Diagnosis: Vomiting Treatment: Inpatient admission The insurer denied the inpatient admission. The denial is upheld. The patient was a female patient who had presented to the ED (emergency department) of the facility filing the appeal for the presenting complaints of emesis and diarrhea. The patient has the diagnosis of DM1 (diabetes mellitus type 1). The patient has no prior history of DKA (diabetic ketoacidosis). The patient also has a history of gastroparesis. The patient reported that the diarrhea was non-bloody. The patient also reported that the many episodes of emesis were non-bloody. The last glucose was 256 on the patient's continual glucose monitoring device. There were no fevers reported. A urine dip for ketones was positive prior to arrival. The patient denied fever, chills, chest pain, shortness of breath, dysuria, headache, dizziness, or any tingling as per the provided record. A venous blood gas had a pH (power of hydrogen) of 7.461. The patient had an anion gap of 19. The lactic acid was 2.4. The betahydroxybutyrate was elevated at 3.60. The highest blood sugar in the ED (emergency department) was documented at 265. The BUN (blood urea nitrogen) was 22 and the creatinine was 0.97. The admitting diagnosis was diabetic gastroparesis. No, inpatient hospital admission was not medically necessary. While the treatment provided was medically appropriate, the care was not rendered at a level at which was medically necessary. The request for authorization of the hospital admission was not medically necessary. The clinical information sent shows that the patient was evaluated in the emergency room for high blood sugar. There was no documentation of high blood sugar with acid in the blood, very high blood sugar with confusion, significant dehydration (loss of body fluid), vomiting that would not stop despite treatment, unexplained fever or severe infection. Despite the patient's presentation the care as provided could have been rendered in its entirety at a lower level of care. The patient has diabetic gastroparesis with episodes of emesis. However, the patient did not show evidence of a change in mental status, high fevers, neurologic changes, hypotension, signs of sepsis, hemodynamic changes, renal abnormalities, need for NPO (nothing by mouth) status, need for invasive surgery, need for invasive monitoring or treatments, severe electrolyte dyscrasias or any other indication for an acute admission. The patient showed no evidence of dehydration on laboratory studies. The patient had improved with treatment delivered in the ED (emergency department). As such, the care could have been rendered at a lesser level.

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