help_outline Skip to main content
Shopping Cart
cancel
HomeBlogsRead Blog

Pediatric Denials Library

Blog Archive
Recent Posts
8/2/2021
17yo. With 5-Day INPT Stay For Acute Psychosis
8/2/2021
Two Cases of Suspected Abuse/Neglect in Young Chil
8/2/2021
Bronchiolitis, 2yo., 68-hour LOS
By Denise Goodman
Posted on 8/2/2021 6:17 PM

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.

Leave a Comment
 *