AB PM -

Specialt Procedu Package Multiple Procedu

JAY
Specialty y Code re Code Code Procedu re Code
Package
Burns Management HBP
BM2.0 S1100001
HBP 1.0 HBP 2.0 Thermal b Yes
BM001 res HBP 2.0
BM001A
Name
Burns Management BM S1100002 BM001 Thermal b Yes BM001B
Burns Management BM S1100003 BM001 Thermal b Yes BM001C
Burns Management BM S1100004 BM001 Thermal b Yes BM001D
Burns Management BM S1100001 BM002 Scald bur Yes BM002A
Burns Management BM S1100002 BM002 Scald bur Yes BM002B
Burns Management BM S1100003 BM002 Scald bur Yes BM002C
Burns Management BM S1100004 BM002 Scald bur Yes BM002D
Burns Management BM S1100001 BM003 Flame bur Yes BM003A
Burns Management BM S1100002 BM003 Flame bur Yes BM003B
Burns Management BM S1100003 BM003 Flame bur Yes BM003C
Burns Management BM S1100004 BM003 Flame bur Yes
Electrical BM003D
Burns Management BM S1100005 BM004 Electrical
contact Yes BM004A
Burns Management burns
BM S1100006 BM004 contact
Electrical Yes BM004B
Burns Management burns
BM S1100006 BM004 contact
Electrical Yes BM004C
Post
Burns Management BM S1100007 BM004 Burn burns
contact Yes BM004D
Post
Chemical
Burns Management BM S1100009 BM005 Burn burns
Contract Yes BM005A
burns
Chemical
Burns Management BM S1100010 BM005 ure Contract Yes BM005B
burns
surgeries
ure
Burns Management BM S1100011 BM006 Yes BM006A
for
surgeries
Burns Management BM S1100012 BM006 Function Yes BM006B
for
al
Function
Improve
al
ment
Improve
ment
% Total Body Surface Area Burns (TBSA) - any %
(not requiring admission).
Needs
% TotalatBody
leastSurface
5-6 dressing
Area Burns (TBSA): Upto 40 %; Includes % TBSA skin grafted, flap cover, follow-up dressing
% Total Body Surface Area Burns (TBSA): 40% - 60 %; Includes % TBSA skin grafted, flap cover, follow-up dressin
%
% Total Body Surface
Total Body Surface Area
Area Burns
Burns (TBSA)
(TBSA):->any
60 %%; Includes % TBSA skin grafted, flap cover, follow-up dressings et
(not requiring admission).
Needs
% TotalatBody
leastSurface
5-6 dressing
Area Burns (TBSA): Upto 40 %; Includes % TBSA skin grafted, flap cover, follow-up dressing
% Total Body Surface Area Burns (TBSA): 40% - 60 %; Includes % TBSA skin grafted, flap cover, follow-up dressin
%
% Total Body Surface
Total Body Surface Area
Area Burns
Burns (TBSA)
(TBSA):->any60% %; Includes % TBSA skin grafted, flap cover, follow-up dressings e
(not requiring admission).
Needs
% TotalatBody
leastSurface
5-6 dressing
Area Burns (TBSA): Upto 40 %; Includes % TBSA skin grafted, flap cover, follow-up dressing
% Total Body Surface Area Burns (TBSA): 40 % - 60 %; Includes % TBSA skin grafted, flap cover, follow-up dressin
% Total Body Surface Area Burns (TBSA): > 60 %; Includes % TBSA skin grafted, flap cover, follow-up dressings e
Electrical contact burns: Low voltage - without part of limb / limb loss; Includes % TBSA skin grafted, flap cover, follo
Electrical contact burns: Low voltage - with part of limb / limb loss; Includes % TBSA skin grafted, flap cover, follow-u
Electrical contact burns: High voltage - with part of limb / limb loss; Includes % TBSA skin grafted, flap cover, follow-
Electrical contact burns: High voltage - without part of limb / limb loss; Includes % TBSA skin grafted, flap cover, follo
Chemical burns: Without significant facial scarring and/or loss of function; Includes % TBSA skin grafted, flap cover,
Chemical burns: With significant facial scarring and/or loss of function; Includes % TBSA skin grafted, flap cover, fol
Post Burn Contracture surgeries for Functional Improvement (Package including splints, pressure garments, silicone
done Burn
Post for each joint withsurgeries
Contracture post - operative regular Improvement
for Functional dressings for (Package
STSG / FTSG / Flapsplints,
including cover.pressure garments, silicone
Full Thickness Skin Graft (FTSG) / Flap cover is done for each joint with post-operative regular dressings for STSG
 Can
No. of
Implants more
Stratific Reserva Reserva
ICHI Stratific / High than one
ation Special tion tion
Procedu ation End type of Level of
Package criteria Conditio Public Tertiary
re / ICD Criteria Consum implant Care
XXX Price
7,000 (Y/N)
No which
0.00 No No ns No
(Y/N) Hospital
No Hospital
No Secondary
Code ables be
XXX 40,000 No can be
0.00 No No No s (Y/N)
No s (Y/N)
No Tertiary
(Y/N) booked
booked
XXX 50,000 No 0.00 No (Y/N)
No No No No Tertiary
XXX 80,000 No 0.00 No No No No No Tertiary
XXX 7,000 No 0.00 No No No No No Secondary
XXX 40,000 No 0.00 No No No No No Tertiary
XXX 50,000 No 0.00 No No No No No Tertiary
XXX 80,000 No 0.00 No No No No No Tertiary
XXX 7,000 No 0.00 No No No No No Secondary
XXX 40,000 No 0.00 No No No No No Tertiary
XXX 50,000 No 0.00 No No No No No Tertiary
XXX 80,000 No 0.00 No No No No No Tertiary
XXX 30,000 No 0.00 No No No No No Tertiary
XXX 40,000 No 0.00 No No No No No Tertiary
XXX 60,000 No 0.00 No No No No No Tertiary
XXX 50,000 No 0.00 No No No No No Tertiary
XXX 40,000 No 0.00 No No No No No Tertiary
XXX 60,000 No 0.00 No No No No No Tertiary
XXX 50,000 No 0.00 No No No No No Tertiary
XXX 50,000 No 0.00 No No No No No Tertiary
 nt clinical
Post
Clinical nt photogra
photogra
Treatme clinical
Clinical
Clinical
Notes, nt ph,
photogra
ph, lab
lab
clinical
Notes, Post Mandato
MLCMandato
Notes, tests,
Post
ph,
testsry
photogra lab X-
or Enhance
MLC Treatme Special Special
Auto Clinical ry rays
Post or ment Medical Day
MLC
copy
copy with with Treatme
tests,
other
ph,
nt Docume labX-
clinical Conditio Conditio
Approve Notes,
copyDocume
number, other
Treatme
nt
with Post
rays
diagnosti
tests, clinical
orX- Procedu applicab or Care
LOS number, photogra nts - Regular n – Pop ns –
d nts
Clinical
number,
Extent
Clinical
MLC - Pre
of diagnosti
nt
photogra
other
c
Treatme
rays clinical
or re Label le Surgical Procedu
NA No Extent of Post Claim – Up
No Rule
No No Surgical
(Y/N) Authoriz
Clinical
Notes,
Extent
burns
Notes,
copy
upto with
ph,
c
photogra
ph,
of nt
diagnosti
procedur
other
lab
lab
clinical
Procedur
Regular Or not (S/M) re No(Y/N)
Treatme
tests,
Post Processi X- e (Y/N) (Y/N)
1900% No Notes,
MLC
upto
visible
MLC
number, procedur
ationon photogra
ph,
tests
ces
diagnosti lab
done Procedur
or Regular No No No
(Y/N) Surgical No
40% nt
rays
Treatme clinical
ngorX- Procedur
1900% No MLC
copy
40%
photogra
Clinical
copy -with Post
es
tests,
other
procedur
as
ph, done
a part
lab e No No No Surgical No
burnswith
Extent > photogra
cother
nt clinical
Regular
copy
number,
60%
ph
Notes,
number,(withwith Treatme
as
rays
diagnosti
Post
es
of
tests, a part
or
done X- e
1900% No 60%
visible on ph, procedur
diagnosti lab Procedur
Regular No No No Surgical No
Clinical
number,
Extent
burns
Clinical
rule
MLC of of
9 photogra
nt
of
other
cas
Treatme
treatmen
Post
rays clinical
a part
or
NA No Extent
burns
photogra of es
tests,
Post done X- e No No No Surgical No
Clinical
Notes,
Extent
burns
visible
Notes,
chart)
copy of ph,
on
with cphotogra
treatmen
diagnosti
procedur
nt
t. clinical
of
Treatme
other lab Procedur
Regular
upto
visible
ph (with on as
Post
rays
Treatme a part
or e
1900% No Circumst
Notes,
MLC
upto
visible
photogra
MLC
number, on procedur
tests,
t.
ces
ph,
photogra
treatmen
Detailed
nt
diagnosti lab
done X-
clinical Procedur
Regular No No No Surgical No
40%
photogra
rule of 9 of
Treatme
other
nt
rays clinical
or
1900% No ances
MLC
copy
40%
Circumst
photogra
Clinical
ph
copy
Extent -with
(with > tests,
with es
Detailed
procedur
as
ph,
t.
clinical
photogra
ctreatmen done
alab
part e
X- Procedur
Regular No No No Surgical No
burns
ph
chart) (with
Clinical nt
diagnosti
photogra
other clinical
1900% No that
copy
number,
60%
ances
ph
Notes,
rule of
number,
60% led
(withwith
of on9 photograas
discharg
es
rays
of
tests,
Detailed
notes.
ph
procedur a part
done
orX- e No No No Surgical No
Circumst
visible
rule
history
to low
Clinical
number,
9 cof lab Procedur
t.
ph,
diagnosti Regular
Extent
burns
that
rule
MLC
chart)
Extent
burns
ances
photogra
chart) led
of of
9
of e
as
other
treatmen
discharg
showing
es
rays
Detailed a part
done
or e
NA No Circumst ph
procedur X- Procedur No No No Surgical No
detailing
voltage
history
Extent
burns
visible
to
chart)
copy
upto low
Circumst
visible
that
ph led
(with of ctests,
on
with
on treatmen
summary
of
diagnosti
t.
e
treated
as
other a part
Regular
1900% No ances
the burns discharg
showing
es
rays
procedur done
or e
Procedur No No No Surgical No
electrical
detailing
upto
visible
photogra
voltage
number,
40%
ances
photogra
to
rule High
of on
9 ctreatmen.t.
Detailed
summary
burns,
of
diagnosti
e
Regular
Circumst
that
-
contact
the led
burns treated
as
other
es
Detailed a part
done e
1900% No 40%
photogra
ph
electrical
Extent
burns
that
ph
voltage
chart) - > procedur
(with
led
(with t.
.clinical
lab
ctreatmen tests, Procedur
Regular No No No Surgical No
ances
to High
etiology, summary
burns,
of
diagnosti
as
discharg a part
1900% No burns,
-
60%
ph
rule
contact
60%
visible(with
of 9 X-rays es
Detailed
notes. done e
or Procedur No No No Surgical No
to
rule
that
voltage
treatmen
MLC
etiology,ledon
of
electrical 9 t.
procedur
.e tests,
lab
ctreatmen
of
Regular
1900% No burns
rule
chart)
burns,
burns
photogra
chemical
chart)
contact of 9 as
discharg
other
Detailed
es a part
done e No No No Surgical No
to
electrical
tcopygiven with X-rays
t.
procedur
Post
summary or Procedur
Regular
1900% No
treatmen
visible
chart)
MLC
visible
ph
burns,(with
chemical
contact on treatmen
on of
e
diagnosti
discharg
as
other
Detailed
es a part
done e
Procedur No No No Surgical No
and
tnumber.
given .Treatme
t. Regular
photogra
copy
MLC
burns, 9 Post
ofwith
photogra
rule treatmen
summary
of
c
e
diagnosti
discharg
as a part e
1900% No resultant
%
and burns nt
Detailed clinical Procedur No No No Surgical No
ph (with
number.
ph (with
chart)
copy
MLC
contractu with Treatme t.
.ce
treatmen
procedur
summary
of
photogra
Regular
1900% No visible
resultant
rule of 9 on
9 Detailed discharg
nt clinical e No No No Surgical No
%
ruleburns
number,
number.
copy
res
of with es
left. .ph,done Procedur
t.
procedur
summary
treatmen Regular
1900% No clinical
contractu
chart)
visible
chart)
and on e
photogra
discharg
Detailed e No No No Surgical No
% burns
number,
left.on es
number.
Function
photogra
res .as
t.
Detailed
summary
ph,
a part Procedur
done Regular
1900% No clinical
area
visible
% and
burns e
discharg
of
as a part e
Procedur No No No Surgical No
al
ph (with discharg
Function
photogra .Detailed
Detailed
summary
e
Regular
burnt
clinical
area
visible treatmen
of e
1000% No rule
al
ph of on
disability
(with
visible
photogra 9 e
on
discharg
.Detailed
discharg
t.Detaile
summary
Procedur
Regular No No No Surgical No
1000% No burnt
clinical
to be
chart)
disability treatmen
e
summary
Procedur
e e
Procedur No No No Surgical No
rule
ph of on
clinical
(with
visible
photogra 9 Detailed d
..t.Detaile
summary
detailed
to be
chart) e /
summary
Procedur e
photogra
rule
ph
and of 9 discharg
clinical
(with Detailed
d
..Operativ
Detailed
detailed
ph
chart) e /
Procedur
photogra
rule of
expected
and 9 discharg
Detailed
Procedur
e Notes
Detailed
(with
ph
chart) rule Operativ
summary
e //
Procedur
functiona
expected e
if surgery
Procedur
e Notes
of
l 9
(with rule summary .
Operativ
e //
Operativ
functiona
chart) done.
e
if surgery
Detailed
e Notes
of 9
limprove Operativ .
Operativ
e Notes.
chart) done.
Procedur
if surgery
ment to Detailed
improve e
e Notes
Notes.
be to e
done./
Procedur
if surgery
ment Operativ
shared. e
be done./
Pre-op e Notes
Operativ
shared. if surgery
clinical
Pre-op done. e Notes
photogra
clinical if surgery
photogra done.
ph.
ph.
Reserve
d
Procedu
re
(Insuran
ce/Trust
)
 AB PM - AB PM - ICHI
Specialt Procedu Package Right / Multiple Procedu
Specialt JAY JAY Procedu
y Code re Code Code RightLeft / Procedu re Code Right Package
y
Cardiolo HBP 2.0 HBP 1.0 HBP 2.0 Package Procedu re / ICD
MC New PackageMC001 Left
Heart res
Yes HBP 2.0 Heart
MC001A Left XXX Price
5,000
gy
Cardiolo Name re Name
Catheteri
Heart Code
MC New PackageMC001 Catheter
Catheteri
Heart Yes MC001B For
zation
For
Deep XXX 5,000
gy
Cardiolo directed
zation Catheteri
vein
MC S1200039 MC002 Catheter
Catheteri Yes MC002A Mesenter
zation XXX 30,800
gy
Cardiolo Thrombo
directed
zation
Catheter thrombos
For
MC S1200039 MC002 lysis Yes MC002B ic
is (DVT) XXX 30,800
gy
Cardiolo Thrombo
directed Peripher
MC S1200039 MC002 lysis Yes Thrombo
MC002C Coarticat XXX 30,800
gy
Cardiolo Thrombo
Balloon al
MC S1200012 MC003 Balloon
lysis Yes MC003A sis
ion of
Pulmona
vessels
Balloon XXX 38,600
gy
Cardiolo Dilatation
Balloon
Pulmona
MC None MC003 Balloon Yes Aorta
MC003B ry Artrey
Pulmona XXX 38,600
gy
Cardiolo Dilatation
ry
Pulmona / Balloon
MC S1200004 MC004 Yes Stenosis
MC004A ry XXX 23,400
gy
Cardiolo Aortic
ry
Balloon / Aortic
Balloon
MC S1200002 MC004 Valvotom Yes MC004B Valvotom XXX 23,400
gy
Cardiolo Aortic
Mitral Valvotom
Mitral
y
MC S1200003 MC005 Balloon
yValvotom
Valvotom No MC005A Balloon
y XXX 35,700
gy
Cardiolo Atrial Valvotom
Atrial
MC S1200001 MC006 yASD ySeptosto No MC006A ASD
y XXX 25,000
gy
Cardiolo Septosto
MC S1200014 MC007 Device VSD
my No MC007A Device
VSD
my XXX 36,900
gy
Cardiolo
MC S1200015 MC008 PDA Closure
Device No Closure
MC008A PDA
Device XXX 37,900
gy
Cardiolo PTCA, PTCA,
MC S1200016 MC009 Device Closure No MC009A Closure
Device XXX 25,000
gy
Cardiolo inclusive
PDA inclusive
PDA
MC S1200019 MC010 of Closure No Closure
MC010A Electrop
of XXX 40,260
gy stenting stenting
Cardiolog MC S1200024 MC011 Percutandiagnosti
Electrop No hysiologi
MC011A Percutan
diagnosti XXX
Electrop 40,600
Cardiolo c
eous cal
c Study XXX
MC New PackageMC012 Electrop
hysiologi Yes MC012A eous
hysiologi 20,000
gy
Cardiolo angiogra
Translum with
angiogra
Translum
cal
MC New PackageMC012 Tempora
hysiologi
Single Study Yes cal Study XXX
MC012B Tempora
Permane 20,000
gy
Cardiolo m
inal
ry Radio
m
inal
ry
MC S1200027 MC013 Chambercal
Double Study No MC013A nt
Permane XXX 34,000
gy
Cardiolo Septal
Pacemak Frequen
Septal
Pacemak
MC S1200021 MC014 ChamberPermane No Pacemak
MC014A nt
cy XXX 19,200
gy
Cardiolo Myocardi
er
nt Myocardi
er
er
Permane
MC S1200023 MC015 implantat
al No Pacemak
Ablation
MC015A implantat
al XXX 24,500
gy
Cardiolo Pacemak
Bronchial
nt Implantat
Bronchial
er
MC S1200022 MC016 Peripher
Ablation
ion
er No MC016A Peripher
Ablation
ion
ion XXX 33,000
gy artery
Pacemak
al al -
artery
Implantat
Cardiolog MC S1200011 MC017 Implantat
Embolisa
er No MC017A Single
Embolisa
ion - XXX 34,500
Cardiolo Angiopla Angiopla
ion
MC S1200035 MC018 Pericardi
tion
Implantat
sty No Chamber
MC018A Pericardi
tion
Double
sty XXX 32,800
gy
Cardiolo Systemic Systemic
(for
ion
MC S1200020 MC019 ocentesi No (for
Chamber
MC019A ocentesi XXX 12,100
gy Cardiac
Thrombo Cardiac
Thrombo
Cardiolog MC S1200013 MC020 Haemopt sDefibrillat No MC020A Haemopt
s
Defibrillat XXX 17,900
Cardiolo lysis
ysis)
Cardiac (for lysis
ysis)
Cardiac(for
MC New PackageMC021KL or MI) No MC021KLAor MI) XXX 10,000
gy
Cardiolo Resnchr Resnchr
MC New Package Implantat
Tempora
MC022KL Single
IVC Filter Implantat
Tempora
No MC022KLAPermane
IVC Filter XXX 10,000
gy
Cardiolo onisation
ion
ry (ICD) onisation
ion
ry (ICD)
MC New Package Chamber
MC023KL Double
Placeme
(CRT) nt
No MC023KLAPermane
Placeme
(CRT) XXX 10,000
gy Pacemak Pacemak
CTVS SV S1200021 MC014 Permane nt
Chamber No MC014A Pacemak
nt XXX 19,200
er
nt
Permane er
er
Pacemak
CTVS SV S1200023 MC015 implantat No MC015A implantat XXX 24,500
Pacemak
nt Implantat
er
CTVS SV S1200022 MC016 Vascularion
er No MC016A Vascular
ion
ion - XXX 33,000
Pacemak
Carotid Implantat
Carotid
CTVS SV New PackageSC074 Surgical
reconstru
Implantat
er No SC074A reconstru
Single
ion - XXX 57,600
Body Body
CTVS SV S100152 SG069 Intercost
ction
ion
Correctio
Implantat
Surgical No SG069A Intercost
ction
Chamber
Double XXX 20,000
tumour
al
n of - tumour
Isolated
al -
CTVS SV ion
S100208 SG077 Correctio
Surgical
Excision No SG077A Chamber
Excision XXX 4,800
drainage
Category Secundu
drainage
CTVS n
Correctio
SV New PackageSV001 Surgical of Yes SV001A mUnifocali XXX 100,000
-Only Iof OnlyAtrial
Category
n
Correctio
CTVS SV New PackageSV001 Surgical
Congenit Yes SV001B Septal XXX 100,000
-Category
Iof
CTVS SV S1300050 SV001 n Correctio
al
Surgical
Congenit Heart Yes SV001C Defect
Glenn pro XXX 100,000
-n Iof
Category (ASD)
CTVS SV New PackageSV001 CorrectioDisease
al
Surgical
CongenitHeart Yes SV001D Pulmonary XXX 100,000
-n Iof
Category Repair
CTVS SV New PackageSV001 Surgical Disease
Correctio
al Heart Yes SV001E ASD
Systemic XXX 100,000
-Congenit
I
Category
n of
CTVS SV New PackageSV001 Surgical Disease
Correctio
al Heart
Congenit Yes SV001F closure
Vascular+ R XXX 100,000
-n Iof
Category
CTVS SV S1300047 SV001 Correctio Disease
al Heart
Congenit Yes SV001G Partial
Coarctatio
ASD XXX 100,000
-n I
Category
of Anomalo
CTVS SV New PackageSV002 al Disease Yes SV002A Closure XXX 120,000
- IIHeart
Congenit
Category us
CTVS SV New PackageSV002 al Disease Yes SV002B + Mitral XXX 120,000
IIHeart
-Congenit Venous
Disease
al Heart procedur
Drainage
Congenit
Disease e
Repair
al Heart
Disease
 Surgical
Correctio
Surgical ASD
n of ASD
Closure
Correctio
Surgical
Category Closure
ASD
+
CTVS SV New PackageSV002 n
Correctio
Surgical of Yes SV002C XXX 120,000
-Category II +
Closure
Tricuspid
CTVS SV New PackageSV002 n
Correctio
Surgical of Yes SV002D Pulmona XXX 120,000
Congenit
-n IIof +
procedur
Category
Correctio ry
CTVS SV New PackageSV002 al
Surgical
Congenit Heart Yes SV002E Infundibu
e XXX 120,000
-n
Category IIof VSD
procedur
CTVS SV S1200015 SV002 Disease
Correctio
al
Surgical Heart Yes SV002F lar
Infundibu XXX 120,000
Congenit
-n IIof
Category closure
e
CTVS SV New PackageSV002 Disease
Correctio Yes SV002G procedur
lar PS XXX 120,000
al
Surgical
-Congenit Heart
IIof Valvular
Category
n e
repair
CTVS SV New PackageSV002 Disease
Correctio
al
Surgical
Congenit Heart Yes SV002H PS / PR
Partial XXX 120,000
-n
Category IIof Intermedi
CTVS SV S1300026 SV002 Disease
Correctio
al
Surgical Heart Yes SV002I repair
AV canal XXX 120,000
Congenit
-n
Category IIof ate AVof
CTVS SV S1300026 SV002 Disease
Correctio
al Heart Yes SV002J Sinus
Atrial
repair XXX 120,000
Surgical
Congenit
-n IIof canal
Category
Disease Valsalva
septecto
Sinus
Atrial of
CTVS SV New PackageSV002 Correctio
al
Surgical Heart Yes SV002K XXX 120,000
-Congenit
Category
n IIof repair
aneurys
my +
Valsalva
septecto
CTVS SV New PackageSV002 Disease
Correctio
al
Surgical
Congenit Heart Yes SV002L m repair
Glenn XXX 120,000
-n
Category IIof aneurys
my + PA
CTVS SV New PackageSV002 Disease
Correctio
al
Surgical
Congenit Heart Yes SV002M with
m
Bandrepair XXX 120,000
-n
Category IIof
CTVS SV New PackageSV002 Disease
Correctio
al
Surgical Heart Yes SV002N aortic
without XXX 120,000
Congenit
-n IIof
Category
CTVS SV New PackageSV002 Disease
Correctio Yes SV002O valve
aortic
Sub-aorti XXX 120,000
al
Surgical
-Congenit Heart
IIof
Category
n procedur
Ebstien
valve
CTVS SV S1300031 SV003 Disease
Correctio
al
Surgical
Congenit Heart Yes SV003A Double XXX 150,000
-n
Category III e
repair
procedur
CTVS SV S1300036 SV003 Disease
Correctio
al
Surgical of
Heart Yes SV003B switch XXX 150,000
Congenit
-n III Rastelli
e
Category
Disease
Correctio of operation
CTVS SV New PackageSV003 al
Surgical
Congenit Heart Yes SV003C Procedur
Fontan XXX 150,000
-n III
Category of Arch
CTVS SV S1300032 SV003 Disease
Correctio
al
Surgical Heart Yes SV003D e
procedur
AP XXX 150,000
-Congenit
Category
n III
of
interrupti
CTVS SV S1300029 SV003 Disease
Correctio
al
Surgical Heart Yes SV003E e
Arch
window
on XXX 150,000
Congenit
-n
Category III
CTVS SV New PackageSV003 Disease
Correctio
al
Surgical of
Heart Yes SV003F interrupti
repair
Repair XXX 150,000
Congenit
-n
Category III on
CTVS SV New PackageSV003 Disease
Correctio
al
Surgical of
Heart Yes SV003G without XXX 150,000
Congenit
-n III
Category Repair
DORV
CTVS SV New PackageSV003 Disease
Correctio of Yes SV003H VSD XXX 150,000
al
Surgical
-Congenit Heart
III Supraval
with
Repair VSD
Category
n of closure
CTVS SV New PackageSV003 Disease
Correctio
al
Surgical
Congenit Heart Yes SV003I vular
closure
Konno AS XXX 150,000
-n
Category III
of
CTVS SV New PackageSV003 Disease
Correctio
al
Surgical Heart Yes SV003J repair
procedur
Norwood XXX 150,000
Congenit
-n
Category III
CTVS SV New PackageSV003 Disease
Correctio
al
Surgical of
Heart Yes SV003K VSD
e
procedur XXX 150,000
Congenit
-n III
Category closure
CTVS SV New PackageSV003 Disease
Correctio
al
Surgical of
Heart Yes SV003L VSD
e + + XXX 150,000
-Congenit
Category
n III
of RV -
Aortic
VSD + PA
CTVS SV New PackageSV003 Disease
Correctio
al
Surgical
Congenit Heart Yes SV003M conduit XXX 150,000
-n
Category III
of procedur
Mitral+
VSD
CTVS SV New PackageSV003 Disease
Correctio
al
Surgical
Congenit Heart Yes SV003N e XXX 150,000
-n
Category III VSD +
procedur
Tricuspid
CTVS SV New PackageSV003 Disease
Correctio
al
Surgical of
Heart Yes SV003O XXX 150,000
Congenit
-n III Pulmona
e
VSD +
procedur
Category
Disease
Correctio of
CTVS SV New PackageSV003 al
Surgical Heart Yes SV003P ry
Infundibu XXX 150,000
-Congenit
Category
n III
of
e
CTVS SV New PackageSV003 Disease
Correctio
al
Surgical Heart Yes SV003Q procedur
lar +
VSD XXX 150,000
Congenit
-n
Category III
CTVS SV New PackageSV003 Disease
Correctio of Yes SV003R e
procedur
Coarctati XXX 150,000
al
Surgical
Congenit
-n Heart
III
Category
Disease
Correctio of TAPVC
e repair
on
CTVS SV New PackageSV003 al
Surgical
Congenit Heart Yes SV003S Truncus XXX 150,000
-n III
Category of Repair
CTVS SV New PackageSV003 Disease
Correctio
al
Surgical Heart Yes SV003T arteriosu
Tetralogy XXX 150,000
-Congenit
Category
n III
of Complet
CTVS SV New PackageSV003 Disease
Correctio
al
Surgical Heart Yes SV003U s
ofrepair
Fallot XXX 150,000
Congenit
-n III
Category e AV
CTVS SV S1300026 SV003 Disease
Coronary
al
Surgicalof
CorrectioHeart Yes SV003V Repair
Coronary XXX 150,000
Congenit
-arteryIII Arterial
canal
Category
n
Diseaseof
Correctio artery
CTVS SV S1300035 SV003 al
CongenitHeart Yes SV003W switch
Senning
repair XXX 150,000
-n III
bypass
Category
of bypass
CTVS SV S1300037 SV003 Disease
al Yes SV003X operation
Operatio XXX 150,000
IIIHeart
-Congenit
grafting
Category
Mustard
grafting
CTVS SV S1300038 SV003 Disease
al Yes SV003Y n
Operatio XXX 150,000
IIIHeart
(CABG),
Congenit
-Single (CABG),
CTVS SV S1300001 SV004 Disease
including
al Heart No SV004A n
including XXX 118,100
Congenit
Valve Aortic
CTVS SV S1300013 SV005 Single
intra
Disease
al Heart Yes SV005A intra XXX 119,000
Procedur
Valve
operative
Single Valve
Mitral
operative
CTVS SV S1300011 SV005 Disease
e Yes SV005B XXX 119,000
Procedur
balloon
Valve
Double Valve
balloon
Tricuspid
Double
CTVS SV S1300012 SV005 e
pump Yes SV005C XXX 119,000
Valve (if
Procedur
Closed
Triple
pump
Valve (if
Valve
Closed
Triple
CTVS SV New PackageSV006 required)
e
Mitral No SV006A required)
Mitral XXX 142,000
Procedur
valve Procedur
valve
CTVS SV New PackageSV007 Valvotom
e No SV007A Valvotom
e XXX 170,000
procedur procedur
CTVS SV S1300009 SV008 ye No SV008A y
e XXX 57,000
including including
thoracoto thoracoto
my my
 Surgery Surgery
for for
Ross
Hypertro Ross
Hypertro
CTVS SV S1300023 SV009 Pericardi
Procedur
phic No SV009A Pericardi
Procedur
phic XXX 150,000
CTVS SV S1300030 SV010 al
e
Obstructi
Patent No SV010A al
e
Obstructi
Patent XXX 120,000
window
ve
Ductus window
ve
Ductus
CTVS SV New PackageSV011 No SV011A XXX 30,000
(via
Pericardi
Cardiom
Arteriosu (via
Pericardi
Cardiom
Arteriosu
CTVS SV S1300052 SV012 thoracoto
Aortic No SV012A thoracoto XXX 67,000
sectomy
yopathy (PDA) ectomy
yopathy
s (PDA)
CTVS SV S1300046 SV013 my)
Root
(HOCM)
Aortic No SV013A my)
Bental
(HOCM) XXX 57,000
Closure Closure
CTVS SV S1300040 SV014 Replace
Root
via
Aortic Yes SV014A Procedur
Aortic
via XXX 150,000
CTVS SV New PackageSV014 ment
Aortic
Replace
thoracoto
Root Yes SV014B e
Dissectio
thoracoto
Aortic XXX 150,000
Aortic
Surgery
Arch Valve
CTVS SV New PackageSV014 ment
my
Aortic
Replace
Root Yes SV014C n
my
Aneurys
sparing XXX 150,000
Aortic
Replace
Surgery
Arch
CTVS SV New PackageSV014 ment
Replace Yes SV014D AVR
root +
m
Aortic XXX 150,000
Root
ment
Replace / Thoraco
Surgery
ment Root
Arch
replacem
CTVS SV New PackageSV014 Replace
Thoraco
ment / Yes SV014E Aortic
abdomin XXX 150,000
Surgery enlargem
Replace
ent
CTVS SV New PackageSV015 ment
abdomin
Thoraco Yes SV015A Aneurys
al XXX 150,000
ent
ment
Aortic
CTVS SV New PackageSV015 Surgery
al
abdomin Yes SV015B Aortic
m
aneurysRepair XXX 150,000
Aortic using
Aneurys
Aneurys
aneurys
al using
m Repair
CTVS SV S1300042 SV016 Aneurys
Aortic Yes SV016A bypass
Aortic
m
m Repair
Repair XXX 120,000
m
aneurys Repair Cardiopu
using
CTVS SV New PackageSV016 m
Aneurys
Aortic Repair Yes SV016B Aneurys
using
without XXX 120,000
using
m
Aorto Repair lmonary
bypass
CTVS SV S1300043 SV016 m
Aneurys
bypass Repair Yes SV016C m
Left
using
bypass Repair XXX 65,500
Aortic
using
Iliac /
Aorto
m Repair without
Heart
Aorto
Cardiopu
(CPB)
CTVS SV New PackageSV016 Aneurys
bypass
Aorto
Iliac / Yes SV016D XXX 65,500
Aorto using
Bypass
Iliac
lmonary
Aorto
CTVS SV S1300092 SV017 m
femoral
Aorto Repair Yes SV017A XXX 64,500
Iliac
Aorto / Left
bypass
femoral -
CTVS SV S1300092 SV017 bypass
femoral Yes SV017B Aorto
Heart XXX 64,500
Aorto
Iliac
Pulmona /and U/L
(CPB)
bypass -
(Uni
bypass Iliac
Aorto
Bypass
CTVS SV S1300079 SV017 femoral
Aorto
ry Yes SV017C U/L XXX 64,500
Bi)
Pulmona
(Uni and bypass
Pulmona-
femoral
CTVS SV S1300079 SV017 bypass
femoral
Embolect Yes SV017D XXX 64,500
ry
Bi) B/L
bypass -
ry
CTVS SV S1300044 SV018 (Uni
bypass
omy and
/ Yes SV018A XXX 141,000
Embolect
Peripher
Bi) Thrombo
B/L
Embolect
CTVS SV New PackageSV018 (Uni
Thrombo
omy and
/ Yes SV018B endarter XXX 141,000
al
Peripher
Bi) Femoro
omy -
CTVS SV New PackageSV019 endarter
Thrombo
Arterial Yes SV019A ectomy
Femoral XXX 50,000
al
Peripher
ectomy Carotid -
CTVS SV New PackageSV019 endarter
Surgerie
Arterial Yes SV019B Carotid
Bypass
endearte XXX 50,000
al
Peripher
CTVS SV S100152 SV019 sectomy
Surgerie
Arterial Yes SV019C
Body
Thoracic
rectomy XXX 50,000
al
Peripher Tumor
sSurgerie Outlet
CTVS SV New PackageSV019 Arterial
al
Peripher Yes SV019D Carotid
Excision XXX 50,000
sArterial syndrom
Subclavi
CTVS SV S100151 SV019 Surgerie
al Yes SV019E aneurys XXX 50,000
Peripher e
an Repair
CTVS SV New PackageSV019 sSurgerie
Arterial Yes SV019F m repair XXX 50,000
al
Peripher Axillary
aneurys
CTVS SV New PackageSV019 sSurgerie
Arterial Yes SV019G aneurys XXX 50,000
al
Peripher Brachial
m repair
CTVS SV New PackageSV019 sSurgerie
Arterial Yes SV019H m
aneurysrepair XXX 50,000
al
Peripher Femoral
CTVS SV New PackageSV019 sArterial
Surgerie Yes SV019I m
aneurysrepair XXX 50,000
al
Peripher Popliteal
CTVS SV New PackageSV019 sArterial
Surgerie Yes SV019J Femoral
m
aneurysrepair XXX 50,000
al
Peripher
sSurgerie -m repair
CTVS SV S1300081 SV019 Arterial
al
Peripher Yes SV019K Axillo - XXX 50,000
sSurgerie popliteal
CTVS SV S1300082 SV019 Arterial
al
Peripher Yes SV019L Brachial
Carotio
Bypass - XXX 50,000
CTVS SV New PackageSV019 sArterial
Surgerie Yes SV019M Carotido
Bypass
carotid XXX 50,000
al
Peripher
sSurgerie -Bypass
CTVS SV New PackageSV019 Arterial
al
Peripher Yes SV019N Carotido XXX 50,000
sSurgerie subclavia
Axillo -
CTVS SV New PackageSV019 Arterial
al
Peripher Yes SV019O -n axillary
bypass XXX 50,000
sSurgerie femoral
Axillo
bypass -
CTVS SV S1300092 SV019 Arterial
al
Peripher Yes SV019P XXX 50,000
sArterial bypass
femoral -
CTVS SV S1300079 SV019 Surgerie
al Yes SV019Q Aorto XXX 50,000
Peripher
sSurgerie bypass- -
U/L
CTVS SV S1300085 SV019 Arterial
al Yes SV019R carotid
Aorto
B/L - XXX 50,000
CTVS SV New PackageSV019 sSurgerie
Peripher
Arterial Yes SV019S bypass
Peripher
subclavia XXX 50,000
Thrombo
Thoracot Thrombo
Thoracot
CTVS SV S1300072 SV020 sal arterial
Surgerie
embolect No SV020A al
n arterial
bypass
embolect XXX 28,000
omy,
injury
somy omy,
injury
CTVS SV New PackageSV021 Thoraco No SV021A omy
Thoraco XXX 30,000
Lung
repair repair
CTVS SV S1300060 SV022 Abdomin
surgery
(without No SV022A Abdomin
Lung
(without XXX 30,000
CTVS SV S1300054 SV023 al
including
bypass) Yes SV023A al
cyst
bypass) XXX 50,000
Approac
Thoracot Approac
exision
h
omy h
 Lung
surgery
Lung Other
Decortic
simple
CTVS SV S100157 SV023 including
surgery
Lung Yes SV023B XXX 45,000
ation
Hydatid
lung
CTVS SV S100079 SV023 Thoracot
including
surgery Yes SV023C XXX 45,000
omy
Isolated
Pulmona cyst
procedur
Isolated
Pulmona
CTVS SV New PackageSV023 Thoracot
including Yes SV023D XXX 45,000
Foreign
Intercost
ry
omy Foreign
e
Intercost
ry
CTVS SV New PackageSV024 Thoracot
Surgical
Body No SV024A Surgical
Body XXX 70,000
al
Resectio excludin
al
Resectio
omy
Correctio
Space - Correctio
Space
CTVS SV S1300061 SV025 Removal
Drainage
n No SV025A lung -
Removal
g
Drainage
n XXX 20,000
n
with
and of
Occupyin n of
Occupyin
with
resection
and
CTVS SV S1300056 SV026 No SV026A XXX 65,000
Broncho
g Lesion
scope
Manage Broncho
g Lesion
scope
Manage
CTVS SV S1300055 SV027 pleural No SV027A pleural XXX 65,500
(SOL)
ment of (SOL)
ment of
CTVS SV S1300066 SV028 Fistula
Diaphrag
mediasti No SV028A Fistula
Diaphrag
mediasti XXX 10,000
ICD,
Surgery ICD,
Surgery
CTVS SV S1300059 SV029 Immediat
matic
num
Intercost No SV029A matic
num
Intercost XXX 30,000
for
e
Repair
Immediat for
Repair
CTVS SV S1300045 SV030 al Block, No SV030A al Block,
Tetralogy XXX 95,000
Cardiac
reoperati
e Cardiac
CTVS SV New PackageSV031 Antibiotic
Immediat
Tumour Yes SV031A Antibiotic
of Fallot
Tumour XXX 75,000
on
reoperati
sImmediat
e & Aortic
s&
CTVS SV New PackageSV031 Yes SV031B Repair XXX 59,500
(within
on
Physioth5
reoperati Valve
Physioth
Mitral
CTVS SV New PackageSV031 e
Low
Immediat
days) Yes SV031C Low XXX 59,500
(within
erapy
on 5
reoperati erapy
Valve
Tricuspid
CTVS SV New PackageSV031 Cardiac
e
Immediat
days) Yes SV031D Cardiac
Double XXX 59,500
(within
on
Output 5
reoperati Valve
Output
Valve
CTVS SV New PackageSV031 e
days) Yes SV031E Triple XXX 71,000
(within
syndrom
on 5
reoperati syndrom
Procedur
valve
CTVS SV New PackageSV031 days)
e
(within 5 Yes SV031F e XXX 85,000
on
Excessiv procedur
Excessiv
CTVS SV New PackageSV032 requiring
days)
Re-do
(within 5
e No SV032A requiring
Re-do
e XXX 50,000
CTVS SV New PackageSV033 IABP
sternoto
days)
bleeding No SV033A IABP
sternoto
bleeding XXX 20,000
CTVS SV New PackageSV034 insertion
my
requiring No SV034A insertion
my
requiring XXX 10,000
post
re- - post
re- -
operative
explorati operative
explorati
ly
on ly
on
 Can
No. of
Implants more
Stratific Reserva Reserva
Stratific / High than one Auto
ation Special tion tion
ation End type of Level of Approve
criteria Conditio Public Tertiary LOS
Criteria Consum implant Care d
No which
0.00 No No ns No
(Y/N) Hospital
No Hospital
No Tertiary 200% No
(Y/N) ables be (Y/N)
No can be
0.00 No No No s (Y/N)
No s (Y/N)
No Tertiary 200% No
(Y/N) booked
booked
No 0.00 No (Y/N)
No No No No Tertiary 200% No
No 0.00 No No No No No Tertiary 200% No
No 0.00 No No No No No Tertiary 200% No
No 0.00 Yes No No No No Tertiary 200% No
No 0.00 Yes No No No No Tertiary 200% No
No 0.00 Yes No No No No Tertiary 200% No
No 0.00 Yes No No No No Tertiary 200% No
No 0.00 Yes No No No No Tertiary 200% No
No 0.00 No No No No No Tertiary 200% No
No 0.00 Yes No No No No Tertiary 200% No
No 0.00 Yes No No No No Tertiary 200% No
No 0.00 Yes No No No No Tertiary 200% No
No 0.00 Yes No No No No Tertiary 200% No
No 0.00 Yes Yes No No No Tertiary 200% No
No 0.00 Yes No No No No Tertiary 100% No
No 0.00 Yes No No No No Tertiary 100% No
No 0.00 No No No No No Tertiary 200% No
No 0.00 No No No No No Tertiary 200% No
No 0.00 Yes No No No No Tertiary 200% No
No 0.00 Yes No No No No Tertiary 200% No
No 0.00 Yes No No No No Tertiary 200% No
No 0.00 No No No No No Tertiary 300% No
No 0.00 No No No No No Tertiary 100% No
No 0.00 No No No No No Tertiary 300% No
No 0.00 Yes No No Yes Yes Tertiary 300% No
No 0.00 Yes No No Yes Yes Tertiary 300% No
No 0.00 Yes No No No Yes Tertiary 200% Yes
No 0.00 No No No No No Tertiary 200% No
No 0.00 Yes No No No No Tertiary 200% No
No 0.00 Yes No No No No Tertiary 200% No
No 0.00 No No No Yes No Tertiary 900% No
No 0.00 No No No No No Tertiary 700% Yes
No 0.00 No No No No No Secondary 100% Yes
No 0.00 No No No No No Tertiary 1000% No
No 0.00 No No No No No Tertiary 1000% No
No 0.00 No No No No No Tertiary 1000% No
No 0.00 No No No No No Tertiary 1000% No
No 0.00 Yes No No No No Tertiary 1000% No
No 0.00 No No No No No Tertiary 1000% No
No 0.00 Yes No No No No Tertiary 1000% No
No 0.00 Yes No No No No Tertiary 1000% No
No 0.00 Yes No No No No Tertiary 1000% No
No 0.00 Yes No No No No Tertiary 1000% No
No 0.00 Yes No No No No Tertiary 1000% No
No 0.00 Yes No No No No Tertiary 1000% No
No 0.00 Yes No No No No Tertiary 1000% No
No 0.00 Yes No No No No Tertiary 1000% No
No 0.00 Yes No No No No Tertiary 1000% No
No 0.00 Yes No No No No Tertiary 1000% No
No 0.00 Yes No No No No Tertiary 1000% No
No 0.00 Yes No No No No Tertiary 1000% No
No 0.00 Yes No No No No Tertiary 1000% No
No 0.00 Yes No No No No Tertiary 1000% No
No 0.00 Yes No No No No Tertiary 1000% No
No 0.00 Yes No No No No Tertiary 1000% No
No 0.00 Yes No No No No Tertiary 1200% No
No 0.00 Yes No No No No Tertiary 1200% No
No 0.00 Yes No No No No Tertiary 1200% No
No 0.00 Yes No No No No Tertiary 1200% No
No 0.00 Yes No No No No Tertiary 1200% No
No 0.00 Yes No No No No Tertiary 1200% No
No 0.00 Yes No No No No Tertiary 1200% No
No 0.00 Yes No No No No Tertiary 1200% No
No 0.00 Yes No No No No Tertiary 1200% No
No 0.00 Yes No No No No Tertiary 1200% No
No 0.00 Yes No No No No Tertiary 1200% No
No 0.00 Yes No No No No Tertiary 1200% No
No 0.00 Yes No No No No Tertiary 1200% No
No 0.00 Yes No No No No Tertiary 1200% No
No 0.00 Yes No No No No Tertiary 1200% No
No 0.00 Yes No No No No Tertiary 1200% No
No 0.00 Yes No No No No Tertiary 1200% No
No 0.00 Yes No No No No Tertiary 1200% No
No 0.00 Yes No No No No Tertiary 1200% No
No 0.00 Yes No No No No Tertiary 1200% No
No 0.00 Yes No No No No Tertiary 1200% No
No 0.00 Yes No No No No Tertiary 1200% No
No 0.00 Yes No No No No Tertiary 1200% No
No 0.00 Yes No No No No Tertiary 1200% No
No 0.00 Yes No No No No Tertiary 1200% No
No 0.00 No No No No No Tertiary 1000% No
No 0.00 Yes No No No No Tertiary 700% No
No 0.00 Yes No No No No Tertiary 700% No
No 0.00 Yes No No No No Tertiary 700% No
Yes 2.00 Yes Yes No No No Tertiary 1000% No
Yes 3.00 Yes Yes No No No Tertiary 1200% No
No 0.00 No No No No No Tertiary 700% No
No 0.00 Yes No No No No Tertiary 1000% No
No 0.00 No No No No No Tertiary 1000% No
No 0.00 No No No No No Tertiary 700% No
No 0.00 No No No No No Tertiary 1000% No
No 0.00 No No No No No Tertiary 700% No
No 0.00 Yes No No No No Tertiary 1200% No
No 0.00 Yes No No No No Tertiary 1200% No
No 0.00 Yes No No No No Tertiary 1200% No
No 0.00 Yes No No No No Tertiary 1200% No
No 0.00 Yes No No No No Tertiary 1200% No
No 0.00 Yes No No No No Tertiary 1200% No
No 0.00 Yes No No No No Tertiary 1200% No
No 0.00 Yes No No No No Tertiary 1000% No
No 0.00 Yes No No No No Tertiary 1000% No
No 0.00 Yes No No No No Tertiary 1000% No
No 0.00 Yes No No No No Tertiary 1000% No
No 0.00 Yes No No No No Tertiary 700% No
No 0.00 Yes No No No No Tertiary 700% No
No 0.00 Yes No No No No Tertiary 700% No
No 0.00 Yes No No No No Tertiary 700% No
No 0.00 No No No No No Tertiary 1000% No
No 0.00 No No No No No Tertiary 1000% No
No 0.00 Yes No No No No Tertiary 700% No
No 0.00 Yes No No No No Tertiary 700% No
No 0.00 Yes No No No No Tertiary 700% Yes
No 0.00 Yes No No No No Tertiary 700% No
No 0.00 Yes No No No No Tertiary 700% Yes
No 0.00 Yes No No No No Tertiary 700% No
No 0.00 Yes No No No No Tertiary 700% No
No 0.00 Yes No No No No Tertiary 700% No
No 0.00 Yes No No No No Tertiary 700% No
No 0.00 Yes No No No No Tertiary 700% No
No 0.00 Yes No No No No Tertiary 700% No
No 0.00 Yes No No No No Tertiary 700% No
No 0.00 Yes No No No No Tertiary 700% No
No 0.00 Yes No No No No Tertiary 700% No
No 0.00 Yes No No No No Tertiary 700% No
No 0.00 Yes No No No No Tertiary 700% No
No 0.00 Yes No No No No Tertiary 700% No
No 0.00 Yes No No No No Tertiary 700% No
No 0.00 Yes No No No No Tertiary 700% No
No 0.00 No No No No No Tertiary 400% No
No 0.00 No No No No No Tertiary 400% No
No 0.00 No No No No No Tertiary 1000% No
No 0.00 No No No No No Tertiary 1000% No
No 0.00 No No No No No Tertiary 1000% Yes
No 0.00 No No No No No Tertiary 1000% No
No 0.00 No No No No No Tertiary 1000% No
Yes 1.00 No No No No No Tertiary 1000% No
No 0.00 No No No No No Tertiary 200% No
No 0.00 No No No No No Tertiary 1000% No
No 0.00 No No No No No Tertiary 1000% No
No 0.00 No No No No No Tertiary 400% No
No 0.00 Yes No No No No Tertiary 1000% No
No 0.00 No No No No No Tertiary 1000% No
No 0.00 Yes No Yes No No Tertiary 1200% No
No 0.00 Yes No Yes No No Tertiary 700% No
No 0.00 Yes No Yes No No Tertiary 700% No
No 0.00 Yes No Yes No No Tertiary 700% No
Yes 2.00 Yes Yes Yes No No Tertiary 1000% No
Yes 3.00 Yes Yes Yes No No Tertiary 1200% No
No 0.00 No No Yes No No Tertiary 700% No
No 0.00 No No No No No Tertiary 0% No
No 0.00 No No Yes No No Tertiary 0% No
 e
procedur
Discharg
Post Colour
Doppler
summary
e Colour
procedur
of
,e Mandato Reserve
Clinical Procedur
Mandato Doppler
summary
affected
Colour ry Special Special
Enhance
d
ry Procedur
e
of
,
Procedur
Doppler / ment Medical Day
notes
Clinical limb/part, Docume Conditio Conditio Procedu
Clinical
Docume e
Operativ
affected
Procedur
e
of nts - /
/ Procedu applicab or Care
with
notes
Clinical Procedur
invoice n – Pop ns – re
notes
nts
Clinical - Pre Operativ
e
limb/part,
Operativ
affected Notes
// Regular
re Label le Surgical Procedu
planned
with
notes e
Procedur
of Claim – Up Rule (Insuran
andAuthoriz
notes e
with
invoice
Operativ
e
limb/part, Notes.
Notes Procedur
Regular No No No
Or not Medical
(S/M) re No(Y/N)
line
planned
and of Operativ
e
catheter Processi/ (Y/N) (Y/N) ce/Trust
doppler
and ation Procedur
Invoices
images,
of
e
with
invoice Notes. e
Procedur No No No
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of
barcode
e notes,,
e
Procedur
Regular No No No Surgical No
report
reports
ECHO
Angio + notes,
Discharg
graft
operative
n notes,
synthetic
Detailed
and
notes
Clinical of
barcode e
Procedur No No No Surgical No
CT
report
reports
Angiogra
and + Discharg e
notes,
Discharg
graft
operative
synthetic
Detailed
Regular
notes
Chest
Clinical of
e
summary e
Procedur No No No Surgical No
CT
m / CT Discharg
Angiogra
and
e
notes,
graft
operative
synthetic
Detailed
Regular
report
notes
Chest
Clinical summary
e
summary
Discharg e
Procedur
Regular No No No Surgical No
Angiogra
m /
Angiogra CT notes,
graft
operative
and
report
notes ;
e barcode
Detailed
summary e
Procedur No No No Surgical No
m // MRI
Clinical
Angiogra
m CT Discharg
notes, Regular
Angiogra
and of graft
operative
; barcode
Detailed
summary e
reports
notes
m // MRI
Clinical e Procedur No No No Surgical No
Angiogra
m
Angiogra
and CT Discharg used.
notes,
of
; graft
operative
barcode
Detailed
Regular
reports
notes
m // MRI
Clinical summary Procedur
e e No No No Surgical No
Angiogra
m
Angiogra
and CT Discharg used.
notes,
of
; graft
operative
barcode
Detailed
Regular
reports
notes
m
Clinical// MRI summary
e
Discharg e
Procedur
Regular No No No Surgical No
Angiogra
m
Angiogra CT used.
notes,
of graft
operative
and
reports
notes ;
e barcode
Detailed
summary e
Procedur No No No Surgical No
m
Clinical
Angiogra
m // MRI CT Discharg
used.
notes, Regular
Angiogra
and of graft
operative
; barcode
Detailed
summary e
reports
notes
m
Clinical // MRI e Procedur No No No Surgical No
Angiogra
m
Angiogra
and CT Discharg used.
notes,
of
; graft
operative
barcode
Detailed
Regular
reports
notes
m
Clinical // MRI summary Procedur
e e No No No Surgical No
Angiogra
m
Angiogra
and CT Discharg used.
notes,
of
; graft
operative
barcode
Detailed
Regular
reports
notes
m
Clinical // MRI summary
e
Discharg e
Procedur
Regular No No No Surgical No
Angiogra
m
Angiogra CT used.
notes,
of graft
operative
and
reports
notes ;
e barcode
Detailed
summary e
Procedur No No No Surgical No
m
Clinical
Angiogra
m // MRI CT Discharg
used.
notes, Regular
Angiogra
and of graft
operative
; barcode
Detailed
summary e
reports
notes
m
Clinical // MRI e Procedur No No No Surgical No
Angiogra
m
Angiogra
and CT Discharg used.
notes,
of
; graft
operative
barcode
Detailed
Regular
reports
notes
m
Clinical // MRI summary Procedur
e e No No No Surgical No
Angiogra
m
Angiogra
and CT Discharg used.
notes,
of
; graft
operative
barcode
Detailed
Regular
reports
notes
m
Clinical // MRI summary
e
Discharg e
Procedur
Regular No No No Surgical No
Angiogra
m
Angiogra CT used.
notes,
of graft
operative
; barcode
and
reports
notes
m
Soon
Clinical
Angiogra
m // MRI CTas Detailed summary
e
Discharg
used.
notes,
e
Procedur
Regular No No No Surgical No
Angiogra
and of graft
operative
; barcode
Detailed
summary e
reports
documen
notes
m
Clinical // MRI e Procedur No No No Surgical No
Angiogra
m
Angiogra
ts
and are CT Discharg used.
notes,
of
; graft
operative
barcode
Regular
reports
notes
m // MRI summary Procedur
e e No No No Surgical No
Angiogra
m
uploaded
Angiogra
and CT Discharg used.
notes,
of
; graft
Detailed
barcode
Regular
reports
m
Clinical // MRI summary
e
Discharg e
Procedur
Regular No No No Surgical No
,Angiogra
Clinical
mconfirm
Angiogra CT discharg used.
of
; graft
Detailed
barcode
reports
notes
m
notes
evidence // MRI summary
e
Detailed
e e
Procedur
Regular No No No Surgical No
Angiogra
m CT used.
discharg
of graft
with
reports
and
of CT Operatio ; barcode
summary
summary e
Procedur No No No Surgical No
m / MRI
Angiogra e
used. Regular
planned
Chest
embolus/ of
;
n
and graft
barcode
notes, e
reports
m / MRI Detailed
summary Procedur
Regular No No No Surgical No
line
establishi
Thrombu of used.
of graft
detailed
operative
Clinical
reports Operatio
and e
Procedur No No No Surgical No
treatmen
ng
s inthe used.
discharg
notes Regular
notes n notes,
operative e
t,
aetiology
duples e Procedur No No No Surgical No
and CT Discharg notes
Doppler
for
USG/ which e summary e
Chest
surgery
Angio .
summary
is done
 Detailed
Clinical Detailed
Operatio
Detailed
HPE of Regular
Clinical Operativ
notes n
Operatio
Detailed
resected
notes,
Procedur No No No Surgical No
and CT e Discharg notes, Regular
notes
Clinical
Clinical n
Operatio
tissue notes, e
Clinical
Chest Detailed
e Procedur
Regular No No No Surgical No
and
notes
notes CT Discharg
n
detailed notes,
notes discharg
summary e
Procedur
Regular No No No Surgical No
Chest
and
and CT e
Pre- Detailed
Discharg
Detailed
operation
and e
summary
discharg e
Procedur No No No Surgical No
Chest
Op X-ray e
operative
notes,
Detailed Regular
Radiologi
Clinical e summary
Post op e
/notesCT summary
notes
discharg Procedur
Regular No No No Surgical No
cal
Clinical ,
ECHO
Detailed
Post
summary op ,
Scan and e
Procedur No No No Surgical No
evidence
Cl
and
notes
Clinical CT e
notes Detailed
Photogra
procedur
ECHO
,
Post
Detailed op , Regular
ECHO
of foreign
detailing discharg
/ summary
procedur
ph
e of
notes. e
Procedur No No No Surgical No
Chest
and
notes
Clinical
Doppler CT Detailed
Detailed
ECHO
Operatio
.
,
e notes, , Regular
body
need Remove
of Detailed
procedur e
Procedur
Regular No No No Surgical No
Chest
and
Clinical
notes
Report, Operatio
Detailed
n
summary
Detailed
detailed notes,
Clinical
ICD;
Chest d
X-/ discharg
e notes, e No No No Surgical No
ECHO
notes
Clinical
and
Detailed Detailed
n
procedur
Discharg
Operativ
discharg notes, Procedur
Regular
notes
ray
XRAY, chest Foreign
e
detailed
Doppler
and
notes
ECHO
Operativ
Clinical
and / discharg
HPE
e
e
body
e
summary
discharg notes, Adde- On
of Procedur
notes, No No No Surgical No
CT
report,
ECHO e
SOL
detailed
summary
and
Doppler
e
notes
ECHO notes/ barcode
Clinical
Chest ,summary
e
summary
discharg Adde- On
Procedur No Yes No Surgical No
Detailed
report
ECHO
report,
indicatin ,
of HPE
and
Doppler
notes
Clinical
Operativ
and
,.,e
Detailed
summary
report of Adde- On
Procedur No Yes No Surgical No
Detailed
g
ECHO need
report, Implant,
Barcode
with
notes
e Operativ
,tumor.
notes Detailed
Clinical
doppler
Operativ
for
and summary
if used. Adde- On
Procedur No Yes No Surgical No
Detailed
planned of
Procedur
e notes, Procedur
Barcode
with
indicatin
notes
reports,
e notes
Reoperat
doppler
Operativ
line of
Operativ
,Ascertain
implant,
e / Adde- On No Yes No Surgical No
planned barcode
of
Procedur
e notes,
Barcode
g
with need
Detailed
indicatin
ion
reports,
e
line notes
treatmen of ifthe
used.
Operativ
of
implant,
e / Adde- On
need Procedur No Yes No Surgical No
for
planned
Operativ barcode
of
Procedur
g
tline need Ascertain
Detailed
indicatin
treatmen
Reoperatof
for
ife Notes,
valves/ri
used.
Operativ
of
implant,
e / Adde- On
Procedur No Yes No Surgical No
e
for notes
need reoperati
Operativ
g
t(includin
ion
treatmen
indicatin
Reoperat
the
Detailed
ngs
Ascertain
e Notes,
ifvalves/ri
used.
Operativ Adde- On
need Procedur Yes No No Surgical No
e
for
g notes on.
for
Discharg
need the
t(includin
g
ion
indicatin
Reoperat
used.
Detailed
ngs
Ascertain
e Notes, Adde- On
need Procedur No No No Surgical No
indicatio
g reoperati
e
Ascertain
for
Discharg
used.
the need Procedure
(includin
for
g
ionneed Detailed No Yes No Surgical No
n for
indicatio on.
Summar
the
e need
reoperati
Ascertain
for
g
Reoperat
for Discharg e
need
n for of yfor
indicatio on.
Summar
the need
reoperati
e
ion
Reoperat
required
n
ionfor of reoperati
need yfor
on.
Summar
Procedur
