| TN 0373 ACQUIRED HEART DISEASE WITH CONGESTIVE CARDIAC FAILURE | ||||||
|---|---|---|---|---|---|---|
| PREAUTH | CLAIMS | |||||
| MIN. CLINICAL SYMPTOMS | MIN. REQUIRED | CRITERIA | DETAILS | % breakup score - claims | WEIGHTAGE(%) IN CLAIMS AMOUNT | SPECIAL MENTION |
| RESP. DISTRESS, CYANOTIC SPELLS | CLINICAL PHOTO, CBC, CXR, ECG | TOTAL BED DAYS | > 5 | 20 | ||
| DAYS IN ICU | discretion of treating doctor | |||||
| DAYS UNDER VENTILATOR SUPPORT | ||||||
| INVESTIGATIONS | GENERAL WORK UP | 30 | ||||
| ECG, CBC, CXR | mandatory | |||||
| ECHO | mandatory | |||||
| repeat ecg/ and other appropriate investigations | ||||||
| CULTURES | ||||||
| TREATMENT | SUPPORTIVE CARE | 50 | mandatory | nasal oxygen | ||
| ANTIBIOTICS SOS | ||||||
| ANTIFAILURE TREATMENT | mandatory | IONOTROPES AND DIURETICS | ||||