Diagnosis: Rash
Treatment: Inpatient hospital admission
The insurer denied: Inpatient hospital admission
The denial is upheld.

The patient in this case is an adult female with lung cancer on treatment with chemotherapy. She presented to the emergency department with a thigh rash. This had developed over two days and gradually worsened. She had no pain or other symptoms.
The patient's exam revealed an area of erythema along the right upper inner thigh. The area measured 1x1 centimeters, and there was no tenderness, fluctuance, or induration. Vital signs were unremarkable. Labs were notable for white cell count of 28, though she had no fever or signs of sepsis. She was treated with broad spectrum antibiotics and admitted to the hospital. Potassium was low at 2.6. She was treated for hypokalemia and evaluation revealed no infection. She was discharged on day #3.

The inpatient hospital admission was not medically necessary.

This patient had a small rash and an elevated white cell count. Of note, she had been treated with Neulasta days before this emergency department visit. Records indicate that she had no significant symptoms, normal vital signs, and no signs of sepsis or infection. She did have hypokalemia. While she required treatment for hypokalemia, she did not require acute care inpatient admission. She could have been safely cared for in an observation setting to ensure that her potassium corrected and
that she did not develop any signs of worsening infection. The inpatient admission was not medically necessary.