Diagnosis: Cellulitis (of right lower limb)
Treatment: Skilled Nursing Facility Level II
The insurer denied: Skilled Nursing Facility Level II
The denial is upheld.

The patient is an adult male who was admitted to skilled nursing facility from the hospital. The patient was treated for cellulitis of the right lower limb at the hospital and had undergone incision and drainage of the right lower extremity necrotic soft tissue at the hospital. The patient had past history of encephalopathy, substance abuse, hepatitis C virus (HCV) - status post treatment, right third finger osteomyelitis - treated with antibiotics. On admission to the skilled nursing facility, the patient was afebrile and had stable vital signs. The patient was alert, oriented and responsive to all stimuli. His right lower leg had a wound dressing and Unna boot. The patient was able to stand on his unaffected leg with assistance and required one person assistance for transfer. The patient was able to perform bed mobility independently. The patient was able to ambulate ten feet with rolling walker and one person. The patient was admitted for wound care and physical therapy / occupational therapy / rehab services. The patient benefited from above services, continued to improve and was discharged.

The proposed skilled nursing facility level II was not medically necessary.

The patient had improved steadily after admission to nursing home and by the requested dates of service, the
patient had improved notably and did not require continued admission for the above services. The patient had gained adequate strength and had progressed from a physical therapy -
occupational therapy standpoint. The wound was improving and stable without need for additional interventions related to wound care / physical therapy / occupational therapy. In view of above improvements, services provided did not require continued nursing facility stay. The patient could have been managed at a lower level of care for the above period.