need of on.
required reoperati
y
e )
Procedur
required on.
e )
Procedur
e)
 AB PM - AB PM - ICHI
Specialt Procedu Package Laceratio Multiple Procedu Laceratio
Specialt JAY JAY Procedu
Emergen y Code re Code Code
nPackage
- Procedu re Code Emergen
Emergen
n - Package
cy y
Room HBP 2.0 HBP 1.0 HBP 2.0 Cardiopu
Emergen Procedu
cy
cy with
with re / ICD
ER New PackageER001 Suturing res
No HBP 2.0
ER001A Suturing XXX Price
2,000
Package
cy Room Name
lmonary re Name Code
unstable
stable
Emergen ER M700001 ER002 Cardiopu
/Fracture Yes ER002A /Fracture XXX 2,000
s
Package Animal
emergen cardiopul
Animal
cardiopul
cy Room
Emergen lmonary
Dressing Dressing
s ER New PackageER002 -bites
cy Yes ER002B -monary
bites
monary XXX 10,000
Package
cy Room
Emergen emergen
Conserv Conserv
ER M700004 ER003 Emergen
(Excludin No status
ER003A Emergen
(Excludin
status XXX 1,700
s
Package
cy Room cy
ative ative
Emergen ER New PackageSB001 cy
g Snake No SB001A with
cy
g Snake XXX 2,000
s
Package
cy Room Manage
manage Manage
resuccita
manage
ER S700157 SU073 Bite) No SU073A Bite) XXX 2,000
s
Package ment
ment -of ment
ment -of
tion
s Without
Hematuri Without
Hematuri
plaster
a plaster
a
 Can
No. of
Implants more
Stratific Reserva Reserva
Stratific / High than one Auto
ation Special tion tion
ation End type of Level of Approve
criteria Conditio Public Tertiary LOS
Criteria Consum implant Care d
No which
0.00 No No ns (Y/N)
No Hospital
No Hospital
No Secondary NA Yes
(Y/N) ables be (Y/N)
No can be
0.00 No No No s (Y/N)
No s (Y/N)
No Secondary NA Yes
(Y/N) booked
booked
No 0.00 No (Y/N)
No No No No Tertiary NA Yes
No 0.00 No No Yes No No Secondary NA Yes
No 0.00 No No No No No Secondary 100% No
Yes 1.00 No No No No No Tertiary 200% No
 Clinical
Clinical notes Beneficia /
notes Mandato
discharg Reserve
Mandato ry Clinical Enhance
withry e
signaturery Special Special d
notes / ment Medical Day
Docume Conditio Conditio Procedu
Docume Clinical
planned
Clinical summary
/Procedur
thumb
discharg Procedu applicab or Care
nts /- n – Pop ns – re
line
nts of
notes
Clinical- Pre notes
with
impessio
e
e / Regular
re Label le Surgical Procedu
Claim
discharg – Up
No Rule
No No Medical (Insuran
treatmen
with
Authoriz
notes
Clinical
Classific
planned
n;
Operatio
summary
Procedur
Regular Or not (S/M) re No(Y/N)
twithwith
planned e Processi
line
Evidence
invoice of / e
Procedur (Y/N)
No (Y/N)
No No Medical No ce/Trust
ation
notes
ation of n with notes, Regular (Y/N)
pre-
line of summary
treatmen
of
bar ng
code e )
planned
detailing
bites Post
with planned Procedur No No No Medical No
clinical
treatmen
line of
with & postof Regular
tprocedur
investiga
sticker e
the
pre-
photogra line
planned
clinicalof Procedur
Regular No Yes No Medical No
t, ECG tions
ttreatmen
hematuri
clinical
the
e X-ray e
ph treatmen
line
photograofwith Procedur No No No Medical Yes
t,
a ECG done
including
with
photogra
vaccine,
films
ttreatmen
Regular
e
planned ph
Clinical
reports, Procedur No No No Surgical No
urine
ph
line of t given;
Notes
Detailed e
report
treatmen detailed
with
showing Discharg
t, discharg
complete
frank or e
X-ray
films with e
microsco treatmen
Summar
reports summary
pic? ty details
given
 Excision
of AB PM -
Pinna AB PM - ICHI
Specialt Procedu Package Excision Multiple Procedu
Specialt for JAY
Pinna Procedu re Code JAY Procedu
y Code re Code Code of Excision Package
y Package
Growths
Palatecto
for Procedu
Soft re / ICD
ENT HBP 2.0 HBP 1.0 HBP 2.0 of
SL New PackageSC002 / InjuriesPinna res
Yes HBP 2.0
SC002A re Name Code XXX Price
20,000
my Name
Growths
Palatecto palate
Hard
ENT for
SL New PackageSC002 -/ Injuries Yes SC002B XXX 20,000
my Total
Growths Growth
palate -
ENT SL New PackageSC064 Amputati
/- Injuries
Total Yes SC064A Squamo XXX 21,600
on & Growth
us -
ENT SL New PackageSC064 Amputati
- Total Yes SC064B XXX 21,600
Excision
Radical Basal
Radical
ENT on
SL New PackageSC064 Amputati & Yes SC064C Injury XXX 21,600
Surgical
of
Neck Surgical
Neck
ENT SL S100114 SG067 Excision
on
removal
External
& No SG067A removal XXX 21,200
Dissectio
of
Excision Dissectio
ENT SL S100014 SG068 of Auditory
n
External No SG068A of
Hemi
n XXX 15,000
of
Thyroide
Branchial Total
Branchial
ENT SL Meatus
S100168 SG070 Auditory
External Yes SG070A thyroidec
Total XXX 17,000
ctomy
Thyroide
Cyst Thyroide
Cyst
ENT SL Meatus
S100169 SG070 Auditory Yes tomy
SG070B ctomy
thyroidec XXX 20,000
ctomy
Thyroide
ENT SL S100242 SG070 Meatus
Foreign Yes SG070C tomy
with
Foreign XXX 28,000
Pinna
ctomy
ENT SL S100058 SG098 Body No Pinna
Block
SG098A Body XXX 5,000
surgery
Pinna
Removal surgery
Dissectio
Pinna
Removal
ENT SL S200020 SL001 forsurgery Yes SL001A XXX 8,600
for
n
surgery
ENT SL S200020 SL001 fortumour / Yes SL001B tumour XXX 8,600
Tympano
trauma for
Tympano
ENT SL S200017 SL002 Stapede
tumour / No SL002A trauma XXX 12,900
plasty
ctomy
trauma/ plasty
Stapede
ENT SL S200025 SL003 Stapede Yes SL003A XXX 13,000
tympanot
ctomy / ctomy
Tympano
ENT SL S200016 SL003 omy Yes SL003B XXX 13,000
tympanot
Mastoide tomy
ENT SL S200003 SL004 omyMyringot Yes SL004A Simple XXX 28,000
ctomy
Mastoide
ENT SL S200004 SL004 omy Yes SL004B Radical XXX 28,000
ctomywith
Myringot Unilatera
ENT SL S200009 SL005 or omy with Yes SL005A XXX 5,000
l
ENT SL S200008 SL005 or without Yes SL005B Bilateral XXX 5,000
Endosco
Grommet
Epistaxis
without Endosco
Epistaxis
ENT SL S200051 SL006 No SL006A XXX 19,300
pic
treatmen
Grommet DCR pic DCR
treatmen
ENT SL New PackageSL007 Function No SL007A Function XXX -
tal- septo tal- septo
ENT SL S200055 SL008 packing No SL008A packing XXX 21,800
rhinoplas
Septopla
Fracture rhinoplas
Septopla
Fracture
ENT SL S200047 SL009 Inferior
ty No SL009A Inferior
ty XXX 12,000
sty
- setting sty
- setting
ENT SL S200037 SL010 turbinate No SL010A turbinate XXX 8,000
nasal nasal
ENT SL S200043 SL011 reduction
Open
bone
Function No SL011A reduction
Open
bone
Function XXX 7,825
Ant.
under under
ENT SL S200040 SL012 sinus
al
Ethmoid No SL012A sinus
al
Ant. XXX 15,000
Ant.
GA
surgery GA
surgery
ENT SL S200038 SL013 Endosco
al /
Ethmoid No SL013A Ant.
Endosco
Ethmoid XXX 11,000
Ant.
pic Sinus Ethmoid
pic Sinus
ENT SL S200028 SL014 sphenop
al /
Ethmoid Yes SL014A al artery
Sphenop XXX 15,000
Ant. al artery-
ENT SL S200028 SL014 (FESS)
alatine
sphenop
al /
Ethmoid Yes SL014B (FESS)
ligation
Sphenop
alatine XXX 15,000
artery ligation
Open
alatine -
ENT SL alatine
S200028 SL014 sphenop
al / Yes SL014C artery XXX 15,000
ligation Endosco
artery
ENT SL artery
alatine
S200028 SL014 sphenop Yes ligation
SL014D pic - XXX 15,000
ligation
Adenoid
artery ligation
Adenoid
Open -
ENT SL S200057 SL015 alatine No SL015A Tonsillec XXX 5,675
ectomy
ligation
Peritonsil
Tonsillec Endosco
ectomy
ENT SL S200074 SL016 artery
lar Yes SL016A tomy
pic -
Tonsillec XXX 9,125
tomy
ligation
Peritonsil
Tonsillec Peritonsil
ENT SL S200074 SL016 lar abscess Yes U/L
SL016B tomy - XXX 9,125
tomy
Thyroglo lar
ENT SL S200069 SL017 abscess
drainage Yes B/L
SL017A Intraoral XXX 5,800
ssal
Thyroglo/ abscess
ENT SL / intraoral
S200069 SL017 Branchial
drainage Yes SL017B Thyroglo
calculus XXX 5,800
ssal
Thyroglo/ drainage
ENT SL S200073 SL018 calculus
/Branchial
intraoral
cyst
ssal / / Yes SL018A Thyroglo
removal
ssal cyst XXX 15,300
removal
Thyroglo ssal
ENT SL S200073 SL018 calculus
sinus
cyst //
Excision
Branchial
ssal
/ Yes SL018B Thyroglo
excision XXX 15,300
removal
Thyroglo
fistula sinus
Excision
ssal
ENT SL sinus
of
S200073 SL018 Branchial
cyst / Yes SL018C Branchial XXX 15,300
ssal //
excision
fistula
tumour
excision
of
fistula
ENT SL sinus
S200079 SL018 Branchial
cyst / / Yes SL018D tumour
sinus
Branchial XXX 15,300
excision
of oral/ excision
ENT SL fistula
S200079 SL018 Uvulopal
sinus
cyst / Yes SL018E Uvulopal
excision
of oral
fistula XXX 15,300
cavity
excision
atophary
fistula / atophary
ENT SL sinus
S200077 SL019 paranasa / No SL019A cavity
excision / XXX 18,600
ngoplast
excision
fistula ngoplast
paranasa
ENT SL New PackageSL020 lysinus (UPPP) / Yes SL020A y (UPPP) XXX 10,000
excision l sinus /
laryngop
laryngop
harynx
harynx
with or
without
without
reconstru
reconstru
 of
Excision Excision
tumour
tumour
of of
of oral
of oral
tumour tumour
cavity /
cavity
of oral / of oral
paranasa
paranasa
cavity / cavity
l sinus//
ENT SL New PackageSL020 lparanasa sinus / Yes SL020B paranasa XXX 36,500
laryngop
ENT SL New PackageSL020 laryngop
l sinus / Yes SL020C lharynx
Totalsinus / XXX 25,000
Parotide
harynx
laryngop
Removal Superfici
laryngop
Removal
ENT SL S200075 SL021 Yes SL021A Parotide
with XXX 28,200
ctomy
with
Parotide
harynx
of or al
harynx
of
ENT SL S200076 SL021 Rigid
Removal Yes SL021B ctomy
pedicled XXX 23,800
without
ctomy
with
Subman or Parotide
with
Subman free
ENT SL S200089 SL022 laryngos
of
Rigid
Removal Yes SL022A flap
Removal XXX 9,000
reconstru
without
dibular Removal
ctomy
flap
dibular
copy
Subman
laryngos
of / reconstru
of
ENT SL S200089 SL022 Rigid
ction
reconstru
Salivary Yes SL022B Rigid
of
reconstru
Salivary XXX 9,000
bronchos
dibular
copy
Subman / ction
Subman
ENT SL S100133 SL022 laryngos
ction
gland Yes SL022C laryngos
Ranula
ction
Rigid
gland XXX 9,000
copy
Salivary
bronchos
dibular
copy // dibular
Rigid
copy -
bronchos
ENT SL New PackageSL023 oesopha
gland
copy
Salivary
bronchos / Yes SL023A Lymph
oesopha XXX 7,000
Diagnosti
copy -
ENT SL New PackageSL023 goscopy
Microlary
oesopha
gland
copy / Yes SL023B Microlary
node
goscopy XXX 7,000
Open c + /
Diagnosti
Open -
ENT SL New PackageSL023 -ngeal
goscopy
oesopha Yes SL023C ngeal
-c XXX 7,000
laryngeal biopsy
+/-
laryngeal
Diagnosti
surgery
-goscopy surgery
Diagnosti
ENT SL S200058 SL024 framewor
cwith No SL024A biopsy
framewor XXX 17,100
ENT SL New PackageSL025 -k +
Diagnosti
Tracheos
/ or
-
surgery No SL025A
with
c
k + / or
-
surgery XXX 5,000
biopsy
without
ctomy
Diagnosti + / -/ without
biopsy
Tracheos
/laser Tracheos
/laser
ENT SL S1500021 SL026 biopsy
ctomy + / -/ Yes SL026A Selective XXX 6,000
Tracheot
Thyropla tomy
Tracheot
Thyropla
ENT SL New PackageSL026 biopsy
Neck
omy Yes SL026B Compreh
Benign XXX 6,000
Tracheot
sty omy
sty
ensive
ENT SL S200067 SL027 dissectio
Neck
omy Yes SL027A Selective
neck XXX 18,800
Deep
n Compreh
Benign
Pharyng
tumour
ENT SL S200067 SL027 dissectio
Neck Yes SL027B ensive XXX 18,800
neck
Deep neck
eal
excision
ENT SL S200067 SL027 n
dissectio
Neck Yes SL027C Pharyng XXX 18,800
abscess
neck tumour
diverticul
ENT SL S200067 SL027 n
dissectio Yes SL027D Deep
eal
excision XXX 18,800
drainage/
abscess um
Post
n neck
diverticul
ENT SL S200068 SL028 Post
drainage/ Yes SL028A excision
trauma
Endosco XXX 16,800
Anterior abscess
um
ENT SL New PackageSL028 trauma
Post Yes SL028B neck
pic CSF XXX 16,800
skull drainage
excision
ENT SL S800073 SL029 neck
Anterior
trauma Yes SL029A Optic
explorati
Rhinorrh XXX 26,000
base
explorati
skull
neck
Anterior nerve
on
ENT SL S200032 SL029 Yes SL029B ea
Orbital XXX 25,500
surgery
on
base
explorati
skull decompr
ENT SL S200032 SL029 Anterior Yes SL029C Repair
decompr XXX 25,500
surgery
on
base Craniofa
ession
skull
Anterior
Advance ession
ENT SL S200050 SL029 surgery Yes SL029D cial XXX 25,500
base
skull
d Maxillary
Endosco
ENT SL New PackageSL029 Advance Yes SL029E resection XXX 25,500
surgery
base
anterior swing
pic
ENT SL S200052 SL030 d Yes SL030A XXX 39,800
surgery
Lateral
skull Clival
Hypophy
anterior Post-
ENT SL New PackageSL030 skull
base
Lateral Yes SL030B tumour
Subtotal
sectomy XXX 39,800
skull traumatic
ENT SL S200050 SL031 base
surgery
skull Yes SL031A excision
petrosect XXX 24,700
base
Lateral facial
ENT SL S200050 SL031 procedur
base
surgery
skull Yes SL031B omy
CSF XXX 24,700
Advance
es nerve
ENT SL S200050 SL031 procedur
base
d lateral Yes SL031C Otorrhoe XXX 24,700
Advance
Closed decompr
Fisch
ENT SL S200002 SL032 es
procedur
skull Yes SL032A a repair XXX 39,900
d
reduction
Advance lateral ession
Translab
approach
Closed
es
base
ENT SL S200002 SL032 skull
/Advance
d
reduction lateral Yes SL032B yrinthine
Transcoc XXX 39,900
Closed
surgery
base approach
ENT SL S200002 SL032 intermaxi
skull
/d
reduction lateral Yes SL032C Closed
hlear
Tempora XXX 39,900
Closed
surgery
llary
base reduction
approach
ENT SL S200002 SL032 intermaxi
skull
/reduction Yes SL032D Closed
lClosed
Bone XXX 39,900
fixation
surgery
llary
base
intermaxi for
reduction
resection
Closed
ENT SL S200036 SL033 /for Yes SL033A reduction XXX 9,625
fixation
surgery
Open
llary fracture
for
reduction
ENT SL S200036 SL033 intermaxi
fracture Yes SL033B and
of XXX 9,200
for
reduction
fixation
Open
llary fracture
Open
for
Intermaxi
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fracture
and Yes SL033C maxilla
of
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for
reduction
fixation
Open fracture
Open
llary
ENT SL S200036 SL033 maxilla
of
internal
fracture / Yes SL033D mandible
and
of XXX 9,200
and
for
reduction
mandible reduction
fixation
Open
ENT SL S200036 SL034 maxilla
fixation
of
internal
fracture / Yes SL034A internal
zygoma
and
for XXX 14,000
and
/of
Clinic
mandiblezygoma reduction
ENT SL S200036 SL034 maxilla
fixation
of
internal / Yes SL034B fixation
internal
fracture
and XXX 14,000
based
/of
Clinic
maxillazygoma
mandible // of
ENT SL S200036 SL034 maxilla
fixation
therapeu Yes SL034C fixation
of
internal
Turbinat XXX 14,000
based
mandible
/ofzygoma
Clinic
maxilla
mandible / maxilla
of
mandible
ENT SL New PackageSL035 tic
therapeu Yes SL035A fixation
e XXX 1,200
//Clinic
zygoma
based
mandible
zygoma
maxilla / mandible
of
ENT SL New PackageSL035 interventi
tic
therapeu Yes SL035B reduction
Biopsy
Intratymp XXX 1,200
/based
onszygoma
mandible
of zygoma
ENT SL New PackageSL035 interventi
tic Yes SL035C Wide
anic XXX 1,200
therapeu
/ENT
zygoma
ons bore
ENT SL New PackageSL035 tic of
interventi Yes SL035D injections XXX 1,200
ENT
ons of aspiratio
interventi
ENT n
ons of
ENT
 Neurecto
Neurecto my -
ENT
Otorhinol SL S800049 SN035 Caldwell Yes SN035B Caldwell XXX 16,500
my
- luc- Trigemin
- luc-
aryngolo
Otorhinol SL New Package
SL036KL Decompr No SL036KLADecompr
al XXX 5,025
Unilatera Unilatera
gy
aryngolo
Otorhinol SL New Package
SL037KL ession
Preauric No SL037KLAession
Preauric XXX 11,350
l l
gy
aryngolo
Otorhinol SL SL038KL sac
New Package ular
Repair of No SL038KLAsac
ular
Repair of XXX 5,600
gy
aryngolo
Otorhinol SL SL039KL sinus
New Package Parotid No SL039KLAsinus
Parotid XXX 8,250
Styloidec Styloidec
gy
aryngolo
Otorhinol SL SL040KL Trans
New Package Duct No SL040KLATrans
Duct XXX 8,975
tomy
Antral tomy
Antral
gy
aryngolo SL New Package
SL041KL No SL041KLA XXX 6,750
Ethmoid Ethmoid
gy
ectomy ectomy
 Can
No. of
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Stratific / High than one Auto
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No No Yes No Tertiary 200% Yes
No 0.00 No No No Yes No Tertiary 200% Yes
No 0.00 No No No Yes No Tertiary 200% Yes
No 0.00 No No No No No Tertiary 600% Yes
No 0.00 No No No No No Secondary 200% Yes
No 0.00 No No No No No Secondary 200% Yes
No 0.00 No No No No No Secondary 400% Yes
No 0.00 No No No No No Tertiary 500% Yes
Yes 1.00 No No No No No Secondary 100% Yes
No 0.00 No No No No No Tertiary 100% Yes
No 0.00 No No No No No Secondary 100% Yes
No 0.00 Yes No No No No Secondary 200% Yes
No 0.00 Yes No No No No Secondary 200% Yes
No 0.00 Yes No No No No Secondary 200% Yes
No 0.00 No No No No No Secondary 200% Yes
No 0.00 No No No No No Secondary 200% Yes
Yes 1.00 No No No No No Secondary 100% Yes
Yes 1.00 No No No No No Secondary 100% Yes
No 0.00 No No No No No Secondary 100% Yes
Yes 1.00 No No No No No Secondary NA No
No 0.00 No No No No No Secondary 200% Yes
Yes 1.00 No No No No No Secondary 100% Yes
Yes 1.00 No No No No No Secondary 200% Yes
No 0.00 No No No No No Secondary 100% Yes
No 0.00 No No No No No Secondary 200% Yes
No 0.00 No No No No No Secondary 200% Yes
No 0.00 No No No No No Secondary 200% Yes
No 0.00 No No No No No Secondary 200% Yes
No 0.00 No No No No No Secondary 200% No
No 0.00 No No No No No Secondary 200% No
No 0.00 No No No No No Secondary 100% Yes
No 0.00 No No No No No Secondary 200% Yes
No 0.00 No No No No No Secondary 200% Yes
No 0.00 No No No No No Secondary 100% Yes
No 0.00 No No No No No Secondary 100% No
No 0.00 No No No No No Secondary 200% Yes
No 0.00 No No No No No Secondary 200% No
No 0.00 No No No No No Secondary 200% Yes
No 0.00 No No No No No Secondary 200% Yes
No 0.00 No No No No No Secondary 200% Yes
No 0.00 No No No No No Secondary 200% Yes
No 0.00 Yes No No No No Tertiary 500% No
No 0.00 No No No No No Tertiary 600% No
No 0.00 Yes No No No No Tertiary 700% No
No 0.00 No No No No No Secondary 300% Yes
No 0.00 No No No No No Secondary 300% Yes
Yes 1.00 No No No No Yes Secondary 200% Yes
Yes 1.00 No No No No Yes Secondary 200% Yes
Yes 1.00 No No No No Yes Tertiary 200% Yes
Yes 1.00 No No No No No Secondary 100% No
Yes 1.00 No No No No No Secondary 100% No
Yes 1.00 No No No No No Secondary 100% No
No 0.00 No No No No No Secondary 200% Yes
No 0.00 Yes No No No No Secondary 100% No
Yes 1.00 No No No No No Secondary 0% No
Yes 1.00 No No No No No Secondary 0% No
No 0.00 No No No No No Tertiary 300% No
No 0.00 No No No No No Tertiary 300% No
No 0.00 No No No No No Tertiary 300% Yes
No 0.00 No No No No No Tertiary 300% Yes
No 0.00 No No No No No Secondary 200% Yes
No 0.00 No No No No No Tertiary 200% No
No 0.00 Yes No No No No Tertiary 600% Yes
No 0.00 Yes No No No No Tertiary 600% No
No 0.00 Yes No No No No Tertiary 600% No
No 0.00 Yes No No No No Tertiary 600% Yes
No 0.00 Yes No No No No Tertiary 600% No
No 0.00 Yes No No No No Tertiary 700% Yes
No 0.00 Yes No No No No Tertiary 700% No
No 0.00 Yes No No No No Tertiary 600% No
No 0.00 Yes No No No No Tertiary 600% No
No 0.00 Yes No No No No Tertiary 600% No
No 0.00 Yes No No No No Tertiary 700% No
No 0.00 Yes No No No No Tertiary 700% No
No 0.00 Yes No No No No Tertiary 700% No
No 0.00 Yes No No No No Tertiary 700% Yes
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No 0.00 No No No No No Secondary 100% No
No 0.00 No No No No No Secondary 100% No
No 0.00 No No No No No Secondary 100% No
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No 0.00 No No No No No Secondary NA No
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No 0.00 No No No No No Secondary NA No
No 0.00 No No No No No Secondary NA No
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No 0.00 No No No No No Secondary 100% Yes
No 0.00 No No No No No Secondary 200% Yes
No 0.00 No No No No No Secondary 100% Yes
No 0.00 No No No No No Secondary 100% Yes
Yes 1.00 No No No No No Secondary 100% Yes
No 0.00 No No No No No Secondary 100% Yes
 Procedur
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Study) Photogra
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Operativ
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tive y
Summar
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y
 AB PM -
Specialt Procedu Package Multiple Procedu
Specialt JAY
y Code re Code Code Acute Procedu re Code
y
General Package
HBP
MG2.0 M100011
HBP 1.0 HBP 2.0 febrile
MG001 res
No HBP 2.0
MG001A
Medicine
General Name
Severe
MG M100055 MG002 illness Yes MG002A
Medicine
General sepsis
Severe
MG M100055 MG002 Yes MG002B
Medicine
General sepsis
MG M100014 MG003 Malaria Yes MG003A
Medicine
General
MG M100051 MG003 Malaria Yes MG003B
Medicine
General Dengue
MG M100015 MG004 Yes MG004A
Medicine
General fever
Dengue
MG M100050 MG004 Yes MG004B
Medicine
General fever
Dengue
MG M100050 MG004 Chikung Yes MG004C
Medicine
General fever
MG M100016 MG005 unya No MG005A
Medicine
General Enteric
MG M100018 MG006 fever HIV No MG006A
Medicine
General feverwith
MG M100039 MG007 complica
Acute No MG007A
Medicine
General Leptospir
MG M100017 MG008 Acute tions
gastroent No MG008A
Medicine
General osis
MG M100001 MG009 gastroent
eritis with Yes MG009A
Medicine
General
MG M100048 MG009 eritisdehydrati
with Yes MG009B
Medicine
General Diarrohe
on
MG M100036 MG010 dehydrati Yes MG010A
Medicine
General a
Diarrohe
on
MG M100036 MG010 Yes MG010B
Medicine
General a
Dysenter
MG M100003 MG011 Acute No MG011A
Medicine
General y
MG M100022 MG012 viral No MG012A
Medicine
General hepatitis
MG M100022 MG013 Chronic He No MG013A
Medicine
General Liver
MG M100021 MG014 Visceral No MG014A
Medicine
General abscess
MG M100038 MG015 leishman No MG015A
Medicine
General Pneumo
MG M100019 MG016 iasis Severe No MG016A
Medicine
General nia
MG M100047 MG017 pneumon No MG017A
Medicine
General Empyem
ia
MG M200043 MG018 Pericardi No MG018A
Medicine
General a
Lung
MG M100033 MG019 al /
Pericardi No MG019A
Medicine
General abscess
MG M100027 MG020 Pleural
al / Yes MG020A
Medicine
General
MG M100027 MG020 tuberculo
Pleural
Urinary Yes MG020B
Medicine
General sis
MG M100013 MG021 Viral tuberculo
Tract No MG021A
Medicine
General sis
Infection
MG M100035 MG022 encephal No MG022A
Medicine
General itis
MG New PackageMG023 Recurren
Septic Arth No MG023A
Medicine
General
MG New PackageMG024 tSkin and s No MG024A
Medicine
General vomiting
MG M100002 MG025 Pyrexia No MG025A
Medicine
General with
of
MG M100026 MG026 dehydrati No MG026A
Medicine
General unknown
MG New PackageMG027 on Bronchiect
Acute
origin No MG027A
Medicine
General Acute
MG M100005 MG028 Acute bronchiti No MG028A
Medicine
General excabera
excabera
MG M100012 MG029 s No MG029A
Medicine
General tion
tion ofof
MG M100020 MG030 COPD No MG030A
Medicine
General Interstitia
Endocar
MG M100031 MG031 l Lung Yes MG031A
Medicine
General ditis
Endocar
MG M100031 MG031 Disease Yes MG031B
Medicine
General ditis
Vasculiti
MG M100029 MG032 No MG032A
Medicine
General sPancreat
MG M100037 MG033 Yes MG033A
Medicine
General itis
Pancreat
MG M100037 MG033 Yes MG033B
Medicine
General itis
MG New PackageMG034 Ascites
Acute No MG034A
Medicine
General
MG M100060 MG035 transvers No MG035A
Medicine
e myelitis
General
MG New PackageMG036 Atrial Fibri No MG036A
Medicine
General
MG New PackageMG037 Cardiac T
Congesti No MG037A
Medicine
General
MG M100008 MG038 ve heart No MG038A
Medicine
General
MG M100045 MG039 failure
Asthma Yes MG039A
Medicine
General
MG M100066 MG039 Asthma
Respirat Yes MG039B
Medicine
General
MG M100044 MG040 ory
Respirat Yes MG040A
Medicine
General
MG M100044 MG040 failure
ory
Respirat Yes MG040B
Medicine
General
MG M100044 MG040 failure
ory Yes MG040C
Medicine
General Upper
MG M100056 MG041 failure GI Yes MG041A
Medicine
General bleeding
Upper GI
MG M100057 MG041 Lower GI Yes MG041B
Medicine
General bleeding
MG M100058 MG042 hemorrh No MG042A
Medicine
General
MG New PackageMG043 age
Addison’s No MG043A
Medicine
General Renal
MG M100004 MG044 AKI No MG044A
Medicine
General colic/
MG M100064 MG045 Renal No MG045A
Medicine
General
MG M100030 MG046 failure
Seizures
Status No MG046A
Medicine
General
MG M100065 MG047 Cerebral
epileptic
Cerebrov No MG047A
Medicine
General sino-
MG M100054 MG048 us
Cerebral
ascular No MG048A
Medicine
General venous
sino-
MG M100063 MG049 accident
Cerebral Yes MG049A
Medicine
General thrombos
venous
sino-
MG M100063 MG049 Cerebral
is / Yes MG049B
Medicine
General thrombos
venous
sino-
MG M100063 MG049 Stroke
is / Yes MG049C
Medicine
General thrombos
venous
Immune
MG M100063 MG049 Stroke
is / Yes MG049D
Medicine
General thrombos
mediated
MG M100059 MG050 Stroke
is / No MG050A
Medicine
General CNS
Hydroce
MG M100062 MG051 Stroke
disorders No MG051A
Medicine
General phalus
MG New PackageMG052 Myxedema No MG052A
Medicine
General
MG New PackageMG053 Thyrotoxic No MG053A
Medicine
General
MG New PackageMG054 Gout No MG054A
Medicine
General Pneumot
MG M100006 MG055 Neuromu No MG055A
Medicine
General hroax
MG M100040 MG056 scular No MG056A
Medicine
General
MG New PackageMG057 disorders
Hypoglyce No MG057A
Medicine
General
MG New PackageMG058 Diabetic F
Diabetic No MG058A
Medicine
General Electrolyt
MG M100010 MG059 ketoacid No MG059A
Medicine
General e
Electrolyt
MG New PackageMG060 osis Yes MG060A
Medicine
General Imbalanc
e
Electrolyt
MG New PackageMG060 e Yes MG060B
Medicine
General Imbalanc
e
Electrolyt
MG New PackageMG060 e
Hyperos Yes MG060C
Medicine
General Imbalanc
e
MG New PackageMG060 molar
e Yes MG060D
Medicine
General Imbalanc
Accelerat
MG M100053 MG061 Non-
e No MG061A
Medicine
General ed
Hyperten
MG M100007 MG062 Ketotic No MG062A
Medicine
General hyperten
sive
coma
MG M100049 MG063 sion No MG063A
Medicine
General emergen
Severe
MG M100009 MG064 Sickle
cies No MG064A
Medicine
General anemia
MG M100042 MG065 cell No MG065A
Medicine
General
MG New PackageMG066 Anemia
Anaphylax No MG066A
Medicine
General Heat
Systemat
MG M100052 MG067 No MG067A
Medicine
General stroke
ic lupus
Guillian
MG M100028 MG068 No MG068A
Medicine
General erythema
Barre
MG M100061 MG069 tosus No MG069A
Medicine
General Syndrom
Snake
MG M100023 MG070 e No MG070A
Medicine bite
General Poisonin
MG M100024 MG071 Haemodi Yes MG071A
Medicine
General g
Poisonin
MG M100043 MG071 alysis
Haemodi / Yes MG071B
Medicine
General g
MG M100070 MG072 Peritone
alysis
General / Yes MG072A
Medicine
General General
MG M100070 MG072 al
High
Peritone
Medicine end Yes MG072B
Medicine
General Medicine
Plasmap
MG M100069 MG073 Dialysis
radiologi
al
--High
Blood Acute
Neuro end No MG073A
Medicine
General heresis
cal
Dialysis
MG dissemin
M100068 MG074 muscular
transfusi
histopath Yes MG074A
Medicine Blood
diagnosti
General ated
on
MG M100068 MG074 weaknes
ology
transfusi
cEncephal Yes MG074B
Medicine
General
MG M100071 MG075 s(Biopsies
on
CRRTCV
(CT,
omyelitie
General
due to No MG075A
Medicine
General immune
)VHDF and
MG M100072 MG076 MRI, s,
Medicine
based No MG076A
Medicine
General advance
initiation
MG MG077KLImaging
New Package -General
Multiple
diseases
d No MG077KLA
Medicine
General cost
including
Medicine for
MG MG079KLSclerosis
New Package Meningiti
like
serology
disposab
nuclear No MG079KLA
Medicine
General ,Acute
-s Auto Acute
/
MG MG080KLAIDP,
New Package investiga
le
imaging)
meningo
Stroke
immune No MG080KLA
Medicine
General Acute
Encephal
Myasthe
MG MG081KLtions
New Package encephal
encephal
meningo
itis -and No MG081KLA
Medicine
General Acute
nia
MG MG082KLitis
New Package Febrile
ities,
encephal
Bacterial / No MG082KLA
Medicine meningo
CIDP
Acute
General seizures
aseptic
longitudi
itis
/meningo //
Fungal /
MG M200050 MP001 encephal with
Epileptic Yes MP001C
Medicine
General /aseptic
meningiti
nally
Viral other
MG M200010 MP002 encephal itis
without
Acute / No MP002A
Medicine
General sseizures
extensiv
meningiti
aseptic / febrile
MG M200090 MP003 encephal haemody
opathy
itis / Yes MP003A
Medicine Acute
e
sAcute
meningiti
namic / febrile
General aseptic
MG M200090 MP003 itis opathy
myelities,
encephal
scomprom / febrile/ Yes MP003B
Medicine
General meningiti
hyperten
MG M200078 MP004 opathy itis
Acute
itis
encephal
ise / No MP004A
Medicine
General ssive / febrile
MG M200048 MP005 opathy Transver
hyperten
syndrom
autonomi / Yes MP005A
Medicine encephal
encehalo
General se
sive
e
hyperten
c
MG M200027 MP005 opathy pathy // Yes MP005C
Medicine
General Myelitis,
encehalo
sive
disturban
MG M200058 MP005 metaboli hyperten Yes MP005E
Medicine Guillian
pathy
encehalo
ce /
General sive
cpathy
MG M200094 MP005 Barre metaboli / Yes MP005F
Medicine
General encehalo
Meningiti
MG M200049 MP006 encephal Syndrom
cpathy /
metaboli Yes MP006A
Medicine
General sopathy
Meningiti /
MG M200027 MP006 e cencephal
metaboli Yes MP006B
Medicine
General shepatic
opathy
Meningiti /
MG M200035 MP006 encephal cencephal
hepatic Yes MP006C
Medicine
General sopathy
Meningiti /
MG M200095 MP006 encephal opathy
encephal
hepatic / Yes MP006D
Medicine
General sopathy
Meningiti
Acute
Intracrani /
MG M200012 MP006 opathy brain
encephal / Yes MP006E
Medicine
General hepatic
sabscess
neuroreg
al
Optic ring
MG M200011 MP007 encephal Intracrani
brain
opathy / No MP007A
Medicine
General ression
space/
enhancin
neuritis
al
abscess
brain
opathy
Medicine
MG M200084 MP010 Acute g lesion/
occupyin
No MP010A
General abscess
brain
worsenin
MG M200050 MP011 with Cerebral
g lesion No MP011A
Medicine
General abscess
MG M200092 MP012 g in
complica
herniatio
Acute No MP012A
Medicine
General neuro
tion
MG M200053 MP013 n demyelin No MP013A
Medicine
General metaboli
(tubercul
MG M200079 MP014 Acute ating
cAcute
oma)and No MP014A
Medicine
General
MG M100063 MP017 ischemic myelopat
neurode
urticaria No MP017A
Medicine
General Acute /
MG M200007 MP020 hy stroke
generativ
Anaphyla
urticaria / Yes MP020A
Medicine
General e
MG M200007 MP020 xis acute
Anaphyla
Unexplai Yes MP020B
Medicine
General condition
Celiac
asthma
MG M200062 MP022 xis ned acute
sdisease No MP022A
Medicine
General asthma
Acute
MG M200064 MP023 Nephroti hepatosp No MP023A
Medicine
General glomerul
MG M200006 MP025 clenomeg Haemoly No MP025A
Medicine
General onephriti
syndrom
MG M200026 MP026 aly tic
se with No MP026A
Medicine
General
MG M200038 MP027 uremic Rheumat
peritoniti No MP027A
Medicine
General
MG M200047 MP038 Idiopathi syndrom
oid
s No MP038A
Medicine
General Rheumat
e
MG M200046 MP039 carthritis No MP039A
Medicine
General ic fever
Thrombo
MG M200039 MP042 No MP042A
Medicine cytopeni
c
Purpura
 Ketogeni
Steven
General cJohnson
diet
MG M200057 MP044 initiation No MP044A
Medicine
General syndrom
MG M200059 MP046 in
e No MP046A
Medicine
refractor
y
epilepsy
 No. of
Implants
Stratific
ICHI Stratific / High
ation
AB PM - JAY Procedu ation End
Package criteria
Procedure Name re / ICD Criteria Consum
Acute febrile illness XXX Price- Yes which
1.00 No
Code (Y/N) ables
Severe sepsis XXX - Yes can be
1.00 No
(Y/N)
booked
Septic shock XXX - Yes 1.00 No
Malaria XXX - Yes 1.00 No
Complicated malaria XXX - Yes 1.00 No
Dengue fever XXX - Yes 1.00 No
Dengue hemorrhagic fever XXX - Yes 1.00 No
Dengue shock syndrome XXX - Yes 1.00 No
Chikungunya fever XXX - Yes 1.00 No
Enteric fever XXX - Yes 1.00 No
HIV with complications XXX - Yes 1.00 No
Leptospirosis XXX - Yes 1.00 No
Acute gastroenteritis with moderate
XXX - Yes 1.00 No
dehydration
Acute gastroenteritis with severe dehydration XXX - Yes 1.00 No
Chronic diarrohea XXX - Yes 1.00 No
Persistent diarrohea XXX - Yes 1.00 No
Dysentery XXX - Yes 1.00 No
Acute viral hepatitis XXX - Yes 1.00 No
Chronic Hepatitis XXX - Yes 1.00 No
Liver abscess XXX - Yes 1.00 No
Visceral leishmaniasis XXX - Yes 1.00 No
Pneumonia XXX - Yes 1.00 No
Severe pneumonia XXX - Yes 1.00 No
Empyema XXX - Yes 1.00 No
Lung abscess XXX - Yes 1.00 No
Pericardial tuberculosis XXX - Yes 1.00 No
Pleural tuberculosis XXX - Yes 1.00 No
Urinary Tract Infection XXX - Yes 1.00 No
Viral encephalitis XXX - Yes 1.00 No
Septic Arthritis XXX - Yes 1.00 No
Skin and soft tissue infections XXX - Yes 1.00 No
Recurrent vomiting with dehydration XXX - Yes 1.00 No
Pyrexia of unknown origin XXX - Yes 1.00 No
Bronchiectasis XXX - Yes 1.00 No
Acute bronchitis XXX - Yes 1.00 No
Acute excaberation of COPD XXX - Yes 1.00 No
Acute excaberation of Interstitial Lung
XXX - Yes 1.00 No
Disease
Bacterial Endocarditis XXX - Yes 1.00 No
Fungal Endocarditis XXX - Yes 1.00 No
Vasculitis XXX - Yes 1.00 No
Acute pancreatitis XXX - Yes 1.00 No
Chronic pancreatitis XXX - Yes 1.00 No
Ascites XXX - Yes 1.00 No
Acute transverse myelitis XXX - Yes 1.00 No
Atrial Fibrillation XXX - Yes 1.00 No
Cardiac Tamponade XXX - Yes 1.00 No
Congestive heart failure XXX - Yes 1.00 No
Acute asthmatic attack XXX - Yes 1.00 No
Status asthmaticus XXX - Yes 1.00 No
Type 1 respiratory failure XXX - Yes 1.00 No
Type
Due to2 any
respiratory failure
cause (pneumonia, asthma, XXX - Yes 1.00 No
COPD, ARDS, foreign body, poisoning, head XXX - Yes 1.00 No
injury
Upperetc.)
GI bleeding (conservative) XXX - Yes 1.00 No
Upper GI bleeding (endoscopic) XXX - Yes 1.00 No
Lower GI hemorrhage XXX - Yes 1.00 No
Addison’s disease XXX - Yes 1.00 No
Renal colic XXX - Yes 1.00 No
AKI / Renal failure XXX - Yes 1.00 No
Seizures XXX - Yes 1.00 No
Status epilepticus XXX - Yes 1.00 No
Cerebrovascular accident XXX - Yes 1.00 No
Cerebral sino-venous thrombosis XXX - Yes 1.00 No
Acute stroke XXX - Yes 1.00 No
Acute ischemic stroke XXX - Yes 1.00 No
Acute heamorrhagic stroke XXX - Yes 1.00 No
Immune mediated CNS disorders XXX - Yes 1.00 No
Hydrocephalus XXX - Yes 1.00 No
Myxedema coma XXX - Yes 1.00 No
Thyrotoxic crisis XXX - Yes 1.00 No
Gout XXX - Yes 1.00 No
Pneumothroax XXX - Yes 1.00 No
Neuromuscular disorders XXX - Yes 1.00 No
Hypoglycemia XXX - Yes 1.00 No
Diabetic Foot XXX - Yes 1.00 No
Diabetic ketoacidosis XXX - Yes 1.00 No
Hypercalcemia XXX - Yes 1.00 No
Hypocalcemia XXX - Yes 1.00 No
Hyponatremia XXX - Yes 1.00 No
Hypernatremia XXX - Yes 1.00 No
Hyperosmolar Non-Ketotic coma XXX - Yes 1.00 No
Accelerated hypertension XXX - Yes 1.00 No
Hypertensive emergencies XXX - Yes 1.00 No
Severe anemia XXX - Yes 1.00 No
Sickle cell Anemia XXX - Yes 1.00 No
Anaphylaxis XXX - Yes 1.00 No
Heat stroke XXX - Yes 1.00 No
Systematic lupus erythematosus XXX - Yes 1.00 No
Guillian Barre Syndrome XXX - Yes 1.00 No
Snake bite XXX - Yes 1.00 No
Acute organophosphorus poisoning XXX - Yes 1.00 No
Other poisonings XXX - Yes 1.00 No
Haemodialysis XXX 900 No 0.00 No
Peritoneal Dialysis XXX 3,000 No 0.00 No
Plasmapheresis XXX 25,000 No 0.00 No
Whole Blood transfusion XXX 1,000 No 0.00 No
Blood component including platelet
XXX 1,000 No 0.00 No
transfusion (RDP, PC,diagnostic
High end radiological SDP)
XXX 5,000 No 0.00 No
(CT, MRI,
High Imaging including
end histopathology nuclearand
(Biopsies) imaging)
XXX 5,000 No 0.00 No
advanced serology investigations
CRRTCVVHDF
In addition to ward initiation
cost ifcost for disposable
Chemical XXX 35,000 No 0.00 No
In addition to wardiscost
Thrombolectomy the drugs
indicated cost needed
of the drug XXX - No 1.00 No
exclusively
In
canaddition forward
to
be claimed the care
usingcost of the infection if
IVtemplate
the Immunoglobulin if
In addition XXX - No 1.00 No
needed
needed cantobe
can beward cost of
claimed
claimed the the
using
using drug-IV
the Methyl
template
template
Prednisolone
attached along / Immunoglobulin if needed can XXX - No 1.00 No
attached, with utilise Plasmapheresis
be claimed
package ,if using
needed. the template attached, XXX - No 1.00 No
along with utilise Plasmapheresis package, if
Neurocysticercosis XXX - Yes 1.00 No
needed.
Epileptic encephalopathy XXX - Yes 1.00 No
Infectious - uncomplicated XXX - Yes 1.00 No
Immune-mediated - uncomplicated XXX - Yes 1.00 No
Acute encephalitis syndrome XXX - Yes 1.00 No
Acute meningo encephalitis XXX - Yes 1.00 No
Febrile encephalopathy XXX - Yes 1.00 No
Metabolic encephalopathy XXX - Yes 1.00 No
Hepatic encephalopathy XXX - Yes 1.00 No
Chronic meningitis XXX - Yes 1.00 No
Partially treated pyogenic meningitis XXX - Yes 1.00 No
Neuro tuberculosis XXX - Yes 1.00 No
Complicated bacterial meningitis XXX - Yes 1.00 No
Acute meningitis XXX - Yes 1.00 No
Optic neuritis XXX - Yes 1.00 No
Intracranial space occupying lesion XXX - Yes 1.00 No
Intracranial ring enhancing lesion with
XXX - Yes 1.00 No
complication (tuberculoma)
Cerebral herniation
Acute neuroregression / Acute worsening in XXX - Yes 1.00 No
neuro metabolic and neurodegenerative XXX - Yes 1.00 No
conditions
Acute demyelinating myelopathy XXX - Yes 1.00 No
Acute ischemic stroke XXX - Yes 1.00 No
Acute urticaria XXX - Yes 1.00 No
Anaphylaxis acute asthma XXX - Yes 1.00 No
Celiac disease XXX - Yes 1.00 No
Unexplained hepatosplenomegaly XXX - Yes 1.00 No
Acute glomerulonephritis XXX - Yes 1.00 No
Nephrotic syndrome with peritonitis XXX - Yes 1.00 No
Haemolytic uremic syndrome XXX - Yes 1.00 No
Rheumatoid arthritis XXX - Yes 1.00 No
Rheumatic fever XXX - Yes 1.00 No
Idiopathic Thrombocytopenic Purpura XXX - Yes 1.00 No
Steven Johnson syndrome XXX - Yes 1.00 No
Ketogenic diet initiation in refractory epilepsy XXX - Yes 1.00 No
 Clinical
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detailed
Discharg
details,
nt
Procedur
Regular
line
notes
n
detailing
Admissio of
notes Treatme
e
summary
ICPs, e
No No No No Secondary NA Yes notes
showing
reports
and
Clinical
ion
ment
planned
history discharg
e
Detailed
detailed Procedur
Regular
examinat
manage
detailing
showing
history
n notes details,
nt
summary
Treatme
No No No No Secondary NA Yes detailing
vitals;
Admissio
notes
findings
line
and
Clinical e
summary
ICPs,
discharg
Detailed e
Procedur
ion
ment
history
vitals
and
showing detailed
details,
,Treatme
nt All Regular
history
planned
n
(incl
managenotes
detailing
Admissio
notes summary
e
ICPs, e
No No No No Secondary NA Yes findings
and
Clinical
Admissio
vitals discharg
Detailed
detailed
investiga
details, Procedur
Regular
and
line
showing
history
neurologi
ment;
n notes
detailing ,
nt
summary
1st Treatme All
No No No No Tertiary NA Yes (incl
Admissio
notes
examinat
n
and notes e
ICPs,
discharg
Detailed
tions
detailed e
Procedur
Regular
Admissio
manage
vitals
and
cal
seizure
showing
history investiga
details,
,Treatme
nt All
No No No No Tertiary NA Yes neurologi
n
ion notes
detailing
showing
examinat summary
e
ICPs,
reports.
discharg e
Procedur
n
ment;
and notes
Admissio
examinat
or
vitals
and past Detailed
tions
detailed
investiga
details, Regular
cal
showing
history
findings;
vitals
ion ,Treatme
nt
summary
e All e
No No No No Secondary NA Yes showing
past
examinat
n
ion); h/o
notes
history
Clinical
and
Admissio any ICPs,
reports.
discharg
Detailed
tions
detailed Procedur
Regular
examinat
vitals
and
any
Clinical
findings; investiga
details,
,Treatme
nt
summary All
vitals
epilpesy
Clinical
ion
showing e e
No No No No Secondary NA Yes investiga
notes
examinat
n
ion);
Clinical
and
Admissio
investiga
examinat
notes
any any ICPs,
notes reports.
discharg
Detailed
tions
detailed
investiga
details,
, All
Procedur
Regular
and
notes
findings;
vitals
tions
detailing
ion
showing nt
summary
Treatme
e
ICPs, e
No No No No Secondary NA Yes investiga
notes
examinat
n
tions
ion notes
detailing
investiga reports.
discharg
Detailed
tions
detailed
investiga Procedur
Regular
examinat
detailing
any
and
done;
Clinical
history
findings;
vitals ,details,
nt
summary
Treatme All
No No No No Tertiary NA Yes tions
detailing
ion
showing
done;
findings
history
tions e
ICPs,
reports.
discharg
Detailed
tions e
Procedur
ion
history
investiga
examinat
planned
notes
and
any detailed
investiga
details,
,Detailed
nt All Regular
done;
history
findings;
vitals
planned
(incl
and
done; summary
Treatme
e
ICPs,
reports. e
No No No No Secondary NA Yes findings
and
tions
ion
line
with
Admissio
investiga
examinat of discharg
Detailed
tions
detailed
investiga
details, Procedur
Regular
planned
and
any
line
neurologi
Admissio
planned of ,Treatme
nt
ICPs
summary All
No No No No Secondary NA Yes Clinical
(incl
Admissio
done;
findings
manage
planned
n
tions notes e
ICPs,
reports.
discharg
Detailed
tions e
Procedur
ion
line
Admissio
investiga
examinat
manage
cal
n of
notes detailed
investiga
details,
(daily
,
nt All Regular
line
notes
neurologi
n
(incl
ment
line
showing
done; of
notes
planned
Clinical of summary
Treatme
e
ICPs,
reports. e
No No No No Secondary NA Yes findings
manage
n
tions
ion
ment notes
examinat
showing discharg
Detailed
tions
detailed
Treatme
investiga Procedur
Regular
manage
detailing
cal
showing
line
notes
neurologi
treatmen
vitals
planned
(incl of ,details,
nt
summary
Treatme
e All e
No No No No Secondary NA Yes ment
showing
done;
findings
ion);
vitals
ment any ICPs,
reports.
discharg
nt
tions
detailed Procedur
Regular
history
examinat
vitals
manage
detailing
cal
tand
line(incl
of investiga
details,
,Treatme
nt All
No No No No Secondary NA Yes neurologi
vitals
planned
(incl
investiga summary
e
details),
reports.
discharg e
Procedur
and
ion);
ment
history
birth
examinat
manage any
& Detailed
tions
detailed
investiga
details, Regular
cal
and
line of
neurologi
tions
Clinical
fundus ,Procedur
nt
summary
e All e
No No No No Tertiary NA Yes Admissio
investiga
examinat
and
ion);
past
ion
ment any ICPs, reports.
discharg
Detailed
tions
detailed Procedur
Regular
examinat
manage
cal
done;
notes
findings investiga
details,
,
e
summary All
/
No No No No Tertiary NA Yes n
tionsnotes Treatme
Clinical
ion
Admissio
investiga
history),
findings e
ICPs,
reports.
discharg
Detailed e
Procedur
ion);
ion
ment
examinat
planned
& any tions
detailed
investiga
Operativ
, All Regular
detailing
showing
done;
notes
findings;
n
tionsnotes Treatme
Investiga
(incl nt
summary
e e
No No No No Tertiary NA Yes investiga
findings
ion);
line ofany Detailed ICPs,
reports.
discharg
tions
e Notes Procedur
Regular
photogra
history
vitals
planned
Clinical
detailing
any
showing
done;
tion
neurologi investiga
details,
,Treatme
nt
summary All
No No No No Tertiary NA Yes tions
(incl
investiga
manage
and
ph; e
ICPs,
reports.
(if
Detailed
tions e
Procedur
line
notes
vitals
planned
Reports
cal of
investiga
history detailed
investiga
details,
,applicabl
nt All Regular
done;
neurologi
tions
Clinical
ment
Admissio
planned summary
Treatme
ICPs,
reports. e
No No No No Tertiary NA Yes examinat
manage
detailing
and
tions
line
examinatof
supportin discharg
Detailed
tions
detailed
investiga
details, Procedur
Regular
planned
cal
done;
notes
n
line notes Treatme ,
nt
e), All
No No No No Secondary NA Yes Clinical
ion
ment
history
Admissio
done;
examinat
manage
g
ion); any e
ICPs,
reports.
discharg
Detailed
tions e
Procedur
line
examinat
planned of
detailing
showing detailed
investiga
details,
Detailed Regular
No No No No Secondary NA Yes notes nt
manage
notes
findings;
including
n
planned
Clinical
ion
ment
diagnosi
investiga
manage
summary
Treatme
e
ICPs,
reports.
discharg
Detailed e
Procedur
ion);
line
history
vitals
ment;
vitals;
detailing
any any
of tions
detailed
Discharg
details,
,Treatme All Regular
past
showing
line
notes
s
tions
Clinical
ment of
findings; nt
summary
e e
No No No No Secondary NA Yes investiga
manage
and
planned
history ICPs,
reports.
discharg
Detailed
e
detailed Procedur
Regular
investiga
history,
vitals
manage
vitals;
detailing
any
(includin
done;
notes investiga
details,
,eAll
nt
summary
No No No No Secondary NA Yes tions
ment
Admissio
line
and Treatme
ICPs,
Summar
discharg
Detailed e
Procedur
tions
examinat
ment
planned
history
investiga
g CT
planned
detailing tions
detailed
investiga
,details, All Regular
done;
n notes
manage
Admissio nt
summary
Treatme
y,
e
ICPs, All e
No No No No Secondary NA Yes done;
ion
examinat
line
and
tions
head),
line
history of reports.
discharg
Detailed
tions
detailed
investiga Procedur
Regular
planned
showing
findings;
ment;
n notes Treatme details,
,
nt
investiga
summary All
No No No No Secondary NA Yes planned
findindgs
ion
manage
Admissio
done;
Planned
manage
and e
ICPs,
reports.
discharg
Detailed
tions e
Procedur
line
vitals of detailed
investiga
details,
tions Regular
,vitals;
any
specify
showing
line
ment;
n
ment of
findings;
notes
planned
line of
Admissio
,Treatme
nt
summary
e
ICPs,
reports.
All e
No No No No Secondary NA Yes manage
and
planned
the
vitals discharg
tions
detailed
reports.
investiga
details, Procedur
Regular
manage
investiga
any
specify
showing
line
n of
treatmen
notes ,eAll
nt
summary
Treatme
No No No No Secondary NA Yes ment
examinat
line
trigger
and reports.
discharg
tions
detailed e
Procedur
Regular
ment
tions
investiga
the
tvitals
manage
showing investiga
,details,
nt All
No No No No Secondary NA Yes ion
manage
done;
examinat summary
e
reports.
discharg e
Procedur
done
tions
trigger
and
ment
vitals and tions
detailed
investiga
details, Regular
findings;
ment;
planned
ion ,e All
summary e
No No No No Secondary NA Yes Admissio
done;
examinat
and reports.
discharg
tions
detailed Procedur
Regular
any
investiga
line of
findings; investiga
,eAll
summary
No No No No Secondary NA Yes n
ionnotes
planned
examinat reports.
discharg e
Procedur
investiga
tions
manage
any tions
investiga
,eAll
showing
line of
findings;
ion summary e
tions
done
ment
investiga reports.
tions
vitals;
manage
any
findings; ,investiga
All
summary
done;
tions
planned
ment
investiga reports.
tions
investiga
any
planned , All
done;
line
tions
investiga reports.
tions
investiga
line
manage
done; of
planned reports.
tions
manage tions
 n
andnotes ICPs,
Detailed
showing Treatme
Admissio ICPs,
vitals nt
n notes Treatme
and details,
showing nt
examinat detailed
details, Regular
vitals
No No No No Secondary NA Yes ion discharg
detailed Procedur
Regular
and
No No No No Secondary NA Yes findings e e
examinat discharg Procedur
(incl summary
e e
ion
neurologi , All
findings; summary
cal investiga
, All
any
examinat tions
investiga investiga
ion); reports.
tions any tions
investiga
done; reports.
tions
planned
done;
line of
planned
manage
line
mentof
manage
ment
 Reserve
Enhance
Special Special d
ment Day
Conditio Conditio sutu Procedu
applicab Care
n – Pop ns – Surgical re
le Procedu
–No
Up Rule
No Yes (S/M) (Insuran
Or not Medical re No(Y/N)
(Y/N)
No (Y/N)
No Yes Medical No ce/Trust
(Y/N)
)
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
Yes No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
Yes Yes No Medical Yes
Yes Yes No Medical Yes
No Yes No Medical Yes
No No No Medical Yes
No Yes No Medical Yes
Yes No No Medical No
Yes No No Medical No
No No No Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
No No Yes Medical No
 Specialt Procedu Package Multiple Procedu
Specialt AB PM - JAY
y Code re Code Code Procedu re Code
y Package Name
HBP 2.0 HBP 1.0 HBP 2.0 res HBP 2.0
General
SG S1200020 MC019 Pericardiocentesis No MC019A
Surgery
General
SG S500074 SB065 Excision of Bursa No SB065A
Surgery
General
SG S100103 SG001 Oesophagectomy No SG001A
Surgery
Operations for
General
SG S100213 SG002 Replacement of No SG002A
Surgery
Oesophagus by Colon
General S SG S100009 SG003 Gastrectomy Yes SG003A

