Diagnosis: Right lower quadrant pain.
Treatment: Inpatient admission.
The insurer denied the inpatient admission.
The denial is upheld.

This patient is an adult female with hypothyroidism, hypertension, diabetes mellitus, uterine embolization, and Cesarean section who presented to the emergency department with right lower quadrant (RLQ) pain for three days. The pain was exacerbated when she urinated. The patient had nausea. The patient was afebrile and had leukocytosis to 14,000.
Computed tomography (CT) scan of the abdomen / pelvis showed sigmoid diverticulitis without perforation or abscess. The patient was treated with intravenous fluids. The patient was started on levofloxacin 750milligrams (mg) intravenous (IV) every 24 hours (q24h) and metronidazole 500 milligrams intravenous every 8 hours. The patient was also treated with Protonix 40 milligrams daily and clear liquid diet / advanced as tolerated. Levofloxacin was discontinued due to possible allergy.

The requested health service was not medically necessary.

The patient did not have hemodynamic instability, severe pain requiring acute inpatient management, or peritoneal signs. The patient did not require identification of etiology or finding; or evaluation requiring the patient to not eat or drink for extended period (e.g., more than 24 hours). The patient did not have inability to maintain oral hydration (e.g., needs intravenous fluid support) that persists after observation care; and did not have suspected toxic megacolon. The patient did not have bacteremia. The patient did not require a procedure that could not have been performed on an ambulatory basis. Therefore, the requested health service is not medically necessary.