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Protocal for Enhancement of COVID-19 cases.

 

Procedure code  Minimum days Enhancement document for COVID 19
3A.M1.00071/
 2B.M1.00071
Auto preauth for 10 days  Enhancement should be uploaded on the 9th day with SPO2 chart for last 8 days, CBC report, clinical conditions, X-ray report. Based on these findings enhancment should be decided.
(i) clinically normal, with haemotological investigation within normal limits, SPO2 consistently within normal range in the last 5 days with no radiological abnormality of chest x-ray
 (ii) Any deviation of the above enhancement can be given for next 5 days and subsequent enhancement for every 5 days based on the clinical findings 
3A.M1.00072/
 2B.M1.00072
Auto preauth for 10 days  Enhancement should be uploaded on the 9th day with SPO2 chart for last 8 days, CBC report, clinical conditions, X-ray report. Based on these findings enhancment should be decided.
 (i) Any deviation of the above enhancement can be given for next 5 days and subsequent enhancement for every 5 days based on the clinical findings 
3A.M1.00073/
 2B.M1.00073
Auto preauth for 10 days  Enhancement should be uploaded on the 9th day with SPO2 chart for last 8 days, CBC report, clinical conditions, X-ray/CT MRI report, high end investigation report, treatment chart and follow up chart. Based on these findings enhancment should be decided.
 (i)  Any deviation of the above enhancement can be given for next 5 days and subsequent enhancement for every 5 days based on the clinical findings 
3A.M1.00074/
 2B.M1.00074
Auto preauth for 10 days  Enhancement should be uploaded on the 9th day with SPO2 chart for last 8 days, CBC report, clinical conditions, X-ray/CT MRI report, high end investigation report, treatment chart and follow up chart. Based on these findings enhancment should be decided.
 (i) Any deviation of the above enhancement can be given for next 5 days and subsequent enhancement for every 5 days based on the clinical findings 

Note:

3A.M4.00035#, 3A.M4.00035A#, 3A.M4.00035B# - Bone tumors/soft tissue sarcomas : surgery (inlcuding prosthesis) - Comprehensive package includes surgery, invoice, irradiation and mega prothesis/custom made prothesis. The code is designed for limb salvage in sarcoma cases which are detected early and have a good prognosis. The design is for neo-adjuvant chemotherapy to reduce the activity, local irradiation followed by surgical excision of the tumour. The CAD of the prosthesis requires sometime and normally being taken on the second stage of surgery. The approvals are to be given in staged manner with the first approval for neo-adjuvant chemotherapy with appropriate drugs and the cost as per the chemo packages of AB-ArK, second for the local irradiation as per the cost per cycle of irradiation factored in the packages, third for the surgical excision of the tumour as per the surgical package and fourth for the implantation of mega prosthesis or custom designed prosthesis as per the cost within the limit of package and finally the follow of treatment of chemo, radio and follow up treatment. The treatment packages are provided under code - 3A.M4.00033, 3A.M4.00034, 3A.S15.00045 & 3A.M4.00036. The whole package should not exceed the rates prescribed under 3A.M4.00035, 3A.M4.00035A, 3A.M4.00035B

3A.M6.00006 : Linear Accelerator External Beam Radiotherapy  IGRT (Image Guided radiotherapy) (Radical/Adjuvant/Neoadjuvent) - Hospitals needs to produce AERB Certificate of Linear Acceleration, Cone Beam CT fitted in machine or tracking device with variable. Package includes planning and execution. Additional CBCT report log print to be submitted during claim submission.

Oncology codes where in supportive care/rehabilitation is mentioned: Comprehensive package which includes treatment for Neutropenia, septicaemia and nutritional support along with antibiotics, oral supplements with counselling. In case of relapse CT is recommended.