General S SG S100008 SG003 Gastrectomy Yes SG003B

General
SG S100009 SG003 Gastrectomy Yes SG003C
Surgery
General
SG S100009 SG003 Gastrectomy Yes SG003D
Surgery
General
SG New PackageSG003 Gastrectomy Yes SG003E
Surgery
General
SG S100009 SG003 Gastrectomy Yes SG003F
Surgery
General
SG S100064 SG004 Operative Gastrostomy No SG004A
Surgery

General S SG S100060 SG005 Vagotomy Yes SG005A

General S SG S100060 SG005 Vagotomy Yes SG005B

General Operation for Bleeding

SG S100196 SG006 No SG006A
Surgery Peptic Ulcer
General Operation for Gastric /
SG S100089 SG007 Yes SG007A
Surgery Duodenal Perforation
General Operation for Gastric /
SG S100065 SG007 Yes SG007B
Surgery Duodenal Perforation
General
SG S100112 SG008 Pyloroplasty No SG008A
Surgery
General
SG S100185 SG009 Pyloromyotomy No SG009A
Surgery
General
SG S100063 SG010 Gastrojejunostomy No SG010A
Surgery
General CystoJejunostomy /
SG S100205 SG011 Yes SG011A
Surgery Cystogastrostomy
General CystoJejunostomy /
SG S100205 SG011 Yes SG011B
Surgery Cystogastrostomy
General CystoJejunostomy /
SG S100205 SG011 Yes SG011C
Surgery Cystogastrostomy
General CystoJejunostomy /
SG S100182 SG011 Yes SG011D
Surgery Cystogastrostomy
General
SG S100088 SG012 Feeding Jejunostomy No SG012A
Surgery
General
SG S100095 SG013 Ileostomy No SG013A
Surgery
Congenital Atresia &
General
SG S100204 SG014 Stenosis of Small No SG014A
Surgery
Intestine
General Operation for
SG S100030 SG015 No SG015A
Surgery Duplication of Intestine

General S SG S100028 SG016 Diverticulectomy Yes SG016A

General
SG S100028 SG016 Diverticulectomy Yes SG016B
Surgery
General
SG S100003 SG017 Appendicectomy Yes SG017A
Surgery
General
SG S100180 SG017 Appendicectomy Yes SG017B
Surgery
General Appendicular
SG S100091 SG018 No SG018A
Surgery Perforation
General Operative drainage of
SG S100004 SG019 No SG019A
Surgery Appendicular Abscess
General
SG New PackageSG020 Total Colectomy Yes SG020A
Surgery
General
SG S100174 SG020 Total Colectomy Yes SG020B
Surgery
General
SG New PackageSG021 Hemi colectomy Yes SG021A
Surgery
General
SG S100172 SG021 Hemi colectomy Yes SG021B
Surgery
General
SG New PackageSG021 Hemi colectomy Yes SG021C
Surgery
General
SG S100171 SG021 Hemi colectomy Yes SG021D
Surgery
 Operative
General Management of
SG S100144 SG022 No SG022A
Surgery Volvulus of Large
Bowel
General
SG S100018 SG023 Colostomy No SG023A
Surgery
General
SG S100202 SG024 Closure of stoma No SG024A
Surgery
General
SG S100127 SG025 Sigmoid Resection No SG025A
Surgery
General Perineal Procedure for
SG S100117 SG026 No SG026A
Surgery Rectal Prolapse
General Abdominal Procedure
SG New PackageSG027 Yes SG027A
Surgery for Rectal Prolapse
General Abdominal Procedure
SG New PackageSG027 Yes SG027B
Surgery for Rectal Prolapse
General
SG S100108 SG028 Rectal Polyp Excision No SG028A
Surgery
General Anterior Resection of
SG New PackageSG029 Yes SG029A
Surgery rectum
General Anterior Resection of
SG New PackageSG029 Yes SG029B
Surgery rectum
General Resection
SG S100090 SG030 Yes SG030A
Surgery Anastomosis
General Resection
SG S100090 SG030 Yes SG030B
Surgery Anastomosis
Procedure for Fissure
General S SG S100053 SG031 No SG031A
in Ano
General
SG S100123 SG032 Haemorroidectomy Yes SG032A
Surgery
General
SG S100123 SG032 Haemorroidectomy Yes SG032B
Surgery
Management of
General S SG S100042 SG033 No SG033A
Pilonidal Sinus
Exicision of Sinus and
General S SG S100050 SG034 No SG034A
Curettage
General Exploratory
SG S100190 SG035 No SG035A
Surgery Laparotomy
General Closure of Burst
SG S100092 SG036 No SG036A
Surgery Abdomen
General
SG S100070 SG037 Hepatic Resection Yes SG037A
Surgery
General
SG S100177 SG037 Hepatic Resection Yes SG037B
Surgery
General Abdominal Hydatid
SG S100079 SG038 No SG038A
Surgery Cyst (Single Organ)
General
SG New PackageSG039 Cholecystectomy Yes SG039A
Surgery
General
SG S100153 SG039 Cholecystectomy Yes SG039B
Surgery
General
SG New PackageSG039 Cholecystectomy Yes SG039C
Surgery
General
SG New PackageSG039 Cholecystectomy Yes SG039D
Surgery
General Operative
SG S100154 SG040 Yes SG040A
Surgery Cholecystostomy
General Operative
SG S100154 SG040 Yes SG040B
Surgery Cholecystostomy
General Operation of
SG S100211 SG041 No SG041A
Surgery Choledochal Cyst
General
SG S100132 SG042 Splenectomy Yes SG042A
Surgery
General
SG S100132 SG042 Splenectomy Yes SG042B
Surgery
General Bypass - Inoperable
SG S100016 SG043 No SG043A
Surgery Pancreas
Distal Pancreatectomy
General with
SG S100107 SG044 No SG044A
Surgery Pancreatico
Jejunostomy
General PancreaticoDuodenect
SG S100106 SG045 No SG045A
Surgery omy (Whipple's)
General Porto Caval
SG S100111 SG046 No SG046A
Surgery Anastomosis
General Mesenteric Caval
SG S100100 SG047 No SG047A
Surgery Anastomosis
General Mesenteric Cyst –
SG S100099 SG048 No SG048A
Surgery Excision
General Retroperitoneal Tumor
SG S100122 SG049 No SG049A
Surgery – Excision

General
SG New PackageSG050 Groin Hernia Repair Yes SG050A
Surgery
General
SG New PackageSG050 Groin Hernia Repair Yes SG050B
Surgery
General
SG New PackageSG050 Groin Hernia Repair Yes SG050C
Surgery
General
SG New PackageSG050 Groin Hernia Repair Yes SG050D
Surgery
General
SG New PackageSG050 Groin Hernia Repair Yes SG050E
Surgery
General
SG S100074 SG051 Hernia - Ventral Yes SG051A
Surgery

General
SG S100074 SG051 Hernia - Ventral Yes SG051B
Surgery

General
SG New PackageSG051 Hernia - Ventral Yes SG051C
Surgery
General
SG S100115 SG051 Hernia - Ventral Yes SG051D
Surgery
General Repair of Incisional
SG S100072 SG052 No SG052A
Surgery Hernia
General Hiatus Hernia Repair /
SG S100078 SG053 Yes SG053A
Surgery Fundoplication
General Hiatus Hernia Repair /
SG S100184 SG053 Yes SG053B
Surgery Fundoplication
General Hiatus Hernia Repair /
SG S100059 SG053 Yes SG053C
Surgery Fundoplication
General Hiatus Hernia Repair /
SG S100059 SG053 Yes SG053D
Surgery Fundoplication
Excision of cyst /
General S SG New PackageSG054 Sebaceous Cysts over Yes SG054A
scrotum
Excision of cyst /
General S SG New PackageSG054 Sebaceous Cysts over Yes SG054B
scrotum
Excision Filarial
General S SG S100039 SG055 No SG055A
Scrotum
General Operation for
SG S100080 SG056 No SG056A
Surgery Hydrocele (U/L)
General Epididymal Cyst /
SG S100033 SG057 Yes SG057A
Surgery Nodule Excision
General Epididymal Cyst /
SG S100033 SG057 Yes SG057B
Surgery Nodule Excision
General
SG S100143 SG058 Vasovasostomy No SG058A
Surgery
General
SG S100031 SG059 Orchidectomy No SG059A
Surgery
General Inguinal Node
SG S100084 SG060 No SG060A
Surgery (dissection) - U/L
General Estlander Operation
SG S100160 SG061 No SG061A
Surgery (lip)
General Operation for
SG S100198 SG062 Yes SG062A
Surgery Carcinoma Lip
General Operation for
SG New PackageSG062 Yes SG062B
Surgery Carcinoma Lip
General Operation for
SG S100209 SG062 Yes SG062C
Surgery Carcinoma Lip
Complete Excision of
General Growth from Tongue
SG S100044 SG063 No SG063A
Surgery only (inclusive of
Histopathology)
Excision of Growth
General
SG S100045 SG064 from Tongue with neck No SG064A
Surgery
node dissection
General Microlaryngoscopic
SG S100101 SG065 No SG065A
Surgery Surgery
General Submandibular Mass
SG S100134 SG066 No SG066A
Surgery Excision
General Radical Neck
SG S100114 SG067 No SG067A
Surgery Dissection
General Surgical removal of
SG S100014 SG068 No SG068A
Surgery Branchial Cyst
General Carotid Body tumour -
SG S100152 SG069 No SG069A
Surgery Excision
General
SG S100168 SG070 Thyroidectomy Yes SG070A
Surgery
General
SG S100169 SG070 Thyroidectomy Yes SG070B
Surgery
General
SG S100242 SG070 Thyroidectomy Yes SG070C
Surgery
General Excision of Parathyroid
SG S100162 SG071 Yes SG071A
Surgery Adenoma / Carcinoma
General Excision of Parathyroid
SG S100162 SG071 Yes SG071B
Surgery Adenoma / Carcinoma
General
SG S100210 SG072 Thymectomy No SG072A
Surgery
General
SG S100239 SG073 Sympathectomy No SG073A
Surgery
General Breast Lump Excision
SG S100012 SG074 No SG074A
Surgery (Benign)
General
SG S100098 SG075 Mastectomy Yes SG075A
Surgery
General
SG S100113 SG075 Mastectomy Yes SG075B
Surgery
Excision Mammary
General S SG S100040 SG076 No SG076A
Fistula
General Intercostal drainage
SG S100208 SG077 No SG077A
Surgery Only
General Rib Resection &
SG S100224 SG078 No SG078A
Surgery Drainage
General
SG S100233 SG079 Thoracoplasty No SG079A
Surgery
General Decortication
SG S100157 SG080 No SG080A
Surgery (Pleurectomy)
General
SG S100236 SG081 Lobectomy Yes SG081A
Surgery
General
SG S100236 SG081 Lobectomy Yes SG081B
Surgery
General Thoracoscopic
SG S100238 SG082 No SG082A
Surgery Segmental Resection
General Lung Hydatid Cyst
SG S100235 SG083 No SG083A
Surgery removal
General Incision & Drainage of
SG S100024 SG084 No SG084A
Surgery Abscess
Lipoma / Cyst / other
General S SG S100096 SG085 cutaneous swellings Yes SG085A
Excision
Lipoma / Cyst / other
General S SG New PackageSG085 cutaneous swellings Yes SG085B
Excision
Lipoma / Cyst / other
General S SG New PackageSG085 cutaneous swellings Yes SG085C
Excision
General S SG S100244 SG086 Debridement of Ulcer No SG086A

General Flap Reconstructive

SG S100163 SG087 No SG087A
Surgery Surgery
General Free Grafts - Wolfe
SG S100167 SG088 No SG088A
Surgery Grafts
General Tissue Reconstruction
SG S100245 SG089 No SG089A
Surgery Flap
General Split thickness skin
SG S100164 SG090 Yes SG090A
Surgery grafts
General Split thickness skin
SG S100165 SG090 Yes SG090B
Surgery grafts
General Split thickness skin
SG S100166 SG090 Yes SG090C
Surgery grafts
General Skin Flaps - Rotation
SG S100225 SG091 No SG091A
Surgery Flaps
General
SG S100246 SG092 Tendon Transfer No SG092A
Surgery
Lymphatics Excision of
General
SG S100192 SG093 Subcutaneous Tissues No SG093A
Surgery
In Lymphoedema
General AV Fistula without
SG S100251 SG094 No SG094A
Surgery prosthesis
General Management of
SG S100142 SG095 No SG095A
Surgery Varicose Veins
General
SG New PackageSG096 Biopsy Yes SG096A
Surgery
General
SG New PackageSG096 Biopsy Yes SG096B
Surgery
General
SG New PackageSG096 Biopsy Yes SG096C
Surgery
General
SG New PackageSG096 Biopsy Yes SG096D
Surgery
General
SG New PackageSG096 Biopsy Yes SG096E
Surgery

General S SG New PackageSG097 Stoma Management Yes SG097A

General S SG New PackageSG097 Stoma Management Yes SG097B

General
SG S100058 SG098 Foreign Body Removal No SG098A
Surgery
General
SG New Package
SG099KL Caecopexy No SG099KLA
Surgery
General Oesophageal Varices
SG New Package
SG100KL No SG100KLA
Surgery Banding
General Oesophagus Portal
SG New Package
SG101KL No SG101KLA
Surgery Hypertension
General Repair of Renal Artery
SG New Package
SG102KL No SG102KLA
Surgery Stenosis
General
SG S200075 SL021 Parotidectomy Yes SL021A
Surgery
General
SG S200076 SL021 Parotidectomy Yes SL021B
Surgery
General
SG S200067 SL027 Neck dissection Yes SL027A
Surgery
General
SG S200067 SL027 Neck dissection Yes SL027B
Surgery
General
SG S200067 SL027 Neck dissection Yes SL027C
Surgery
General
SG S200067 SL027 Neck dissection Yes SL027D
Surgery
Deep neck abscess
General
SG S200068 SL028 drainage/ Post trauma Yes SL028A
Surgery
neck exploration
Deep neck abscess
General
SG New PackageSL028 drainage/ Post trauma Yes SL028B
Surgery
neck exploration
Conservative
General
SG New PackageST001 Management of Head Yes ST001A
Surgery
Injury
Conservative
General
SG S800047 ST001 Management of Head Yes ST001B
Surgery
Injury injury with repair
Head
General of Facio-Maxillary
SG S600004 ST002 No ST002A
Surgery Injury & fixations
Craniotomy and
(including implants)
evacuation of
General
SG S600006 ST003 Haematoma with Yes ST003A
Surgery Craniotomy and of
fixation of fracture
evacuation
long bone of
General
SG S600006 ST003 Haematoma with Yes ST003B
Surgery Craniotomy and of
fixation of fracture
evacuation
long bone of
General
SG S600007 ST003 Haematoma with Yes ST003C
Surgery Craniotomy and of
fixation of fracture
evacuation
long bone of
General
SG S600007 ST003 Haematoma with Yes ST003D
Surgery
fixation of fracture of
Management
long bone of Chest
General
SG New PackageST004 injury with fracture of Yes ST004A
Surgery
Long bone
Management of Chest
General
SG New PackageST004 injury with fracture of Yes ST004B
Surgery
Long bone
Management of
General
SG S600010 ST005 Visceral injury and Yes ST005A
Surgery
fracture long bone
 Management of
General
SG S600011 ST005 Visceral injury and Yes ST005B
Surgery
fracture long bone
Internal fixation of
General
SG S600005 ST006 Pelviacetabular No ST006A
Surgery
fracture
Internal fixation with
General Flap cover Surgery for
SG S600003 ST007 No ST007A
Surgery wound in compound
Emergency
fracture tendons
General repair ± Peripheral
SG S600012 ST008 No ST008A
Surgery Nerve repair/
reconstructive
Management ofsurgery
Nerve
General
SG S600001 ST009 Plexus / Tendon Yes ST009A
Surgery
injuries
Management of Nerve
General
SG S600001 ST009 Plexus / Tendon Yes ST009B
Surgery
injuries
Management of Nerve
General
SG S600001 ST009 Plexus / Tendon Yes ST009C
Surgery
injuries
Management of Nerve
General
SG S600001 ST009 Plexus / Tendon Yes ST009D
Surgery
injuries
Management of Nerve
General
SG S600001 ST009 Plexus / Tendon Yes ST009E
Surgery
injuries
Plexus injury along
General
SG S600002 ST010 with Vascular injury Yes ST010A
Surgery
repair / graft
Plexus injury along
General
SG S600002 ST010 with Vascular injury Yes ST010B
Surgery Aortic
repair Arch
/ graft
Replacement /
General
SG New PackageSV015 Thoracoabdominal Yes SV015A
Surgery Aortic ArchRepair using
aneurysm
Replacement
bypass /
General
SG New PackageSV015 Thoracoabdominal Yes SV015B
Surgery
aneurysm Repair using
General bypass
Aortic Aneurysm
SG S1300042 SV016 Yes SV016A
Surgery Repair
General Aortic Aneurysm
SG New PackageSV016 Yes SV016B
Surgery Repair
General Aortic Aneurysm
SG S1300043 SV016 Yes SV016C
Surgery Repair
General Aortic Aneurysm
SG New PackageSV016 Yes SV016D
Surgery Repair
General
SG S1300072 SV020 Thromboembolectomy No SV020A
Surgery
General Foreign Body Removal
SG S1300061 SV025 No SV025A
Surgery with scope
Space - Occupying
General
SG S1300055 SV027 Lesion (SOL) No SV027A
Surgery
mediastinum
 Isolated Intercostal
Drainage and
General Management of ICD,
SG S1300066 SV028 No SV028A
Surgery Intercostal Block,
Antibiotics &
Physiotherapy
 No. of
Stratific
ICHI Stratific
ation
AB PM - JAY Procedu ation
Package criteria
Procedure Name re / ICD Criteria
Price which
Code (Y/N)
can be
Pericardiocentesis XXX 12,100 No 0.00
booked

