Diagnosis: Shortness of breath and cough
Treatment: Inpatient admission
The insurer denied: Inpatient admission
The denial is upheld.

The patient is an adult female. She presented to the emergency room with cough and wheezing for two days. This did not improve with home Symbicort and frequent Albuterol MDI (metered dose inhaler). In the emergency room, the patient's temperature was 97.9, pulse 74, blood pressure 127/70, and
oxygen 99% (percent). Chest X-ray revealed no acute finding. She had a history of chronic obstructive pulmonary disease (COPD), hypertension, diabetes mellitus, and gastroesophageal reflux disease (GERD). In the emergency room, she received Duonebs x3 and intravenous Solumedrol with improvement. The patient received intravenous Rocephin and Zithromax. The patient was admitted from the emergency room with shortness of breath and cough with "no wheezing on physical examination." On day #2, the visit report still noted shortness of breath and "wheezing." Lungs were noted as positive for wheezing bilaterally. She
received Nebs treatment x3 and intravenous Solumedrol x3.
On day #3, no acute complaints were noted, but report on exam noted bilateral expiratory wheezes and labored breathing on exam. The patient received Nebs treatment x3 and intravenous Solumedrol x2. On day #4, the patient was noted to feel better." The physical exam reported, "bilateral expiratory wheezes and labored breathing on exam." The patient received Nebs treatment x3 and intravenous Solumedrol x1. On day #5, the patient was discharged. The physical exam reported, "bilateral expiratory wheezes and labored breathing on exam." The nurse's note revealed no distress and clear breath sound since day of admission.

The inpatient admission was not medically necessary.

The patient was admitted with shortness of breath and wheezing. Her symptoms improved after day of admission. Her treatment did not required hospitalization. The patient only required a few breathing treatments. She had no problem in oral intake, and her medication could have been given by mouth instead of intravenously. There was no indication that her condition was worsening, such as requiring more frequent breathing treatments, requiring higher oxygen or requiring breathing support, or any evidence of infection. The chest X-ray was reported clear. The inpatient admission was not medically necessary.