| TN0729 RHINOCEREBRAL MUCORMYCOSIS | ||||||
|---|---|---|---|---|---|---|
| PREAUTH | CLAIMS | |||||
| MIN. CLINICAL SYMPTOMS | MIN. REQUIRED | CRITERIA | DETAILS | % breakup amount - claims | POINTS AWARDED | SPECIAL MENTION |
| fever, respiratory distress, +/- altered sensorium | CLINICAL PHOTO, CT SCAN BRAIN, DIABETIC PROFILE | TOTAL BED DAYS | 20 | |||
| BEDS IN ICU | ||||||
| DAYS UNDER VENTILATOR SUPPORT | ||||||
| INVESTIGATIONS | GENERAL WORK UP | 30 | mandatory | INCLUDING ABG | ||
| LP + CSF STUDY | ||||||
| PCR ASSAY | ||||||
| BIOPSY & HPE | ||||||
| CT SCAN | mandatory | |||||
| CONTRAST ENHANCED MRI | ||||||
| TREATMENT | ANTIFUNGAL | 50 | mandatory | |||
| DEBRIDEMENT | mandatory | |||||
| SUPPORTIVE CARE | ||||||