Excision of Bursa XXX 4,525 No 0.00

Oesophagectomy XXX 28,300 No 0.00

Operations for Replacement of Oesophagus by Colon XXX 30,500 No 0.00

Bleeding Ulcer - Partial Gastrectomy without Vagotomy XXX 25,000 No 0.00

Bleeding Ulcer - Partial Gastrectomy with Vagotomy XXX 25,000 No 0.00

Partial Gastrectomy for Carcinoma XXX 27,800 No 0.00

Subtotal Gastrectomy for Carcinoma XXX 27,800 No 0.00

Total Gastrectomy - Lap. XXX 51,600 No 0.00

Total Gastrectomy - Open XXX 51,600 No 0.00

Operative Gastrostomy XXX 16,725 No 0.00

G J Vagotomy XXX 23,500 No 0.00

Vagotomy + Pyloroplasty XXX 23,500 No 0.00

Operation for Bleeding Peptic Ulcer XXX 22,500 No 0.00

Gastric Perforation XXX 18,500 No 0.00

Duodenal Perforation XXX 18,500 No 0.00

Pyloroplasty XXX 14,000 No 0.00

Pyloromyotomy XXX 20,000 No 0.00

Gastrojejunostomy XXX 18,500 No 0.00

CystoJejunostomy - Open XXX 20,000 No 0.00

CystoJejunostomy - Lap. XXX 20,000 No 0.00

Cystogastrostomy - Open XXX 20,000 No 0.00

Cystogastrostomy - Lap. XXX 20,000 No 0.00

Feeding Jejunostomy XXX 20,000 No 0.00

Ileostomy XXX 19,600 No 0.00

Congenital Atresia & Stenosis of Small Intestine XXX 23,000 No 0.00

Operation for Duplication of Intestine XXX 18,000 No 0.00

Excision Duodenal Diverticulum XXX 20,000 No 0.00

Excision Meckel's Diverticulum XXX 17,025 No 0.00

Open XXX 11,000 No 0.00

Lap. XXX 18,000 No 0.00

Appendicular Perforation XXX 17,500 No 0.00

Operative drainage of Appendicular Abscess XXX 12,000 No 0.00

Open XXX 23,000 No 0.00

Lap. XXX 35,000 No 0.00

Right - Open XXX 25,000 No 0.00

Right - Lap. XXX 25,000 No 0.00

Left - Open XXX 25,000 No 0.00

Left - Lap. XXX 25,000 No 0.00

Operative Management of Volvulus of Large Bowel XXX 26,000 No 0.00

Colostomy XXX 14,000 No 0.00

Closure of stoma XXX 14,500 No 0.00

Sigmoid Resection XXX 21,500 No 0.00

Perineal Procedure for Rectal Prolapse XXX 14,000 No 0.00

Open XXX 19,000 No 0.00

Lap. XXX 19,000 No 0.00

Rectal Polyp Excision XXX 9,600 No 0.00

Open XXX 28,500 No 0.00

Lap. XXX 70,000 No 0.00

Open XXX 25,000 No 0.00

Lap. XXX 25,000 No 0.00

Procedure for Fissure in Ano XXX 8,000 No 0.00

without Stapler XXX 15,000 No 0.00

with Stapler XXX 15,000 No 0.00

Management of Pilonidal Sinus XXX 5,000 Yes 1.00

Exicision of Sinus and Curettage XXX 7,900 No 0.00

Exploratory Laparotomy XXX 13,000 No 0.00

Closure of Burst Abdomen XXX 15,000 No 0.00

Open XXX 20,000 No 0.00

Lap. XXX 25,000 No 0.00

Abdominal Hydatid Cyst (Single Organ) XXX 15,800 No 0.00

Without Exploration of CBD - Open XXX 22,800 No 0.00

With Exploration of CBD - Open XXX 22,800 No 0.00

Without Exploration of CBD - Lap. XXX 22,800 No 0.00

With Exploration of CBD - Lap. XXX 25,000 No 0.00

Open XXX 16,000 No 0.00

Lap. XXX 16,000 No 0.00

Operation of Choledochal Cyst XXX 24,500 No 0.00

Open XXX 25,000 No 0.00

Lap. XXX 30,000 No 0.00

Bypass - Inoperable Pancreas XXX 23,500 No 0.00

Distal Pancreatectomy with

XXX 50,000 No 0.00
Pancreatico Jejunostomy

PancreaticoDuodenectomy (Whipple's) XXX 30,000 No 0.00

Porto Caval Anastomosis XXX 31,500 No 0.00

Mesenteric Caval Anastomosis XXX 28,500 No 0.00

Mesenteric Cyst – Excision XXX 17,000 No 0.00

Retroperitoneal Tumor – Excision XXX 23,000 No 0.00

Inguinal - Open XXX 14,200 No 0.00

Inguinal - Lap. XXX 14,200 No 0.00

Femoral - Open XXX 14,200 No 0.00

Femoral - Lap XXX 14,200 No 0.00

Obturator - Lap. XXX 20,000 No 0.00

Epigastric XXX 17,400 No 0.00

Umbilical XXX 17,400 No 0.00

Paraumbilical XXX 17,400 No 0.00

Spigelian XXX 17,400 No 0.00

Repair of Incisional Hernia XXX 20,000 No 0.00

Hiatus Hernia Repair - Open XXX 23,500 No 0.00

Hiatus Hernia Repair - Lap. XXX 23,500 No 0.00

Fundoplication - Open XXX 23,500 No 0.00

Fundoplication - Lap. XXX 70,000 No 0.00

Single Cyst XXX 2,000 No 0.00

Multiple Cysts XXX 7,000 No 0.00

Excision Filarial Scrotum XXX 11,500 No 0.00

Operation for Hydrocele (U/L) XXX 5,000 No 0.00

Epididymal Cyst exision XXX 4,600 No 0.00

Epididymal Nodule excision XXX 7,000 No 0.00

Vasovasostomy XXX 12,425 No 0.00

Orchidectomy XXX 11,200 No 0.00

Inguinal Node (dissection) - U/L XXX 16,000 No 0.00

Estlander Operation (lip) XXX 9,300 No 0.00

Wedge Excision XXX 19,000 No 0.00

Wedge Excision and Vermilionectomy XXX 23,800 No 0.00

Cheek advancement XXX 26,800 No 0.00

Complete Excision of Growth from Tongue only

XXX 9,400 No 0.00
(inclusive of Histopathology)
Excision of Growth from Tongue with neck node
XXX 23,500 No 0.00
dissection

Microlaryngoscopic Surgery XXX 18,500 No 0.00

Submandibular Mass Excision XXX 20,000 No 0.00

Radical Neck Dissection XXX 21,200 No 0.00

Surgical removal of Branchial Cyst XXX 15,000 No 0.00

Carotid Body tumour - Excision XXX 20,000 No 0.00

Hemi thyroidectomy XXX 17,000 No 0.00

Total thyroidectomy XXX 20,000 No 0.00

Total Thyroidectomy with Block Dissection XXX 28,000 No 0.00

Excision of Parathyroid Adenoma XXX 22,000 No 0.00

Excision of Parathyroid Carcinoma XXX 22,000 No 0.00

Thymectomy XXX 28,000 No 0.00

Sympathectomy XXX 15,000 No 0.00

Breast Lump Excision (Benign) XXX 6,000 Yes 1.00

Simple Mastectomy XXX 20,000 No 0.00

Radical / Modified Radical Mastectomy XXX 25,000 No 0.00

Excision Mammary Fistula XXX 14,500 No 0.00

Intercostal drainage Only XXX 4,800 No 0.00

Rib Resection & Drainage XXX 14,000 No 0.00

Thoracoplasty XXX 25,000 No 0.00

Decortication (Pleurectomy) XXX 28,000 No 0.00

Thoracoscopic XXX 27,500 No 0.00

Open XXX 27,500 No 0.00

Thoracoscopic Segmental Resection XXX 25,000 No 0.00

Lung Hydatid Cyst removal XXX 20,000 No 0.00

Incision & Drainage of Abscess XXX 5,000 Yes 1.00

Lipoma Excision XXX 5,000 Yes 1.00

Cyst Excision XXX 5,000 Yes 1.00

Other cutaneous swellings Excision XXX 5,000 Yes 1.00

Debridement of Ulcer XXX 5,000 Yes 1.00

Flap Reconstructive Surgery XXX 25,875 No 0.00

Free Grafts - Wolfe Grafts XXX 14,000 No 0.00

Tissue Reconstruction Flap XXX 25,000 No 0.00

Small (< 4% TBSA) XXX 13,500 No 0.00

Medium (4 - 8% TBSA) XXX 13,500 No 0.00

Large (> 8% TBSA) XXX 15,000 No 0.00

Skin Flaps - Rotation Flaps XXX 11,400 No 0.00

Tendon Transfer XXX 25,000 No 0.00

Lymphatics Excision of Subcutaneous Tissues In

XXX 10,000 No 0.00
Lymphoedema

AV Fistula without prosthesis XXX 6,000 No 0.00

Management of Varicose Veins XXX 14,000 No 0.00

Lymph Node XXX 5,000 No 0.00

Endometrial Aspiration XXX 2,000 No 0.00

Cervix Cancer screening (PAP + Colposcopy) XXX 1,500 No 0.00

Cervical (Neck) XXX 1,500 No 0.00

Vulval XXX 1,500 No 0.00

Stoma Management follow up of Ileostomy XXX 4,500 No 0.00

Stoma Management follow up of Colostomy XXX 4,500 No 0.00

Foreign Body Removal XXX 5,000 Yes 1.00

Caecopexy XXX 16,000 No 0.00

Oesophageal Varices Banding XXX 6,000 No 0.00

Oesophagus Portal Hypertension XXX 22,000 No 0.00

Repair of Renal Artery Stenosis XXX 30,000 No 0.00

Total Parotidectomy XXX 28,200 No 0.00

Superficial Parotidectomy XXX 23,800 No 0.00

Selective Benign neck tumour excision XXX 18,800 No 0.00

Comprehensive Benign neck tumour excision XXX 18,800 No 0.00

Selective Pharyngeal diverticulum excision XXX 18,800 No 0.00

Comprehensive Pharyngeal diverticulum excision XXX 18,800 No 0.00

Deep neck abscess drainage XXX 16,800 No 0.00

Post trauma neck exploration XXX 16,800 No 0.00

Severe XXX 1,000 Yes 1.00

Depressed Fracture XXX 5,000 Yes 1.00

Head injury with repair of Facio-Maxillary Injury & fixations

XXX 31,000 No 0.00
(including implants)
Subdural hematoma along with fixation of fracture of
XXX 60,000 No 0.00
single long bone
Extradural hematoma along with fixation of fracture of
XXX 60,000 No 0.00
single long bone
Subdural hematoma along with fixation of fracture of 2 or
XXX 75,000 No 0.00
more long bone.
Extradural hematoma along with fixation of fracture of 2 or
XXX 75,000 No 0.00
more long bone.
Management of Chest injury with fixation of Single Long
XXX 30,000 No 0.00
bone
Management of Chest injury with fixation of 2 or more
XXX 45,000 No 0.00
Long bones
Surgical intervention for Visceral injury and fixation of
XXX 30,000 No 0.00
fracture of single long bone
Surgical intervention for Visceral injury and fixation of
XXX 45,000 No 0.00
fracture of 2 or more long bones

Internal fixation of Pelviacetabular fracture XXX 40,000 No 0.00

Internal fixation with Flap cover Surgery for wound in

XXX 40,000 No 0.00
compound fracture
Emergency tendons repair ± Peripheral Nerve repair/
XXX 30,000 No 0.00
reconstructive surgery

Nerve Plexus injury repair XXX 50,000 No 0.00

Nerve Plexus injury reconstruction XXX 50,000 No 0.00

Tendon injury repair XXX 50,000 No 0.00

Tendon injury reconstruction XXX 50,000 No 0.00

Tendon Transfer XXX 50,000 No 0.00

Plexus injury along with Vascular injury repair XXX 60,000 No 0.00

Plexus injury along with Vascular injury graft XXX 60,000 No 0.00

Aortic Arch Replacement using bypass XXX 150,000 No 0.00

Thoracoabdominal aneurysm Repair using bypass XXX 150,000 No 0.00

Aortic Aneurysm Repair using Cardiopulmonary bypass

XXX 120,000 No 0.00
(CPB)

Aortic Aneurysm Repair using Left Heart Bypass XXX 120,000 No 0.00

Aortic Aneurysm Repair without using Cardiopulmonary

XXX 65,500 No 0.00
bypass (CPB)

Aortic Aneurysm Repair without using Left Heart Bypass XXX 65,500 No 0.00

Thromboembolectomy XXX 28,000 No 0.00

Foreign Body Removal with scope XXX 20,000 No 0.00

Space - Occupying Lesion (SOL) mediastinum XXX 65,500 No 0.00

Isolated Intercostal Drainage and Management of ICD,
XXX 10,000 No 0.00
Intercostal Block, Antibiotics & Physiotherapy
 Can
Implants more Mandato
Reserva Reserva
/ High than one Auto Clinicalry
Special tion tion
End type of Level of Approve notes
Docume
Clinical
Conditio Public Tertiary LOS
Consum implant Care d nts
and
notes - Pre
ns (Y/N) Hospital Hospital Clinical
ables be (Y/N) ECHO
Authoriz
detailing
s (Y/N) s (Y/N) notes
(Y/N)
No booked
No No No No Tertiary 100% No ation
report
findings
and
Clinical
(Y/N) justifying
confirmin
USG/CT/
notes
need
g theX-of
MRI/
No No No No No Secondary 100% Yes and
procedur
diagnosi
Biopsy
ray,
e
s, clinical
report
CT/MRI/
No No No No No Tertiary 500% photogra
Yes UGIE
confirmin
ph
g of
the
findings
Clinical
affected
diagnosi
confirmin
No No No No No Tertiary 1000% Yes notes,
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s
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Clinical
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which
Clinical
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No No No No No Tertiary 500% the
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and
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Scan
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No No No No No Tertiary 600% g
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Scan
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No No No No No Tertiary 500% diagnosi
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EMG(Ele
FIR
bone) injury
+/-
on
notes
+/-
surgery. MRI +
No No No No No Secondary 1000% Yes and
ctromyog
Nerve need
velocity
detailing
/-
MLC/
of
raphy)
conducti
(NCV)
the
EMG(Ele
FIR injury
+/-
surgery.
on
No No No No No Secondary 1000% Yes +/-
and
ctromyog
Nerve MRI
need +
MLC/
velocity
/-
of
raphy)
conducti
FIR
(NCV) +/-
EMG(Ele
surgery.
on
Nerve
+/- MRI +
No No No No No Tertiary 1000% Yes ctromyog
MLC/
velocity
conducti
/-
raphy)
FIR
(NCV) +/-
on
EMG(Ele
Nerve
+/-
Clinical
velocity MRI +
No No No No No Tertiary 1000% Yes ctromyog
conducti
/-
notes
(NCV)
raphy)
on
EMG(Ele
and
+ /- MRI
Yes No No No No Tertiary 1200% No Clinical
velocity
ctromyog
angio /
+
Clinical /- MRA
notes
(NCV)
raphy)
CT angio
+
notes /- EMG
and
+
/and /- MRI
MRI
(Electro
Yes No No No No Tertiary 1200% No angio
+
reports
Clinical/- MRA /
myograp
ECHO /
CT
+
notes angio
/- EMG
hy)
Angio /
/and MRI
(Electro
Yes No No No No Tertiary 1000% No CT
reports angio
myograp
ECHO
/ MRI /
hy) /
Angio
reports
Yes No No No No Tertiary 1000% No CT
Clinical
showing angio
/aneurys
MRI
notes
reports
Soon
angio
m as
/
Yes No No No No Tertiary 1000% No Clinical
showing
documen
CT angio
notes
/aneurys
ts MRIare
angio
reports/
m
uploaded
Yes No No No No Tertiary 1000% No
,CT angio
confirm
/Clinical
MRI
evidence
No No No No No Tertiary 400% No reports
of
notes
embolus/
and
Thrombu
Radiologi
No No No No No Tertiary 200% No s in
cal
Clinical
duples
evidence
notes
USG/
of foreign
No No No No No Tertiary 1000% No
and
Angio
body CT
Chest
 Cl notes
detailing
No No No No No Tertiary 400% No need of
ICD; X-
ray chest
 Enhance
Special Special
ment Medical
Conditio Conditio
Procedu applicab or
Mandatory Documents - Claim Processing n – Pop ns –
re Label le Surgical
– Up Rule
Intra procedure clinical photograph, post Regular Or not (S/M)
(Y/N) (Y/N)
procedure ECHO report; Analysis of fluid Procedur No No (Y/N)
No Medical
removed. e
Detailed discharge summary, Post Procedure Regular
clinical photgraph, detailed Procedure / Procedur No No No Surgical
Operative Notes. e
Histopath, Intra procedure clinical photograph, Regular
detailedofdischarge
Picture removedsummary,
esopahgusDetailed
(Intra Procedur No No No Surgical
Operative notes
procedure clinical photograph), Scar photo e
Regular
(should be two scars or one huge
Procedur No No No Surgical
thoracolumbar scar coverin both colon
e
removal
Intra & esopagus
Operative replacement)
Photograph, Detailed
Histopathology Regular
discharge
report, summary,
Detailed Detailed
Operative Operative
notes notes
& detailed Procedur No No No Surgical
discharge summary. e
Intra Operative Photograph, Histopathology Regular
report, Detailed Operative notes & detailed Procedur No No No Surgical
discharge
Intra summary.
procedure clinical photograph, e
Regular
Histopathology report, post procedure clinical
Procedur No No No Surgical
photograph, Detailed Operative notes,
Intra procedure clinical photograph, e
Detailed discharge summary Regular
Histopathology report, post procedure clinical
Procedur No No No Surgical
photograph, Detailed Operative notes,
Intra procedure clinical photograph, e
Detailed discharge summary Regular
Histopathology report, post procedure clinical
Procedur No No No Surgical
photograph, Detailed Operative notes,
Intra procedure clinical photograph, e
Detailed discharge summary Regular
Histopathology report, post procedure clinical
Procedur No No No Surgical
photograph, Detailed Operative notes,
Intra procedure clinical photograph, e
Detailed discharge summary Regular
Histopathology report, post procedure clinical
Procedur No No No Surgical
photograph, Detailed Operative notes,
e
Detailed
Endoscopicdischarge summary
intra operative Regular
Photograph,Histopathology report, Detailed Procedur No No No Surgical
Operative notes, detailed discharge summary e
Endoscopic intra operative Regular
Photograph,Histopathology report, Detailed Procedur No No No Surgical
Operative notes, detailed discharge summary e
Regular
Intra procedure clinical Photograph, Detailed
Procedur No No No Surgical
discharge summary, Detailed Operative notes
e
Regular
Intra procedure clinical photograph, Detailed
Procedur No No No Surgical
Operative notes, detailed discharge summary
e
Regular
Intra procedure clinical photograph, Detailed
Procedur No No No Surgical
Operative notes, detailed discharge summary
e
Regular
Intra procedure clinical photograph, detailed
Procedur No No No Surgical
discharge summary, Detailed Operative notes
e
Regular
Endoscopic still Photograph, Detailed
Procedur No No No Surgical
discharge summary, Detailed Operative notes
e
Regular
intra operative photograph Detailed Operative
Procedur No No No Surgical
notes, detailed discharge summary
e
Detailed discharge summary, post procedure Regular
clinical photograph, Detailed Operative notes, Procedur No No No Surgical
scar photo e
Detailed discharge summary, post procedure Regular
clinical photograph, Detailed Operative notes, Procedur No No No Surgical
scar photo e
Detailed discharge summary, post procedure Regular
clinical photograph, Detailed Operative notes, Procedur No No No Surgical
scar photo e
Detailed discharge summary, post procedure Regular
clinical photograph, Detailed Operative notes, Procedur No No No Surgical
scar photo e
Regular
Intra procedure clinical photograph detailed
Procedur No No No Surgical
discharge summary, Detailed Operative notes
e
Histopath, Post procedure clinical photograph, Regular
Detailed Operative notes, detailed discharge Procedur No No No Surgical
summary e
Regular
Intra procedure clinical stills, Detailed
Procedur No No No Surgical
Operative notes, Detailed discharge summary
e
USG, Intra operative clinical photograph, Regular
Detailed Operative notes, Detailed discharge Procedur No No No Surgical
summary, histopath of removed part. e
Intra operative clinical photograph, Detailed Regular
Operative notes, scar photo Detailed Procedur No No No Surgical
discharge summary e
Histopath, Intra operative clinical photograph, Regular
Detailed Operative notes; detailed discharge Procedur No No No Surgical
summary
Histopathology report, Intra procedure clinical e
Regular
photograph of removed appendix, post
Procedur No No No Surgical
procedure clinical photograph, Detailed
Histopathology e
Operative notes,report, Intra
Detailed procedure
discharge clinical
summary Regular
photograph of removed appendix, post
Procedur No No No Surgical
procedure clinical photograph, Detailed
e
Operative
Histopath, notes, Detailed discharge
Intra procedure summary
clinical photograph, Regular
detailed discharge summary and Detailed Procedur No No No Surgical
Operative notes e
Regular
Intra Operative clinical photograph, Detailed
Procedur No No No Surgical
Operative notes & discharge summary.
e
Histopathology, Intra procedure clinical Regular
photograph, detailed discharge summary, Procedur No No No Surgical
Detailed Operative notes e
Histopathology, Intra procedure clinical Regular
photograph, detailed discharge summary, Procedur No No No Surgical
Detailed Operative notes e
Histopathology report and Intra procedure Regular
Clinical photograp of removed colon, Detailed Procedur No No No Surgical
discharge summary, Detailed Operative notes e
Histopathology report and Intra procedure Regular
Clinical photograp of removed colon, Detailed Procedur No No No Surgical
discharge summary, Detailed Operative notes e
Histopathology report and Intra procedure Regular
Clinical photograp of removed colon, Detailed Procedur No No No Surgical
discharge summary, Detailed Operative notes e
Histopathology report and Intra procedure Regular
Clinical photograp of removed colon, Detailed Procedur No No No Surgical
discharge summary, Detailed Operative notes e
 Regular
Detailed discharge summary, X Ray
Procedur No No No Surgical
Abdomen, Detailed Operative notes.
e
Regular
Post procedure clinical photograph, Detailed
Procedur No No No Surgical
Operative notes & detailed surgery notes.
e
Regular
Post procedure clinical photograph, Detailed
Procedur No No No Surgical
Operative notes, Detailed discharge summary
e
Histopathology, Intra procedure clinical Regular
photograph, Detailed Operative notes, Procedur No No No Surgical
detailed discharge summary e
Histopath, Intra procedure clinical photograph, Regular
detailed discharge summary, Detailed Procedur No No No Surgical
Operative notes e
Regular
Intra procedure clinical photograph, detailed
Procedur No No No Surgical
discharge summary, Detailed Operative notes,
e
Regular
Intra procedure clinical photograph, detailed
Procedur No No No Surgical
discharge summary, Detailed Operative notes,
e
Histopath, Intra procedure clinical photograph, Regular
Detailed Operative notes, detailed discharge Procedur No No No Surgical
summary e
Histopathology report, post procedure clinical Regular
photograph, Detailed Operative notes & Procedur No No No Surgical
detailed discharge summary e
Histopathology report, post procedure clinical Regular
photograph, Detailed Operative notes & Procedur No No No Surgical
detailed discharge summary e
Histopath of resected part, Intra procedure Regular
clinical photograph, detailed discharge Procedur No No No Surgical
summary and Detailed Operative notes e
Histopath of resected part, Intra procedure Regular
clinical photograph, detailed discharge Procedur No No No Surgical
summary and Detailed Operative notes e
Regular
Detailed Operative notes; detailed discharge
Procedur No No No Surgical
summary
e
Regular
Post procedure clinical photograph, Detailed
Procedur No No No Surgical
Operative notes, detailed discharge summary
e
Regular
Post procedure clinical photograph, Detailed
Procedur No No No Surgical
Operative notes, detailed discharge summary
e
Regular
Histopath, Intra-operative clinical photograph,
Procedur No No No Surgical
Detailed Operative notes
e
post procedure clinical photograph, Detailed Regular
Operative notes;clinical
Intra procedure detailed discharge Analysis
photograph, summary. Procedur No No No Surgical
+/- Histopath of surreted material
of fluid removed, Detailed discharge summary, e
Stand
Detailed Operative notes describing Alone
No Yes No Surgical
management done of pathology that led to Procedur
peritonitis; cautious about OT time; this should e
Regular
Intra procedure
take 2-3 hours. clinical photograph, Detailed Procedur No No No Surgical
Operative notes, detailed discharge summary
e
Histopath, Intra procedure clinical photograph, Regular
detailed discharge summary, Detailed Procedur No No No Surgical
Operative notes e
Histopath, Intra procedure clinical photograph, Regular
detailed discharge summary, Detailed Procedur No No No Surgical
Operative notes e
Histopath, Intra procedure clinical photograph, Regular
Detailed Operative notes and detailed Procedur No No No Surgical
discharge summary e
Regular
Intra procedure clinical photograph, Detailed
Procedur No No No Surgical
discharge summary, Detailed Operative notes
e
Regular
Intra procedure clinical photograph, Detailed
Procedur No No No Surgical
discharge summary, Detailed Operative notes
e
Regular
Intra procedure clinical photograph, Detailed
Procedur No No No Surgical
discharge summary, Detailed Operative notes
e
Regular
Intra procedure clinical photograph, Detailed
Procedur No No No Surgical
discharge summary, Detailed Operative notes
e
Regular
Intra procedure clinical photograph, Detailed
Procedur No No No Surgical
discharge summary, Detailed Operative notes
e
Regular
Intra procedure clinical photograph, Detailed
Procedur No No No Surgical
discharge summary, Detailed Operative notes
e
Regular
Histopath, Detailed discharge summary, Scar
Procedur No No No Surgical
photo, Detailed Operative notes
e
Regular
Detailed Operative notes, histopath, detailed
Procedur No No No Surgical
discharge summary,
e
Regular
Detailed Operative notes, histopath, detailed
Procedur No No No Surgical
discharge summary,
e
Histopathology report, Intra operative clinical Regular
photograph, Detailed Operative notes and Procedur No No No Surgical
discharge summary. e
Histopath, Intra procedure clinical photograph, Regular
detailed discharge summary, Detailed Procedur No No No Surgical
Operative notes e
Histopath, Intra procedure clinical photograph, Regular
detailed discharge summary and Detailed Procedur No No No Surgical
Operative notes e
Regular
Intra procedure clinical photograph, detailed
Procedur No No No Surgical
discharge summary, Detailed Operative notes
e
Intra procedure clinical photograph, detailed Regular
discharge summary and Detailed Operative Procedur No No No Surgical
notes e
Histopath, Intra procedure clinical photograph, Regular
detailed discharge summary and Detailed Procedur No No No Surgical
Operative notes e
Histopath, Intra procedure clinical photograph, Regular
detailed discharge summary, Detailed Procedur No No No Surgical
Operative notes e

Post procedure clinical photograph, detailed Regular

discharge summary Detailed Operative notes, Procedur No No No Surgical
Invoice of Mesh used e
Post procedure clinical photograph, detailed Regular
discharge summary Detailed Operative notes, Procedur No No No Surgical
Invoice of Mesh used e
Post procedure clinical photograph, detailed Regular
discharge summary Detailed Operative notes, Procedur No No No Surgical
Invoice of Mesh used e
Post procedure clinical photograph, detailed Regular
discharge summary Detailed Operative notes, Procedur No No No Surgical
Invoice of Mesh used e
Post procedure clinical photograph, detailed Regular
discharge summary Detailed Operative notes, Procedur No No No Surgical
Invoice of Mesh used e
Post procedure clinical photograph, detailed Regular
discharge summary Detailed Operative notes Procedur No No No Surgical
+/- Invoice of Mesh used e

Post procedure clinical photograph, detailed Regular

discharge summary Detailed Operative notes Procedur No No No Surgical
+/- Invoice of Mesh used e

Post procedure clinical photograph, detailed Regular

discharge summary Detailed Operative notes Procedur No No No Surgical
+/- Invoice of Mesh used e
Post procedure clinical photograph, detailed Regular
discharge summary Detailed Operative notes Procedur No No No Surgical
+/- Invoice of Mesh used e
Post procedure clinical photograph, detailed Regular
discharge summary Detailed Operative notes Procedur No No No Surgical
+/- Invoice of Mesh used e
Regular
Intra procedure clinical photograph, Detailed
Procedur No No No Surgical
Operative notes & discharge summary
e
Regular
Intra procedure clinical photograph, Detailed
Procedur No No No Surgical
Operative notes & discharge summary
e
Regular
Intra procedure clinical photograph, Detailed
Procedur No No No Surgical
Operative notes & discharge summary
e
Regular
Intra procedure clinical photograph, Detailed
Procedur No No No Surgical
Operative notes & discharge summary
e
Regular
Intra operative clinical photograph, Detailed
Procedur No No No Surgical
Operative notes; detailed discharge summary.
e
Regular
Intra operative clinical photograph, Detailed
Procedur No No No Surgical
Operative notes; detailed discharge summary.
e
Regular
Histopath, detailed Operative notes, Detailed
Procedur No No No Surgical
discharge summary
e
Histopath, Intra procedure clinical photograph, Regular
Detailed Operative notes and detailed Procedur No No No Surgical
discharge summary e
Histopath, Intra operative clinical photograph, Regular
Detailed Operative notes, Detailed discharge Procedur No No No Surgical
summary e
Histopath, Intra operative clinical photograph, Regular
Detailed Operative notes, Detailed discharge Procedur No No No Surgical
summary e
Detailed discharge summary, Detailed Regular
Operative notes. Since this is microsurgery Procedur No No No Surgical
evaluate time taken (2 hours+) e
Histopath, Intra operative clinical photograph, Regular
Detailed Operative notes, Detailed discharge Procedur No No No Surgical
summary e
Histopath, Intra procedure clinical photograph Regular
detailed discharge summary, Detailed Procedur No No No Surgical
Operative notes e
Regular
Post procedure clinical photograph, Detailed
Procedur No No No Surgical
Operative notes, Detailed discharge summary
e
Histopath, Post procedure clinical photograph, Regular
Detailed Operative notes, Detailed discharge Procedur No No No Surgical
summary e
Histopath, Post procedure clinical photograph, Regular
Detailed Operative notes, Detailed discharge Procedur No No No Surgical
summary e
Histopath, Post procedure clinical photograph, Regular
Detailed Operative notes, Detailed discharge Procedur No No No Surgical
summary e
Histopath, Post procedure clinical photograph, Regular
Detailed Operative notes; detailed discharge Procedur No No No Surgical
summary e
Histopath, Post procedure clinical photograph, Regular
Detailed Operative notes; detailed discharge Procedur No No No Surgical
summary
Post procedure Nasal Endoscopy and post e
Regular
procedure clinical photograph OR Intra
Procedur No No No Surgical
procedure clinical photograph, detailed
e
discharge
Histopath, summary, Detailed
Post procedure Operative
clinical notes
photograph, Regular
Detailed Operative notes, detailed discharge Procedur No No No Surgical
summary Intra procedure clinical photograph
Histopath, e
Regular
OR Post procedure clinical photograph,
Procedur No No No Surgical
detailed discharge summary, Detailed
e
Operative notesreport, post procedure clinical
Histopathology Regular
photograph, Detailed Operative notes & Procedur No No No Surgical
detailed discharge summary. e
Intra procedure clinical photograph, Detailed Regular
Operative notes, Histopathology, Detailed Procedur No No No Surgical
discharge summary e
Histopath report, Post procedure clinical Regular
photograph, Detailed Operative notes, Procedur No No No Surgical
Detailed discharge summary e
Histopath report, Post procedure clinical Regular
photograph, Detailed Operative notes, Procedur No No No Surgical
Detailed discharge summary e
Histopath report, Post procedure clinical Regular
photograph, Scar Photo, Detailed discharge Procedur No No No Surgical
summary, Detailed Operative notes e
Histopathology, Intra procedure clinical Regular
photograph, Detailed discharge summary,, Procedur No No No Surgical
Detailed Operative notes e
Histopathology, Intra procedure clinical Regular
photograph, Detailed discharge summary,, Procedur No No No Surgical
Detailed Operative notes e
Histopath, Post procedure clinical photograph, Regular
Detailed Operative notes, Detailed discharge Procedur No No No Surgical
summary e
Regular
Intra procedure clinical photograph, detailed
Procedur No No No Surgical
discharge summary, Detailed Operative notes
e
Histopathology report, intra operative clinical Regular
photograph, Detailed Operative notes & Procedur No No No Surgical
detailed discharge summary. e
Histopath, Post procedure clinical photograph, Regular
Detailed Operative notes; detailed discharge Procedur No No No Surgical
summary e
Regular
Histopath, detailed discharge summary,
Procedur No No No Surgical
Detailed Operative notes
e
Regular
Histopath, Detailed Operative notes, Detailed
Procedur No No No Surgical
discharge summary
e
Analysis report of drained fluid; post Regular
procedure clinical photograph, Detailed Procedur No No No Surgical
Operative notes; Detailed discharge summary e
Pus C/S, Post procedure X Ray, Post Regular
procedure clinical photograph, Detailed Procedur No No No Surgical
Operative notes, detailed discharge summary e
Post procedure clinical photograph, Detailed Regular
Operative notes, Intra procedure clinical Procedur No No No Surgical
photograph, Detailed discharge summary e
Regular
Histopathology, Detailed discharge summary
Procedur No No No Surgical
and Detailed Operative notes
e
Intra procedure clinical photograph, Detailed Regular
Operative notes, histopath, Detailed discharge Procedur No No No Surgical
summary, Scar Photo e
Intra procedure clinical photograph, Detailed Regular
Operative notes, histopath, Detailed discharge Procedur No No No Surgical
summary, Scar Photo e
Intra procedure clinical photograph, Detailed Regular
Operative notes, histopath, Detailed discharge Procedur No No No Surgical
summary, Scar Photo
Post procedure clinical photograph, Detailed e
Regular
Operative notes, Intra procedure clinical
Procedur No No No Surgical
photograph, Detailed discharge summary,
e
Histopathology
C/S report of Wound or Pus, Intra operative Regular
clinical photograph, Detailed Operative notes Procedur No No No Surgical
& detailed discharge summary. e
Histopath, Post procedure clinical photograph, Regular
Detailed Operative notes, detailed discharge Procedur No No No Surgical
summary e
Histopath, Post procedure clinical photograph, Regular
Detailed Operative notes, detailed discharge Procedur No No No Surgical
summary e
Histopath, Post procedure clinical photograph, Regular
Detailed Operative notes, detailed discharge Procedur No No No Surgical
summary e
Regular
Post procedure clinical photograph, Detailed
Procedur No No No Surgical
Operative notes, Detailed discharge summary
e
Regular
Post procedure clinical photograph, Detailed
Procedur No No No Surgical
Operative notes, Detailed discharge summary
e
 Regular
Post procedure clinical photograph, Detailed
Procedur No No No Surgical
Operative notes, Detailed discharge summary
Intra procedure clinical photograph, Post e
Regular
procedure clinical photograph (if flap taken
Procedur No No No Surgical
from other site; even of donor site), Detailed
e
Operative notes, Detailed discharge summary Regular
Post procedure clinical photograph, Detailed
Procedur No No No Surgical
Operative notes, Detailed discharge summary
e
Regular
Post procedure clinical photograph, Detailed
Procedur No No No Surgical
Operative notes, Detailed discharge summary
e
Regular
Post procedure clinical photograph, Detailed
Procedur No No No Surgical
Operative notes, Detailed discharge summary
e
Regular
Post procedure clinical photograph, Detailed
Procedur No No No Surgical
Operative notes, detailed discharge summary
e
Intra procedure clinical photograph, Post Regular
procedure clinical photograph, Detailed Procedur No No No Surgical
Operative notes, Detailed discharge summary e
Histopathology report, post procedure clinical Regular
photograph, Detailed Operative notes, Procedur No No No Surgical
Detailed discharge summary. e
Regular
Post Procedure clinical photograph, Detailed
Procedur No No No Surgical
Operative notes, Detailed discharge summary
e
Regular
Detailed discharge summary, Post procedure
Procedur No No No Surgical
clinical photograph, Detailed Operative notes
e
Regular
Histopathology report, post procedure clinical
Procedur No No No Surgical
photograph, Detailed Operative notes
e
Regular
Pic of specimen, Histopathology report,
Procedur No No No Surgical
discharge summary
e
Regular
Pic of specimen, Histopathology report,
Procedur No No No Surgical
discharge summary
e
Regular
Pic of specimen, Histopathology report,
Procedur No No No Surgical
discharge summary
e
Regular
Pic of specimen, Histopathology report,
Procedur No No No Surgical
discharge summary
e -
Follow
Up
Invoice / Receipt of drugs and consumables Yes Yes No Medical
Procedur
Follow
e -
Up
Invoice / Receipt of drugs and consumables Yes Yes No Medical
Procedur
Post procedure clinical photograph, Detailed e
Regular
Operative notes, detailed discharge summary Procedur No No No Surgical
and relevant imaging study for comparison e
Regular
Clinical note/Procedure note and Detailed
Procedur No No No Medical
Discharge summary
e
Regular
Clinical note/Procedure note and Detailed
Procedur No No No Medical
Discharge summary
e
 Regular
Clinical note/Procedure note and Detailed
Procedur No No No Medical
Discharge summary
e
Regular
Clinical note/Procedure note and Detailed
Procedur No No No Medical
Discharge summary
Histopathology report, post procedure clinical e
Regular
photograph of affected part, detailed
Procedur No No No Surgical
Procedure / Operative Notes and detailed
Histopathology report, post procedure clinical e
discharge summary. Regular
photograph of affected part, detailed
Procedur No No No Surgical
Procedure / Operative Notes and detailed
Histopathology report, Post procedure e
discharge summary. Regular
Imaging, post procedure clinical photograph of
Procedur No No No Surgical
affected part, detailed Procedure / Operative
Histopathology e
Notes; detailed report, Post
discharge procedure
summary Regular
Imaging, post procedure clinical photograph of
Procedur No No No Surgical
affected part, detailed Procedure / Operative
Histopathology e
Notes; detailed report, Post
discharge procedure
summary Regular
Imaging, post procedure clinical photograph of
Procedur No No No Surgical
affected part, detailed Procedure / Operative
Histopathology e
Notes; detailed report, Post
discharge procedure
summary Regular
Imaging, post procedure clinical photograph of
Procedur No No No Surgical
affected part, detailed Procedure / Operative
e
Notes; detailed
C/S of pus, postdischarge
proceduresummary
clinical photograph Regular
of affected part, detailed Procedure / Procedur No No No Surgical
Operative Notes; detailed discharge summary e
C/S of pus, post procedure clinical photograph Regular
of affected part, detailed Procedure / Procedur No No No Surgical
Operative Notes; detailed discharge summary e
Regular
Discharge summary Procedur No No No Surgical
e
Regular
Discharge summary Procedur No No No Surgical
e
Post- op Clinical Photograph showing implant Regular
for fixation and repairs; detailed discharge Procedur No No No Surgical
summary, Detailed
Post- op Clinical operatives&notes
Photograph X-rays e
Regular
showing craniotomy evidence and implant for
Procedur No No No Surgical
fixation; detailed discharge summary, Detailed
Post- op Clinical e
operatives notes Photograph & X-rays Regular
showing craniotomy evidence and implant for
Procedur No No No Surgical
fixation; detailed discharge summary, Detailed
Post- op Clinical e
operatives notes Photograph & X-rays Regular
showing craniotomy evidence and implant for
Procedur No No No Surgical
fixation; detailed discharge summary, Detailed
Post- op Clinical e
operatives notes Photograph & X-rays Regular
showing craniotomy evidence and implant for
Procedur No No No Surgical
fixation; detailed discharge summary, Detailed
Intra- op Clinical e
operatives notes Photograph & X-rays Regular
showing chest injury repair and implant for
Procedur No No No Surgical
fixation; detailed discharge summary, Detailed
Intra- op Clinical e
operatives notes Photograph & X-rays Regular
showing chest injury repair and implant for
Procedur No No No Surgical
fixation; detailed discharge summary, Detailed
Intra- op Clinical e
operatives notes Photograph & X-rays Regular
showing visceral injury repair and implant for
Procedur No No No Surgical
fixation; detailed discharge summary, Detailed
e
operatives notes
Intra- op Clinical Photograph & X-rays
Regular
showing visceral injury repair and implant for
Procedur No No No Surgical
fixation; detailed discharge summary, Detailed
e
operatives
Post- notes Photograph showing implant
op Clinical Regular
for fixation; detailed discharge summary, Procedur No No No Surgical
Detailed operatives notes e
Post- op Clinical Photograph showing implant Regular
for fixation and flap cover; detailed discharge Procedur No No No Surgical
summary, Detailed operatives notes e
Intra- op Clinical Photograph showing tendon/ Regular
nerve injury repair and reconstruction; detailed Procedur No No No Surgical
discharge summary, Detailed operatives notes e
Regular
Intra operative still photograph, detailed
Procedur No No No Surgical
discharge summary, Detailed operatives notes
e
Regular
Intra operative still photograph, detailed
Procedur No No No Surgical
discharge summary, Detailed operatives notes
e
Regular
Intra operative still photograph, detailed
Procedur No No No Surgical
discharge summary, Detailed operatives notes
e
Regular
Intra operative still photograph, detailed
Procedur No No No Surgical
discharge summary, Detailed operatives notes
e
Regular
Intra operative still photograph, detailed
Procedur No No No Surgical
discharge summary, Detailed operatives notes
e
Regular
Intra operative still photograph, detailed
Procedur No No No Surgical
discharge summary, Detailed operatives notes
e
Regular
Intra operative still photograph, detailed
Procedur No No No Surgical
discharge summary, Detailed operatives notes
e
Regular
Detailed procedure notes, detailed discharge
Procedur No No No Surgical
summary.
e
Regular
Detailed procedure notes, detailed discharge
Procedur No No No Surgical
summary.
e
Regular
Detailed procedure notes, detailed discharge
Procedur No No No Surgical
summary.
e
Regular
Detailed procedure notes, detailed discharge
Procedur No No No Surgical
summary.
e
Regular
Detailed procedure notes, detailed discharge
Procedur No No No Surgical
summary.
e
Regular
Detailed procedure notes, detailed discharge
Procedur No No No Surgical
summary.
e
Regular
Detailed discharge summary and operative
Procedur No No No Surgical
notes
e
Detailed Operative notes, Detailed discharge Regular
summary, Photograph of Removed Foreign Procedur No No No Surgical
body e
Regular
Detailed discharge summary, Detailed
Procedur No No No Surgical
Operation notes, HPE of SOL
e
 Regular
Detailed procedure notes. Detailed discharge
Procedur No No No Surgical
summary
e
 Reserve
d
Day
Procedu
Care
re
Procedu
(Insuran
re (Y/N)
ce/Trust
No )

Yes

No

No

No

No

No

No

No

No

No

No

No

No

No

No

No

No

No
No

No

No

No

No

No

No

No

No

No

No

No

No

No

No

No

No

No

No

No
No

No

No

No

No

No

No

No

No

No

No

No

Yes

Yes

Yes

Yes

Yes

No

No

No
No

No

No

No

No

No

No

No

No

No

No

No

No

No

No

No

No

No

No
No

No

No

No

No

No

No

No

No

No

No

No

No

No

No

No

Yes

Yes
Yes

No

No

No

No

No

No

No

Yes

No

No

No

No

No

No

No

No

No

No

No
No

No

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No
 AB PM - Acute
AB PM - ICHI
Specialt Procedu Package Treatme Multiple Procedu Pyrexia
Febrile
Specialt JAY JAY Procedu
Infectiou y Code re Code Code Treatme
nt of Procedu re Code of
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y Package Procedu
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 Can
No. of
Implants more
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ation Special tion tion
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Criteria Consum implant Care d
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No No No No NA NA Yes
Yes 1.00 No No No No No NA NA Yes
Yes 1.00 No No No No No NA NA Yes
Yes 1.00 No No No No No NA NA Yes
No 0.00 Yes No No No No NA NA No
 Mandato Reserve
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Negative Special Special d
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items
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notes
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used, used,
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notes
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Notes
notes notes
 Stimulati Stimulati
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Package Package
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 Can
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Yes 1.00 No No No No No Secondary NA No
No 1.00 No No No No No Secondary NA No
Yes 1.00 No No No No No Secondary NA No
No 0.00 No No No No No Secondary 0% No
No 0.00 No No No No No Secondary 100% No
No 0.00 No No No No No Secondary 100% No
history
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 •requiring Babies SNCU/NICU:
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 Can
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1,500 No 0.00 No No No No No Tertiary 100%
15,000 No 0.00 No No No No No Tertiary 500%
5,000 No 0.00 No No No No No Tertiary 200%
 examiant
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 Reserve
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 Specialty Procedure Package Multiple
Code Code Code AB PM - JAY Procedure
Specialty HBP 2.0 HBP 1.0 HBP 2.0 Package Name s

Bilateral
Obstetrics & Gynecology SO New Package SC030 salpingoophorectomy Yes

Bilateral
Obstetrics & Gynecology SO New Package SC030 salpingoophorectomy Yes

Obstetrics & Gynecology SO New Package SC032 Radical Hysterectomy Yes

Obstetrics & Gynecology SO New Package SC032 Radical Hysterectomy Yes

Obstetrics & Gynecology SO New Package SC032 Radical Hysterectomy Yes

Obstetrics & Gynecology SO New Package SC032 Radical Hysterectomy Yes

Obstetrics & Gynecology SO New Package SC032 Radical Hysterectomy Yes

Obstetrics & Gynecology SO New Package SC032 Radical Hysterectomy Yes

Obstetrics & Gynecology SO New Package SC032 Radical Hysterectomy Yes

 Vulvectomy +
reconstruction
Obstetrics & Gynecology SO New Package SC034 procedures No

Obstetrics & Gynecology SO New Package SC035 Radical Trachelectomy No

Closure of Burst
Obstetrics & Gynecology SO S100092 SG036 Abdomen No

Obstetrics & Gynecology SO New Package SG096 Biopsy Yes

Obstetrics & Gynecology SO New Package SG096 Biopsy Yes

Obstetrics & Gynecology SO New Package SG096 Biopsy Yes

Obstetrics & Gynecology SO New Package SG096 Biopsy Yes

Obstetrics & Gynecology SO New Package SG096 Biopsy Yes

Lap. Salpingo-
Obstetrics & Gynecology SO New Package SO001 oophrectomy No
Laparotomy and
proceed for Ovarian
Cancers. Omentomy
with Bilateral Salpingo-
Obstetrics & Gynecology SO S400008 SO002 oophorectomy No
 Laparoscopic tubal
surgeries
(for any indication
including ectopic
Obstetrics & Gynecology SO S400028 SO003 pregnancy) No

Procedure on Fallopian
Tube for establishing
Obstetrics & Gynecology SO New Package SO004 Tubal Patency No

Laparotomy for broad

Obstetrics & Gynecology SO S400051 SO005 ligament haematoma No

Obstetrics & Gynecology SO S400002 SO006 Abdominal Myomectomy No

Hysteroscopic
Obstetrics & Gynecology SO S400030 SO007 myomectomies No

Obstetrics & Gynecology SO S200001 SO008 Polypectomy No

Hysteroscopic
Obstetrics & Gynecology SO S400032 SO009 polypectomy No

Obstetrics & Gynecology SO New Package SO010 Hysterectomy Yes

Obstetrics & Gynecology SO S400001 SO010 Hysterectomy Yes

Obstetrics & Gynecology SO S400009 SO010 Hysterectomy Yes

Obstetrics & Gynecology SO S400010 SO010 Hysterectomy Yes

Obstetrics & Gynecology SO S400023 SO010 Hysterectomy Yes

Obstetrics & Gynecology SO New Package SO010 Hysterectomy Yes

Caesarean
Obstetrics & Gynecology SO S400035 SO011 hysterectomy No

Obstetrics & Gynecology SO New Package SO012 Manchester Repair No

Surgeries for Prolapse -

Obstetrics & Gynecology SO S400003 SO013 Sling Surgeries No

Obstetrics & Gynecology SO New Package SO014 Hysterotomy No

Lap. Surgery for

Endometriosis
(Other than
Obstetrics & Gynecology SO New Package SO015 Hysterectomy) No

