| TN0697 PERICARDIAL EFFUSION, TAMPONADE | ||||||
|---|---|---|---|---|---|---|
| PREAUTH | CLAIMS | |||||
| MIN. CLINICAL SYMPTOMS | MIN. REQUIRED | CRITERIA | DETAILS | % BREAKUP AMOUNT - CLAIMS | POINTS AWARDED | SPECIAL MENTION |
| BREATHLESSNESS | XRAY CHEST / ECHO / CLINICAL PHOTO | TOTAL BED DAYS | 20 | |||
| BEDS IN ICU | ||||||
| DAYS UNDER VENTILATOR SUPPORT | ||||||
| INVESTIGATIONS | General Work UP | 30 | ||||
| ECG | mandatory | |||||
| ECHO | mandatory | |||||
| CXR | mandatory | |||||
| TREATMENT | other supportive medicines ( antibiotics / ATT ) | 50 | ||||
| pericardial effusion tapping | mandatory | |||||
| TAPPING FLUID ANALYSIS | mandatory | |||||