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Follow Up Procedure Guidelines - CARDIOTHORACIC

SERIAL NUMBER Procedure 1st Qtr Per Qtr (for next 3 Qtrs) Requirements while submitting for follow-up Preauth Requirements while submitting for follow-up Claims
13 FP0013 : Coronary Bypass Surgery 4,000 2,000 Previous Discharge Summary [ECG, Clinical History,(PT/INR x 1st 6 months)-Mandatory]
14 FP0014 : Coronary Bypass Surgery - post Angioplasty 4,000 2,000 Previous Discharge Summary [ECG, Clinical History, Clinical Evaluation,(PT/INR x 1st 6 months)-Mandatory]
15 FP0015 : CABG with IABP Pump 4,000 2,000 Previous Discharge Summary [ECG, Clinical History, Clinical Evaluation, X-ray, ECHO,(PT/INR x 1st 6 months)-Mandatory]
16 FP0016 : CABG with aneurismal repair 4,000 2,000 Previous Discharge Summary [ECG, Clinical History, Clinical Evaluation, X-ray, Doppler flow, (PT/INR x 1st 6 months)-Mandatory]
17 FP0017 : With prosthetic Ring 4,000 2,000 Previous Discharge Summary (ECG,ECHO, Clinical Evaluation-Mandatory), PT/INR
18 FP0018 : Without prosthetic Ring 4,000 2,000 Previous Discharge Summary (ECG,ECHO, Clinical Evaluation-Mandatory), PT/INR
19 FP0019 : Open Pulmonary Valvotomy 4,000 2,000 Previous Discharge Summary (ECG,ECHO, Clinical Evaluation-Mandatory), PT/INR
20 FP0020 : Closed mitral Valvotomy 4,000 2,000 Previous Discharge Summary (ECG,ECHO, Clinical Evaluation-Mandatory), PT/INR
21 FP0021 : Mitral Valvotomy (open) 4,000 2,000 Previous Discharge Summary (ECG,ECHO, Clinical Evaluation-Mandatory), PT/INR
22 FP0022 : Mitral Valve Replacement (with valve) 4,000 2,000 Previous Discharge Summary (ECG, ECHO, Inr Level, Clinical Evaluation-Mandatory), PT/INR
23 FP0023 : Aortic Valve Replacement (with valve) 4,000 2,000 Previous Discharge Summary (ECG, ECHO, Inr Level, Clinical Evaluation-Mandatory), PT/INR
24 FP0024 : Tricuspid Valve Replacement 4,000 2,000 Previous Discharge Summary (ECG, ECHO, Inr Level, Clinical Evaluation-Mandatory), PT/INR
25 FP0025 : Double Valve Replacement (with valve) 4,000 2,000 Previous Discharge Summary (ECG, ECHO, Inr Level, Clinical Evaluation-Mandatory), PT/INR
26 FP0026 : Carotid Embolectomy 4,000 2,000 Previous Discharge Summary (Color Doppler, Neurological Evaluation, Clinical Evaluation-Mandatory), CT in first quarter, ECHO, Lipid Profile