Obstetrics & Gynecology SO New Package SO016 Diagnostic hysteroscopy Yes

Obstetrics & Gynecology SO New Package SO016 Diagnostic hysteroscopy Yes

 Hysteroscopic IUCD
Obstetrics & Gynecology SO S400033 SO017 removal No

D&C
Obstetrics & Gynecology SO S400068 SO018 (Dilatation&curretage) No

Dilation and Evacuation

Obstetrics & Gynecology SO S400017 SO019 (D&E) No

Obstetrics & Gynecology SO New Package SO020 Pyometra drainage No

Obstetrics & Gynecology SO S400079 SO021 Intrauterine transfusions No

Hysteroscopic
Obstetrics & Gynecology SO S400031 SO022 adhesiolysis No

Laparoscopic
Obstetrics & Gynecology SO S400027 SO023 adhesiolysis No

Trans - vaginal tape /

Obstetrics & Gynecology SO S400052 SO024 Trans-obturator tape Yes

Trans - vaginal tape /

Obstetrics & Gynecology SO S400052 SO024 Trans-obturator tape Yes

Sacrocolpopexy
Obstetrics & Gynecology SO S400012 SO025 (Abdominal) Yes
 Sacrocolpopexy
Obstetrics & Gynecology SO S400012 SO025 (Abdominal) Yes

LLETZ (including PAP

Obstetrics & Gynecology SO S400015 SO026 smear and colposcopy) No

Vaginal Sacrospinus
Obstetrics & Gynecology SO New Package SO027 fixation with repair No

Excision of Vaginal
Obstetrics & Gynecology SO S400074 SO028 Septum (vaginal route) No

Hymenectomy for
Obstetrics & Gynecology SO S400075 SO029 imperforate hymen No

Anterior & Posterior

Obstetrics & Gynecology SO New Package SO030 Colpoperineorrhapy No

Vaginoplasty (McIndoe
Obstetrics & Gynecology SO S400014 SO031 procedure) No

Vaginal repair for

Obstetrics & Gynecology SO S400011 SO032 vesico-vaginal fistula No

Rectovaginal fistula
Obstetrics & Gynecology SO S400013 SO033 repair No

Vulval Hamatoma
Obstetrics & Gynecology SO New Package SO034 drainage No
Obstetrics & Gynecology SO S400020 SO035 Vulvectomy simple No

Radical Vulvectomy with

Inguinal and Pelvic
Obstetrics & Gynecology SO S1500044 SO036 lymph node disection No

Abdomino Perineal
repair for Mullerian
Obstetrics & Gynecology SO New Package SO037 Anomaly No

Pelvic Abscess
Management including
Obstetrics & Gynecology SO S100105 SO038 Colpotomy No

Diagnostic / Staging
Obstetrics & Gynecology SO New Package SO039 laparoscopy No

Laparotomy for benign

Obstetrics & Gynecology SO New Package SO040 disorders Yes

Laparotomy for benign

Obstetrics & Gynecology SO New Package SO040 disorders Yes

Laparoscopic
Obstetrics & Gynecology SO S400025 SO041 cystectomy No

Cystocele - Anterior
Obstetrics & Gynecology SO S400065 SO042 repair No

Obstetrics & Gynecology SO S400004 SO043 Burch Yes

Obstetrics & Gynecology SO S400004 SO043 Burch Yes

Electro Cauterisation /
Obstetrics & Gynecology SO S400070 SO044 Cryo Surgery No

EUA for (minor girls /

unmarried sexually
inactive / victims of
Obstetrics & Gynecology SO New Package SO045 sexual abuse) No

Hospitalisation for
Obstetrics & Gynecology SO New Package SO046 Antenatal Complications No

Obstetrics & Gynecology SO S400076 SO047 Amniocentesis No

Obstetrics & Gynecology SO S400077 SO048 Chorionic villus sampling No

Obstetrics & Gynecology SO S400078 SO049 Cordocentesis No

Obstetrics & Gynecology SO S400048 SO050 McDonald's stitch No

Obstetrics & Gynecology SO S400049 SO051 Shirodkar's stitch No

Medical management of
Obstetrics & Gynecology SO New Package SO052 ectopic pregnancy No
Obstetrics & Gynecology SO S400047 SO053 Medical Termination of P Yes

Obstetrics & Gynecology SO S400046 SO053 Medical Termination of P Yes

Obstetrics & Gynecology SO S400045 SO053 Medical Termination of P Yes

Obstetrics & Gynecology SO S400036 SO054 High risk delivery Yes

Obstetrics & Gynecology SO S400038 SO054 High risk delivery Yes

Obstetrics & Gynecology SO S400040 SO054 High risk delivery Yes

Obstetrics & Gynecology SO S400041 SO054 High risk delivery Yes

Obstetrics & Gynecology SO S400042 SO054 High risk delivery Yes

Manual removal of
Obstetrics & Gynecology SO S400043 SO055 placenta No

Secondary suturing of
Obstetrics & Gynecology SO S400073 SO056 episiotomy No
Obstetrics & Gynecology SO S400034 SO057 Caesarean Delivery No

Re exploration after
laparotomy / Caesarean
Obstetrics & Gynecology SO New Package SO058 Section Yes

Re exploration after
laparotomy / Caesarean
Obstetrics & Gynecology SO New Package SO058 Section Yes

Vulvo vaginal cyst

Obstetrics & Gynecology SO S400063 SO059 enucleation / drainage Yes

Vulvo vaginal cyst

Obstetrics & Gynecology SO New Package SO059 enucleation / drainage Yes

Obstetrics & Gynecology SO New Package SO060KL Normal Vaginal delivery No

Uretero-vaginal / Uterine
Obstetrics & Gynecology SO S700048 SU029 fistula repair Yes

Uretero-vaginal / Uterine
Obstetrics & Gynecology SO S700048 SU029 fistula repair Yes

Uretero-vaginal / Uterine
Obstetrics & Gynecology SO S700049 SU029 fistula repair Yes

Uretero-vaginal / Uterine
Obstetrics & Gynecology SO S700049 SU029 fistula repair Yes
 Urethrovaginal fistula
Obstetrics & Gynecology SO S700087 SU075 repair No

Radical Retroperitoneal
Obstetrics & Gynecology SO S700142 SU090 lymph node dissection Yes

Radical Retroperitoneal
Obstetrics & Gynecology SO S700143 SU090 lymph node dissection Yes

Hysterectomy as part of
VVF / uterovaginal
Obstetrics & Gynecology SO New Package SU092 fistula repair No
 No. of
Stratificat
ion
ICHI criteria
Procedure Procedu Stratificatio which
Code AB PM - JAY re / ICD Package n Criteria can be
HBP 2.0 Procedure Name Code Price (Y/N) booked

SC030A Open XXX 21,000 No 0.00

SC030B Lap. XXX 21,000 No 0.00

Class I radical hysterectomy +

bilateral salpingoophorectomy
SC032A + BPLND - Lap. XXX 27,000 No 0.00

Class I radical hysterectomy +

bilateral salpingoophorectomy
SC032B + BPLND - Open XXX 50,000 No 0.00

Class I radical Hysterectomy

+/- bilateral
SC032C salpingoophorectomy - Lap. XXX 27,000 No 0.00

Class I radical Hysterectomy

+/- bilateral
SC032D salpingoophorectomy - Open XXX 27,000 No 0.00

Class II radical hysterctomy +

SC032E BPLND XXX 27,000 No 0.00

Class III radical hysterctomy +

SC032F BPLND XXX 27,000 No 0.00

Hysterectomy + bilateral
salpingoophorectomy +
omentectomy + peritonectomy
SC032G and organ resections XXX 34,000 No 0.00
 Vulvectomy + reconstruction
SC034A procedures XXX 36,000 No 0.00

SC035A Radical Trachelectomy XXX 40,000 No 0.00

SG036A Closure of Burst Abdomen XXX 15,000 No 0.00

SG096A Lymph Node XXX 5,000 No 0.00

SG096B Endometrial Aspiration XXX 2,000 No 0.00

Cervix Cancer screening

SG096C (PAP + Colposcopy) XXX 1,500 No 0.00

SG096D Cervical (Neck) XXX 1,500 No 0.00

SG096E Vulval XXX 1,500 No 0.00

SO001A Lap. Salpingo-oophrectomy XXX 14,000 No 0.00

Laparotomy and proceed for

Ovarian Cancers. Omentomy
with Bilateral Salpingo-
SO002A oophorectomy XXX 38,000 No 0.00
 Laparoscopic tubal surgeries
(for any indication including
SO003A ectopic pregnancy) XXX 13,900 No 0.00

Procedure on Fallopian Tube

SO004A for establishing Tubal Patency XXX 15,000 No 0.00

Laparotomy for broad

SO005A ligament haematoma XXX 16,000 No 0.00

SO006A Abdominal Myomectomy XXX 20,000 No 0.00

SO007A Hysteroscopic myomectomies XXX 9,900 No 0.00

SO008A Polypectomy XXX 8,550 No 0.00

SO009A Hysteroscopic polypectomy XXX 8,050 No 0.00

SO010A Abdominal Hysterectomy XXX 20,000 No 0.00

Abdominal Hysterectomy +
SO010B Salpingo-oophorectomy XXX 20,000 No 0.00

Non descent vaginal

SO010C hysterectomy XXX 20,000 No 0.00
 Vaginal hysterectomy with
anterior and posterior
SO010D colpoperineorrhaphy XXX 22,000 No 0.00

Laparoscopic hysterectomy
SO010E (TLH) XXX 25,000 No 0.00

Laparoscopically assisted
SO010F vaginal hysterectomy (LAVH) XXX 20,000 No 0.00

SO011A Caesarean hysterectomy XXX 22,000 No 0.00

SO012A Manchester Repair XXX 17,000 No 0.00

Surgeries for Prolapse - Sling

SO013A Surgeries XXX 28,900 No 0.00

SO014A Hysterotomy XXX 5,000 No 0.00

Lap. Surgery for

Endometriosis
SO015A (Other than Hysterectomy) XXX 11,200 No 0.00

SO016A With biopsy XXX 6,000 No 0.00

SO016B Without biopsy XXX 6,000 No 0.00

SO017A Hysteroscopic IUCD removal XXX 4,700 No 0.00

SO018A D&C (Dilatation&curretage) XXX 3,000 No 0.00

SO019A Dilation and Evacuation (D&E) XXX 5,100 No 0.00

SO020A Pyometra drainage XXX 5,000 No 0.00

SO021A Intrauterine transfusions XXX 11,000 No 0.00

SO022A Hysteroscopic adhesiolysis XXX 6,900 No 0.00

SO023A Laparoscopic adhesiolysis XXX 6,000 No 0.00

SO024A Trans-vaginal tape XXX 15,200 No 0.00

SO024B Trans-obturator tape XXX 15,200 No 0.00

SO025A Open XXX 23,900 No 0.00

SO025B Lap. XXX 23,900 No 0.00

LLETZ (including PAP smear

SO026A and colposcopy) XXX 15,000 No 0.00

Vaginal Sacrospinus fixation

SO027A with repair XXX 15,000 No 0.00

Excision of Vaginal Septum

SO028A (vaginal route) XXX 14,500 No 0.00

Hymenectomy for imperforate

SO029A hymen XXX 7,000 No 0.00

Anterior & Posterior

SO030A Colpoperineorrhapy XXX 14,000 No 0.00

Vaginoplasty (McIndoe
SO031A procedure) XXX 11,000 No 0.00

Vaginal repair for vesico-

SO032A vaginal fistula XXX 34,000 No 0.00

SO033A Rectovaginal fistula repair XXX 24,000 No 0.00

SO034A Vulval Hamatoma drainage XXX 3,000 No 0.00

SO035A Vulvectomy simple XXX 15,000 No 0.00

Radical Vulvectomy with

Inguinal and Pelvic lymph
SO036A node disection XXX 38,500 No 0.00

Abdomino Perineal repair for

SO037A Mullerian Anomaly XXX 20,000 No 0.00

Pelvic Abscess Management

SO038A including Colpotomy XXX 10,000 No 0.00

Diagnostic / Staging
SO039A laparoscopy XXX 9,700 No 0.00

SO040A Ectopic XXX 14,000 No 0.00

SO040B PID XXX 14,000 No 0.00

SO041A Laparoscopic cystectomy XXX 15,000 No 0.00

SO042A Cystocele - Anterior repair XXX 12,000 No 0.00

SO043A Abdominal XXX 35,000 No 0.00

SO043B Laparoscopic XXX 35,000 No 0.00

Electro Cauterisation / Cryo

SO044A Surgery XXX 4,000 No 0.00

EUA for (minor girls /

unmarried sexually inactive /
SO045A victims of sexual abuse) XXX 2,000 No 0.00

Hospitalisation for Antenatal

SO046A Complications XXX - Yes 1.00

SO047A Amniocentesis XXX 14,500 No 0.00

SO048A Chorionic villus sampling XXX 14,500 No 0.00

SO049A Cordocentesis XXX 14,500 No 0.00

SO050A McDonald's stitch XXX 5,000 No 0.00

SO051A Shirodkar's stitch XXX 4,000 No 0.00

Medical management of
SO052A ectopic pregnancy XXX - Yes 1.00
SO053A MTP upto 8 weeks XXX 3,500 No 0.00

SO053B MTP 8 to 12 weeks XXX 5,000 No 0.00

SO053C MTP > 12 weeks XXX 6,500 No 0.00

SO054A Pre-mature delivery XXX 11,500 No 0.00

Mothers with eclampsia /

imminent eclampsia / severe
SO054B pre-eclampsia XXX 11,500 No 0.00

Major Fetal malformation

requiring intervention
SO054C immediately after birth XXX 11,500 No 0.00

Mothers with severe anaemia

SO054D (<7 g/dL)
Other maternal and fetal XXX 11,500 No 0.00
conditions as per guidelines-
eg previous caesarean
section, diabetes, severe
growth retardation, etc that
SO054E qualify for high risk delivery. XXX 11,500 No 0.00

SO055A Manual removal of placenta XXX 8,500 No 0.00

Secondary suturing of
SO056A episiotomy XXX 2,500 No 0.00
 SO057A Caesarean Delivery XXX 12,000 No 0.00

Re exploration after
SO058A Caesarean Section XXX 14,000 No 0.00

Re exploration after
SO058B laparotomy XXX 14,000 No 0.00

SO059A Vulvo vaginal cyst enucleation XXX 4,700 No 0.00

SO059B Vulvo vaginal cyst drainage XXX 4,700 No 0.00

SO060KLA Normal Vaginal delivery XXX 7,000 No 0.00

Uretero - vaginal fistula repair

SU029A - Open XXX 27,000 No 0.00

Uretero - Uterine fistula repair

SU029B - Open XXX 27,000 No 0.00

Uretero - vaginal fistula repair

SU029C - Laparoscopic XXX 37,000 No 0.00

Uretero - Uterine fistula repair

SU029D - Laparoscopic XXX 37,000 No 0.00
SU075A Urethrovaginal fistula repair XXX 30,000 No 0.00

SU090A Open XXX 36,500 No 0.00

SU090B Lap. XXX 36,500 No 0.00

Hysterectomy as part of VVF /

SU092A uterovaginal fistula repair XXX 5,000 No 0.00
 Can more
than one
type of Reservat Reservat
implant ion ion
be Special Public Tertiary
Implants / High End booked Conditions Hospital Hospital
Consumables (Y/N) (Y/N) (Y/N) s (Y/N) s (Y/N) Level of Care LOS

No No No Yes No Tertiary 500%

No No No Yes No Tertiary 500%

No No No Yes No Tertiary 1100%

No No No Yes No Tertiary 1100%

No No No Yes No Tertiary 600%

No No No Yes No Tertiary 600%

No No No Yes No Tertiary 1100%

No No No Yes No Tertiary 1100%

No No No Yes No Tertiary 1300%

No No No Yes No Tertiary 1100%

No No No Yes No Tertiary 1100%

No No No No No Secondary 600%

No No No No No Secondary 100%

No No No No No Secondary 100%

No No No No No Secondary 100%

No No No No No Secondary 100%

No No No No No Secondary 100%

No No No No No Secondary 300%

No No No No Yes Secondary 500%

No No No No No Secondary 300%

No No No No No Secondary 500%

No No No No No Secondary 300%

No No No No No Secondary 500%

No No No No No Secondary 100%

No No No No No Secondary 100%

No No No No No Secondary 200%

No No No No No Secondary 500%

No No No No No Secondary 500%

No No No No No Secondary 400%
No No No No No Secondary 500%

No No No No No Secondary 500%

No No No No No Secondary 500%

No No No No No Secondary 500%

No No No No No Secondary 500%

Yes No No No Yes Tertiary 500%

No No No No No Secondary 100%

No No No No No Secondary 200%

No No No No No Secondary 100%

No No No No No Secondary 100%
No No No Yes No Secondary 100%

No No No No No Secondary 100%

No No No No No Secondary 100%

No No No No No Secondary 300%

No No No No Yes Secondary 100%

No No No No No Secondary 100%

No No No No No Secondary 100%

Yes No No No No Secondary 100%

Yes No No No No Secondary 100%

Yes No No No No Secondary 700%

Yes No No No No Secondary 700%

No No No No No Secondary 300%

No No No No No Secondary 500%

No No No No Yes Secondary 100%

No No No No No Secondary 100%

No No No No No Secondary 500%

No No No No Yes Secondary 300%

No No No No Yes Secondary 500%

No No No No Yes Secondary 300%

No No No No No Secondary 100%
No No No No No Secondary 300%

No No No No Yes Secondary 300%

No No No No Yes Secondary 500%

No No No No No Secondary 100%

No No No No No Secondary 300%

No No No No No Secondary 500%

No No No No No Secondary 500%

No No No No No Secondary 500%

No No No No No Secondary 300%

No No No No Yes Secondary 500%

No No No No Yes Secondary 500%

No No No No No Secondary 100%

No No No No No Secondary 100%

No No No No No Secondary NA

No No No No Yes Secondary 100%

No No No No Yes Secondary 100%

No No No No Yes Secondary 100%

No No No No No Secondary 100%

No No No No No Secondary 100%

No No No No No Secondary 500%
No No No No No Secondary 100%

No No No No No Secondary 100%

No No No No No Secondary 100%

No No No No No Secondary 300%

No No No No No Secondary 300%

No No No No No Secondary 300%

No No No No No Secondary 300%

No No No No No Secondary 300%

No No Yes No No Secondary 200%

No No No No No Secondary 200%
No No No No No Secondary 500%

No No Yes No No Secondary 500%

No No Yes No No Secondary 500%

No No No No No Secondary 100%

No No No No No Secondary 100%

No No No No No Secondary 2

No No No No No Tertiary 300%

No No No No No Tertiary 300%

No No No No No Tertiary 200%

No No No No No Tertiary 200%
No No No No No Tertiary 200%

No No No No No Tertiary 300%

No No No No No Tertiary 300%

No No No No No Tertiary 0%
 Auto
Approved
(Y/N) Mandatory Documents - Pre Authorization

No Clinical notes with planned line of treatment, HPE

No Clinical notes with planned line of treatment, HPE

Clinical notes with planned line of treatment and

No Biopsy, CECT/ MRI

Clinical notes with planned line of treatment and

No Biopsy, CECT/ MRI

Clinical notes with planned line of treatment and

No Biopsy, CECT/ MRI

Clinical notes with planned line of treatment and

No Biopsy, CECT/ MRI

Clinical notes with planned line of treatment and

No Biopsy, CECT/ MRI

Clinical notes with planned line of treatment and

No Biopsy, CECT/ MRI

Clinical notes with planned line of treatment and

No Biopsy, CECT/ MRI
 Clinical notes with planned line of treatment,
No Biopsy/HPE

No Clinical notes and CECT, biopsy

Clinical notes describing the original surgery that

led to burst abdomen and X Ray/USG/ CT
Abdomen confirming the diagnosis for which the
Yes surgery is done

Clinical notes and Clinical Photograph of

No Enlarged lymph nodes +/- FNAC report

No Clinical notes with supporting investigations

Yes Clinical notes with supporting investigations

No Clinical notes with supporting investigations

No Clinical notes with supporting investigations

Clinical notes establishing indication, USG

No Abdomen Pelvis/ CT/ MRI abdomen Pelvis

Clinical notes and USG Abdomen + Pelvis/ CT

Yes abdomen+ Pelvis establishing indication
 Clinical notes establishing indication for the
Yes procedure, USG uterus & adnexa, Beta HCG

Indication of the procedure preferably with record

of previous sterilization/ reason for non-
No availability

Clinical notes with physical examination findings

Yes supported by evidence of hematoma (USG)

Clinical notes establishing indication, USG

Yes Abdomen Pelvis/ MRI abdomen. Pap smear

physical examination findings with indications for

Yes the procedure. USG pelvis / MRI Pelvis

Clinical notes with planned line of treatment

(including System Examination) and Relavant
Investigations (USG Abdomen + Pelvis/ CT
Yes abdomen+ Pelvis),

Admission Notes comprising of history and

examination with indications for the procedure,
Relavant Investigations (establishing
Yes diagnosis),USG
Admission Notesshowing polyp
comprising of history and
examination with indications for the
Clinical notes with notes
procedure,Clinical plannedwithline of treatment
planned line of
(including System Examination)
treatment (clearly indicating medical and Relavant
Investigations
management tried(USG Abdomen
and failed or+not Pelvis/ CT If
indicated.
No abdomen+ Pelvis) confirming the indication
failed documents proving duration of treatment
and failure. The medical management should
have been tried for atleast 4-6 months covering 1
course of
Clinical hormone
notes cycle) and
with planned lineUSG Abdomen +
of treatment
Pelvis/ CT/
(clearly MRI abdomen+
indicating Pelvis confirming
medical management the
tried and
Yes indication,
failed or notPap smear, IfEB/EAC
indicated. failed documents
proving duration of treatment and failure. The
medical management should have been tried for
atleast 4-6 months covering 1 course of hormone
cycle), USG Abdomen + Pelvis, Pap smear,
Yes EB/EAC
 Clinical notes with planned line of treatment
(clearly indicating medical management tried and
failed or not indicated with reason. If failed
documents proving duration of treatment and
failure. The medical management should have
been tried for atleast 4-6 months covering 1
course of hormone cycle), Photographic
documentation with patient’s consent, Pap smear
Yes ( EB/EAC is optional )
Admission Notes comprising of history and
examination(clearly indicating medical
Clinical notes tried
management with planned
and failedline
or of
nottreatment
indicated,and
USGreason.
with Abdomen + Pelvis/
If failed CT abdomen+
documents proving Pelvis
duration
Yes confirming
of treatmenttheandindication
failure. The medical
management
Admission should
Notes have been
comprising tried forand
of history atleast
4-6 months covering 1 course of
examination (clearly indicating medical hormone
cycle) , USG Abdomen
management + Pelvis/
tried and failed MRI
or not abdomen+
indicated with
Pelvis confirming the indication, Pap smear,
reason. If failed documents proving duration of
No EB/EAC
treatment and failure. The medical management
should have been tried for atleast 4-6 months
covering 1 course of hormone cycle), detailed
Ante natal care records/ reasons for non-
availability of ANC records. Per op clinical pic is
Yes optional

Admission Notes comprising of history and

examination with indications for the
procedure,Relavant Investigations (establishing
No diagnosis),
Admission Notes comprising of history and
examination with indications for the
procedure,Relavant Investigations (establishing
diagnosis) ; Photographic documentation of
degree/severity of prolapse with patient’s
Yes consent,Pap
Admission smear.
Notes comprising of history and
examination with indications for the
procedure,Relavant Investigations (establishing
diagnosis), USG - Obstetric confirming the above
package. Has medicolegal compliance been
No done?

Admission Notes comprising of history and

examination, Relavant Investigations
(establishing diagnosis) USG/ CT/ MRI/
No laparoscopy findings

Admission Notes comprising of history and

examination with indications for the procedure,
Relavant Investigations (establishing
Yes diagnosis),USG uterus & adnexa

Admission Notes comprising of history and

examination with indications for the procedure,
Relavant Investigations (establishing
Yes diagnosis),USG uterus & adnexa
 Clinical notes with details of IUCD insertion
(reason for non availability of details), indication
Yes for removing IUCD, USG showing misplaced IUD

Admission Notes comprising of history and

examination with indications for the
procedure,Relavant Investigations (establishing
Yes diagnosis), (USG Abdomen + Pelvis)- optional

Admission Notes comprising of history and

examination with indications for the
procedure,Relavant Investigations (establishing
Yes diagnosis),USG abdomen and pelvis)

Admission Notes comprising of history and

examination with indications for the
procedure,Relavant Investigations (establishing
No diagnosis)

Admission Notes comprising of history and

examination with indications for the
procedure,Relavant Investigations (establishing
Yes diagnosis)
Admission Notes comprising of history and
examination with indications for the procedure,
Relavant Investigations (establishing
diagnosis),USG Abdomen Pelvis / CT/MRI
Yes Abdomen Pelvis

Admission Notes comprising of history and

examination, Relavant Investigations
(establishing diagnosis), USG Abdomen/ Pelvis
Yes (CT abdomen- Optional)

Admission Notes comprising of history and

examination with indications for the
procedure,Relavant Investigations (establishing
Yes diagnosis)

Admission Notes comprising of history and

examination with indications for the
procedure,Relavant Investigations (establishing
Yes diagnosis)
Admission Notes comprising of history and
examination with indications for the
procedure,Relavant Investigations (establishing
diagnosis) , Photographic documentation with
Yes patient’s consent.
 Admission Notes comprising of history and
examination with indications for the
procedure,Relavant Investigations (establishing
diagnosis) , Photographic documentation with
Yes patient’s consent.
Admission Notes comprising of history and
examination with indications for the
procedure,Relavant Investigations (establishing
diagnosis) , Evidence of cervical pre-cancer
(PAP smear) Colposcopiy. Cervical Biopsy is
Yes optional

Admission Notes comprising of history and

examination with indications for the
procedure,Relavant Investigations (establishing
No diagnosis),
Admission Notes comprising of history and
examination with indications for the
procedure,Relavant Investigations (establishing
diagnosis), need of procedure (USG Abdomen +
Yes Pelvis)

Admission Notes comprising of history and

examination with indications for the procedure
Yes and need of procedure

Admission Notes comprising of history and

examination with indications for the
procedure,Relavant Investigations (establishing
No diagnosis), clinical pic if feasible
Admission Notes comprising of history and
examination with indications for the
procedure,Relavant Investigations (establishing
diagnosis), need of procedure (USG Abdomen +
Yes Pelvis)
Admission Notes comprising of history and
examination with indications for the
procedure,Relavant Investigations (establishing
diagnosis) and Cystoscopy/ Cystourethroscopy.
Yes Voiding Cystourethrogram is optional.

Admission Notes comprising of history and

examination with indications for the
procedure,Relavant Investigations (establishing
Yes diagnosis)

Admission Notes comprising of history and

examination with indications for the
procedure,Relavant Investigations (establishing
No diagnosis),
 Admission Notes comprising of history and
examination with indications for the
procedure,Relavant Investigations (establishing
diagnosis) with Evidence (biopsy). Clinical pic if
Yes patient permits

Admission Notes comprising of history and

examination with indications for the procedure,
Relavant Investigations (establishing
No diagnosis),vulval biopsy, CT/MRI for staging

Admission Notes comprising of history and

examination with indications for the
procedure,Relavant Investigations (establishing
No diagnosis), (USG/ CT/ MRI)

Admission Notes comprising of history and

examination with indications for the
procedure,Relavant Investigations (establishing
Yes diagnosis) , USG Abdomen & Pelvis

Admission Notes comprising of history and

examination, Relavant Investigations
Yes (establishing diagnosis)

Admission Notes comprising of history and

examination with indications for the
procedure,Clinical notes establishing ruptured
Yes ectopic with Evidence of beta hCG & USG

Admission Notes comprising of history and

examination with indications for the
procedure,Clinical notes establishing ruptured
No ectopic with Evidence of beta hCG & USG

Admission Notes comprising of history and

examination, Relavant Investigations
(establishing diagnosis), USG Abdomen Pelvis/
Yes CT abdomen.

Admission Notes comprising of history and

examination with findings establishing Cystocoele
Yes . Clinical pic if feasible

Admission Notes comprising of history and

examination with indications for the
procedure,Relavant Investigations (establishing
Yes diagnosis) ; Urodynamic studies are optional.
 Admission Notes comprising of history and
examination with indications for the
procedure,Relavant Investigations (establishing
Yes diagnosis) ; Urodynamic studies are optional.

Admission Notes comprising of history and

examination with indications for the
procedure,Relavant Investigations (establishing
Yes diagnosis), pap smear- optional
Admission Notes comprising of history and
examination with indications for the
procedure,Relavant Investigations (establishing
diagnosis), and parental consent (incase of
No minor girls)

Admission Notes comprising of history and

examination with indications for the
procedure,Relavant Investigations (establishing
No diagnosis),

Consulting notes giving the indication for

amniocentesis; does the hospital have fetal
Yes medicine expert?

Admission Notes comprising of history and

examination with indications for the
procedure,Relavant Investigations (establishing
Yes diagnosis),

Admission Notes comprising of history and

examination with indications for the
procedure,Relavant Investigations (establishing
Yes diagnosis),

Admission Notes comprising of history and ANC

findings justifying cervical incompetence and the
Yes procedure.

Admission Notes comprising of history and ANC

findings justifying cervical incomptenecs and the
Yes procedure.

Admission Notes comprising of history and

examination with indications for the
procedure,Relavant Investigations (establishing
No diagnosis),
 Admission Notes comprising of history and
examination with indications for the
procedure,Relavant Investigations (establishing
diagnosis), USG - Obstetric confirming the above
package. Has medicolegal compliance been
Yes done?
Admission Notes comprising of history and
examination with indications for the
procedure,Relavant Investigations (establishing
diagnosis), USG - Obstetric confirming the above
package. Has medicolegal compliance been
Yes done?
Admission Notes comprising of history and
examination with indications for the
procedure,Relavant Investigations (establishing
diagnosis), USG - Obstetric confirming the above
package. Has medicolegal compliance been
Yes done?
Admission Notes comprising of history and
detailed Ante natal care records/ reasons for
non-availability of ANC records. Obstetric USG.
All high risk deliveries are to be clubbed & case
No specific documents required.
Admission Notes comprising of history and
detailed Ante natal care records/ reasons for
non-availability of ANC records. Obstetric USG.
All high risk deliveries are to be clubbed & case
No specific documents required.
Admission Notes comprising of history and
detailed Ante natal care records/ reasons for
non-availability of ANC records. Obstetric USG.
All high risk deliveries are to be clubbed & case
No specific documents required.
Admission Notes comprising of history and
detailed Ante natal care records/ reasons for
non-availability of ANC records. Obstetric USG.
All high riskNotes
Admission deliveries are to be
comprising clubbedand
of history & case
No specific documents required.
detailed Ante natal care records with special
reference to investigations supporting the
diagnosis/ reasons for non-availability of ANC
records. Obstetric USG. All high risk deliveries
are to be clubbed & case specific documents
No required.

Clinical notes documenting need of manual

removal of placenta/ use of Active Management
Yes of Third Stage of Labor (AMTSL)
Admission Notes comprising of history detailing
when was first surgery done? and examination
with indications for the procedure, Physical
examination findings with indications for the
Yes procedure.
 Admission Notes comprising of history and
examination with detailed Ante natal care
records/ reasons for non-availability of ANC
records. Indications for the procedure. USG
Obstetrics with Doppler is case specific &
Yes optional. Labor charting, CTG if available.

Admission Notes comprising of history and

examination with indications for the
procedure,Relavant Investigations (establishing
No diagnosis) , USG

Admission Notes comprising of history and

examination with indications for the
procedure,Relavant Investigations (establishing
No diagnosis) , USG

Admission Notes comprising of history and

examination with indications for the procedure,
Yes Relavant Investigations (establishing diagnosis)

Admission Notes comprising of history and

examination with indications for the procedure,
No Relavant Investigations (establishing diagnosis)

Yes Admission notes and Investigative reports

Clinical notes and IVP/ CT-IVP + cystoscopy and

vaginoscopy Scopy confirming the diagnosis for
Yes which the surgery is done,

Clinical notes and IVP/ CT-IVP + cystoscopy and

vaginoscopy Scopy confirming the diagnosis for
Yes which the surgery is done,

Clinical notes and IVP/ CT-IVP + cystoscopy and

vaginoscopy Scopy confirming the diagnosis for
Yes which the surgery is done,

Clinical notes and IVP/ CT-IVP + cystoscopy and

vaginoscopy Scopy confirming the diagnosis for
Yes which the surgery is done,
 Clinical notes and urethro Cystoscopy
Yes +vaginoscopy +USG confirming the diagnosis

Clinical notes and USG/CT / Biopsy confirming

Yes bilateral testicular cancer

Clinical notes and USG/CT / Biopsy confirming

Yes bilateral testicular cancer

Clinical notes and Cystoscopy+vaginoscopy+CT

No - IVP/IVP +/- cystogram confirming the diagnosis
 Enhance
Proc Special ment
edur Conditi applicab
e on – le
Lab Pop – Special Conditions Or not
Mandatory Documents - Claim Processing el Up (Y/N) – Rule (Y/N) (Y/N)
Reg
ular
Procedure / Operative Notes, Post Procedure Proc
Photographs of surgical site, HPE report, Detailed edur
Discharge Summary e No No No
Reg
ular
Procedure / Operative Notes, Post Procedure Proc
Photographs of surgical site, HPE report, Detailed edur
Discharge Summary e No No No
Reg
ular
Procedure / Operative Notes, Post Procedure Proc
Photographs of surgical site, HPE report, Detailed edur
Discharge Summary e No No No
Reg
ular
Procedure / Operative Notes, Post Procedure Proc
Photographs of surgical site, HPE report, Detailed edur
Discharge Summary e No No No
Reg
ular
Procedure / Operative Notes, Post Procedure Proc
Photographs of surgical site, HPE report, Detailed edur
Discharge Summary e No No No
Reg
ular
Procedure / Operative Notes, Post Procedure Proc
Photographs of surgical site, HPE report, Detailed edur
Discharge Summary e No No No
Reg
ular
Procedure / Operative Notes, Post Procedure Proc
Photographs of surgical site, HPE report, Detailed edur
Discharge Summary e No No No
Reg
ular
Procedure / Operative Notes, Post Procedure Proc
Photographs of surgical site, HPE report, Detailed edur
Discharge Summary e No No No
Reg
ular
Procedure / Operative Notes, Post Procedure Proc
Photographs of surgical site, HPE report, Detailed edur
Discharge Summary e No No No
 Reg
ular
Proc
Procedure / Operative Notes, HPE report, Detailed edur
Discharge Summary e No No No
Reg
ular
HPE report, detailed Procedure / Operative Notes. Proc
Detailed discharge summary , Post procedure edur
Clinical photgraph showing scar e No No No
Reg
ular
Proc
Intra procedure clinical photograph, Detailed edur
Operative notes, detailed discharge summary e No No No
Reg
ular
Proc
Histopathology report, post procedure clinical edur
photograph, Detailed Operative notes e No No No
Reg
ular
Proc
Pic of specimen, Histopathology report, discharge edur
summary e No No No
Reg
ular
Proc
Pic of specimen, Histopathology report, discharge edur
summary e No No No
Reg
ular
Proc
Pic of specimen, Histopathology report, discharge edur
summary e No No No
Reg
ular
Proc
Pic of specimen, Histopathology report, discharge edur
summary e No No No

Reg
ular
Detailed Operative notes,HPE Pic of specimen. Proc
Intraop stills with date & patient ID, Detailed edur
discharge summary e No No No
Reg
ular
Proc
Histopathology, Detailed Operative notes, per op pic edur
of specimen removed, Detailed Discharge Summary. e No No No
 Reg
ular
Detailed Operative notes, HPE if ectopic pregnancy Proc
or salpingectomy for any other indication, Detailed edur
discharge summary e No No No
Reg
ular
Proc
Detailed discharge summary; Detailed Operative edur
notes. Intra procedure clinical photograph e No No No
Reg
ular
Proc
Detailed discharge summary; Detailed Operative edur
notes. Intra procedure clinical photograph e No No No
Reg
ular
Detailed Operative notes,HPE, Pic of specimen Proc
removed- Gross and Histopathology, Detailed edur
discharge summary e No No No
Reg
ular
Proc
Detailed Operative notes, HPE, Intraop stills with edur
date & patient ID, Detailed discharge summary e No No No
Reg
ular
Procedure / Operative Notes, Intraop. Stills,Pic of Proc
specimen, Histopathology report, Detailed Discharge edur
Summary e No No No
Reg
Detailed Procedure / Operative Notes together with ular
indication of surgery, Intraop. stills with date & Proc
patient ID, pic off gross specimen removed , edur
HPE,Progress notes,detailed discharge summary. e No No No
Reg
ular
Proc
Histopathology, Detailed Discharge Summary with edur
Procedure / Operative Notes e No No No
Reg
Detailed Procedure / Operative Notes together with ular
indication of surgery, Intraop. stills with date & Proc
patient ID, pic off gross specimen removed , edur
HPE,Progress notes,detailed discharge summary. e No No No
Reg
Detailed Procedure / Operative Notes together with ular
indication of surgery, Intraop. stills with date & Proc
patient ID, pic off gross specimen removed , HPE, edur
Progress notes,detailed discharge summary. e No No No
 Reg
Detailed Procedure / Operative Notes together with ular
indication of surgery, Intraop. stills with date & Proc
patient ID, pic off gross specimen removed , HPE, edur
Progress notes,detailed discharge summary. e No No No
Reg
ular
Proc
Histopathology, Detailed Discharge Summary with edur
Detailed operative notes e No No No
Reg
Detailed Procedure / Operative Notes together with ular
indication of surgery, Intraop. stills with date & Proc
patient ID, pic off gross specimen removed , HPE, edur
Progress notes,detailed discharge summary. e No No No
Detailed Procedure / Operative Notes. Histopath of Reg
uterus removed, per op pic of specimen removed; ular
status of the child at the time of delivery and at the Proc
time of discharge; progress notes,Detailed discharge edur
summary e No No No
Reg
ular
Proc
Detailed Procedure / Operative Notes, Intraop. Stills, edur
Progress notes, Detailed discharge summary e No No No
Reg
ular
Detailed Procedure / Operative Notes, Intraop. Proc
stills ,Barcode of sling used; progress notes,Detailed edur
discharge summary e No No No
Reg
ular
Detailed Procedure / Operative Notes, Intraop. stills Proc
with date & patient ID, HPE of specimen,Progress edur
notes, Detailed discharge summary e No No No
Reg
Detailed Procedure / Operative Notes together with ular
indication of surgery, Intraop. stills with date & Proc
patient ID, pic off gross specimen removed , HPE, edur
Progress notes,detailed discharge summary. e No No No
Detailed Procedure / Operative Notes together with Reg
indication of surgery, Intraop. stills with date & ular
patient ID, pic off gross specimen removed , HPE of Proc
biopsy specimen,Progress notes, Detailed discharge edur
summary e No No No
Detailed Procedure / Operative Notes together with Reg
indication of surgery, Intraop. stills with date & ular
patient ID, pic off gross specimen removed , HPE of Proc
biopsy specimen,Progress notes, Detailed discharge edur
summary e No No No
 Reg
Detailed Procedure / Operative Notes together with ular
indication of surgery, Intraop. stills with date & Proc
patient ID, pic off gross specimen removed , edur
HPE,Progress notes,detailed discharge summary. e No No No
Reg
ular
Detailed Procedure / Operative Notes, Intraop. Stills, Proc
Histopathology of curetted material, Progress notes, edur
Detailed discharge summary e No No No
Reg
ular
Detailed Procedure / Operative Notes, Intraop. Proc
Stills,Histopathology of evacuated material, Progress edur
notes, Detailed discharge summary e No No No
Reg
ular
Proc
Detailed Procedure / Operative Notes, Intraop. Stills, edur
Progress notes, Detailed discharge summary e No No No
Reg
ular
Proc
Detailed Procedure / Operative Notes, Intraop. Stills, edur
Progress notes, Detailed discharge summary e No No No
Reg
Detailed Procedure / Operative Notes together with ular
indication of surgery, Intraop. stills with date & Proc
patient ID, pic off gross specimen removed , edur
Stan
HPE,Progress notes,detailed discharge summary. e
d No No No
Alon
Detailed Procedure / Operative Notes together with e
indication of surgery, Intraop. stills with date & Proc
patient ID, pic off gross specimen removed , HPE, edur
Progress notes,detailed discharge summary. e No No No
Reg
ular
Detailed Procedure / Operative Notes, Barcode of Proc
TVT/TOT tape used; progress notes,Detailed edur
discharge summary e No No No
Reg
ular
Detailed Procedure / Operative Notes, Barcode of Proc
TVT/TOT tape used; progress notes,Detailed edur
discharge summary e No No No
Reg
Detailed Procedure / Operative Notes, Intraop. stills ular
with date & patient ID, Barcode of mesh used; Proc
progress notes,Detailed discharge summary edur
summary e No No No
 Reg
Detailed Procedure / Operative Notes, Intraop. stills ular
with date & patient ID, Barcode of mesh used; Proc
progress notes,Detailed discharge summary edur
summary e No No No
Reg
ular
Detailed Procedure / Operative Notes, Intraop. stills Proc
with date & patient ID, HPE of specimen,Progress edur
notes, Detailed discharge summary e No No No
Reg
ular
Proc
Detailed Procedure / Operative Notes, Intraop. Stills, edur
Progress notes, Detailed discharge summary e No No No
Reg
ular
Proc
Detailed Procedure / Operative Notes, Intraop. Stills, edur
Progress notes, Detailed discharge summary e No No No
Reg
ular
Proc
Detailed Procedure / Operative Notes, Intraop. Stills, edur
Progress notes, Detailed discharge summary e No No No
Reg
ular
Proc
Detailed Procedure / Operative Notes, Intraop. Stills, edur
Progress notes, Detailed discharge summary e No No No
Reg
ular
Proc
Detailed Procedure / Operative Notes, Intraop. Stills, edur
Progress notes, Detailed discharge summary e No No No
Reg
ular
Detailed Procedure / Operative Notes, Intraop. stills Proc
with date & patient ID, Progress notes,detailed edur
discharge summary.detailed discharge summary. e No No No
Reg
ular
Detailed Procedure / Operative Notes, Intraop. stills Proc
with date & patient ID, Progress notes,detailed edur
discharge summary. e No No No
Reg
ular
Proc
Detailed Procedure / Operative Notes, Intraop. Stills, edur
Progress notes, Detailed discharge summary e No No No
 Reg
ular
Detailed Procedure / Operative Notes, Intra Proc
procedure clinical photograph/ stills, histopathology; edur
progress notes,Detailed discharge summary e No No No
Reg
Detailed Procedure / Operative Notes together with ular
indication of surgery, Intraop. stills with date & Proc
patient ID, pic off gross specimen removed , HPE, edur
Progress notes,detailed discharge summary. e No No No
Reg
ular
Proc
Detailed Procedure / Operative Notes, Intraop. Stills, edur
Progress notes, Detailed discharge summary e No No No
Reg
ular
Detailed Procedure / Operative Notes, Intra Proc
procedure clinical photograph/ stills; progress edur
notes,Detailed discharge summary e No No No
Reg
Detailed Procedure / Operative Notes together with ular
indication of surgery, Intraop. stills with date & Proc
patient ID, pic off gross specimen removed , HPE, edur
Progress notes,detailed discharge summary. e No No No
Reg
Detailed Procedure / Operative Notes together with ular
indication of surgery, Intraop. stills with date & Proc
patient ID, pic off gross specimen removed , edur
HPE,detailed discharge summary. e No No No
Reg
Detailed Procedure / Operative Notes together with ular
indication of surgery, Intraop. stills with date & Proc
patient ID, pic off gross specimen removed , edur
HPE,detailed discharge summary. e No No No
Reg
Detailed Procedure / Operative Notes together with ular
indication of surgery, Intraop. stills with date & Proc
patient ID, pic off gross specimen removed , HPE, edur
Progress notes,detailed discharge summary. e No No No
Reg
ular
Proc
Detailed Procedure / Operative Notes, Intraop. Stills, edur
Progress notes, Detailed discharge summary e No No No
Reg
ular
Proc
Detailed Procedure / Operative Notes; Intraop. edur
stills ,progress notes,Detailed discharge summary e No No No
 Reg
ular
Proc
Detailed Procedure / Operative Notes; Intraop. edur
stills ,progress notes,Detailed discharge summary e No No No
Reg
ular
Proc
Detailed Procedure / Operative Notes, Intraop. Stills, edur
Progress notes, Detailed discharge summary e No No No
Reg
ular
Proc
Detailed Procedure / Operative Notes, Intraop. Stills, edur
Progress notes, Detailed discharge summary e No No No
Reg
ular
Proc
Detailed Procedure / Operative Notes, Intraop. Stills, edur
Progress notes, Detailed discharge summary e No No Yes
Reg
ular
Detailed Procedure / Operative Notes, Intraop. Proc
Stills, ; Amniotic fluid analysis report; Progress notes, edur
Detailed discharge summary e No No No
Reg
ular
Procedure / Operative Notes with report of chorionic Proc
villi sampling; Progress notes, Detailed discharge edur
summary e No No No
Reg
ular
Detailed Procedure / Operative Notes, Intraop. Stills, Proc
report of cordocentesis; Progress notes, Detailed edur
discharge summary e No No No
Reg
ular
Proc
Detailed Procedure / Operative Notes, Intraop. Stills, edur
Progress notes, Detailed discharge summary e No No No
Reg
ular
Proc
Detailed Procedure / Operative Notes, Intraop. Stills, edur
Progress notes, Detailed discharge summary e No No No
Reg
ular
Proc
Detailed Procedure / Operative Notes, Intraop. Stills, edur
Progress notes, Detailed discharge summary e No No Yes
 Reg
ular
Detailed Procedure / Operative Notes, Intraop. stills , Proc
HPE of specimen,Progress notes, Detailed discharge edur
summary e No No No
Reg
ular
Detailed Procedure / Operative Notes, Intraop. stills , Proc
HPE of specimen,Progress notes, Detailed discharge edur
summary e No No No
Reg
ular
Detailed Procedure / Operative Notes, Intraop. stills , Proc
HPE of specimen,Progress notes, Detailed discharge edur
summary e No No No
Reg
Detailed delivery notes, PNC notes along with ular
relevant investigation details; status of the child at Proc
the time of delivery and at the time of discharge; edur
progress notes, Detailed discharge summary. e No No No
Reg
Detailed delivery notes, PNC notes along with ular
relevant investigation details; status of the child at Proc
the time of delivery and at the time of discharge; edur
progress notes, Detailed discharge summary. e No No No
Reg
Detailed delivery notes, PNC notes along with ular
relevant investigation details; status of the child at Proc
the time of delivery and at the time of discharge; edur
progress notes, Detailed discharge summary. e No No No
Reg
Detailed delivery notes, PNC notes along with ular
relevant investigation details; status of the child at Proc
the time of delivery and at the time of discharge; edur
progress notes, Detailed discharge summary. e No No No
Reg
Detailed delivery notes, PNC notes along with ular
relevant investigation details; status of the child at Proc
the time of delivery and at the time of discharge; edur
progress notes, Detailed discharge summary. e No No No
Reg
ular
Detailed Procedure / Operative Notes,stills of Proc
placenta, progress note Detailed discharge edur
summary; Post natal course e No Yes No
Reg
ular
Proc
Detailed Procedure / Operative Notes, Intraop. Stills, edur
Progress notes, Detailed discharge summary e No No No
 Reg
Detailed Procedure / Operative Notes, status of the ular
child at the time of delivery and at the time of Proc
discharge; progress notes,Detailed discharge edur
summary e No No No
Reg
ular
Detailed Procedure / Operative Notes, Intra Proc
procedure clinical photograph/ stills; progress edur
notes,Detailed discharge summary e No Yes No
Reg
ular
Detailed Procedure / Operative Notes, Intra Proc
procedure clinical photograph/ stills; progress edur
notes,Detailed discharge summary e No Yes No
Reg
ular
Proc
Detailed operative notes, discharge summary, edur
histopathology report of tissue removed e No No No
Reg
ular
Proc
edur
Detailed operative notes, discharge summary e No No No
Reg
ular
Proc
edur
Procedure Note with Discharge Summary e No No No
Reg
ular
Proc
Intra procedure still photograph,Detailed discharge edur
summary, detailed Procedure / Operative Notes e No No No
Reg
ular
Proc
Intra procedure still photograph,Detailed discharge edur
summary, detailed Procedure / Operative Notes e No No No
Reg
ular
Proc
Intra procedure still photograph,Detailed discharge edur
summary, detailed Procedure / Operative Notes e No No No
Reg
ular
Proc
Intra procedure still photograph,Detailed discharge edur
summary, detailed Procedure / Operative Notes e No No No
 Reg
ular
Proc
Detailed Procedure / Operative Notes, detailed edur
discharge summary. e No No No
Reg
ular
Proc
Histopathology, Detailed discharge summary, edur
detailed Procedure / Operative Notes e No No No
Reg
ular
Proc
Histopathology, Detailed discharge summary, edur
detailed Procedure / Operative Notes e No No No
Add
- On
Proc
Histopathology, Detailed Procedure / Operative edur
Notes, detailed discharge summary. e No No No
 Res
erve
d
Proc
edur
e
Medical (Ins
or uran
Surgical Day Care ce/T
(S/M) Procedure (Y/N) rust)

