autologous stem cell transplantation. The patient was found to have persistent CMV (Cytomegalovirus) viremia with rising level of viral load and developing thrombocytopenia while on Valcyte. He was hospitalized for intravenous (iv) foscarnet induction therapy.

An inpatient hospital admission was medically necessary.
CMV (Cytomegalovirus viremia) infection is a life threatening condition in a patient with immunocompromised state such as bone marrow transplantation. Foscarnet is FDA approved antiviral therapy for CMV infection. Trials with intravenous foscarnet in CMV infections have reported favorable results using initial daily doses of 180-230 mg/kg/d (milligrams/kilogram/day) given as intermittent infusions every eight hours, followed by maintenance regimens of 60-90 mg/kg/d given as single daily one- or two-hour infusions. Foscarnet therapy may result in renal impairment, and indefinite intravenous maintenance therapy may be required to prevent recurrence of CMV infection. Foscarent is administered in the hospital setting due to the need for IV therapy and close clinical monitoring and management of toxicities.