Bronchiolitis, 2yo., 68-hour LOS

Submitted by Alyssa Riley, MD, FAAP
Physician Advisor, Dell Children’s Medical Group 

Type of Denial: Lack of Medical Necessity Retrospective
Age: 2 years
Insurance: Medicaid replacement (MCO)
Length of Stay: 68 hours
Reason for being Hospitalized: Respiratory distress due to bronchiolitis
Pertinent Past Medical or Maternal History: Chromosomal deletion, developmental delay, hypotonia, dysphagia, gastrostomy tube dependence

Hospital Course:

2 yr old male with chromosome deletion, developmental delay, hypotonia, failure to thrive, dysphagia, gastroparesis, feeding intolerance, gastrostomy tube dependence, asthma and recurrent aspiration pneumonia brought for evaluation of fever and respiratory distress. Pt’s initial VS were notable for T 38.7C, P 157, BP 122/97, RR 34, SpO2 95% on room air. Physical exam was notable for hypotonia, tachycardia and bilateral coarse breath sounds with intermittent expiratory wheeze and mild subcostal retractions. A chest x-ray showed perihilar thickening. Pt was intermittently treated with supplemental blowby and nasal cannula O2 over about 36 hours. Pt had difficulty tolerating full gastrostomy tube regimen, beginning with continuous Pedialyte, transitioning to formula, and then resuming bolus feeds. Pt discharged home after tolerating bolus feeds and 24 hours without need for supplemental oxygen.

Appeal Strategy:

This denial was overturned via peer to peer discussion demonstrating patient’s prolonged recovery including need on and off for supplemental oxygen, and with failure to thrive, the need to demonstrate tolerance of usual feeding regimen.