Surgical No

Surgical No

Surgical No

Surgical No

Surgical No

Surgical No

Surgical No

Surgical No

Surgical No
Surgical No

Surgical No

Surgical No

Surgical Yes

Surgical Yes

Surgical Yes

Surgical Yes

Surgical Yes

Surgical No

Surgical No
Surgical No

Surgical No

Surgical No

Surgical No

Surgical No

Surgical No

Surgical No

Surgical No

Surgical No

Surgical No
Surgical No

Surgical No

Surgical No

Surgical No

Surgical No

Surgical No

Surgical Yes

Surgical No

Surgical No

Surgical No
Surgical No

Surgical Yes

Surgical Yes

Surgical No

Surgical Yes

Surgical No

Surgical No

Surgical Yes

Surgical Yes

Surgical No
Surgical No

Surgical No

Surgical No

Surgical No

Surgical No

Surgical No

Surgical No

Surgical No

Surgical No

Surgical Yes
Surgical No

Surgical No

Surgical No

Surgical Yes

Surgical No

Surgical No

Surgical No

Surgical No

Surgical No

Surgical No
Surgical No

Surgical Yes

Medical Yes

Medical No

Surgical Yes

Surgical Yes

Surgical Yes

Surgical Yes

Surgical Yes

Medical No
Surgical No

Surgical No

Surgical No

Surgical No

Surgical No

Surgical No

Surgical No

Surgical No

Surgical No

Surgical No
Surgical No

Surgical No

Surgical No

Surgical Yes

Surgical Yes

Medical No

Surgical No

Surgical No

Surgical No

Surgical No
Surgical No

Surgical No

Surgical No

Surgical No
 Specialty Code Procedure Code Package Code
Specialty
HBP 2.0 HBP 1.0 HBP 2.0

Ophthalmology SE S300019 SE001

Ophthalmology SE S300034 SE002

Ophthalmology SE S300035 SE003

Ophthalmology SE S300038 SE004

Ophthalmology SE New Package SE005

Ophthalmology SE S300022 SE006

Ophthalmology SE New Package SE007

Ophthalmology SE S300040 SE008

Ophthalmology SE S300040 SE008

Ophthalmology SE S300033 SE009

Ophthalmology SE S300008 SE010

Ophthalmology SE S300002 SE010

Ophthalmology SE S300002 SE010

Ophthalmology SE New Package SE010

Ophthalmology SE New Package SE011

Ophthalmology SE S300004 SE012

Ophthalmology SE New Package SE012

Ophthalmology SE New Package SE013

Ophthalmology SE S300007 SE014

Ophthalmology SE New Package SE015

Ophthalmology SE New Package SE016

Ophthalmology SE S300021 SE017

Ophthalmology SE S300001 SE018

Ophthalmology SE S300016 SE019

Ophthalmology SE S300031 SE020

Ophthalmology SE S300030 SE020

Ophthalmology SE S300015 SE021

Ophthalmology SE S300015 SE021

Ophthalmology SE New Package SE021

Ophthalmology SE S300003 SE022

Ophthalmology SE New Package SE023

Ophthalmology SE New Package SE024

Ophthalmology SE S300020 SE025

Ophthalmology SE S300024 SE026

Ophthalmology SE S300006 SE027

Ophthalmology SE New Package SE027

Ophthalmology SE S300006 SE027

Ophthalmology SE S300006 SE027

Ophthalmology SE New Package SE028

Ophthalmology SE New Package SE029

Ophthalmology SE New Package SE029

Ophthalmology SE New Package SE030

Ophthalmology SE S300005 SE031

Ophthalmology SE S300028 SE032

Ophthalmology SE S300027 SE033

Ophthalmology SE New Package SE034

Ophthalmology SE S300009 SE035

Ophthalmology SE S300010 SE035

Ophthalmology SE S300036 SE036

Ophthalmology SE S300011 SE037

Ophthalmology SE S300023 SE038

Ophthalmology SE S300039 SE039

Ophthalmology SE New Package SE040

Ophthalmology SE New Package SE041KL

Ophthalmology SE New Package SE042KL

Ophthalmology SE New Package SE043KL

Ophthalmology SE New Package SE044KL

Ophthalmology SE New Package SE045KL

 AB PM - JAY Multiple Procedure Code
Package Name Procedures HBP 2.0

Ptosis Surgery No SE001A

Entropion correction No SE002A

Ectropion correction No SE003A

Lid Tear Repair No SE004A

Lid Abscess Drainage No SE005A

Lid Tumor excision + Lid

No SE006A
Reconstruction

Chalazion Removal No SE007A

Squint correction Yes SE008A

Squint correction Yes SE008B

Conjunctival tumour excision including

No SE009A
Amniotic Membrane Graft

Dacryocystorhinostomy Yes SE010A

Dacryocystorhinostomy Yes SE010B

Dacryocystorhinostomy Yes SE010C

Dacryocystorhinostomy Yes SE010D

Corneal Ulcer Management No SE011A

Corneal Grafting Yes SE012A

Corneal Grafting Yes SE012B

Corneal Collagen Crosslinking No SE013A

Pterygium + Conjunctival Autograft No SE014A

Corneo / Scleral / Corneo scleral tear

No SE015A
repair

Corneal / Scleral Patch Graft No SE016A

Scleral buckling surgery No SE017A

Scleral Buckle Removal No SE018A

Limbal Dermoid Removal No SE019A

Cataract surgery Yes SE020A

Cataract surgery Yes SE020B

Surgery for Pediatric Cataract Yes SE021A

Surgery for Pediatric Cataract Yes SE021B

Surgery for Pediatric Cataract Yes SE021C

Capsulotomy (YAG) No SE022A

SFIOL (inclusive of Vitrectomy) No SE023A

Secondary IOL / IOL Exchange /
No SE024A
Explant

IRIS Prolapse – Repair No SE025A

Iridectomy No SE026A

Glaucoma Surgery Yes SE027A

Glaucoma Surgery Yes SE027B

Glaucoma Surgery Yes SE027C

Glaucoma Surgery Yes SE027D

EUA for Confirmation of Pediatric

No SE028A
Glaucoma

Retinal Laser Photocoagulation Yes SE029A

Retinal Laser Photocoagulation Yes SE029B

ROP Laser - Per Eye No SE030A

Retinal Cryopexy No SE031A

Vitreoretinal Surgery (with Silicon Oil

No SE032A
Insertion)

SOR (Silicon Oil Removal) No SE033A

Endophthalmitis (excluding
No SE034A
Vitrectomy)

Enucleation Yes SE035A

Enucleation Yes SE035B

Evisceration No SE036A

Exenteration No SE037A

Socket Reconstruction including

No SE038A
Amniotic Membrane Graft

Orbitotomy No SE039A

GA / EUA separate add on package No SE040A

Fracture Orbital repair No SE041KLA

Iris cyst removal No SE042KLA

Keratoprosthesis Stage 1&2 No SE043KLA

Tumours of IRIS No SE044KLA

UV radiation for cross linkig for

No SE045KLA
Keratoconus
 AB PM - JAY ICHI Procedure / Package Stratification
Procedure Name ICD Code Price Criteria (Y/N)

Ptosis Surgery XXX 10,000 No

Entropion correction XXX 6,600 No

Ectropion correction XXX 6,500 No

Lid Tear Repair XXX 5,000 No

Lid Abscess Drainage XXX 3,000 No

Lid Tumor excision + Lid

XXX 10,000 No
Reconstruction

Chalazion Removal XXX 2,000 No

Minor - upto 2 muscles XXX 4,000 No

Major - 3 or more muscles

(complex surgery involving four XXX 14,000 No
muscles or oblique muscles)

Conjunctival tumour excision

XXX 7,000 No
including Amniotic Membrane Graft

Canaliculo Dacryocystorhinostomy
XXX 8,000 No
with Silicon Tube / Stent

Canaliculo Dacryocystorhinostomy
XXX 10,000 No
without Silicon Tube / Stent

Dacryocystorhinostomy with Silicon

XXX 8,000 No
Tube / Stent

Dacryocystorhinostomy without
XXX 8,000 No
Silicon Tube / Stent

Corneal Ulcer Management XXX 4,000 No

Corneal Grafting XXX 8,500 No

Corneal Graft - Follow Up XXX 2,000 No

Corneal Collagen Crosslinking XXX 9,000 No

Pterygium + Conjunctival Autograft XXX 7,500 No

Corneo / Scleral / Corneo scleral

XXX 11,500 No
tear repair

Corneal / Scleral Patch Graft XXX 3,000 No

Scleral buckling surgery XXX 15,000 No

Scleral Buckle Removal XXX 7,500 No

Limbal Dermoid Removal XXX 1,000 No

Phaco emulsification with foldable

XXX 4,500 No
hydrophobic acrylic IOL

SICS with non-foldable IOL XXX 4,000 No

Paediatric lensectomy XXX 9,200 No

Pediatric lens aspiration with

posterior capsulotomy & anterior XXX 9,200 No
vitrectomy

Paediatric Membranectomy &

XXX 9,200 No
anterior vitrectomy

Capsulotomy (YAG) XXX 2,225 No

SFIOL (inclusive of Vitrectomy) XXX 15,000 No

Secondary IOL / IOL Exchange /
XXX 2,000 No
Explant

IRIS Prolapse – Repair XXX 5,600 No

Iridectomy XXX 2,000 No

Glaucoma Surgery/
Cyclocryotherapy
(Trabeculectomy only) with or XXX 4,025 No
Cyclophotocoagulation
without Mitomycin C, including
postoperative medications for 12
weeks XXX 11,000 No
(and wherever surgical or laser
procedures required for bleb
augmentation
Glaucoma ShuntandSurgery
anterior chamber XXX 13,000 No
maintenance)

Pediatric Glaucoma Surgery XXX 15,000 No

EUA for Confirmation of Pediatric

XXX 3,000 No
Glaucoma

For retinal tear repair Per Eye Per

XXX 1,500 No
Sitting
Pan Retinal Photocoagulation
(PRP) - Retinal Laser including 3
sittings / package of retino laser XXX 8,500 No
photocoagulation
(3 sittings per eye for both eyes)
ROP Laser - Per Eye XXX 5,000 No

Retinal Cryopexy XXX 5,675 No

Vitreoretinal Surgery (with Silicon

XXX 17,900 No
Oil Insertion)

SOR (Silicon Oil Removal) XXX 9,300 No

Endophthalmitis (excluding
XXX 8,000 No
Vitrectomy)

Without implant XXX 8,400 No

With implant XXX 8,400 No

Evisceration XXX 3,800 No

Exenteration XXX 15,000 No

Socket Reconstruction including

XXX 11,200 No
Amniotic Membrane Graft

Orbitotomy XXX 14,000 No

GA / EUA separate add on package XXX 3,000 No

Fracture Orbital repair XXX 10,500 No

Iris cyst removal XXX 2,500 No

Keratoprosthesis Stage 1&2 XXX 15,000 No

Tumours of IRIS XXX 4,450 No

UV radiation for cross linkig for

XXX 2,250 No
Keratoconus
No. of Stratification criteria Implants / High End Can more than one type of
which can be booked Consumables (Y/N) implant be booked (Y/N)

0.00 No No

0.00 No No

0.00 No No

0.00 No No

0.00 No No

0.00 No No

0.00 No No

0.00 No No

0.00 No No

0.00 Yes No

0.00 Yes No

0.00 No No

0.00 Yes No

0.00 No No

0.00 No No
0.00 No No

0.00 No No

0.00 No No

0.00 No No

0.00 No No

0.00 No No

0.00 No No

0.00 No No

0.00 Yes No

0.00 Yes No

0.00 Yes No

0.00 Yes No

0.00 Yes No

0.00 Yes No

0.00 No No

0.00 Yes No
0.00 Yes No

0.00 No No

0.00 No No

0.00 No No

0.00 No No

0.00 Yes No

0.00 No No

0.00 No No

0.00 No No

0.00 No No

0.00 No No

0.00 No No

0.00 Yes No

0.00 No No

0.00 No No

0.00 No No
0.00 Yes No

0.00 Yes No

0.00 No No

0.00 No No

0.00 No No

0.00 No No

0.00 No No

0.00 No No

0.00 No No

0.00 No No

0.00 No No
 Special Reservation Reservation Level of
LOS
Conditions (Y/N) Public Hospitals (Y/N) Tertiary Hospitals (Y/N) Care

No No No Secondary 100%

No No No Secondary 100%

No No No Secondary 100%

No No No Secondary 100%

No No No Secondary 100%

No No No Secondary 100%

No No No Secondary 100%

No No No Secondary 100%

No No No Secondary 100%

No No No Secondary 100%

No No No Tertiary 100%

No No No Tertiary 100%

No No No Tertiary 100%

No No No Tertiary 100%

No No No Tertiary 500%
Yes No No Tertiary 100%

Yes No No Secondary 100%

No No No Tertiary 100%

No No No Tertiary 100%

No No No Tertiary 200%

No No No Tertiary 300%

No No No Tertiary 100%

Yes No No Tertiary 100%

No No No Tertiary 100%

No No No Secondary 100%

No No No Secondary 100%

No No No Tertiary 100%

No No No Tertiary 100%

No No No Tertiary 100%

Yes No No Tertiary 100%

No No No Tertiary 100%
No No No Secondary 100%

Yes No Yes Secondary 100%

No No No Secondary 100%

No No No Tertiary 100%

No No No Tertiary 100%

No No No Tertiary 300%

No No No Tertiary 400%

No No No Secondary 100%

Yes No No Secondary 100%

Yes No No Secondary 100%

No No No Secondary 100%

No No No Secondary 100%

No No No Secondary 100%

Yes No No Secondary 100%

No No No Secondary 500%

No No No Tertiary 200%
No No No Tertiary 200%

No No No Secondary 100%

No No No Secondary 100%

No No No Tertiary 100%

No No No Tertiary 100%

No No No Secondary 100%

No No No Secondary 200%

No No No Secondary Day Care

No No No Secondary 200%

No No No Secondary 100%

No No No Secondary Day Care

Auto Approved
(Y/N)

No

No

No

No

No

No

No

No

No

No

No

No

No

No

No
No

No

No

No

No

No

No

No

No

No

No

No

No

No

No

No
No

No

No

No

No

No

No

No

No

No

No

No

No

No

No

No
No

No

No

No

No

No

Yes

Yes

Yes

Yes

Yes
 Mandatory Documents - Pre Authorization

Clinical Photograph of affected eye (Photographic record of the patient should be maintained for comparison.
Photographs should have be taken in primary position as well as in lateral gazes)

Clinical notes and Clinical Photograph

Clinical notes and Clinical Photograph

Clinical notes; FIR/MLC in case of accident, Clinical Photograph

Patient details, diagnosis, doctors notes, photo

Clinical notes and Clinical Photograph of affected part, stated plan for lab investigation of host tissue (HP/
Microbiology/other)

Patient details, diagnosis, doctors notes, photo

Clinical notes detailing which muscles affected; indication justifying the need for GA (if required), Clinical Photograph

Clinical notes detailing which muscles affected; indication justifying the need for GA (if required), Clinical Photograph

Clinical notes , Clinical Photograph of affected part

Dye disappearance test , Tear meniscus height measurement, Probing and irrigation

Dye disappearance test , Tear meniscus height measurement, Probing and irrigation

Clinical notes and establishing lacrimal cancer with Evidence of biopsy. Pre-op clinical photograph.

Clinical notes and establishing lacrimal cancer with Evidence of biopsy. Pre-op clinical photograph.

clinical presentation photo

Clinical notes detailing Indication for corneal grafting and supporting investigation, Clinical Photograph; details of don
cornea, stated plan for lab investigation of host tissue (HPE/ Microbiology/other)

clinical notes

PENTACAM PROGRESSION MAPS 3 to 6 months apart

Clinical notes and Retinoscopy, Corneal topography (not mandatory), keratometry, Clinical Photograph

Clinical notes and FIR/MLC (since injury), USG B scan, Clinical Photograph

preoperative clinical photo

Clinical notes

Clinical notes with, Indication for removal, stated plan for lab investigation of host tissue (Microbiology)

Clinical notes and Indication for Limbal Dermoid Removal like increase in dermoid size/ increasing astigmatism/visua
deterioration/central opacification of the cornea) Clinical Photograph

Clinical notes detailing visual impairment (Best corrected visual acquity- BCVA) of cataract and , Ocular Biometry (A
scan and ketometry) and Clinical photo of affected part

Clinical notes detailing visual impairment (Best corrected visual acquity- BCVA) of cataract and , Ocular Biometry (A
scan and ketometry) and Clinical photo of affected part

Clinical notes detailing Indication for Lensectomy /pediatric lens aspiration/ membranectomy and supporting
investigation, Clinical Photograph

Clinical notes detailing Indication for Lensectomy /pediatric lens aspiration/ membranectomy and supporting
investigation, Clinical Photograph

Clinical notes detailing Indication for Lensectomy /pediatric lens aspiration/ membranectomy and supporting
investigation, Clinical Photograph

Clinical notes detailing when was cataract surgery was done and notes mentioning indication for this procedure with
vision and fundus. Clinical photo of patient before procedure

Clinical notes with planned line of treatment, Pre operative Clinical Photograph of affected part
Clinical notes, pre operative documentation of indication for intervention and Clinical Photograph of affected part

Clinical notes, pre operative documentation of indication for intervention and Clinical Photograph of affected part

Clinical notes showing Indication for Iridectomy(Laser), Tonometry, Gonioscopy,and clinical photo

Clinical notes establishing long standing history of Glaucoma with recent documentation of vision and reports of field
vision.

Clinical notes and IOP measurement, documentary evidence supporting chronicity

Clinical notes and IOP measurement, documentary evidence supporting chronicity/ Failed Trabeculectomy

Clinical notes and IOP measurement, documentary evidence of paediatric glaucoma with confirmation of diagnosis
under GA/Examination under anaesthesia (EUA)

Clinical notes and/or documentary evidence

clinical notes and or supportive documents

clinical notes and or supportive documents

Clinical notes

Clinical notes with Indication for procedure

Clinical notes and or Clinical documents, B Scan (optional)

Clinical notes and or Clinical documents, B Scan

Clinical notes with planned line of treatment, Pre operative Clinical Photograph of affected part

Clinical notes establishing Indication and justifying enucleation and supporting investigation, Clinical Photograph;
Recommendation/opinion of 2 ophthalmologists for the procedure
Clinical notes establishing Indication and justifying enucleation and supporting investigation, Clinical Photograph,
Recommendation/opinion of 2 ophthalmologists for the procedure

Indication for Evisceration and supporting investigation report, Clinical Photograph, Recommendation/opinion of 2
ophthalmologists for the procedure, stated plan for lab investigation of host tissue (HP/ Microbiology/other)

Indication for Exenteration and supporting investigation, (Biopsy / CT / MRI establishing indication for Exenteration)
Clinical Photograph, Recommendation/opinion of 2 ophthalmologists for the procedure

Clinical notes and showing Indication for socket reconstruction, Clinical Photograph of affected part

Clinical notes detailing indication and CT Scan, Clinical Photograph, stated plan for lab investigation of host tissue (H
Microbiology/other)

Clinical Notes justifying the need for GA in the associated surgery

Admission notes and Investigative reports

Admission notes and Investigative reports

Admission notes and Investigative reports

Admission notes and Investigative reports

Admission notes and Investigative reports

 Mandatory Documents - Claim Processing

Still image of the the procedure with pt. ID and date, Detailed discharge summary, detailed operative notes.

Detailed discharge summary, Still image of the the procedure with pt. ID and date,operative notes.

Detailed discharge summary, Still image of the the procedure with pt. ID and date,operative notes.

Still image of the the procedure with pt. ID and date,operative notes. Detailed discharge summary

Discharge notes, microbiology report,Still image of the patient undergoing the procedure with date stamp

Still image of the the procedure with pt. ID and date, HP report, Procedure / Operative Notes. Detailed discharge su

Discharge notes, pathology report, Still image of the patient undergoing the procedure with date stamp

Still image of the the procedure with pt. ID and date,Procedure / Operative Notes. Detailed discharge summary

Still image of the the procedure with pt. ID and date,Procedure / Operative Notes. Detailed discharge summary

Still image of the the procedure with pt. ID and date, HP report, detailed discharge summary, detailed Procedure / O

Still image of the the procedure with pt. ID and date, operative notes

Still image of the the procedure with pt. ID and date, operative notes

Still image of the the procedure with pt. ID and date,operative notes. Detailed discharge summary Invoice of implan

Still image of the the procedure with pt. ID and date,operative notes. Detailed discharge summary Invoice of implan

Still image of the patient undergoing the procedure with date stamp
Still image of the the procedure with pt. ID and date,operative notes. Detailed discharge summary

Still image of the patient undergoing the procedure with date stamp

Still image of the patient undergoing the procedure with date stamp

Still image of the the procedure with pt. ID and date, detailed discharge summary, detailed operative notes.

Still image of the the procedure with pt. ID and date, Detailed discharge summary, barcode of Intraocular Lens used

operative notes, Still image of the patient undergoing the procedure with date stamp

operative notes. Detailed discharge summary,Still image of the the procedure with pt. ID and date

Still image of the the procedure with pt. ID and date, operative notes. Detailed discharge summary, microbiological

Still image of the the procedure with pt. ID and date, Detailed discharge summary, detailed operative notes.

Detailed discharge summary, operative notes. Barcode of IOL used. Still image of the the procedure with pt. ID and

Detailed discharge summary, operative notes. Barcode of IOL used. Still image of the the procedure with pt. ID and

Still image of the the procedure with pt. ID and date, Detailed discharge summary, detailed operative notes with visu
Barcode of IOL used

Still image of the the procedure with pt. ID and date, Detailed discharge summary, detailed operative notes with visu
Barcode of IOL used

Still image of the the procedure with pt. ID and date, Detailed discharge summary, detailed operative notes with visu
Barcode of IOL used

procedure notes, Detailed discharge summary, Still image of the the procedure with pt. ID and date

Still image of the patient undergoing the procedure with date stamp operative notes. Detailed discharge summary, B
Still image of the patient undergoing the procedure with date stamp, operative notes. Detailed discharge summary; B

Still image of the patient undergoing the procedure with date stamp, operative notes. Detailed discharge summary

Still image of the the procedure with pt. ID and date, procedure notes. Detailed discharge summary

Detailed Procedure / Operative Notes and discharge summary.

Still image of the the procedure with pt. ID and date ,operative notes. Detailed discharge summary; ensure that pos
12 weeks is given

Still image of the patient undergoing the procedure with date stamp, operative notes. Detailed discharge summary

Still image of the patient undergoing the procedure with date stamp, operative notes. Detailed discharge summary

Still image of the patient undergoing the procedure with date stamp, operative notes. Detailed discharge summary w
IOP,Fundus,Corneal diameter

discharge summary, clinical notes, Still image of the the procedure with pt. ID and date

Still image of the the procedure with pt. ID and date; discharge summary, clinical notes

Discharge summary, Still image of the patient undergoing the procedure with date stamp

Detailed Procedure notes and discharge summary,Still image of the the procedure with pt. ID and date

Detailed discharge summary, operative notes, IOL sticker, Still image of the the procedure with pt. ID and date

Detailed discharge summary, operative notes., sticker of IOL,Still image of the the procedure with pt. ID and date

Still image of the patient undergoing the procedure with date stamp, operative notes. Detailed discharge summary

Intra procedure clinical photograph, detailed discharge summary, ,operative notes, confirmation that specimen was s
histopathology.
Still image of the the procedure with pt. ID and date, detailed discharge summary, ,operative notes. Invoice of impla
declaration that the specimen has been sent for histopathology and report will be sent for filing later

Detailed discharge summary, Still image of the the procedure with pt. ID and date,operative notes, Confirmation/dec
specimen sent for lab investigationmicrobio/path and report will be submitted

Still image of the the procedure with pt. ID and date,operative notes. Histopathological exam report. Detailed discha
confirmation/ declaration that the specimen has been sent for histopathology and report will be sent for filing later

Still image of the the procedure with pt. ID and date,operative notes. Detailed discharge summary

Still image of the the procedure with pt. ID and date, HP Report of actual surgery, operative notes, Lab (Histopath)

Clinical Notes for the associated surgery / disease along with Pre OP, Operative and Anesthesia, Post OP notes

Procedure Note with Discharge Summary

Procedure Note with Discharge Summary

Procedure Note with Discharge Summary

Procedure Note with Discharge Summary

Procedure Note with Discharge Summary

Procedure Special Condition – Special Conditions – Enhancement applicable
Label Pop – Up (Y/N) Rule (Y/N) Or not (Y/N)

Regular
No No No
Procedure

Regular
No No No
Procedure

Regular
No No No
Procedure

Regular
No No No
Procedure

Regular
No No No
Procedure

Regular
No No No
Procedure

Regular
No No No
Procedure

Regular
No No No
Procedure

Regular
No No No
Procedure

Regular
No No No
Procedure

Regular
No No No
Procedure

Regular
No No No
Procedure

Regular
No No No
Procedure

Regular
No No No
Procedure

Regular
No No No
Procedure
 Regular
Yes No No
Procedure

Follow - Up
Yes No No
Procedure

Regular
No No No
Procedure

Regular
No No No
Procedure

Regular
No No No
Procedure

Regular
No No No
Procedure

Regular
No No No
Procedure

Regular
Yes Yes No
Procedure

Regular
No No No
Procedure

Regular
No No No
Procedure

Regular
No No No
Procedure

Stand Alone
No No No
Procedure

Stand Alone
No No No
Procedure

Stand Alone
No No No
Procedure

Regular
Yes Yes No
Procedure

Regular
No No No
Procedure
 Regular
No No No
Procedure

Regular
Yes Yes No
Procedure

Regular
No No No
Procedure

Regular
No No No
Procedure

Regular
No No No
Procedure

Regular
No No No
Procedure

Stand Alone
No No No
Procedure

Regular
No No No
Procedure

Regular
Yes Yes No
Procedure

Regular
Yes No No
Procedure

Regular
No No No
Procedure

Regular
No No No
Procedure

Regular
No No No
Procedure

Add - On
Yes Yes No
Procedure

Regular
No No No
Procedure

Regular
No No No
Procedure
 Regular
No No No
Procedure

Regular
No No No
Procedure

Regular
No No No
Procedure

Regular
No No No
Procedure

Regular
No No No
Procedure

Add - On
No No No
Procedure

Regular
No No No
Procedure

Regular
No No No
Procedure

Regular
No No No
Procedure

Regular
No No No
Procedure

Regular
No No No
Procedure
 Medical or Day Care Reserved Procedure
Surgical (S/M) Procedure (Y/N) (Insurance/Trust)

Surgical Yes

Surgical Yes

Surgical Yes

Surgical Yes

Surgical Yes

Surgical Yes

Surgical Yes

Surgical Yes

Surgical Yes

Surgical Yes

Surgical No

Surgical No

Surgical Yes

Surgical Yes

Surgical No
Surgical Yes

Medical Yes

Surgical Yes

Surgical Yes

Surgical No

Surgical No

Surgical No

Surgical Yes

Surgical Yes

Surgical Yes

Surgical Yes

Surgical Yes

Surgical Yes

Surgical Yes

Surgical Yes

Surgical Yes
Surgical Yes

Surgical Yes

Surgical Yes

Surgical Yes

Surgical Yes

Surgical No

Surgical No

Surgical Yes

Surgical Yes

Surgical Yes

Surgical Yes

Surgical Yes

Surgical Yes

Surgical Yes

Surgical No

Surgical No
Surgical No

Surgical Yes

Surgical Yes

Surgical No

Surgical Yes

Surgical Yes

Surgical No

Surgical Yes

Surgical No

Surgical No

Surgical Yes
 Specialty Procedure Package AB PM - JAY
Multiple
Specialty Code Code Code Package
Procedures
HBP 2.0 HBP 1.0 HBP 2.0 Name
Fracture -
Conservative
Orthopedics SB New Package SB001 No
Management -
Without plaster

Application of
Orthopedics SB S500084 SB002 Yes
Traction

Application of
Orthopedics SB S500085 SB002 Yes
Traction

Application of
Orthopedics SB S500082 SB003 Yes
P.O.P. casts

Application of
Orthopedics SB S500082 SB003 Yes
P.O.P. casts

Application of
Orthopedics SB S500083 SB004 P.O.P. Spikas Yes
& Jackets

Application of
Orthopedics SB S500083 SB004 P.O.P. Spikas Yes
& Jackets

External
Orthopedics SB S500070 SB005 fixation of Yes
Fracture

External
Orthopedics SB S500069 SB005 fixation of Yes
Fracture

External
Orthopedics SB S500043 SB005 fixation of Yes
Fracture

External
Orthopedics SB S500087 SB005 fixation of Yes
Fracture

Percutaneous -
Orthopedics SB S500073 SB006 Fixation of No
Fracture

Elastic nailing
Orthopedics SB New Package SB007 for fracture Yes
fixation
 Elastic nailing
Orthopedics SB New Package SB007 for fracture Yes
fixation

Elastic nailing
Orthopedics SB New Package SB007 for fracture Yes
fixation

Internal
Orthopedics SB S500058 SB008 Fixation of No
Small Bones
Fracture -
Long Bones -
Orthopedics SB S500052 SB009 No
Metaphyseal -
ORIF
Fixation of
Diaphyseal
Orthopedics SB New Package SB010 Yes
Fracture -
Long Bone
Fixation of
Diaphyseal
Orthopedics SB New Package SB010 Yes
Fracture -
Long Bone
Surgery for
Comminuted
Orthopedics SB New Package SB011 Fracture - No
Olecranon of
Ulna
Fracture Head
Orthopedics SB S500086 SB012 Yes
radius

Fracture Head
Orthopedics SB S1000003 SB012 Yes
radius
Fracture -
Single Bone -
Forearm -
Orthopedics SB New Package SB013 No
ORIF -
Fracture
Plating / - Both
Bones
Nailing -
Forearm -
Orthopedics SB New Package SB014 No
ORIF -
Plating /
Fracture
Nailing
Condyle -
Orthopedics SB New Package SB015 Yes
Humerus -
ORIF
Fracture
Condyle -
Orthopedics SB New Package SB015 Yes
Humerus -
ORIF
Fracture
intercondylar
Orthopedics SB S500088 SB016 Humerus + No
olecranon
osteotomy
 Displaced
Orthopedics SB S500023 SB017 Clavicle No
Fracture

Fracture -
Orthopedics SB S500046 SB018 Yes
Acetabulum

Fracture -
Orthopedics SB S500046 SB018 Yes
Acetabulum

Fracture -
Orthopedics SB S500031 SB019 Yes
Neck Femur

Fracture -
Orthopedics SB S500031 SB019 Yes
Neck Femur

Fracture -
Orthopedics SB S500031 SB019 Yes
Neck Femur

Ankle
Orthopedics SB New Package SB020 No
Fractures

Cervical spine
fixation
Orthopedics SB New Package SB021 No
including
odontoid
Dorsal and
Orthopedics SB New Package SB022 lumber spine Yes
fixation

Dorsal and
Orthopedics SB New Package SB022 lumber spine Yes
fixation
Bone grafting
for Non union
Orthopedics SB S500068 SB023 No

Arthorotomy of
Orthopedics SB S500016 SB024 No
any joint

Arthrolysis of
Orthopedics SB S500015 SB025 Yes
joint

Arthrolysis of
Orthopedics SB S500099 SB025 Yes
joint
 Arthrolysis of
Orthopedics SB S500015 SB025 Yes
joint

Orthopedics SB S500101 SB026 Arthrodesis Yes

Orthopedics SB S500098 SB026 Arthrodesis Yes

Orthopedics SB S500100 SB026 Arthrodesis Yes

Orthopedics SB S500099 SB026 Arthrodesis Yes

Orthopedics SB S500004 SB026 Arthrodesis Yes

Orthopedics SB New Package SB026 Arthrodesis Yes

Orthopedics SB New Package SB026 Arthrodesis Yes

Orthopedics SB S500011 SB027 Disarticulation Yes

Orthopedics SB S500011 SB027 Disarticulation Yes

Closed
reduction of
Orthopedics SB S500037 SB028 Yes
joint
dislocation
Closed
reduction of
Orthopedics SB S500098 SB028 Yes
joint
dislocation
Closed
reduction of
Orthopedics SB S500015 SB028 Yes
joint
dislocation
Closed
reduction of
Orthopedics SB S500099 SB028 Yes
joint
dislocation
 Open
Orthopedics SB S500067 SB029 Reduction of No
Small Joint

Tension Band
Orthopedics SB New Package SB030 No
Wiring

Hemiarthroplas
Orthopedics SB S500095 SB031 Yes
ty

Hemiarthroplas
Orthopedics SB S500094 SB031 Yes
ty

Hemiarthroplas
Orthopedics SB S500094 SB031 Yes
ty

AC Joint
Orthopedics SB S500001 SB032 reconstruction Yes
/ Stabilization

AC Joint
Orthopedics SB S500001 SB032 reconstruction Yes
/ Stabilization

AC Joint
Orthopedics SB S500001 SB032 reconstruction Yes
/ Stabilization

AC Joint
Orthopedics SB S500001 SB032 reconstruction Yes
/ Stabilization

AC Joint
Orthopedics SB S500001 SB032 reconstruction Yes
/ Stabilization

AC Joint
Orthopedics SB S500001 SB032 reconstruction Yes
/ Stabilization

Excision
Orthopedics SB S500018 SB033 Arthoplasty of No
Femur head

Open
Orthopedics SB S500066 SB034 Reduction of No
CDH

Orthopedics SB S500071 SB035 Patellectomy No

 Arthroscopic
Meniscus
Orthopedics SB S500090 SB036 No
Repair /
Meniscectomy

Elbow
Orthopedics SB S500097 SB037 No
replacement

Total Hip
Orthopedics SB S500091 SB038 Yes
Replacement

Total Hip
Orthopedics SB S500092 SB038 Yes
Replacement

Total Hip
Orthopedics SB S500093 SB038 Yes
Replacement

Total Hip
Orthopedics SB New Package SB038 Yes
Replacement

Total Knee
Orthopedics SB S500096 SB039 Yes
Replacement

Bone Tumour
Total Knee
Orthopedics SB New Package SB039 Yes
Excision
Replacement
(malignant)
including GCT
+ Joint
Orthopedics SB S500022 SB040 No
replacement
(depending
upon type of
Bone Tumour
joint and
Orthopedics SB S500020 SB041 Excision + No
implant)
reconstruction
Bone Tumour
(benign)
curettage /
Orthopedics SB New Package SB042 No
Excision
and bone
grafting
Single Stage
Orthopedics SB S500004 SB043 Yes
Amputation

Single Stage
Orthopedics SB S500003 SB043 Yes
Amputation

Single Stage
Orthopedics SB S500009 SB043 Yes
Amputation
 Single Stage
Orthopedics SB S500004 SB043 Yes
Amputation

Single Stage
Orthopedics SB New Package SB043 Yes
Amputation

Single Stage
Orthopedics SB S500004 SB043 Yes
Amputation

Single Stage
Orthopedics SB S500100 SB043 Yes
Amputation

Two Stage
Orthopedics SB S500004 SB044 Yes
Amputation

Two Stage
Orthopedics SB S500003 SB044 Yes
Amputation

Two Stage
Orthopedics SB S500009 SB044 Yes
Amputation

Two Stage
Orthopedics SB S500004 SB044 Yes
Amputation

Two Stage
Orthopedics SB New Package SB044 Yes
Amputation

Two Stage
Orthopedics SB S500004 SB044 Yes
Amputation

Two Stage
Orthopedics SB S500100 SB044 Yes
Amputation

Amputation -
Orthopedics SB S500005 SB045 Yes
Fingers / Toes

Amputation -
Orthopedics SB S500007 SB045 Yes
Fingers / Toes

Tendon
Orthopedics SB S500078 SB046 Grafting / Yes
Repair
 Tendon
Orthopedics SB S500061 SB046 Grafting / Yes
Repair

Tendon
Orthopedics SB S500079 SB047 Release / No
Tenotomy

Orthopedics SB S500080 SB048 Tenolysis No

Reconstruction
of Cruciate
Orthopedics SB New Package SB049 Ligament with Yes
implant and
Reconstruction
brace
of Cruciate
Orthopedics SB New Package SB049 Ligament with Yes
implant and
brace

Orthopedics SB S500044 SB050 Fasciotomy No

Duputryen’s
Contracture
Orthopedics SB S500039 SB051 No
release +
Debridement &
rehabilitation
Closure of
injuries -
Orthopedics SB New Package SB052 Yes
contused
Debridement
lacerated &
Closure
wounds of
injuries -
Orthopedics SB New Package SB052 Yes
contused
lacerated
wounds
Sequestectom
Orthopedics SB New Package SB053 No
y / Curettage

Spine
Orthopedics SB New Package SB054 deformity No
correction

Orthopedics SB S500070 SB055 Osteotomy Yes

Orthopedics SB S500069 SB055 Osteotomy Yes

Pelvic
Orthopedics SB S500072 SB056 Osteotomy and No
fixation
 High Tibial
Orthopedics SB S500055 SB057 No
Osteotomy

Ilizarov
Orthopedics SB S500060 SB058 No
Fixation
Limb
Lengthening /
Orthopedics SB S500059 SB059 Bone No
Transport by
Ilizarov
Growth
Orthopedics SB New Package SB060 Modulation No
and fixation
Corrective
Surgery for
Orthopedics SB New Package SB061 Yes
foot
deformities
Corrective
Surgery for
Orthopedics SB New Package SB061 Yes
foot
deformities
Correction of
Orthopedics SB S500089 SB062 club foot per No
cast
Corrective
Surgery in
Orthopedics SB S500089 SB063 No
Club Foot /
JESS Fixator
Excision of
Orthopedics SB S500014 SB064 Osteochondro Yes
ma / Exostosis

Excision of
Orthopedics SB S500014 SB064 Osteochondro Yes
ma / Exostosis

Excision of
Orthopedics SB S500074 SB065 No
Bursa

Nerve
Transposition /
Orthopedics SB S500063 SB066 Yes
Release /
Neurolysis
Nerve
Transposition /
Orthopedics SB S500063 SB066 Yes
Release /
Neurolysis
Nerve
Transposition /
Orthopedics SB S500063 SB066 Yes
Release /
Neurolysis
 Nerve Repair
Orthopedics SB S500062 SB067 No
Surgery

Nerve root
Orthopedics SB New Package SB068 No
block

Exploration
Orthopedics SB S500040 SB069 and Ulnar No
nerve Repair

Implant
Orthopedics SB New Package SB070 Removal under Yes
LA

Implant
Orthopedics SB New Package SB070 Removal under Yes
LA

Implant
Orthopedics SB New Package SB071 Removal under Yes
RA / GA

Implant
Orthopedics SB New Package SB071 Removal under Yes
RA / GA

Calcaneal
Orthopedics SB New Package SB072KL No
Spur - Excision

Epiphyseal
Orthopedics SB New Package SB073KL No
stimulation

Hip
Orthopedics SB New Package SB074KL Arthroscopy No
Labral Fixation
Bone tumors /
soft tissue
Orthopedics SB New Package SC070 No
sarcomas:
surgery
 Tendon
Orthopedics SB S100246 SG092 No
Transfer

Thoracic /
Lumbar
Orthopedics SB New Package SN032 Yes
Corpectomy
with fusion
Thoracic /
Lumbar
Orthopedics SB S800069 SN032 Yes
Corpectomy
with fusion

Orthopedics SB S800016 SN034 Laminectomy Yes

Orthopedics SB S800015 SN034 Laminectomy Yes

Spine -
Orthopedics SB S800028 SN038 Decompressio Yes
n & Fusion

Spine -
Orthopedics SB S800029 SN038 Decompressio Yes
n & Fusion

Carpal Tunnel
Orthopedics SB S800004 SN046 No
Release

Conservative
Orthopedics SB New Package ST001 Management Yes
of Head Injury

Conservative
Orthopedics SB S800047 ST001 Management Yes
Head
of Headinjury
Injury
with repair of
Facio-Maxillary
Orthopedics SB S600004 ST002 Injury & No
fixations
Craniotomy
(including
and evacuation
implants)
of Haematoma
Orthopedics SB S600006 ST003 Yes
with fixation of
Craniotomy
fracture of long
and
boneevacuation
of Haematoma
Orthopedics SB S600006 ST003 Yes
with fixation of
Craniotomy
fracture of long
and
boneevacuation
of Haematoma
Orthopedics SB S600007 ST003 Yes
with fixation of
fracture of long
bone
 Craniotomy
and evacuation
of Haematoma
Orthopedics SB S600007 ST003 Yes
with fixation of
fracture of long
Management
bone
of Chest injury
Orthopedics SB New Package ST004 Yes
with fracture of
Long bone
Management
of Chest injury
Orthopedics SB New Package ST004 Yes
with fracture of
Long bone
Management
of Visceral
Orthopedics SB S600010 ST005 injury and Yes
fracture long
Management
bone
of Visceral
Orthopedics SB S600011 ST005 injury and Yes
fracture long
bone
Internal fixation
of
Orthopedics SB S600005 ST006 No
Pelviacetabula
Internal
r fracturefixation
with Flap cover
Surgery for
Orthopedics SB S600003 ST007 No
wound in
Emergency
compound
tendons
fracture repair
± Peripheral
Orthopedics SB S600012 ST008 No
Nerve repair/
reconstructive
Management
surgery
of Nerve
Orthopedics SB S600001 ST009 Plexus / Yes
Tendon
Management
injuries
of Nerve
Orthopedics SB S600001 ST009 Plexus / Yes
Tendon
Management
injuries
of Nerve
Orthopedics SB S600001 ST009 Plexus / Yes
Tendon
Management
injuries
of Nerve
Orthopedics SB S600001 ST009 Plexus / Yes
Tendon
Management
injuries
of Nerve
Orthopedics SB S600001 ST009 Plexus / Yes
Tendon
injuries
Plexus injury
along with
Orthopedics SB S600002 ST010 Yes
Vascular injury
repair / graft
 Plexus injury
along with
Orthopedics SB S600002 ST010 Yes
Vascular injury
repair / graft
 No. of
Procedure AB PM - JAY ICHI Stratification
Package Stratification
Code Procedure Procedure / criteria which
Price Criteria (Y/N)
HBP 2.0 Name ICD Code can be
booked
Fracture -
Conservative
SB001A XXX 2,000 No 0.00
Management -
Without plaster
Skeletal
SB002A Tractions with XXX 3,000 No 0.00
pin

