Diagnosis: Hypoglycemia.
Treatment: Inpatient Hospital Stay.
The insurer denied the Inpatient Hospital Stay.
The determination is overturned.

This is a female patient with a past medical history (PMH) of diabetes mellitus type 2 (DM2), hypertension (HTN), and hyperlipidemia (HL) who was admitted with complaints of (c/o) hypoglycemia and altered mental status (AMS); the patient received two doses of dextrose (D) 50 with minimal improvement in the AMS. Her vital signs were unremarkable. The physical exam was notable for lethargy, non-toxic appearance, and no apparent distress (NAD). Lab work was notable for glucose 31. Imaging studies included a chest x-ray (CXR) which showed no acute pathology. An electrocardiogram (EKG) showed normal sinus rhythm (NSR). The patient was diagnosed with recurrent hypoglycemia and treated with D50 and dextrose fluids. The patient was discharged in stable condition. At issue is the medical necessity of an inpatient stay.
The hospital stay was medically necessary at an acute inpatient level of care. This patient with a known history of diabetes on a sulfonylurea presented to the emergency department (ED) with complaints of (c/o) altered mental status and was found to have hypoglycemia. The patient received two doses of D50, once pre-hospital and another in the ED, with minimal improvement in altered mental status. As such, this patient had a new and persistent alteration in mental status with the intake of a long-acting oral hypoglycemic, with an inadequate decrease in symptoms with the administration of glucose, requiring the continuous administration of dextrose and close clinical and glucose monitoring. Overall, this patient could not have been safely and appropriately treated at a lower level of care.