| TN 0379 HYPOPLASTIC/APLASTIC ANEMIA (FANCONI ANEMIA) |
|---|
| PREAUTH | CLAIMS |
| MIN. CLINICAL SYMPTOMS | MIN. REQUIRED | CRITERIA | DETAILS | % breakup amount - claims | WEIGHTAGE(%) IN CLAIMS AMOUNT | SPECIAL MENTION |
|---|
| ANEMIA, ORGANOMEGALY | CLINICAL PHOTO, CBC,BONE MARROW STUDY | TOTAL BED DAYS | > 5 | | | |
| | | DAYS IN ICU | | | | discretion of treating doctor |
| | | DAYS UNDER VENTILATOR SUPPORT | | | | |
| | | INVESTIGATIONS | GENERAL WORK UP | | MANDATORY | |
| | | | BONE MARROW STUDY | | MANDATORY | |
| | | | LFT + RFT | | | |
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| | | TREATMENT | SUPPORTIVE CARE | | | PACKAGE RATE TO BE REVISED |
| | | | BLOOD TRANSFUSION | | 40 | |
| | | | BONE MARROW TRANSPLANTATION | | | |
| | | | ANTI THYMOCYTE GLOBULIN | | | |
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