Inpatient Admission Prior to Surgery (Preop Days)

Aetna covers inpatient preoperative admission only for specified high‑risk scenarios (e.g., infants <1 needing IV fluids before cardiac cath/major surgery within 24 hours; extensive bowel prep with comorbidities risking electrolyte/volume imbalance; partially obstructed bowel needing slow extensive prep; invasive diagnostic study followed by major surgery the next day; brittle insulin‑dependent diabetics needing close glucose/insulin adjustment). Admissions that do not meet these criteria are not medically necessary — routine coumadin-to-subcutaneous heparin conversion is excluded (IV heparin would be required), and transplant candidates are not automatically eligible unless they have other inpatient needs.

"Assessment of the medical necessity of hospitalization prior to transplant surgery is performed using the same criteria that are considered in assessing the medical necessity of hospitalization for..."