Diagnosis: Charcot deformity.
Treatment: Inpatient Hospital Admission.

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

This patient is an adult female with Charcot arthropathy of the right lower extremity and diabetes. She underwent the first stage of reconstruction 5 months ago (calcanectomy, arthrodesis, external fixator). The patient was admitted to the hospital for modification of external fixator (i.e. pins were backed up).

The inpatient hospital admission was not medically necessary.

There was no indication for the acute level services provided. The records show the procedure completed was not complex nor extensive. A small skin incision was placed over the protruding Steinman pin. The pin was repositioned. There was no blood loss. There was not a need for subspecialty consolation, imaging studies nor special wound care. This type of procedure is performed as an ambulatory surgery unit (ASU) setting. The underlying infection and diabetic management were being treated as an outpatient. There were no extenuating circumstances to substantiate admission and length of stay.