SB002B Skin Traction XXX 1,000 No 0.00

SB003A Upper Limbs XXX 3,000 No 0.00

SB003B Lower Limbs XXX 3,000 No 0.00

SB004A Spikas XXX 3,500 No 0.00

SB004B Jackets XXX 5,750 No 0.00

SB005A Long bone XXX 14,000 No 0.00

SB005B Small bone XXX 9,500 No 0.00

SB005C Pelvis XXX 14,000 No 0.00

Both bones -
SB005D XXX 15,000 No 0.00
forearms

Percutaneous -
SB006A Fixation of XXX 3,000 Yes 1.00
Fracture

SB007A Femur XXX 11,000 No 0.00

SB007B Humerus XXX 11,000 No 0.00

SB007C Forearm XXX 11,000 No 0.00

Internal
SB008A Fixation of XXX 8,500 No 0.00
Small Bones
Fracture -
Long Bones -
SB009A XXX 12,700 No 0.00
Metaphyseal -
ORIF
Open
Reduction
SB010A XXX 14,900 No 0.00
Internal
Fixation
Closed
SB010B Reduction & XXX 18,000 No 0.00
Fixation

SB011A Plating XXX 11,800 No 0.00

SB012A Fixation XXX 10,000 No 0.00

SB012B Excision XXX 17,025 No 0.00

Fracture -
Single Bone -
Forearm -
SB013A XXX 8,900 No 0.00
ORIF -
Fracture
Plating / - Both
Bones
Nailing -
Forearm -
SB014A XXX 12,700 No 0.00
ORIF -
Plating /
Nailing
Lateral
SB015A XXX 8,500 No 0.00
Condyle

Medial
SB015B XXX 8,500 No 0.00
Condyle
Fracture
intercondylar
SB016A Humerus + XXX 15,100 No 0.00
olecranon
osteotomy
 Open
Reduction
SB017A XXX 17,000 No 0.00
Internal
Fixation

Single
SB018A XXX 28,000 No 0.00
Approach

Combined
SB018B XXX 33,500 No 0.00
Approach

Closed
Reduction and
SB019A XXX 10,000 No 0.00
Percutaneous
Screw Fixation
Intertrochanteri
c Fracture with
SB019B XXX 15,800 No 0.00
Dynamic Hip
Screw
Intertrochanteri
c Fracture with
SB019C XXX 16,100 No 0.00
Proximal
Femoral Nail
Open
Reduction
SB020A XXX 14,000 No 0.00
Internal
Fixation
Cervical spine
fixation
SB021A XXX 20,000 No 0.00
including
odontoid

SB022A Anterior XXX 40,000 No 0.00

SB022B Posterior XXX 30,000 No 0.00

Bone grafting
for Non union
SB023A XXX 20,000 No 0.00

Arthorotomy of
SB024A XXX 16,725 No 0.00
any joint

SB025A Elbow XXX 21,000 No 0.00

SB025B Knee XXX 21,000 No 0.00

SB025C Ankle XXX 21,000 No 0.00

Ankle / Triple
SB026A XXX 30,000 No 0.00
with implant

SB026B Shoulder XXX 15,000 No 0.00

SB026C Wrist XXX 15,000 No 0.00

SB026D Knee XXX 15,000 No 0.00

SB026E Hand XXX 27,000 No 0.00

SB026F Foot XXX 27,000 No 0.00

Ankle / Triple
SB026G XXX 20,000 No 0.00
without implant

SB027A Hind quarter XXX 25,000 No 0.00

SB027B Fore quarter XXX 25,000 No 0.00

SB028A Hip XXX 7,400 No 0.00

SB028B Shoulder XXX 5,500 No 0.00

SB028C Elbow XXX 5,500 No 0.00

SB028D Knee XXX 6,000 No 0.00

 Open
SB029A Reduction of XXX 8,500 No 0.00
Small Joint

Tension Band
SB030A XXX 13,000 No 0.00
Wiring

SB031A Unipolar XXX 15,000 No 0.00

Bipolar (Non -
SB031B XXX 15,000 No 0.00
Modular)

Bipolar
SB031C XXX 15,000 No 0.00
(Modular)

Rockwood
SB032A XXX 20,500 No 0.00
Type - I

Rockwood
SB032B XXX 20,500 No 0.00
Type - II

Rockwood
SB032C XXX 20,500 No 0.00
Type - III

Rockwood
SB032D XXX 20,500 No 0.00
Type - IV

Rockwood
SB032E XXX 20,500 No 0.00
Type - V

Rockwood
SB032F XXX 20,500 No 0.00
Type - VI

Excision
SB033A Arthoplasty of XXX 22,500 No 0.00
Femur head

Open
SB034A Reduction of XXX 30,000 No 0.00
CDH

SB035A Patellectomy XXX 16,725 No 0.00

 Arthroscopic
Meniscus
SB036A XXX 20,000 No 0.00
Repair /
Meniscectomy

Elbow
SB037A XXX 14,100 No 0.00
replacement

SB038A Cemented XXX 35,000 No 0.00

SB038B Cementless XXX 37,000 No 0.00

SB038C Hybrid XXX 32,000 No 0.00

Revision -
Total Hip
Replacement
SB038D XXX 40,000 No 0.00

Primary - Total
SB039A Knee XXX 25,000 No 0.00
Replacement
Revision -
Total Knee
Bone Tumour
Replacement
SB039B XXX 30,000 No 0.00
Excision
(malignant)
including GCT
+ Joint
SB040A XXX 57,000 No 0.00
replacement
(depending
upon type of
Bone Tumour
joint and
SB041A Excision + XXX 30,000 No 0.00
implant)
reconstruction
Bone Tumour
(benign)
SB042A curettage / XXX 20,000 No 0.00
Excision and
bone grafting

SB043A Above Elbow XXX 15,000 No 0.00

SB043B Below Elbow XXX 16,875 No 0.00

SB043C Above Knee XXX 18,000 No 0.00

SB043D Below Knee XXX 15,000 No 0.00

SB043E Foot XXX 15,000 No 0.00

SB043F Hand XXX 15,000 No 0.00

SB043G Wrist XXX 15,000 No 0.00

SB044A Above Elbow XXX 23,200 No 0.00

SB044B Below Elbow XXX 23,200 No 0.00

SB044C Above Knee XXX 23,200 No 0.00

SB044D Below Knee XXX 23,200 No 0.00

SB044E Foot XXX 23,200 No 0.00

SB044F Hand XXX 23,200 No 0.00

SB044G Wrist XXX 23,200 No 0.00

SB045A Finger(s) XXX 10,400 No 0.00

SB045B Toe(s) XXX 10,400 No 0.00

Tendon
SB046A XXX 20,475 No 0.00
Grafting
SB046B Tendon Repair XXX 34,320 No 0.00

Tendon
SB047A Release / XXX 5,000 No 0.00
Tenotomy

SB048A Tenolysis XXX 9,050 No 0.00

SB049A Anterior XXX 25,700 No 0.00

SB049B Posterior XXX 25,700 No 0.00

SB050A Fasciotomy XXX 10,500 No 0.00

Duputryen’s
Contracture
SB051A XXX 13,500 No 0.00
release +
rehabilitation
Anti-biotic +
dressing -
SB052A XXX 10,900 No 0.00
minimum of 5
sessions
Anti-biotic +
dressing -
SB052B XXX 3,375 No 0.00
minimum of 2
sessions

Sequestectom
SB053A XXX 25,000 No 0.00
y / Curettage

Spine
SB054A deformity XXX 40,000 No 0.00
correction

SB055A Long Bone XXX 18,000 No 0.00

SB055B Small Bone XXX 20,250 No 0.00

Pelvic
SB056A Osteotomy and XXX 30,000 No 0.00
fixation
 High Tibial
SB057A XXX 16,000 No 0.00
Osteotomy

Ilizarov
SB058A XXX 15,000 No 0.00
Fixation
Limb
Lengthening /
SB059A Bone XXX 23,700 No 0.00
Transport by
Ilizarov
Growth
SB060A Modulation XXX 5,000 No 0.00
and fixation

SB061A Vertical Talus XXX 15,000 No 0.00

Other foot
SB061B XXX 15,000 No 0.00
deformities

Correction of
SB062A club foot per XXX 3,000 No 0.00
cast
Corrective
Surgery in
SB063A XXX 12,000 No 0.00
Club Foot /
JESS Fixator

Osteochondro
SB064A XXX 13,350 No 0.00
ma

SB064B Exostosis XXX 10,000 No 0.00

Excision of
SB065A XXX 4,525 No 0.00
Bursa

Nerve
SB066A XXX 17,000 No 0.00
Transposition

SB066B Nerve Release XXX 17,000 No 0.00

Nerve
SB066C XXX 17,000 No 0.00
Neurolysis
 Nerve Repair
SB067A XXX 15,000 No 0.00
Surgery

Nerve root
SB068A XXX 3,000 No 0.00
block

Exploration
SB069A and Ulnar XXX 9,800 No 0.00
nerve Repair

SB070A K - Wire XXX 6,750 No 0.00

SB070B Screw XXX 6,750 No 0.00

SB071A Nail XXX 15,000 No 0.00

SB071B Plate XXX 15,000 No 0.00

Calcaneal
SB072KLA XXX 6,675 Yes 1.00
Spur - Excision

Epiphyseal
SB073KLA XXX 11,275 No 0.00
stimulation

Hip
SB074KLA Arthroscopy XXX 30,000 No 0.00
Labral Fixation
Bone tumors /
soft tissue
SC070A XXX 30,000 No 0.00
sarcomas:
surgery
 Tendon
SG092A XXX 25,000 No 0.00
Transfer

Thoracic
SN032A Corpectomy XXX 60,000 No 0.00
with fusion

Lumbar
SN032B Corpectomy XXX 60,000 No 0.00
with fusion

Laminectomy
SN034A XXX 40,000 No 0.00
with Fusion

Laminectomy
SN034B with Fusion XXX 40,000 No 0.00
and fixation

Spine -
SN038A Decompressio XXX 40,000 No 0.00
n & Fusion
Spine -
Decompressio
SN038B XXX 40,000 No 0.00
n & Fusion
with fixation

Carpal Tunnel
SN046A XXX 10,000 No 0.00
Release

ST001A Severe XXX 1,000 Yes 1.00

Depressed
ST001B XXX 5,000 Yes 1.00
Fracture
Head injury
with repair of
Facio-Maxillary
ST002A Injury & XXX 31,000 No 0.00
Subdural
fixations
hematoma
(including
along with
implants)
ST003A fixation of XXX 60,000 No 0.00
Extradural
fracture of
hematoma
single long
along
bone with
ST003B fixation of XXX 60,000 No 0.00
Subdural
fracture of
hematoma
single long
along
bone with
ST003C fixation of XXX 75,000 No 0.00
fracture of 2 or
more long
bone.
 Extradural
hematoma
along with
ST003D fixation of XXX 75,000 No 0.00
fracture of 2 or
Management
more long
of Chest injury
bone.
ST004A with fixation of XXX 30,000 No 0.00
Single Long
Management
bone
of Chest injury
ST004B with fixation of XXX 45,000 No 0.00
Surgical
2 or more Long
intervention
bones for
Visceral injury
ST005A and fixation of XXX 30,000 No 0.00
Surgical
fracture of
intervention
single long for
Visceral
bone injury
ST005B and fixation of XXX 45,000 No 0.00
fracture of 2 or
more long
Internal fixation
bones
of
ST006A XXX 40,000 No 0.00
Pelviacetabula
Internal
r fracturefixation
with Flap cover
Surgery for
ST007A XXX 40,000 No 0.00
wound in
Emergency
compound
tendons
fracture repair
± Peripheral
ST008A XXX 30,000 No 0.00
Nerve repair/
reconstructive
surgery
Nerve Plexus
ST009A XXX 50,000 No 0.00
injury repair

Nerve Plexus
ST009B injury XXX 50,000 No 0.00
reconstruction

Tendon injury
ST009C XXX 50,000 No 0.00
repair

Tendon injury
ST009D XXX 50,000 No 0.00
reconstruction

Tendon
ST009E XXX 50,000 No 0.00
Transfer

Plexus injury
along with
ST010A XXX 60,000 No 0.00
Vascular injury
repair
 Plexus injury
along with
ST010B XXX 60,000 No 0.00
Vascular injury
graft
 Implants / Can more Reservation Reservation
Special
High End than one type Public Tertiary
Conditions Level of Care
Consumables of implant be Hospitals Hospitals
(Y/N)
(Y/N) booked (Y/N) (Y/N) (Y/N)

No No No No No Secondary

No No No No No Secondary

No No No No No Secondary

No No No No No Secondary

No No No No No Secondary

No No No No No Secondary

No No No No No Secondary

Yes No No No No Secondary

Yes No No No No Secondary

Yes No No No No Secondary

Yes No No No No Secondary

Yes No No No No Secondary

Yes No No No No Secondary
Yes No No No No Secondary

Yes No No No No Secondary

Yes No No No No Secondary

Yes No No No No Secondary

Yes No No No No Secondary

Yes No No No No Secondary

Yes No No No No Secondary

Yes No No No No Secondary

No No No No No Secondary

Yes No No No No Secondary

Yes No No No No Secondary

Yes No No No No Secondary

Yes No No No No Secondary

Yes No No No No Secondary
Yes No No No No Secondary

Yes No No No No Secondary

Yes No No No No Secondary

Yes No No No No Secondary

Yes No No No No Secondary

Yes No No No No Secondary

Yes No No No No Secondary

Yes Yes No No No Tertiary

Yes No No No No Tertiary

Yes No No No No Tertiary

No No No No No Secondary

No No No No No Secondary

No No No No No Secondary

No No No No No Secondary
No No No No No Secondary

No No No No No Secondary

Yes No No No No Secondary

Yes No No No No Secondary

Yes No No No No Secondary

No No No No No Secondary

No No No No No Secondary

No No No No No Secondary

No No No No No Tertiary

No No No No No Tertiary

No No No No No Tertiary

No No No No No Secondary

No No No No No Secondary

No No No No No Secondary
Yes No No No No Secondary

Yes No Yes No No Secondary

Yes No No No No Secondary

Yes No No No No Secondary

Yes No No No No Secondary

Yes No Yes No No Secondary

Yes No Yes No No Secondary

Yes No Yes No No Secondary

Yes No Yes No No Secondary

Yes No Yes No No Secondary

Yes No Yes No No Secondary

No No No No No Secondary

No No No No No Secondary

No No No No No Secondary
No No No No No Secondary

Yes No No No No Secondary

Yes No No No No Tertiary

Yes No No No No Tertiary

Yes No No No No Tertiary

Yes No No No Yes Tertiary

Yes No No No No Tertiary

Yes No No No Yes Tertiary

Yes No No No No Tertiary

Yes No No No No Tertiary

No No No No No Tertiary

No No No No No Secondary

No No No No No Secondary

No No No No No Secondary
No No No No No Secondary

No No No No No Secondary

No No No No No Secondary

No No No No No Secondary

No No Yes No No Secondary

No No Yes No No Secondary

No No Yes No No Secondary

No No Yes No No Secondary

No No Yes No No Secondary

No No Yes No No Secondary

No No Yes No No Secondary

No No No No No Secondary

No No No No No Secondary

No No No No No Tertiary
No No No No No Tertiary

No No No No No Tertiary

No No No No No Tertiary

Yes No No No No Tertiary

Yes No No No No Tertiary

No No No No No Tertiary

No No No No No Tertiary

No No Yes No No Secondary

No No Yes No No Secondary

No No No No No Secondary

Yes Yes No No No Secondary

Yes No No No No Secondary

No No No No No Secondary

No No No No No Secondary
Yes No No No No Secondary

Yes No No No No Secondary

Yes No No No No Secondary

Yes No No No No Secondary

No No No No No Secondary

No No No No No Secondary

No No No No No Secondary

Yes No No No No Secondary

No No No No No Secondary

No No No No No Secondary

No No No No No Secondary

No No No No No Secondary

No No No No No Secondary

No No No No No Secondary
No No No No No Secondary

No No No No No Secondary

No No No No No Secondary

No No Yes No No Secondary

No No No No No Secondary

No No No No No Secondary

No No No No No Secondary

No No No No No Secondary

No No No No No Secondary

No No No No No Secondary

No No No Yes No Tertiary
No No No No No Tertiary

Yes No No No No Tertiary

Yes No No No No Tertiary

No No No No No Tertiary

Yes No No No No Tertiary

No No No No No Tertiary

Yes No No No No Tertiary

No No No No No Tertiary

No No No No No Secondary

No No No No No Secondary

Yes No No No No Tertiary

No No No No No Tertiary

No No No No No Tertiary

No No No No No Tertiary
No No No No No Tertiary

Yes No No No No Secondary

No No No No No Secondary

No No No No No Tertiary

No No No No No Tertiary

No No No No No Secondary

No No No No No Secondary

No No No No No Tertiary

No No No No No Tertiary

No No No No No Tertiary

No No No No No Secondary

No No No No No Secondary

No No No No No Secondary

No No No No No Tertiary
No No No No No Tertiary
 Mandatory Special
Auto Mandatory
Documents - Procedure Condition –
LOS Approved Clinical notes Documents - Claim
Pre Label Pop – Up
(Y/N) with planned Processing
Authorization (Y/N)
line of Procedure /
treatment Operation notes, Post
Regular
100% No including procedure X-ray films No
Clinical notes Procedure
planned line of with reports, Detailed
and X-ray Post Procedure
treatment, X- Discharge Summary
showing the clinical photgraph
ray films with
need of with pins, detailed Regular
100% Yes reports No
Clinical notes
procedure, Procedure / Operative Procedure
and X-ray
clinical Post
Notes.Procedure
Detailed
showing
photograph theof clinical
dischargephotgraph,
summary
need of part
affected detailed Procedure / Regular
100% Yes No
Clinical
procedure,notes Operative Notes. Procedure
Post Procedure
and X-ray
clinical Detailed discharge
clinical photgraph
showing
photograph theof summary
with POP cast,
need of part
affected Regular
0% Yes detailed Procedure / No
Clinical
procedure,notes Procedure
Post Procedure
Operative Notes.
and X-ray
clinical
clinical
Detailedphotgraph
discharge
showing
photograph theof
with POP cast,
summary
need of
affected part Regular
0% Yes detailed Procedure / No
Clinical
procedure,notes Procedure
Post Procedure
Operative Notes.
and X-ray
clinical
clinical
Detailedphotgraph
discharge
showing
photograph theof
with POP spika,
summary
need of part
affected Regular
0% Yes detailed Procedure / No
Clinical
procedure,notes Procedure
Post Procedure
Operative Notes.
and X-ray
clinical
clinical
Detailedphotgraph
discharge
showing
photograph theof
with POP Jacket,
summary
need of part
affected Regular
0% Yes detailed Procedure / No
procedure, Procedure
Clinical notes Post Procedure
Operative Notes.
clinical
and X-ray clinical
Detailedphotgraph,
discharge
photograph of
confirming the detailed
summaryProcedure /
affected part Regular
400% Yes diagnosis, Operative Notes. No
Procedure
Clinical
clinical notes Post Procedure
Detailed discharge
and X-ray of
photograph clinical
summary photgraph,
Invoice and
confirming
affected part the detailed
barcode Procedure
of implant /
Regular
300% Yes diagnosis, Operative Notes. No
Procedure
Clinical
clinical notes Post Procedure
Detailed discharge
and X-ray of
photograph clinical
summary photgraph,
Invoice and
confirming
affected part the detailed
barcode Procedure
of implant /
Regular
500% Yes diagnosis, Operative Notes. No
Procedure
Clinical
clinical notes Post Procedure
Detailed discharge
and X-ray of
photograph clinical
summary photgraph,
Invoice and
confirming
affected part the detailed
barcode Procedure
of implant /
Regular
400% Yes Clinical
diagnosis,notes Operative Notes. No
Procedure
with planned
clinical Procedure /
Detailed discharge
line of
photograph of Operation notes, Post
summary Invoice and
treatment
affected part procedure
barcode of X-ray films
implant
Regular
400% Yes Clinical
includingnotes with reports, Stickers No
Procedure
with planned
planned line of Procedure
of implants /used,
line of
treatment, X- Operation notes, Post
Detailed Discharge
treatment
ray films with procedure
Summary X-ray films
Regular
400% No including
reports with reports, Stickers No
Procedure
planned line of of implants used,
treatment, X- Detailed Discharge
ray films with Summary
reports
 Clinical notes
with planned Procedure /
line of Operation notes, Post
treatment procedure X-ray films
Regular
400% No Clinical
includingnotes with reports, Stickers No
Procedure
with planned
planned line of Procedure
of implants /used,
line of
treatment, X- Operation notes, Post
Detailed Discharge
treatment
ray films with procedure
Summary X-ray films
Regular
400% No including
reports Post Procedure
with reports, Stickers No
Procedure
Clinical
plannednotes
line of clinical photgraph,
of implants used,
and X-ray X-
treatment, Post procedure
Detailed DischargeX-
confirming
ray films withthe rayshowing
Summary implant;
Regular
300% Yes Clinical
diagnosis,
reports notes detailed Procedure / No
Procedure
with planned
clinical Procedure /
Operative Notes.
line of
photograph of Operation notes,
Detailed discharge Post
treatment
affected part procedure X-ray films
summary Invoice and
Regular
400% Yes Clinical
includingnotes with reports,
barcode of Stickers
implant. No
Post procedure Procedure
and
planned line of of implants used,
imaging study (X
radiological
treatment, X- Detailed Discharge
Ray), Post Procedure
investigations
ray films with Summary
clinical photograph, Regular
400% Yes Clinical
reports notes
confirming the No
Post procedure
detailed Procedure / Procedure
and
diagnosis (X-
imaging
Operative study (X
Notes.
radiological
ray), clinical
Ray),
invoicePost
andProcedure
barcode
investigations
photograph of
clinical photograph,
of implant Regular
400% Yes confirming
affected part the No
Post Procedure
detailed Procedure / Procedure
Clinical
diagnosis notes
(X-
clinical
Operativephotgraph,
Notes.
and
ray),X-ray
clinical
Post
invoiceprocedure
and barcodeX-ray;
confirming
photographthe of
detailed
of implantProcedure / Regular
300% Yes diagnosis,
affected part Post procedure No
Operative Notes. Procedure
Clinical
clinical notes imaging study (X
Detailed discharge
and X-ray of
photograph Ray), Post Procedure
summary, Invoice and
confirming
affected part the clinical photgraph,
barcode of implant Regular
400% Yes diagnosis, detailed Procedure / No
Post procedure Procedure
Clinical
clinical notes Operative Notes.
imaging study (X
and X-ray of
photograph Detailed discharge
Ray), Post Procedure
confirming
affected part the summary, Invoice and
clinical photgraph, Regular
300% Yes diagnosis, Post
barcodeProcedure
of implant No
detailed Procedure / Procedure
Clinical
clinical notes clinical photgraph,
Operative Notes.
and X-ray of
photograph Post procedure X-
Detailed discharge
confirming
affected part the rayshowing implant;
summary Regular
400% Yes diagnosis, Post Procedure
detailed Procedure / No
Procedure
Clinical
clinical notes clinical
Operativephotgraph,
Notes.
and X-ray of
photograph Post procedure
Detailed dischargeX-
confirming
affected part the rayshowing
summary Invoice implant;
and
Regular
400% Yes diagnosis, Post Procedure
detailed
barcode Procedure
of implant. / No
Procedure
Clinical
clinical notes clinical
Operativephotgraph,
Notes.
and X-ray of
photograph Post procedure
Detailed dischargeX-
confirming
affected part the rayshowing
summary Invoice implant;
and
Regular
300% Yes diagnosis, Post Procedure
detailed
barcode Procedure
of implant. / No
Procedure
Clinical
clinical notes clinical
Operativephotgraph,
Notes.
and X-ray of
photograph Post procedure
Detailed dischargeX-
confirming
affected part the rayshowing
summary Invoice implant;
and
Regular
300% Yes diagnosis, Post Procedure
detailed
barcode Procedure
of implant.X-ray
/ No
Clinical notes Procedure
clinical showing
Operativeosteotomy
Notes.
and X-ray
photograph of as well asdischarge
Detailed frature
showing the
affected part maneged; detailedand
summary Invoice
need of Regular
500% Yes Procedure
barcode of /implant.
Operative No
procedure, Procedure
Notes. Detailed
clinical
discharge summary,
photograph of
Invoice and barcode
affected part
of implant
 Clinical notes
with planned Procedure /
line of Operation notes, Post
treatment procedure X-ray films
Regular
400% Yes Clinical
includingnotes with reports, Stickers No
Procedure
with planned
planned line of Procedure
of implants /used,
line of
treatment, X- Operation notes, Post
Detailed Discharge
treatment
ray films with procedure
Summary X-ray films
Regular
700% Yes Clinical
reports notes with reports, Detailed
including No
Procedure
with planned
planned line of Procedure /
Discharge Summary,
line of
treatment, X- Operation
Invoice andnotes, Post
barcode
treatment
ray films with procedure
of implant X-ray films
Regular
700% Yes including
reports with reports, Detailed No
Post procedure Procedure
Clinical
plannednotesline of Discharge Summary,
imaging study (X
and X-ray X- Invoice and barcode
treatment,
Ray), Post Procedure
confirming
ray films with the of implant
clinical photgraph, Regular
200% Yes diagnosis,
reports No
Post procedure
detailed Procedure / Procedure
Clinical
clinical notes
imaging
Operative study (X
Notes.
and X-ray of
photograph
Ray),
InvoicePost
andProcedure
barcode
confirming
affected part the
clinical photgraph,
of implant Regular
500% Yes diagnosis, No
Post procedure
detailed Procedure / Procedure
Clinical
clinical notes
imaging
Operative study (X
Notes.
and X-ray of
photograph
Ray),
InvoicePost
andProcedure
barcode
confirming
affected part the
clinical photgraph,
of implant Regular
500% Yes diagnosis, No
detailed Procedure / Procedure
clinical Detailed discharge
Clinical notes Operative Notes.
photograph of summary Post
and X-ray of Invoice and barcode
affected part Procedure clinical
ankle joint, Regular
500% Yes Clinical notes of implant
photgraph, detailed No
clinical Procedure
with planned Procedure / Operative
photograph of
line of Operation notes,
Notes, Invoice andPost
affected part
treatment procedure
barcode of X-ray
implantfilms
Regular
700% No Clinical
includingnotes with reports, Detailed No
Procedure
with planned
planned line of Procedure /
Discharge Summary,
line of
treatment, X- Operation
Invoice andnotes, Post
barcode
treatment procedure
ray films with of implant X-ray films
Regular
700% No Clinical
reports notes with reports, Detailed
including No
Procedure
with planned
planned line of Procedure /
Discharge Summary,
line of
treatment, X- Operation
Invoice andnotes, Post
barcode
Clinical notes
treatment
ray films with procedure
of implant X-ray films
detailing earlier Regular
700% No including
reports Post procedure
with reports, Detailed No
surgery that Procedure
planned line of imaging
Discharge study (X
Summary,
resulted in
treatment, X- Ray), InvoicePost
andProcedure
barcode
non-union and
ray films with clinical photgraphof
of implant
radiological Regular
300% Yes reports donor and recipient No
investigations Procedure
Clinical notes sites, detailed
confirming the
and X-ray Post op clinical
Procedure / Operative
diagnosis (X-
confirming the photgraph, detailed
Notes. Detailed
ray of affected Regular
700% Yes diagnosis, Procedure / Operative
discharge summary No
joint), clinical Procedure
Clinical
clinical notes Post Notes.Procedure
Detailed
photograph
and X-ray of clinical photgraph,
photograph Discharge summary
confirming
affected part the detailed Procedure /
Regular
400% Yes diagnosis, Operative Notes., No
Procedure
Clinical
clinical notes Post Procedure
procedure
and X-ray of clinical
photograph imagingphotgraph,
study (X
confirming
affected part the detailed
Ray) Procedure /
Regular
400% Yes diagnosis, Operative Notes., No
Procedure
clinical Post procedure
photograph of imaging study (X
affected part Ray)
 Clinical notes Post Procedure
and X-ray clinical photgraph,
confirming the detailed Procedure /
Regular
400% Yes diagnosis, Operative Notes., No
Clinical notes Post procedure X-ray, Procedure
clinical Post procedure
detailing Post Procedure
photograph of imaging study (X
indication and clinical photgraph,
affected part Ray)
X-ray of ankle detailed Procedure / Regular
500% No No
Clinical
and foot,notes Operative Notes, Procedure
Post procedure X-ray,
detailing
clinical Detailed Discharge
Post Procedure
indication
photograph and
of summary, Invoice and
clinical photgraph,
X-ray
affectedof ankle
part barcode of implant Regular
300% No detailed Procedure / No
Clinical
and foot,notes Procedure
Post procedure
Operative Notes,X-ray,
detailing
clinical
Post Procedure
Invoice and barcode
indication
photograph and
of
clinical photgraph,
of implant
X-ray
affectedof ankle
part Regular
300% No detailed Procedure / No
Clinical
and foot,notes Procedure
Post procedure
Operative Notes,X-ray,
detailing
clinical
Post Procedure
Invoice and barcode
indication
photograph and
of
clinical photgraph,
of implant
X-ray
affectedof ankle
part Regular
400% No detailed Procedure / No
Clinical
and foot,notes Procedure
Operative Notes,
detailing
clinical
Post procedure
Invoice X-ray,
and barcode
indication
photograph and
of
Post Procedure
of implant
X-ray
affectedof ankle
part Regular
300% Yes clinical photgraph, No
Clinical
and foot,notes Procedure
Post procedure
detailed X-ray,
Procedure /
detailing
clinical
Post Procedure
Operative Notes.
indication
photograph and
of
clinical photgraph,
X-ray
affectedof ankle
part Regular
300% No detailed Procedure / No
Clinical
and foot,notes Procedure
Post procedure
Operative Notes,X-ray,
detailing
clinical
Post Procedure
Detailed Discharge
Clinical
indication
photographnotes
and
of
clinical
summary. photgraph,
justifying
X-ray
affectedof ankle
part Regular
300% No detailed Procedure / No
surgery
and foot,with X Procedure
Operative Notes,
Ray of affected Post Procedure
clinical
Clinical notes Detailed Discharge
limb, clinical
photograph of clinical photgraph,
justifying summary.
photograph
affected partof detailed Procedure / Regular
1000% No No
surgery
affected with
part X Operative Notes. Procedure
Ray of affected
showing the Post Procedure
Detailed Discharge
limb, clinical
gangrene/ clinical
summary photgraph,
photograph
injury/ severe of detailed Procedure / Regular
1000% No No
affected
anatomical part Post procedure
Operative Notes. Procedure
Clinical notes
showing
deformity the imaging
Detailed study (X
Discharge
and X-ray
gangrene/ Ray),
summaryPost Procedure
confirming the
injury/ severe clinical photgraph, Regular
100% Yes diagnosis, No
anatomical Post procedure
detailed Procedure / Procedure
Clinical notes
clinical
deformity imaging
Operative study (X
Notes.
and X-ray of
photograph
Ray), Post Procedure
Detailed discharge
confirming
affected part the
clinical
summary, photgraph, Regular
700% Yes diagnosis, No
Post procedure
detailed Procedure / Procedure
Clinical
clinical notes
imaging
Operative study (X
Notes.
and X-ray of
photograph
Ray), Post
Detailed Procedure
discharge
confirming
affected part the
clinical
summary, photgraph, Regular
100% Yes diagnosis, No
Post procedure
detailed Procedure / Procedure
Clinical
clinical notes
imaging
Operative study (X
Notes.
and X-ray of
photograph
Ray), Post
Detailed Procedure
discharge
confirming
affected part the
clinical
summary, photgraph, Regular
100% Yes diagnosis, No
detailed Procedure / Procedure
clinical
Operative Notes.
photograph of
Detailed discharge
affected part
summary,
 Clinical and Post procedure
radiological imaging study (X
investigations Ray), Post Procedure
confirming the clinical photgraph,
Regular
200% Yes Clinical
diagnosis notes
(X- detailed Procedure / No
Procedure
with
ray ofplanned
affected Procedure /
Operative Notes.
line of clinical
joint), Operation notes, Post
Detailed discharge
treatment
photograph of procedure X-ray films
summary, Invoice and
Stand Alone
300% Yes including
child Post
with Procedure
reports,
barcode Detailed
of implant Yes
Procedure
planned line of clinical
Dischargephotgraph,
Summary,
treatment, X- detailed discharge
Invoice and barcode
Clinical notes
ray films with summary,
of implant detailed
and X-ray/ CT Regular
500% No reports Post Procedure
Procedure / Operative No
justifying the Procedure
clinical photgraph,
Notes. Post op X-ray
surgery,
detailed discharge
showing the implant &
Clinical notes
summary,
invoice / bardetailed
code of
and X-ray/ CT Regular
700% No Post Procedure
Procedure
implant. / Operative No
justifying the Procedure
clinical photgraph,
Notes. Post op X-ray
surgery,
detailed
showing discharge
the implant &
Clinical notes
summary,
invoice / bardetailed
code of
and X-ray/ CT Regular
700% No Post-op
implant. X-ray
Procedure of
/ Operative No
Clinical
justifyingnotes
the Procedure
operated
Notes. Postlimb,
op Post
X-ray
detailing
surgery,
Procedure
showing theclinical
implant &
Rockwood
photgraph,
invoice / bardetailed
code of
type of Regular
400% No Post-op
implant. X-ray
Procedure of
/ Operative Yes
Clinical
fracture,notes
X-ray/ Procedure
operated limb, Post
Notes, Detailed
detailing
MRI and
Procedure clinical
Discharge summary,
Rockwood
justification of
photgraph,
Invoice anddetailed
barcode
type
surgeryof done Regular
400% No Post-op
Procedure
of implantX-ray of
/ Operative Yes
Clinical
fracture,notes
X-ray/ Procedure
operated limb, Post
Notes, Detailed
detailing
MRI and
Procedure clinical
Discharge summary,
Rockwood
justification of
photgraph,
Invoice anddetailed
barcode
type
surgeryof done Regular
400% No Post-op
Procedure
of implantX-ray of
/ Operative Yes
Clinical
fracture,notes
X-ray/ Procedure
operated limb, Post
Notes, Detailed
detailing
MRI and
Procedure clinical
Discharge summary,
Rockwood
justification of
photgraph,
Invoice anddetailed
barcode
type
surgeryof done Regular
400% No Post-op
Procedure
of implantX-ray of
/ Operative Yes
Clinical
fracture,notes
X-ray/ Procedure
operated limb, Post
Notes, Detailed
detailing
MRI and
Procedure clinical
Discharge summary,
Rockwood
justification of
photgraph,
Invoice anddetailed
barcode
type
surgeryof done Regular
400% No Post-op
Procedure
of implantX-ray of
/ Operative Yes
Clinical
fracture,notes
X-ray/ Procedure
operated limb, Post
Notes, Detailed
detailing
MRI and
Procedure clinical
Discharge summary,
Rockwood
justification of
photgraph,
Invoice anddetailed
barcode
type
surgeryof done Regular
400% No Procedure
of implant / Operative Yes
fracture, X-ray/ Procedure
Notes, Detailed
Clinical
MRI andnotes Post Procedure
Discharge summary,
detailing
justification of clinical photgraph,
Invoice and barcode
indication
surgery done and detailed Procedure / Regular
500% Yes of implant No
Clinical and
X-ray, clinical Post procedure
Operative Notes. Procedure
radiological
photograph of imaging
Detailed study (X
discharge
investigations
affected part Ray),
summary Post Procedure
confirming the clinical photgraph, Regular
500% Yes No
Clinical
diagnosis notes
(X- Post procedure
detailed Procedure / Procedure
and
ray ofX-ray
bothof imaging
Operative study (X
Notes.
the patella
hips), clinical Ray),
DetailedPost Procedure
discharge
justifying
photograph the clinical
summary photgraph, Regular
500% Yes No
procedure, detailed Procedure / Procedure
clinical Operative Notes.
photograph of Detailed discharge
affected part summary
 Intra operative still
image, post
Clinical notes
procedure clinical
and MRI Regular
200% No Post Procedure
photgraph, detailed No
justifying Procedure
clinical
Procedurephotgraph,
/ Operative
procedure
detailed discharge
Notes, Detailed
Clinical notes
summary,
Discharge detailed
summary.
and X-ray/ CT Regular
500% No Procedure / Operative No
justifying the Post Procedure X-ray Procedure
Notes. Post op X-ray
surgery showing implant,
showing the implant &
Clinical notes detailed Procedure /
invoice / bar code of
and X-ray/ CT Operative Notes. Bar Regular
700% No implant. No
justifying the code of implant & Procedure
Post Procedure X-ray
surgery cement used,
showing implant,
Clinical notes Detailed discharge
detailed Procedure /
and X-ray/ CT summary Regular
700% No Operative Notes. Bar No
justifying the Post Procedure X-ray Procedure
code of implant used,
surgery showing implant,
Detailed discharge
Clinical notes detailed Procedure /
summary
and X-ray/ CT Operative Notes. Bar Regular
700% No No
justifying the Post
code Procedure
of implant /X-ray Procedure
surgery showing implant,
cement used,
Clinical notes detailed
Detailed Procedure
discharge /
and X-ray/ CT Operative
summary Notes. Bar Regular
700% No Post Procedure No
justifying the code of implant / Procedure
clinical photgraph,
surgery cement used,
detailed discharge
Clinical notes Detailed discharge
summary, detailed
and X-ray/ CT summary Regular
500% No Post Procedure
Procedure / Operative No
justifying the Procedure
clinical photgraph,
Notes. Post op X-ray
surgery
detailed
showing discharge
the implant &
Clinical notes
Post
invoiceprocedure
summary, detailed
/ bar code of
and X-ray/ CT Regular
500% No Clinical notes imaging
implant. study
Procedure (X
/ Operative No
justifying the Procedure
justifying need Ray),
Notes.Post
PostProcedure
op X-ray
surgery
of this surgery with implant;
showing invoice &
the implant
and X-ray/ MRI and barcode of of
invoice / bar code
Regular
700% No Clinical notes
of affected Post procedure
implant. detailed No
Procedure
justifying need imaging
part, Biopsy, Procedure study (X
/ Operative
of this surgery Ray),
clinical Notes. Post procedure
Histopathology
Post procedure
and X-ray/ MRI
photograph of clinical
of photgraph,
excised tissue,
imaging study (X Regular
600% No Clinical
of notes
affected
affected part detailed
Detailed Procedure
Discharge / No
Ray), Post Procedure Procedure
justifying need Operative
part, Biopsy, summary Notes.
clinical photgraph of
of this surgery Detailed discharge
clinical
both donor and
and X-ray/ MRI
photograph of summary, invoice and
X Ray of recipient sites, Regular
400% No of affected
affected No
affected part
limb, barcode of implant
detailed Procedure / Procedure
part, Biopsy,
clinical notes Post Procedure
Operative Notes.
clinical
and clinical clinical photgraph,
Histopathology of
photograph
X Ray of of
photograph of detailed
curreted Procedure
tissue, / Regular
500% Yes affected No
affected part
limb,
part Operative Notes.
Detailed Discharge Procedure
clinical
justifyingnotes
the Post Procedure
Detailed
summary discharge
and clinical
indication; clinical
summary photgraph,
X RayFIRof if of detailed Procedure /
photograph
MLC/ Regular
500% Yes No
affected
traumaticlimb,
part Operative Notes. Procedure
clinical
justifyingnotes
the Post Procedure
Detailed discharge
and clinical
indication; clinical
summary photgraph,
photograph
MLC/ FIR if of detailed Procedure / Regular
500% Yes No
affected
traumaticpart Operative Notes. Procedure
justifying the Detailed discharge
indication; summary
MLC/ FIR if
traumatic
 X Ray of
affected limb,
clinical notes Post Procedure
and clinical clinical photgraph,
X Ray of
photograph of detailed Procedure / Regular
500% Yes No
affected limb,
part Operative Notes. Procedure
clinical
justifyingnotes
the Post Procedure
Detailed discharge
and clinical
indication; clinical
summary photgraph,
X RayFIRof if of
photograph
MLC/ detailed Procedure / Regular
500% Yes No
affected
traumaticlimb,
part Operative Notes. Procedure
clinical
justifyingnotes
the Post Procedure
Detailed discharge
and clinical
indication; clinical
summary photgraph,
X RayFIRof if of
photograph
MLC/ detailed Procedure / Regular
500% Yes No
affected
traumaticlimb,
part Operative Notes. Procedure
clinical
justifyingnotes
the Post Procedure
Detailed discharge
and clinical
indication; clinical
summary photgraph,
X RayFIRof if of
photograph
MLC/ detailed Procedure / Regular
500% Yes No
affected
traumaticlimb,
part Operative Notes. Procedure
clinical
justifyingnotes
the Post Procedure
Detailed discharge
and clinical
indication; clinical
summary photgraph,
X RayFIRof if of
photograph
MLC/ detailed Procedure / Regular
500% Yes No
affected
traumaticlimb,
part Operative Notes. Procedure
clinical
justifyingnotes
the Post Procedure
Detailed discharge
and clinical
indication; clinical
summary photgraph,
X RayFIRof if of
photograph
MLC/ detailed Procedure / Regular
500% Yes No
affected
traumaticlimb,
part Operative Notes. Procedure
clinical
justifyingnotes
the Post Procedure
Detailed discharge
and clinical
indication; clinical
summary photgraph,
X RayFIRof if of
photograph
MLC/ detailed Procedure / Regular
500% Yes No
affected
traumaticlimb,
part Operative Notes. Procedure
clinical
justifyingnotes
the Post Procedure
Detailed discharge
and clinical
indication; clinical
summary photgraph,
X RayFIRof if of
photograph
MLC/ detailed Procedure / Regular
500% Yes No
affected
traumaticlimb,
part Operative Notes. Procedure
clinical
justifyingnotes
the Post Procedure
Detailed discharge
and clinical
indication; clinical
summary photgraph,
X RayFIRof if of
photograph
MLC/ detailed Procedure / Regular
500% Yes No
affected
traumaticlimb,
part Operative Notes. Procedure
clinical
justifyingnotes
the Post Procedure
Detailed discharge
and clinical
indication; clinical
summary photgraph,
X RayFIRof if of
photograph
MLC/ detailed Procedure / Regular
500% Yes No
affected
traumaticlimb,
part Operative Notes. Procedure
clinical
justifyingnotes
the Post Procedure
Detailed discharge
and clinical
indication; clinical
summary photgraph,
X RayFIRof if of
photograph
MLC/ detailed Procedure / Regular
500% Yes No
affected
traumaticlimb,
part Operative Notes. Procedure
clinical
justifyingnotes
the Post Procedure
Detailed discharge
and clinical
indication; clinical
summary photgraph,
X RayFIRof if of
photograph
MLC/ detailed Procedure / Regular
200% Yes No
affected
traumaticlimb,
part Operative Notes. Procedure
clinical
justifyingnotes
the Post Procedure
Detailed discharge
and clinical
indication; clinical
summary photgraph,
photograph
MLC/ FIR if of detailed Procedure / Regular
200% Yes No
affected
traumatic part Operative Notes. Procedure
Clinical notes Post Procedure
justifying the Detailed discharge
detailing clinical photgraph of
indication; summary
jusification of donor and receipent
MLC/ FIR if Regular
300% Yes surgery, sites; detailed No
traumatic Procedure
clinical Procedure / Operative
photograph of Notes. Detailed
affected part discharge summary
 Clinical notes
Post Procedure
detailing
clinical photgraph;
jusification of
detailed Procedure / Regular
300% No surgery, No
Operative Notes. Procedure
Clinical
clinical notes
Post Procedure
Detailed discharge
and justifyingof
photograph
clinical
summary photgraph,
need
affectedof part
detailed Procedure / Regular
100% Yes surgery, No
Post Procedure
Operative Notes. Procedure
Clinical
clinical notes
clinical
Detailedphotgraph,
discharge
and justifyingof
photograph
detailed
summaryProcedure /
need
affectedof part
Post Procedure
Operative Notes Regular
100% Yes surgery, No
clinical
includingphotgraph,
agent used Procedure
clinical
Clinical notes detailed Procedure
for lysis of tendon. /
photograph of
and MRI scan Operative Notes. Post
Detailed discharge
affected part Post Procedure
of affected proedure
summary X-ray Regular
300% No No
knee, Clinical clinical
showingphotgraph,
implant; Procedure
Clinical
photographnotes of detailed Procedure
ensure brace is /
and MRI part
affected scan Operative
provided inNotes.
packagePost
of affected proedure X-ray
cost, Detailed Regular
300% No Clinical No
knee, Clinical showing
Discharge implant;
summary Procedure
documents
photograph of Detailed discharge
ensure brace is
justifying
affected part summary,
provided inPostpackage
surgery with
Procedure
cost, Detailedclinical Regular
200% Yes USG No
photgraph, detailed
Discharge summary Procedure
Evidence,
Clinical notes Detailed
Procedure discharge
/ Operative
clinical
and clinical summary
Notes. Post
photograph of
photograph of Procedure clinical Regular
400% Yes affected part No
affected part photgraph, detailed Procedure
Clinical notes Post Procedure
confirming the Procedure / Operative
+/- X-ray clinical photgraph,
diagnosis Notes.
confirming the detailed Procedure /
Regular
600% Yes diagnosis, Operative Notes. No
Procedure
Clinical
clinical notes Post Procedure
Detailed discharge
+/- X-ray of
photograph clinical
summary photgraph,
Evidence of
confirming
affected part the detailed
5 sessions dressing/
Procedure
Regular
100% Yes Clinical
diagnosis,notes Operative Notes. No
Procedure
with planned
clinical Detailed discharge
line of
photograph of Procedure /
summary Evidence of
treatment
affected part Operation
2 sessionsnotes,
dressingPost
Regular
400% No Clinical
includingnotes procedure X-ray films No
Procedure
with planned
planned line of Procedure
with reports, / Detailed
line of
treatment, X- Operation
Discharge notes,
Summary Post
treatment
ray films with procedure X-ray films
Regular
700% No including
reports Post procedure
with reports, Detailed No
Clinical notes Procedure
planned line of imaging
Discharge study (X
Summary,
and X-ray of
treatment, X- Ray),
InvoicePost
andprocedure
barcode
the affected
ray films with clinical photgraph,
of implant
bone justifying Regular
500% Yes reports detailed Procedure / No
Clinical notes
the procedure, Post procedure Procedure
Operative Notes.
and X-ray of
clinical imaging study (X
Detailed discharge
the affected of
photograph Ray), Post Procedure
Post procedure
summary, invoice and
bone
affectedjustifying
part clinical photgraph, Regular
400% Yes imaging
barcode study (X
of implant No
Clinical notes
the procedure, detailed Procedure / Procedure
Ray) showing the
and X-ray of
clinical Operative Notes.
implant, Post
the patella of
photograph Detailed discharge
Procedure clinical
justifying
affected partthe summary Regular
700% Yes photgraph, detailed No
procedure, Procedure
Procedure / Operative
clinical
Notes. Invoice and
photograph of
barcode of implant
affected part
used. Detailed
discharge summary
 Post procedure
Clinical notes imaging study (X
and X-ray Ray), Post procedure
confirming the clinical photgraph,
Regular
500% Yes diagnosis, Post Procedure
detailed Procedure / No
Clinical and Procedure
clinical clinical
Operativephotgraph
Notes. /
radiological
photograph Post procedure X-ray
Clinical and of
investigations
Detailed discharge
affected part showing
summary,implant;
invoice and
radiological
confirming the Regular
600% Yes Post procedure
detailed
barcode Procedure
of implant / No
investigations
indication, Procedure
clinical
Operativephotograph;
Notes.
confirming
clinical the
Intra procedure
Detailed dischargestill
diagnosis,
photograph of
pictures;
summaryDetailed
Invoice and
clinical
affected part Regular
800% Yes Clinical notes discharge
barcode ofsummary
implant. No
photograph of Procedure
with planned Procedure /
Detailed Procedure /
affected part
line of Operation notes,
Operative Notes, Post
showing short
treatment procedure
Invoice andX-ray films
barcode
limb as Regular
600% No Clinical
includingnotes with reports, Detailed
of implant No
compared to Procedure
with planned
planned line of Discharge Summary,
other
line of limb Procedure
treatment, X- Invoice and/ barcode
treatment
ray films with Operation
of implant notes, Post
Regular
500% No Clinical
reports notes
including procedure X-ray films No
Procedure
with planned
planned line of with reports, Detailed
line of
treatment, X- Procedure /
Discharge Summary
treatment
ray films with Operation notes, Post
Regular
500% No including
reports procedure X-ray films No
Procedure
Clinical
plannednotesline of with reports, Detailed
Post Procedure
and X-ray X-
treatment, Discharge Summary
clinical photgraph
confirming
ray films with the
with cast, detailed Regular
100% Yes Clinical
reports notes
diagnosis, No
Procedure / Operative Procedure
with planned
clinical Procedure /
Notes, Detailed
line of
photograph of Operation notes, Post
Discharge summary.
treatment
affected part procedure X-ray films
Clinical notes Regular
100% Yes including with reports, Detailed No
justifying Post Procedure Procedure
planned line of Discharge Summary,
surgery with clinical photgraph,
treatment, X- Invoice and barcode
evidence from detailed Procedure /
ray filmsnotes
Clinical with of implant
X-ray / MRI Operative Regular
300% No reports No
justifying
scan of Post Procedure
Notes.Detailed Procedure
surgery
affected with
part, clinical
Dischargephotgraph,
summary
evidence
clinical from detailed
HistopathProcedure
of removed /
X-ray / MRI of
photograph Operative
tissue Regular
300% No No
Clinical
scan
affectedof notes
part Notes.Detailed Procedure
detailing
affected part, Detailed
Discharge discharge
summary
findings
clinical summary,
Histopath ofPost
removed
confirming
photographthe of Procedure
tissue clinical Regular
100% Yes No
diagnosis,
affected part photgraph, detailed Procedure
Clinical
clinical notes Procedure / Operative
Intra Procedure still
justifying
photograph of Notes.
images, detailed
surgery
affected with
part Regular
300% Yes Procedure / Operative No
evidence of Procedure
Notes. Detailed
Clinical
MRI / EMG/ notes
Intra Procedure
Discharge summarystill
justifying
NCV
images, detailed
surgery with Regular
300% Yes Procedure / Operative No
evidence of Procedure
Notes. Detailed
Clinical
MRI / EMG/ notes
Intra Procedure
Discharge summarystill
justifying
NCV
images, detailed
surgery with Regular
300% Yes Procedure / Operative No
evidence of Procedure
Notes. Detailed
MRI / EMG/
Discharge summary
NCV
 Intra procedure still
Clinical notes
images, Post
justifying
Procedure clinical
surgery with Regular
400% No Clinical notes photgraph, detailed No
evidence of Procedure
with planned Procedure / Operative
MRI / EMG/
line of Procedure /
Notes. Detailed
NCV
treatment Operation notes, Post
discharge summary
Regular
100% No including procedure X-ray films No
Procedure
Clinical
planned+/-lineand
of with reports, Detailed
Detailed discharge
radiological
treatment, X- Discharge Summary
summary, Post
investigations
ray films with
Procedure clinical Regular
400% Yes confirming
reports the No
photgraph, detailed Procedure
need of
Procedure / Operative
surgery;notes
Clinical +/-
Notes.
NCVplanned
with report
line of Procedure /
treatment Operation notes, Post
Follow - Up
100% No including procedure X-ray films Yes
Procedure
planned line of with reports, Detailed
treatment, X- Discharge Summary
ray films with
reports
Clinical notes
with planned
line of Procedure /
treatment Operation notes, Post
Follow - Up
100% No including procedure X-ray films No
Procedure
planned line of with reports, Detailed
treatment, X-
Clinical notes Discharge Summary
ray films
with with
planned
reports
line of Procedure /
treatment Operation notes, Post
Follow - Up
200% No Clinical
includingnotes procedure X-ray films No
Procedure
with planned
planned line of with reports, Detailed
line of
treatment, X- Procedure /
Discharge Summary
treatment
ray films with Operation notes, Post
Follow - Up
200% No including
reports procedure X-ray films No
Procedure
planned line of with reports, Detailed
treatment, X- Discharge Summary
Admission
ray films with
notes and Procedure Note with Regular
200% Yes reports No
Investigative Discharge Summary Procedure
reports
Admission
notes and Procedure Note with Regular
200% Yes No
Investigative Discharge Summary Procedure
reports
Admission
notes and Procedure Note with Regular
500% Yes No
Investigative Discharge Summary Procedure
Procedure / Operative
reports
Notes, Post
HPE, Clinical
Procedure
notes with Regular
600% No Photographs of No
planned line of Procedure
surgical site, HPE
treatment
report, Detailed
Discharge Summary
 Clinical notes
Intra procedure
and Clinical
clinical photograph,
photograph of
Post procedure
affected part, Post procedure Regular
300% Yes clinical photograph, No
Evidence of Imaging with film (X Procedure
Detailed Operative
confirmed ray) showing the
notes, Detailed
diagnosis of implants, Post
discharge summary
Post procedure
Clinical
Leprosynotes procedure Clinical Regular
700% No No
and MRI Imaging
photgraph with film (X
showing Procedure
ray)
scar,showing
Detailedthe
implants,
dischargePostsummary ,
Clinical notes procedure
Detailed Clinical /
Procedure Regular
700% No Post procedure X-ray No
and MRI photgraph
Operative showing
Notes Procedure
showing fixation &
scar, Detailed
Clinical notes fusion, Post
discharge summary ,
and MRI procedure Clinical
Detailed Procedure / Regular
600% Yes establishing Post procedure
photgraph showingX-ray No
Operative Notes Procedure
need of showing
scar, fixation &
Detailed
Clinical
surgery notes fusion,
dischargePostsummary
and MRI procedure Clinical /
Detailed Procedure
Regular
600% Yes establishing photgraph showing
Operative Notes. No
Procedure
need of scar, Detailed
Post op X-ray with
surgery discharge summary
Clinical notes film showing fusion;
Detailed Procedure /
and MRI Detailed discharge Regular
600% Yes Operative Notes. No
supporting summary; Detailed Procedure
surgery Post op X-ray
Procedure with
/ Operative
Clinical notes film showing fusion;
Notes;
and MRI Detailed discharge Regular
600% Yes No
supporting summary; Detailed Procedure
Post procedure
surgery Procedure / Operative
Clinical photgraph
Notes;
showing scar,
Clinical history, Regular
300% Yes Detailed discharge No
MRI, NCV Procedure
summary , Detailed
Procedure / Operative
Clinical notes
Notes & MRI Report
with planned Regular
1000% Yes Clinical notes Discharge summary No
line of Procedure
with planned
treatment
line of
treatment
Regular
1000% Yes Clinical
includingnotes Discharge summary No
Procedure
detailing
planned linethe of Post- op Clinical
injury and X- Photograph showing
treatment,
need
ray of with implant for fixation
films
Clinical notes Regular
1000% Yes surgery.
reports MLC/ and repairs; detailed No
detailing the Post- op Clinical Procedure
FIR with X-ray/ discharge summary,
injury and Photograph & X-rays
CT; pre-op Detailed operatives
need of showing craniotomy
clinical
Clinical notes notes
surgery. MLC/ evidence and implant Regular
1000% Yes photograph No
detailing the
FIR with X-ray/ Post- op Clinical
for fixation; detailed Procedure
injury
CT/ MRI and(of Photograph & X-rays
discharge summary,
need of &
both head showing craniotomy
Detailed operatives
Clinical
affectednotes
surgery. MLC/ evidence
long notes and implant Regular
1000% Yes No
detailing
FIR
bone) the
with X-ray/ Post- op Clinical
for fixation; detailed Procedure
injury
CT/ MRI and(of Photograph & X-rays
discharge summary,
need of &
both head showing craniotomy
Detailed operatives
surgery. MLC/ evidence
affected long notes and implant Regular
1000% Yes No
FIR
bone) with X-ray/ for fixation; detailed Procedure
CT/ MRI (of discharge summary,
both head & Detailed operatives
affected long notes
bone)
 Clinical notes
detailing the Post- op Clinical
injury and Photograph & X-rays
need of showing craniotomy
Clinical notes
surgery. MLC/ evidence and implant Regular
1000% Yes No
detailing the
FIR with X-ray/ Intra- op Clinical
for fixation; detailed Procedure
injury
CT/ MRI and(of Photograph & X-rays
discharge summary,
need of &
both head showing chest injury
Detailed operatives
Clinical
affectednotes
surgery. MLC/ repair
long notes and implant for Regular
500% Yes No
detailing
FIR
bone) the
with X-ray/ Intra- opdetailed
fixation; Clinical Procedure
injury
CT/ MRI and(of Photograph & X-rays
discharge summary,
need
both of
chest & showing
Detailed chest injury
operatives
Clinical notes
surgery.
affected MLC/ repair
notes and implant for Regular
500% Yes detailing long
the No
FIR
bone) with X-ray/ Intra- opdetailed
fixation; Clinical Procedure
injury and
CT/ MRI (of Photograph & X-rays
discharge summary,
need of
both chest & showing
Detailed visceral
operatives
Clinical
surgery.notes
MLC/
affected long injury
notes repair and Regular
1000% Yes detailing the
FIR with X-ray/ No
bone) Intra-
implant opfor
Clinical
fixation; Procedure
injuryMRI
CT/ and(of
Photograph & X-rays
detailed discharge
need of
both affected
showing
summary,visceral
Detailed
surgery.
viscera &MLC/
injury repairnotes
operatives and Regular
1000% Yes FIR with long
affected X-ray/ No
implant for fixation; Procedure
Clinical
CT/
bone) MRInotes
(of
Post-
detailedop discharge
Clinical
detailing
both affectedthe
Photograph showing
summary, Detailed
injury
viscera and&
implant for fixation;
operatives notes Regular
1000% Yes need
affectedof long No
detailed discharge Procedure
bone) MLC/ Post- op Clinical
surgery.
Clinical summary, Detailed
FIR withnotes
X-ray/ Photograph showing
with planned operatives notes
and
CT; PRE OP implant for fixation
Regular
1000% Yes line of
CLINICAL and flap cover; No
Intra- op Clinical Procedure
treatment
PICTURE detailed discharge
Photograph showing
detailing
+/- X-RAY/CT the summary, Detailed
tendon/ nerve injury
Clinical
injury and notes operatives notes
repair and Regular
1000% Yes detailing
need of the No
reconstruction; Procedure
injury
surgery.andMLC/
detailed discharge
need
FIR withof X-ray/ Intra operative still
Clinical summary, Detailed
CT/ MRInotes
surgery. MLC/
(of photograph, detailed
operatives notes Regular
1000% Yes detailing
FIR
both+/- the
Nerve
chest & discharge summary, No
Procedure
injury andlong Detailed operatives
conduction
affected
need
bone)of (NCV) Intra
velocity notesoperative still
Clinical
+/- MRI notes
surgery. +MLC/
/- photograph, detailed
Regular
1000% Yes detailing
FIR the
+/- Nerve
EMG(Electrom discharge summary, No
Procedure
injury and
conduction
yography) Detailed operatives
need
velocityof (NCV) Intra
notesoperative still
Clinical
+/- MRI notes
surgery. +MLC/
/- photograph, detailed
Regular
1000% Yes detailing
FIR the
+/- Nerve
EMG(Electrom discharge summary, No
Procedure
injury and
conduction
yography) Detailed operatives
need
velocityof (NCV) Intra
notesoperative still
Clinical
+/- MRI notes
surgery. +MLC/
/- photograph, detailed
Regular
1000% Yes detailing
FIR the
+/- Nerve
EMG(Electrom discharge summary, No
Procedure
injury and
conduction
yography) Detailed operatives
need
velocityof (NCV) Intra operative still
Clinical notes notes
surgery.
+/- MRI +MLC/
/- photograph, detailed
detailing the Regular
1000% Yes FIR +/- Nerve discharge summary,
EMG(Electrom No
injury and Procedure
conduction
yography) Detailed operatives
need of
velocity (NCV) Intra
notesoperative still
surgery. MLC/
+/- MRI + /- photograph, detailed
FIR +/- Nerve Regular
1000% Yes EMG(Electrom discharge summary, No
conduction Procedure
yography) Detailed operatives
velocity (NCV)
notes
+ /- MRI + /-
MRA + /- EMG
(Electromyogra
phy)
 Clinical notes
detailing the
injury and
need of
Intra operative still
surgery. MLC/
photograph, detailed
FIR +/- Nerve Regular
1000% Yes discharge summary, No
conduction Procedure
Detailed operatives
velocity (NCV)
notes
+ /- MRI + /-
MRA + /- EMG
(Electromyogra
phy)
 Reserved
Special Enhancement Day Care
Medical or Procedure
Conditions – applicable Procedure
Surgical (S/M) (Insurance/Tr
Rule (Y/N) Or not (Y/N) (Y/N)
ust)

