Asthma, 3yo.

Submitted by Denise M. Goodman, MD, MS
Medical Director of Case Management and Care Coordination/Physician Advisor, Ann & Robert H. Lurie Children’s Hospital of Chicago 

Denial Type: 30-day Readmission
Insurance: Medicaid Replacement (MCO)
Reason for Being Hospitalized: 3yo with moderate persistent asthma, admitted for status asthmaticus
Pertinent Past Medical or Maternal History: Moderate persistent asthma, previous PICU admissions, 5 previous intubations

Hospital Course:

3yo with moderate persistent asthma admitted in early October for acute hypoxic respiratory failure to the floor. Recovered and discharged. Seen by a pulmonologist as an outpatient mid-October where the note read “Doing very well with no nasal congestion, no cough, good activity and appetite. Mom reports slight cough past days.” Readmitted 2 weeks after pulmonology visit (< 30 days from first admission) with one day of increased work of breathing. He was admitted to the floor, subsequently worsened, and was transferred to PICU for noninvasive positive pressure support using high flow nasal cannula.

Appeal Strategy:

His history of numerous previous intubations demonstrates severe recurrent disease. An intervening clinic visit showing that he was doing well at baseline indicates that the readmission was not indicative of “poor quality of care, inadequate coordination of care, or lack of effective discharge planning and transitional care” as described by the CMS guidelines for 30-day readmissions.