Diagnosis: Chronic Obstructive Pulmonary Disease.
Treatment: Inpatient Hospital Stay.
The insurer denied the Inpatient Hospital Stay.
The determination is overturned.

This is a male patient with a history of chronic obstructive pulmonary disease (COPD) on 3 liters (L) of oxygen via nasal cannula oxygen at baseline, with obstructive sleep apnea (OSA), and pulmonary hypertension. His presenting complaint was dyspnea, he was told to report to the emergency department (ED) by his pulmonologist and he was requiring 6L of oxygen at the clinic. He was also experiencing blurry vision and a headache. The physical exam was notable for wheezing and pursed lip breathing. Lab results were notable for partial pressure of carbon dioxide (pCO2) of 65. Radiology was notable for a chest x-ray with bibasilar densities and cardiomegaly. The patient was admitted to an inpatient level of care for treatment and monitoring of a COPD exacerbation.
The inpatient admission was medically necessary.
The patient presented with a moderate COPD exacerbation evidenced by pursed lip breathing, hypoxia beyond baseline, and hypercapnia. There was a high likelihood of further clinical decompensation, and so careful monitoring was required in addition to aggressive treatment to improve the patient's symptoms and resolve the COPD exacerbation. Therefore, the inpatient stay was medically necessary.