No No Medical Yes

No No Surgical Yes

No No Surgical Yes

No No Surgical No

No No Surgical No

No No Surgical No

No No Surgical No

No No Surgical No

No No Surgical No

No No Surgical No

No No Surgical No

No No Surgical No

No No Surgical No
No No Surgical No

No No Surgical No

No No Surgical No

No No Surgical No

No No Surgical No

No No Surgical No

No No Surgical No

No No Surgical No

No No Surgical No

No No Surgical No

No No Surgical No

No No Surgical No

No No Surgical No

No No Surgical No
No No Surgical No

No No Surgical No

No No Surgical No

No No Surgical No

No No Surgical No

No No Surgical No

No No Surgical No

No No Surgical No

No No Surgical No

No No Surgical No

No No Surgical No

No No Surgical No

No No Surgical No

No No Surgical No
No No Surgical No

No No Surgical No

No No Surgical No

No No Surgical No

No No Surgical No

No No Surgical No

No No Surgical No

No No Surgical No

No No Surgical No

No No Surgical No

No No Surgical Yes

No No Surgical No

No No Surgical Yes

No No Surgical Yes
No No Surgical No

Yes No Surgical No

No No Surgical No

No No Surgical No

No No Surgical No

No No Surgical No

No No Surgical No

No No Surgical No

No No Surgical No

No No Surgical No

No No Surgical No

No No Surgical No

No No Surgical No

No No Surgical No
No No Surgical No

No No Surgical No

No No Surgical No

No No Surgical No

No No Surgical No

No No Surgical No

No No Surgical No

No No Surgical No

No No Surgical No

No No Surgical No

No No Surgical No

No No Surgical No

No No Surgical No

No No Surgical No
No No Surgical No

No No Surgical No

No No Surgical No

No No Surgical No

Yes No Surgical No

Yes No Surgical No

Yes No Surgical No

Yes No Surgical No

Yes No Surgical No

Yes No Surgical No

Yes No Surgical No

No No Surgical No

No No Surgical No

No No Surgical No
No No Surgical No

No No Surgical Yes

No No Surgical Yes

No No Surgical No

No No Surgical No

No No Surgical No

No No Surgical No

Yes No Surgical No

Yes No Surgical Yes

No No Surgical No

No No Surgical No

No No Surgical No

No No Surgical No

No No Surgical No
No No Surgical No

No No Surgical No

No No Surgical No

No No Surgical No

No No Surgical No

No No Surgical No

No No Surgical Yes

No No Surgical Yes

No No Surgical No

No No Surgical No

No No Surgical Yes

No No Surgical No

No No Surgical No

No No Surgical No
No No Surgical No

No No Surgical Yes

No No Surgical No

No No Surgical Yes

No No Surgical Yes

No No Surgical No

No No Surgical No

No No Surgical No

No No Surgical No

No No Surgical No

No No Surgical No
No No Surgical No

No No Surgical No

No No Surgical No

No No Surgical No

No No Surgical No

No No Surgical No

No No Surgical No

No No Surgical No

No No Surgical No

No No Surgical No

No No Surgical No

No No Surgical No

No No Surgical No

No No Surgical No
No No Surgical No

No No Surgical No

No No Surgical No

No No Surgical No

No No Surgical No

No No Surgical No

No No Surgical No

No No Surgical No

No No Surgical No

No No Surgical No

No No Surgical No

No No Surgical No

No No Surgical No

No No Surgical No
No No Surgical No
 AB PM - AB PM - ICHI
Paediatri Specialt Procedu Package Multiple Procedu
Specialt JAY JAY Procedu
c y y Code re Code Code Unexplai Procedu re Code Unexplai Package
Pediatric Package Procedu re / ICD
medical HBP 2.0 HBP 1.0
MP New Package HBP 2.0
MP047KL Acute
ned res HBP 2.0
No MP047KLAAcute
ned XXX Price-
Medical Name re Name Code
Pediatric
manage MP jaundice
M100011 MG001 febrile No jaundice
MG001A febrile XXX -
Manage
Medical
ment
Pediatric Severe Severe
MP M100055 MG002 illness Yes MG002A illness XXX -
ment
Manage
Medical sepsis
Severe sepsis
Septic
Pediatric MP M100055 MG002 Yes MG002B XXX -
ment
Manage
Medical sepsis shock
Pediatric MP M100014 MG003 Malaria Yes MG003A Complica
Malaria XXX -
ment
Manage
Medical
Pediatric MP M100051 MG003 Malaria Yes MG003B ted XXX -
ment
Manage
Medical Dengue Dengue
Pediatric MP M100015 MG004 Yes MG004A Dengue
malaria XXX -
ment
Manage
Medical fever
Dengue fever
hemorrh
Pediatric MP M100050 MG004 Yes MG004B Dengue XXX -
ment
Manage
Medical fever
Dengue agic
shock
Pediatric MP M100050 MG004 Chikung Yes MG004C Chikung XXX -
ment
Manage
Medical fever fever
syndrom
Pediatric MP M100016 MG005 unya No MG005A unya XXX -
ment
Manage
Medical Enteric e
Enteric
Pediatric MP fever
M100018 MG006 HIV with No fever
MG006A HIV with XXX -
ment
Manage
Medical fever fever
Acute
Pediatric MP M100039 MG007 complica No MG007A complica XXX -
ment
Manage
Medical Acute
Leptospir gastroent
Leptospir
Pediatric MP tions
M100017 MG008 gastroent No tions
Acute
MG008A eritis with XXX -
ment
Manage
Medical Acute
osis osis
Pediatric MP M100001 MG009 eritis with Yes MG009A gastroent
moderat XXX -
ment
Manage gastroent
Medical
Pediatric dehydrati eritis
e with
ment MP M100048 MG009 eritis with Yes MG009B Chronic XXX -
Manage
Medical
Pediatric Diarrohe
on severe
dehydrati
Persisten
MP M100036 MG010 dehydrati Yes MG010A diarrohe XXX -
ment
Manage
Medical a
Diarrohe dehydrati
ton
Pediatric MP M100036 MG010 on Yes MG010B ona XXX -
ment
Manage
Medical a
Dysenter diarrohe
Dysenter
Pediatric MP M100003 MG011 No MG011A XXX -
ment
Manage Acute
y Acute
a
y
Medical
Pediatric
ment MP M100022 MG012 viral No MG012A viral XXX -
Manage
Medical
Pediatric MP hepatitis
M100022 MG013 Chronic He No hepatitis
MG013A Chronic He XXX -
ment
Manage
Medical Liver Liver
Pediatric MP M100021 MG014 Visceral No MG014A Visceral XXX -
ment
Manage
Medical abscess abscess
Pediatric MP M100038 MG015 leishman No MG015A leishman XXX -
ment
Manage
Medical Pneumo Pneumo
Pediatric MP iasis
M100019 MG016 Severe No iasis
MG016A Severe XXX -
ment
Manage
Medical nia nia
Pediatric MP M100047 MG017 pneumon No MG017A pneumon XXX -
ment
Manage
Medical Empyem Empyem
Pediatric MP ia
M200043 MG018 Pericardi No MG018A ia XXX -
ment
Manage
Medical a
Lung a
Lung
Pediatric MP M100033 MG019 No MG019A Pericardi XXX -
ment
Manage al /
Pericardi
abscess abscess
Medical
Pediatric al
ment MP M100027 MG020 Pleural
al / Yes MG020A Pleural XXX -
Manage
Medical
Pediatric tuberculo
MP tuberculo
M100027 MG020 Urinary
Pleural Yes MG020B Urinary
tuberculo XXX -
ment
Manage
Medical sis
Pediatric MP sis
tuberculo
M100013 MG021 Viral
Tract No sis
MG021A Viral
Tract XXX -
ment
Manage
Medical
Pediatric MP M100035 MG022 sis
Infection
encephal No MG022A Infection
encephal XXX -
ment
Manage
Medical
Pediatric itis
MP New PackageMG023 Recurren
Septic Arth No itis
MG023A Recurren
Septic Arth XXX -
ment
Manage
Medical
Pediatric t
MP New PackageMG024 Skin and s No t
MG024A Skin and s XXX -
ment
Manage
Medical vomiting vomiting
Pediatric MP M100002 MG025 Pyrexia No MG025A Pyrexia XXX -
ment
Manage
Medical with
of with
of
Pediatric MP M100026 MG026 Acute No MG026A Acute XXX -
ment
Manage Acute
dehydrati
unknown Acute
dehydrati
unknown
Medical
Pediatric excabera excabera
ment MP M100005 MG028 bronchiti
on
origin No MG028A bronchiti
on
origin XXX -
Manage
Medical
Pediatric tion of tion of
MP M100020 MG030 s No s
MG030A Bacterial XXX -
ment
Manage
Medical Interstitia
Endocar Interstitia
Pediatric MP M100031 MG031 l Lung Yes MG031A Fungal
Endocar XXX -
ment
Manage
Medical ditis
Endocar l Lung
Pediatric MP M100031 MG031 Disease Yes MG031B ditis
Endocar
Disease XXX -
ment
Manage
Medical ditis
Vasculiti Vasculiti
Pediatric MP M100029 MG032 No ditis
MG032A Acute XXX -
ment
Manage
Medical s
Pancreat s
Pediatric MP M100037 MG033 Yes MG033A Chronic
pancreati XXX -
ment
Manage
Medical itis
Pancreat
Pediatric MP M100037 MG033 Yes tis
MG033B pancreati XXX -
ment
Manage
Medical itis
Pediatric MP New PackageMG034 Ascites No MG034A tis
Ascites XXX -
ment
Manage Acute Acute
Medical
Pediatric
ment MP M100060 MG035 transvers No MG035A transvers XXX -
Manage
Medical e myelitis
MP New PackageMG036 Atrial Fibri No e myelitis
MG036A Atrial Fibri XXX -
ment
Manage
ment
Pediatric
Congesti Congesti
Medical
Pediatric MP M100008 MG038 ve heart No MG038A Due
ve
Acute
to
heart XXX -
Manage
Medical
Pediatric any
MP M100045 MG039 failure
Asthma Yes MG039A failure
asthmati
Status XXX -
ment
Manage
Medical cause
Pediatric MP M100066 MG039 Asthma Yes c attack
MG039B asthmati
(pneumo XXX -
ment
Manage Respirat Type 1
Medical
Pediatric cus
ment MP M100044 MG040 ory
Respirat Yes MG040A nia,
respirato
Type 2 XXX -
Manage
Medical
Pediatric
ment MP M100044 MG040 failure
ory
Respirat Yes MG040B asthma,
ry failure
respirato XXX -
Manage
Medical
Pediatric COPD,
ment MP M100044 MG040 failure
ory Yes MG040C Upper
ry failureGI XXX -
Manage
Medical Upper ARDS,
Pediatric MP M100056 MG041 failure GI Yes
bleeding
MG041A foreignGI
Upper XXX -
ment
Manage
Medical bleeding
Upper GI (conserv
bleeding
Pediatric MP M100057 MG041 Yes MG041B body, XXX -
ment
Manage Lower
bleedingGI Lower
ative)
(endosco GI
Medical
Pediatric
ment MP M100058 MG042 hemorrh No MG042A poisonin
hemorrh
pic) XXX -
Manage
Medical
Pediatric MP New PackageMG043 age
Addison’s
AKI / No MG043A g,
age head
Addison’s
AKI XXX -
ment
Manage
Medical
Pediatric injury/
ment MP M100064 MG045 Renal No MG045A Renal
etc.) XXX -
Manage
Medical
Pediatric MP M100030 MG046 failure
Cerebral
Seizures
Status No MG046A failure
Seizures
Status XXX -
ment
Manage
Medical Cerebral
Pediatric MP M100065 MG047 sino-
Cerebral
epileptic No MG047A epileptic XXX -
ment
Manage sino-
Medical
Pediatric venous
sino-
us
ment MP M100063 MG049 Cerebral Yes MG049A us
venous XXX -
Manage
Medical
Pediatric thrombos
venous
sino- Acute
ment MP M100063 MG049 Cerebral
is / Yes MG049B thrombos
Acute XXX -
Manage
Medical
Pediatric thrombos
venous
sino- stroke
is
ment MP M100063 MG049 Stroke
is / Yes MG049C Acute
ischemic XXX -
Manage
Medical
Pediatric thrombos
venous
Immune heamorr
ment MP M100063 MG049 Stroke
is / Yes MG049D Immune
stroke XXX -
Manage
Medical
Pediatric thrombos
mediated hagic
mediated
ment MP M100059 MG050 Stroke
is / No MG050A stroke XXX -
Manage
Medical
Pediatric CNS
Hydroce CNS
Hydroce
ment MP M100062 MG051 Stroke
disorders No MG051A disorders XXX -
Manage
Medical
Pediatric phalus phalus
ment MP New PackageMG052 Myxedema No MG052A Myxedema XXX -
Manage
Medical
Pediatric
ment MP New PackageMG053 Thyrotoxic No MG053A Thyrotoxic XXX -
Manage
Medical
Pediatric Pneumot Pneumot
ment MP M100006 MG055 Neuromu No MG055A Neuromu XXX -
Manage
Medical
Pediatric hroax hroax
ment MP M100040 MG056 scular No MG056A scular XXX -
Manage
Medical
Pediatric MP New PackageMG057 disorders
Hypoglyce
Diabetic No MG057A disorders
Hypoglyce
Diabetic XXX -
ment
Manage
Medical
Pediatric MP M100010 MG059 Electrolyt
ketoacid No MG059A ketoacid XXX -
ment
Manage
Medical e Hypercal
Pediatric MP New PackageMG060 Electrolyt
osis Yes MG060A osis XXX -
ment
Manage
Medical Imbalanc
e cemia
Hypocalc
Pediatric MP New PackageMG060 Electrolyt Yes MG060B XXX -
ment
Manage
Medical e
Imbalanc
e emia
Hyponatr
Pediatric MP New PackageMG060 Electrolyt Yes MG060C Hyperos XXX -
ment
Manage
Medical e
Hyperos
Imbalanc
e emia
Hypernat
Pediatric MP New PackageMG060 Yes MG060D molar XXX -
ment
Manage molar
e
Imbalanc remia
Medical
Pediatric Accelerat
ment MP M100053 MG061 Non-
e No MG061A Accelerat
Non- XXX -
Manage
Medical
Pediatric ed
Hyperten ed
ment MP M100007 MG062 Ketotic No MG062A Hyperten
Ketotic XXX -
Manage
Medical hyperten
sive
coma hyperten
sive
Pediatric
ment MP M100049 MG063 sion No MG063A coma
sion XXX -
Manage
Medical
Pediatric emergen
Severe emergen
Severe
ment MP M100009 MG064 Sickle
cies No MG064A Sickle
cies XXX -
Manage
Medical
Pediatric anemia anemia
ment MP M100042 MG065 cell No MG065A cell XXX -
Manage
Medical
Pediatric MP New PackageMG066 Anemia
Anaphylax No MG066A Anemia
Anaphylax XXX -
ment
Manage
Medical Heat Heat
Pediatric MP M100052 MG067 Systemat No MG067A Systemat XXX -
ment
Manage
Medical stroke
ic lupus stroke
ic lupus
Pediatric MP M100028 MG068 Guillian No MG068A Guillian XXX -
ment
Manage
Medical erythema
Barre erythema
Barre
Pediatric MP M100061 MG069 No MG069A Acute XXX -
ment
Manage
Medical tosus
Syndrom
Snake tosus
Syndrom
Snake
Pediatric MP M100023 MG070 No MG070A organop XXX -
ment
Manage
Medical e
bite
Poisonin e
bite
hosphoru
Pediatric MP M100024 MG071 Yes MG071A Other XXX -
ment
Manage
Medical g
Poisonin s
Pediatric MP M100043 MG071 High end Yes Blood
MG071B High
poisoninend XXX -
ment
Manage
Medical g
Plasmap poisonin
compone
Plasmap
Pediatric MP M100069 MG073 radiologi No radiologi
MG073A Whole
gs
g XXX 25,000
ment
Manage Blood
heresis
cal nt
heresis
cal
Medical
Pediatric Blood
ment MP M100068 MG074 transfusi
Blood
diagnosti Yes MG074A including
diagnosti XXX 1,000
Manage
Medical
Pediatric transfusi
MP M100068 MG074 on
transfusi
c Yes MG074B platelet
c XXX 1,000
ment
Manage
Medical on
MP M100071 MG075 on
(CT, No MG075A transfusi
(CT, XXX 5,000
ment
Manage
MRI, on
MRI, (RDP,
ment PC,
Imaging Imaging
including SDP)
including
nuclear nuclear
imaging) imaging)
 High end High end
histopath histopath
ology ology
Pediatric (Biopsies (Biopsies
Medical
Pediatric )Febrile and ) and
MP M100072 MG076 No MG076A XXX 5,000
Manage
Medical Acute
advance
seizures advance
Febrile
Pediatric MP M200009 MP001 Febrile Yes MP001A XXX -
ment
Manage meningo
d
Acute
/Febrile other d
seizures
Medical
Pediatric seizures Flury of
ment MP New PackageMP001 encephal
serology
meningo
seizures Yes MP001B serology
Neurocy XXX -
Manage
Medical Acute
/seizures other seizures
Pediatric MP M200050 MP001 Febrile
itis
investiga
encephal / Yes MP001C investiga
sticercosi XXX -
ment
Manage meningo
seizures
Acute
/aseptic other
Medical
Pediatric seizures
tions
itis / tions
s
ment MP New PackageMP001 encephal
Epileptic
meningo Yes MP001D Epilepsy
Epileptic XXX -
Manage
Medical
Pediatric /seizures
Acute
meningiti
aseptic other Infectiou
MP M200010 MP002 itis
encephal
Acute
meningo / No MP002A encephal XXX -
ment
Manage
Medical seizures
saseptic
Acute
meningiti / febrile Immune-
s -
Pediatric MP M200090 MP003 opathy
itis
encephal / Yes MP003A opathy XXX -
ment
Manage
Medical sAcute
meningo
Acute
meningiti
aseptic / febrile mediated
Acute
uncompli
Pediatric MP M200090 MP003 itis
opathy
encephal / / Yes MP003B -encephal XXX -
ment
Manage
Medical sencephal
meningo
meningiti
aseptic / febrile cated
Pediatric MP M200078 MP004 hyperten
itis
opathy
itis
encephal / / No MP004A Acute
uncompli
itis XXX -
ment
Manage
Medical saseptic
meningiti
sive / febrile meningo
Pediatric MP M200048 MP005 hyperten
syndrom
itis
opathy / / Yes MP005A cated
syndrom XXX -
ment
Manage encephal
saseptic
encehalo
meningiti / febrile Aseptic
encephal
Medical
Pediatric sive
e
hyperten
opathy e
ment
Manage
Medical
MP M200012 MP005 sencephal
pathy
encehalo
meningiti
sive //
/ febrile Yes MP005B meningiti
Febrile
itis XXX -
Pediatric hyperten
opathy Hyperten
s
ment
Manage
Medical
MP M200027 MP005 metaboli
sencephal
pathy
encehalo
sive //
/ febrile Yes MP005C encephal
sive
XXX -
Pediatric hyperten
cencephal
opathy Metaboli
opathy
ment
Manage
Medical
MP M200097 MP005 metaboli
pathy
encehalo
sive // Yes MP005D
encehalo
c
XXX -
Pediatric encephal
hyperten
cpathy
opathy
ment
Manage
Medical
MP M200058 MP005 metaboli
encehalo
opathy
sive / // Yes MP005E Hepatic
pathy
encephal
XXX -
Pediatric MP M200094 MP005 encephal
hyperten
cpathy
metaboli Yes MP005F encephal XXX -
ment
Manage
Medical hepatic
encehalo
opathy
sive // opathy
Pediatric encephal
cpathy After
opathy
ment MP New PackageMP005 metaboli
encephal
hepatic // Yes MP005G migraine
Partially XXX -
Manage
Medical encehalo
opathy
Meningiti Decompr
chronic
Pediatric
ment MP M200049 MP006 cencephal
opathy
metaboli
encephal
pathy / // Yes MP006A treated XXX -
Manage
Medical shepatic
opathy
Meningiti essive
migraine
Pediatric MP M200027 MP006 encephal
brain
copathy
metaboli / Yes MP006B pyogenic XXX -
ment
Manage encephal
hepatic
sopathy cranioto
Neuro
Complica
Medical
Pediatric Meningiti
abscess
encephal
brain
copathy / meningiti
ment MP M200035 MP006 encephal / Yes MP006C my
ted /
tuberculo XXX -
Manage
Medical hepatic
sopathy
Meningiti
abscess
encephal / s
Pediatric MP M200095 MP006 brain
opathy / Yes MP006D After
sis
bacterial XXX -
ment
Manage encephal
hepatic
sopathy / Acute
Medical
Pediatric Medical
Meningiti
abscess
brain Shunt
meningiti
ment MP M200012 MP006 opathy
encephal
hepatic / Yes MP006E meningiti XXX -
Manage
Medical Manage
sOptic
abscess procedur
Optic
s
Pediatric brain
opathy s
ment
Manage
MP M200011 MP007 encephal
ment
neuritis for/ No MP007A e /
neuritis
XXX -
Medical
Pediatric abscess
Acute
Intracrani
brain / Acute
Intracrani
ment MP New PackageMP008 opathy
Raised No MP008A After XXX -
Manage
Medical
Pediatric neuroreg
al
abscess ring
Intracrani neuroreg
al ring
Intracrani
MP M200093 MP009 brain
intracrani No MP009A other XXX -
ment
Manage
Medical ression
enhancin
hemorrh
al space/ ression
space/
enhancin
hemorrh
al
Pediatric abscess emergen
ment MP M200084 MP010 Acute
g
age lesion No MP010A Acute
g
agelesion XXX -
Manage
Medical
Pediatric occupyin
pressure occupyin
cy neuro
ment MP M200050 MP011 worsenin
with
Cerebral
g lesion No MP011A worsenin
with
Cerebral
g lesion
surgical XXX -
Manage
Medical
Pediatric g in g in
MP M200092 MP012 complica
herniatio No MP012A complica
herniatio
procedur XXX -
ment
Manage
Medical Acute
neuro Acute
neuro
Pediatric MP M200053 MP013 tion
n No MP013A tion
n
es / XXX -
ment
Manage demyelin
metaboli
(tubercul demyelin
metaboli
(tubercul
Medical
Pediatric For ICP
ment MP M200079 MP014 ating
Juvenile
coma) and No MP014A ating
Juvenile
c and
oma) XXX -
Manage
Medical
Pediatric monitorin
MP M200040 MP015 myelopat
myasthe
neurode No MP015A myelopat
myasthe
neurode XXX -
ment
Manage
Medical Acute g
Acute
Pediatric MP M200056 MP016 hy
nia
generativ No MP016A hy
nia
generativ XXX -
ment
Manage Acute
ataxia Acute
ataxia
Medical
Pediatric e e
ment MP M100063 MP017 ischemic No MP017A ischemic XXX -
Manage
Medical
Pediatric condition
Wheezin condition
Wheezin
MP M200016 MP018 stroke No MP018A stroke XXX -
ment
Manage
Medical sChronic
Acute
g s
g
Chronic
Pediatric MP M200015 MP019 No MP019A XXX -
ment
Manage urticaria
cough /
Acute cough
Medical
Pediatric Acute
ment MP M200007 MP020 Anaphyla
urticaria / Yes MP020A Anaphyla XXX -
Manage
Medical
Pediatric urticaria
MP M200007 MP020 xis
Anaphyla acute Yes MP020B xis acute XXX -
ment
Manage
Medical Acute Acute
Pediatric MP M200072 MP021 asthma
xis acute No MP021A asthma XXX -
ment
Manage
Medical Unexplai
abdomen
Celiac Unexplai
abdomen
Celiac
Pediatric MP M200062 MP022 asthma No MP022A XXX -
ment
Manage ned
disease ned
disease
Medical
Pediatric
ment MP M200064 MP023 hepatosp
Infantile No MP023A hepatosp
Infantile XXX -
Manage
Medical
Pediatric Acute Acute
MP M200037 MP024 lenomeg
Nephroti
cholesta No MP024A lenomeg
Nephroti
cholesta XXX -
ment
Manage
Medical glomerul glomerul
Pediatric MP M200006 MP025 aly
csis No MP025A aly
c
sis XXX -
ment
Manage
Medical Global
Haemoly
onephriti
syndrom Haemoly
onephriti
syndrom
Pediatric MP M200026 MP026 develop No MP026A XXX -
ment
Manage tic
se with tic
s
e with
Medical
Pediatric mental
ment MP M200038 MP027 uremic
peritoniti No MP027A uremic
peritoniti XXX -
Manage
Medical
Pediatric delay
ment
Manage
MP M200098 MP028 sCRRT/
syndrom No MP028A Global
syndrom
CRRT
s XXX 25,000
Medical Intellectu
e develop
e
ment MP M200018 MP029 Yes MP029A XXX -
Manage al mental
ment disability delay
of
unknown
etiology
 Global
develop
mental Intellectu
Pediatric delay / al
Medical Rickets
Intellectu- Rickets
disability-
Pediatric MP M200018 MP029 Yes MP029B XXX -
Manage requiring
al requiring
of
Medical
Pediatric Acute
Develop Acute
Develop
ment MP M200020 MP030 admissio
disability No MP030A admissio
unknown XXX -
Manage
Medical
Pediatric severe
mental severe
mental
MP M200029 MP031 n
of for No MP031A n for
etiology XXX -
ment
Manage
Medical malnutriti
and malnutriti
and
Pediatric MP M200024 MP032 Work
unknown Up No MP032A Work Up XXX -
ment
Manage
Medical on
behavior
Short on
behavior
Short
Pediatric MP M200022 MP033 etiology No MP033A XXX -
ment
Manage Dysmorp
al
stature Dysmorp
al
stature
Medical
Pediatric
ment MP M200019 MP034 hic
disorders No MP034A hic
disorders XXX -
Manage
Medical
Pediatric Floppy
Inborn Floppy
Inborn
MP M200052 MP035 children No MP035A children XXX -
ment
Manage
Medical infant
errors of infant
errors of
Pediatric MP M200060 MP036 No MP036A XXX -
ment
Manage
Medical metaboli
Wilson’s metaboli
Wilson’s
Pediatric MP M200061 MP037 No MP037A XXX -
ment
Manage Rheumat
sm
disease Rheumat
sm
disease
Medical
Pediatric
ment MP M200047 MP038 oid No MP038A oid XXX -
Manage
Medical
Pediatric Rheumat Rheumat
MP M200046 MP039 arthritis No MP039A arthritis XXX -
ment
Manage
Medical ic
Cyanoticfever ic fever
Cyanotic
Pediatric MP M200045 MP040 Yes MP040A Cyanotic XXX -
ment
Manage
Medical spells
Cyanotic Cyanotic
spells
spells
Pediatric MP M200045 MP040 Yes MP040B XXX -
ment
Manage spells spells
with
Medical
Pediatric Cyanotic Cyanotic
ment MP M200045 MP040 Yes MP040C with
CHD XXX -
Manage
Medical
Pediatric spells
Cyanotic
Immune spells
Immune
MP M200045 MP040 Idiopathi Yes MP040D Chest
Idiopathi XXX -
ment
Manage
Medical spells with
Pediatric MP M200044 MP041 chaemolyt No MP041A
haemolyt
infection
c XXX -
ment
Manage
Medical ic
Thrombo Sepsis
ic
Thrombo
Pediatric MP M200039 MP042 No MP042A XXX -
ment
Manage
Medical anemia
cytopeni
Kawasak anemia
cytopeni
Kawasak
Pediatric MP M200041 MP043 Steven No MP043A Steven XXX -
ment
Manage
Medical ciKetogeni
Disease
Johnson c
iKetogeni
Disease
Johnson
Pediatric MP M200057 MP044 Purpura No MP044A Purpura XXX -
ment
Manage
Medical csyndrom
diet c diet
syndrom
Pediatric MP M200013 MP045 Trauma No MP045A Trauma XXX -
ment
Manage initiation
e initiation
e
Medical
ment MP M200059 MP046 in No MP046A in XXX -
Manage
refractor refractor
ment
y y
epilepsy epilepsy
 Can
No. of
Implants more
Stratific Reserva Reserva
Stratific / High than one Auto
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Criteria Consum implant Care d
Yes which
1.00 No No ns (Y/N)
No Hospital
No Hospital
No Secondary NA Yes
(Y/N) ables be (Y/N)
Yes can be
1.00 No No No s (Y/N)
No s (Y/N)
No Secondary NA Yes
(Y/N) booked
booked
Yes 1.00 No (Y/N)
No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA No
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA No
Yes 1.00 No No No No No Secondary NA No
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA No
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA No
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA No
Yes 1.00 No No Yes No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA No
Yes 1.00 No No No No No Secondary NA No
Yes 1.00 No No No No No Secondary NA No
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA No
Yes 1.00 No No No No No Secondary NA No
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA No
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA No
Yes 1.00 No No No No No Secondary NA No
Yes 1.00 No No No No No Secondary NA No
Yes 1.00 No No No No No Secondary NA No
Yes 1.00 No No No No No Tertiary NA Yes
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA No
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Tertiary NA Yes
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA Yes
No 0.00 No No Yes No No Secondary 100% No
No 0.00 No No No No No Secondary 100% Yes
No 0.00 No No Yes No No Secondary 100% Yes
No 0.00 No No Yes No No Secondary NA No
No 0.00 No No Yes No No Secondary NA No
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA No
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA No
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Tertiary NA Yes
Yes 1.00 No No No No No Tertiary NA Yes
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA No
Yes 1.00 No No No No No Tertiary NA Yes
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Tertiary NA Yes
Yes 1.00 No No No No No Tertiary NA Yes
Yes 1.00 No No No No No Tertiary NA Yes
Yes 1.00 No No No No No Tertiary NA Yes
Yes 1.00 No No No No No Tertiary NA Yes
Yes 1.00 No No No No No Tertiary NA Yes
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA Yes
No 0.00 No No Yes No No Secondary 100% No
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA Yes
Yes 1.00 No No No No No Secondary NA Yes
Clinical
history
detailing
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Clinical
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detailing
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