Central nervous system
Inpatient stay

Diagnosis: Possible seizure
Treatment: Inpatient stay
The insurer denied the inpatient stay. The health plan's determination is upheld.

The patient is a female who initially presented to the emergency department with concerns of recurrent, witnessed seizures. Pertinent history included migraine headaches, but not a seizure disorder. Initial vital signs revealed a temperature of 98.8F, heart rate (HR) 100, blood pressure (BP) 133/83, respiratory rate (RR) 16, and peripheral capillary oxygen saturation (SpO2) 100%. Initial examination documented the patient as alert and oriented with no focal neurologic deficits.

The inpatient stay was not medically necessary for this patient. The patient had a medical history of migraine headaches who presented with witnessed seizure-like activity. Upon arrival, the patient was alert, oriented, and at baseline neurologic status. Initial laboratory testing was relatively unremarkable and mild, noted abnormalities were not clinically significant. Head imaging with a CT and CT angiogram were unremarkable. The patient was placed in the hospital for observation and additional diagnostic testing. The electroencephalogram (EEG) did reveal rare, localized left temporal sharp waves and oral Keppra was initiated. Following observation care, the patient was at her baseline state of health. There was no recurrence of seizure during the hospital stay. There were no other issues or complications documented.