The patient presented with swelling to the dorsum of the left hand after a fall/bug bite . The patient was admitted for antibiotic treatment. The patient was treated with intravenous (IV) antibiotics for presumed cellulitis and admitted for antibiotic management and to rule out deep tissue infection. Consults were completed. A deep tissue infection was ruled out. The health plan has denied the inpatient stay as not medically necessary. The health plan's determination was upheld. Therefore the inpatient hospital stay was not medically necessary.
1) Halilovic J, Heintz B, Brown J. Risk factors for clinical failure in patients hospitalized with cellulitis and cutaneous abscess. The Journal of Infection. 2012;65(2):128. 2) Stevens D, Bisno A, Chambers H, Dellinger E. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the infectious diseases society of America. Clinical Infectious Diseases. 2014;59(2):147.