Diagnosis: Fracture of tibia/fibula; s/p (status post) mechanical fall.
Treatment: Inpatient admission.

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

The patient is a female, who fell while ice skating. She was evaluated in ED (emergency department) and diagnosed with a closed displaced fracture to her right tibia/fibula. She underwent intramedullary rodding to the tibia. Her post-surgical course was non-complicated.

No, the inpatient admission was not medically necessary.

The medical record was significant for a non-complicated post-surgical course. The young woman was reported to have no problems with pain. She was able to tolerate oral medications. Her vital signs were stable. There were no problems with her surgical site. She did not require medical attention for any other condition. She had progressed with PT (physical therapy) and was independent with use of crutches. There were no underlying comorbidities with increased risk of adverse event.

These findings do not substantiate necessity for acute inpatient admission. There were no extenuating circumstances to support the inpatient admission.