Diagnosis: Abdominal pain - s/p laparoscopic appendectomy
Treatment: Inpatient admission

The insurer denied the inpatient admission. The denial is upheld.

No, the Inpatient admission was not medically necessary.

The patient is a male that presented upon transfer from an outside facility. CT done at an outside hospital (transferring facility) was concerning for appendicitis. The patient was evaluated in the ED and it was determined the patient would undergo appendectomy. Perforated appendicitis was never suspected. The patient was admitted preoperatively to acute inpatient level of care.

The patient underwent single-site laparoscopic appendectomy, which was completed the same day as the arrival in transfer. The operative report describes a straightforward procedure less than one hour in duration. The findings were acute non-perforated appendicitis confirmed by subsequent pathology report. The patient was discharged from the PACU (post-anesthesia care area) home within hours of the procedure.

The care the patient would have received at a lower level of care would have been identical to that which he received. The most appropriate level of care for treatment of non-perforated acute uncomplicated appendicitis is ambulatory. Generally accepted practice guidelines for treatment of acute appendicitis without perforation in pediatric population is the procedure is considered outpatient with a short period observation in some cases. The care does not require acute inpatient level of care.