Appeal type: Medical necessity
Decision: Upheld

Diagnosis: Vestibular neuritis.
Treatment: Inpatient Hospital. 

The insurer denied an inpatient stay. 
The denial is upheld.

This patient is a female who presented at 36-1/7 weeks gestation with a chief complaint of dizziness and weakness with nausea and vomiting. 
The review of her chart from the prior day noted a normal basic metabolic panel and normal lipase and amylase. The patient reported being unable to take oral intake. Fetal heart rate was category 1 and reassuring. The patient was noted to have 2 contractions in 10 minutes. Her exam noted her to be well appearing and in no acute distress. She had appropriate mood and affect. The lungs and heart exam were normal. Abdomen was soft, nontender and nondistended. The vagina was noted to have no lesions or masses with no vaginal bleeding and no leakage of fluid. There is no vaginal discharge. The uterus was gravid, and the size was appropriate for dates with no fundal tenderness. The patient was assessed to have nausea and vomiting and dizziness and was to have repeat labs, Compazine, and intravenous (IV) fluids. The impression was vertigo versus vestibulitis versus gastroenteritis. The patient was admitted for observation at that time. Adult neurology was consulted and noted that the patient had right vestibular neuronitis and acute labyrinthitis. The patient had a normal basic metabolic panel and had normal hemoglobin 11.2 and hematocrit 33.2%. Platelets were normal at 248. The patient was noted to receive IV fluids during hospitalization with lactated Ringer's and also received Zofran for nausea and vomiting. Lab testing was noted to be reassuring and normal. Fetal status remained reassuring. Vital signs were stable with a blood pressure 115/82, respiratory rate of 20, heart rate of 95, and oxygen saturation 96% on room air.  The patient was discharged to home with follow-up in the outpatient setting. The patient was discharged to home medications which were sent to her pharmacy.
The subject under review is the medical necessity for the inpatient stay.

The inpatient hospital stay would not be medically necessary. In this case, the patient received IV antiemetics, IV fluid with lactated Ringer's, a lab profile workup, and a neurology consultation. The patient was noted to be stable with stable vital signs and fetal status remained reassuring throughout hospitalization with a category 1 and reactive nonstress test. In this case, the patient remained stable without any complications that required acute intervention. The patient was given a diagnosis after consultation with neurology and discharged to home. The care and monitoring in this case would not have required admission to acute inpatient hospital stay for delivery of this care. Labyrinthitis is an inner ear infection that affects balance and produces dizziness. It is also referred to as vestibular neuritis. It generally resolves without intervention over a period of weeks. There is treatment with antihistamines or motion-sickness tablets which may improve symptoms. There was no indication for acute inpatient level of care for this therapy given the presentation of a stable pregnant patient with normal vital signs.