TN0727 PRIMARY SJOGREN'S SYNDROME | ||||||
---|---|---|---|---|---|---|
PREAUTH | CLAIMS | |||||
MIN. CLINICAL SYMPTOMS | MIN. REQUIRED | CRITERIA | DETAILS | % BREAKUP AMOUNT - CLAIMS | POINTS AWARDED | SPECIAL MENTION |
DRY EYES, DRY MOUTH, ENLARGED PAROTIDS | CLINICAL PHOTO, ANA, GENERAL WORK UP, SCHIRMER'S TEST | TOTAL BED DAYS | 20 | |||
INVESTIGATIONS | GENERAL WORK UP | 30 | ||||
SEROLOGY | mandatory | |||||
SAILOGRAPHY | ||||||
SALIVARY GLAND BIOPSY + HPE | mandatory | |||||
TREATMENT | STEROIDS /IMMUNOSUPPRESSION / SUPPORTIVE CARE | 50 | mandatory |