| TN0691 ACUTE MI REQUIRING IABP PUMP | ||||||
|---|---|---|---|---|---|---|
| PREAUTH | CLAIMS | |||||
| MIN. CLINICAL SYMPTOMS | MIN. REQUIRED | CRITERIA | DETAILS | % BREAKUP AMOUNT - CLAIMS | POINTS AWARDED | SPECIAL MENTION |
| CHEST PAIN +/_ VOMITING | ECG / CLINICAL PHOTO / ECHO | TOTAL BED DAYS | 20 | |||
| BEDS IN ICU | ||||||
| DAYS UNDER VENTILATOR SUPPORT | ||||||
| INVESTIGATIONS | ECG Changes | 30 | mandatory | |||
| Cardiac Enzymes | ||||||
| echo | mandatory | |||||
| TREATMENT | IABP | 50 | mandatory | |||
| Thrombolysis / LMWH & Others | ||||||
| angiogram | mandatory | |||||
| other supportive medicines | ||||||