TN0668 MALIGNANT PLEURAL EFFUSION |
PREAUTH | CLAIMS |
MIN. CLINICAL SYMPTOMS | MIN. REQUIRED | CRITERIA | DETAILS | % BREAKUP AMOUNT - CLAIMS | POINTS AWARDED | SPECIAL MENTION |
BREATHLESSNESS, PREVIOUS HISTORY OF PLEURAL EFFUSION IN LAST 6 MONTHS | CLINICAL PHOTO, CXR | TOTAL BED DAYS | | 20 | | |
| | BEDS IN ICU | | | | |
| | DAYS UNDER VENTILATOR SUPPORT | | | | |
| | INVESTIGATIONS | GENERAL WORK UP / CXR | 30 | mandatory | |
| | | PLEURAL FLUID ANALYSIS | | mandatory | |
| | | HRCT LUNG | | | |
| | | PLEURAL BIOPSY & HPE | | mandatory | |
| | | TO R/O OTHER CAUSES | | | |
| | TREATMENT | PLEURAL FLUID TAPPING / ASPIRATION | 50 | mandatory | |
| | | SUPPORTIVE CARE /ANTIBIOTICS | | | |
| | | PLEURODESIS | | mandatory | |
| | | NON INVASIVE VENTILLATION | | | |