PACKAGE LIST

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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:

Empanelled hospitals should upload basic investigations conducted in each patient - routine investigations like haemotology, bio-chemical, histopathological, micro biological, radiological films and reports and USG reports for arriving at the diagnosis and clinical notes, provisional diagnosis, planned treatment procedure, and the code selected from the procedure list mandatorily for preauthorization
Procedures mentioned as cross speciality can be done by specialities under which they have been included in addition to the main speciality.
Codes mentioned as * are sub procedures which are a part of the main procedure. Case specific procedure to be selected accordingly and cannot be clubbed with the main procedure.
Scar photos or certain clinical photographs which involves patient private parts need not be furnished at the time of preauth/claims.

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.

1.Payment in special cases:

Patient leave against Medical advice (LAMA)/Discharge against Medical Leave (DAMA):

LAMA/DAMA before surgery: The claim amount would be calculated in line with the existing medical packages according to Length of Stay (LOS) and bed category of patient.
LAMA/DAMA after surgery; Payment for 75% of the package rate will be done to the hospital .

Medical cases: Payment for 100% of the daily package rate for the full number of days for which the patient was admitted will be paid as per the category of ward.

2.Patient dies in the hospital:

Patient leave against Medical advice (LAMA)/Discharge against Medical Leave (DAMA):

A. Surgical cases

Death before Surgery - The claim amount would be calculated on a prorata basis in line with the existing medical packages according to Length of Stay (LOS) and bed category of the patient.
Death on the table during surgery � If the patient dies during the surgery then 75% of the booked package rate will be paid.
Death after Surgery � If the patient dies after the surgery, irrespective of the duration of the post-operative stay, then 100% of package rate will be paid to the hospital.

B. Surgical cases

The claim amount would be calculated on a prorata basis in line with the existing medical packages according to Length of Stay (LOS) and bed category of the patient.