Diagnosis: abdominal pain
Treatment: inpatient stay
The insurer denied the inpatient stay. The health plan's determination is upheld.

The patient is a male with past medical history of renal transplant who presents to the emergency department complaining of abdominal pain. He reports having nausea and vomiting after a meal. Pain is located in his epigastric area. A computed tomography (CT) abdomen/pelvis showed a dilated gallbladder which appears thick walled with surrounding pericholecystic fluid and stranding. A Right upper quadrant ultrasound showed no evidence of gallstones. No evidence of gallbladder wall thickening or pericholecystic fluid was noted. Sonographic Murphy's sign was negative.

The Inpatient Hospital Admission was not medically necessary for this patient.
The patient developed abdominal pain and was admitted as an inpatient for evaluation. Work up consisted of imaging studies and laboratory studies. There was no evidence of acute cholecystitis based on ultrasound and laboratory studies. He did not undergo any surgical intervention and he was discharged the following day. A lower level of care would have been sufficient for this patient's care.