ANNEXURE 7B GOVERNMENT ORDER NO. HFW Package rates for Complex secondary Healthcare Treatments

Transcription

1 1 Operations for Congenital Arteriovenous Fistula CARDIO VASCULAR SURGERY OPHTHALMOLOGY 15,000 2 Prophylactic Cryoretinopexy- Closed 2, Enucleation with Implant Ptosis Surgery IRIS Prolapse Repair 4, Retinal Detachment Surgery 15, Socket Reconstruction with amniotic membrane 8, Iridectomy Surgical 3, Vitrectomy 7, Laser for retinopathy (per sitting) 1, Orbitotomy Squint correction (per muscle) 4, PRP - Retinal Laser including 3 sittings 5, Corneal Grafting 8, Glaucoma Surgery (Trabeculectomy only) with or without Mitomycin C, including postoperative medications for 12 weeks (and wherever surgical or laser procedures required for bleb augmentation and anterior chambermaintenance) Intraocular Foreign Body Removal from Anterior Segment 10, , Lensectomy /pediatric lens aspiration 9, Surgical Membranectomy 8, Perforating Corneo - Scleral Injury 10, Small Tumour of Lid Excision + Lid Reconstruction 10, Cataract with foldable hydrophobic acrylic IOL by Phaco emulsification tech + Glaucoma 10,500 Page 1 of 15

2 Cataract with non-foldable IOL using SICS technique + Glaucoma Anterior Chamber Reconstruction +Perforating corneo - Scleral Injury + IOL Photocoagulation for Retinopathy for 3 sittings-complete package 6,500 11, Therapeutic Penetrating Keratoplasty Lamellar Keratoplasty Scleral Patch Graft Glaucoma Filtering Surgery For Paediatric Glaucoma Mastoidectomy corticol modified/ radical Myringoplasty 5, Ossiculoplasty Stapedectomy Ant. Ethmoidal artery ligation - open/ endoscopic ENT 11, Antrostomy Bilateral Antrostomy Unilateral Cryosurgery 3, Septoplasty + FESS 11, Ethmoidectomy External Fracture - setting maxilla 8, Endoscopic DCR 7, Septo-rhinoplasty Arytenoidectomy 10, Pharyngeal diverticulum's Excision 10, Laryngectomy with block dissection Laryngofissure Oro Antral fistula 7, Tonsillectomy + Styloidectomy Uvulophanyngo Plasty 14, Page 2 of 15

3 49 Commondo Operation (glossectomy) Excision of Cystic Hygroma Minor 5, Excision of the Mandible Segmental 7, Hemi-mandibulectomy with graft 15, Labyrinthectomy 20, Excision of Pinna for Growths (Squamous/Basal) Injuries - Total Amputation & Excision of External Auditory Meatus 8, Mastoidectomy with tympanoplasty 16, Myringoplasty with Ossiculoplasty 13, Excision of Pinna for Growth (Squamous/Basal/ Injuries) Skin Only 2, Tympanotomy 4, Aural polypectomy +Tympanoplasty 10, Nasal polypectomy Bilateral 9, Nasal polypectomy Unilateral 6, Tonsillectomy + Myrinogotomy 10, Thyroglossal Fistula/ cyst Excision 7,000 ORTHOPAEDICS 64 External fixation - Pelvis 15, Limb Lengthening Reconstruction of ACL/PCL with implant and brace Open Reduction Internal Fixation (Large Bone) 30, , Bimalleolar Fracture Fixation 15, Bone Tumour (malignant/ benign) curettage and bone grafting Closed Interlock Nailing + Bone Grafting femur 20,000 19, Closed Interlocking Intermedullary 17,500 Page 3 of 15

4 72 Closed Reduction and Internal Fixation with K wire 6, Closed Reduction and Percutaneous Screw Fixation (neck femur) Closed Reduction and Percutaneous Nailing 15,000 20, External fixation - Long bone 15, Fixator with Joint Arthrolysis 20, Fracture - Hip Internal Fixation (Intertrochanteric Fracture with implant) + rehabilitation 17, Fracture - Humerus Internal Fixation 17, Open Reduction of CDH 30, Open Reduction with bone grafting of nonunion External fixation - both bones of forearms Fracture intercondylarhumerus + olecranon osteotomy Arthroscopic Meniscus Repair/ Meniscectomy Bipolar Hemiarthroplasty (hip & shoulder) 20,000 25,000 20,000 20,000 40, Unipolar Hemiarthroplasty 30, Elbow replacement 40, Arthrodesis of Knee (with implant) 40, Arthrodesis of Wrist (with implant) 30, Arthrodesis of Ankle (with implant) 30, Maysers muscle pedicle graft for Nonunion fracture neck femur (orthroplasty) Facio-Maxillary Injury repairs & fixations Anterolateral Clearance For Tuberculosis 18, Posterior cruciate ligament (PCL) Reconstruction 17, Blunt injury abdomen 10, Page 4 of 15

5 POLYTRAUMA 95 Internal fixation of Pelviacetabular fracture UROLOGY 40, Pyelolithotomy-Laparoscopic Perinephric Abscess drainage (Open) Urachal Cyst excision -open 15, Excision of Urethral Caruncle Orchiopexy-without laparoscopy, bilateral Ilio-Inguinal lymphadenectomyunilateral 15,000 15, Ilio-Inguinal lymphadenectomy-bilateral 25, Operation for Double Ureter 15, Pyelolithotomy 13, OBSTETRICS & GYNAECOLOGY 105 Vaginal hysterectomy with anterior and posterior colpoperineorrhaphy 16, Repair for rectovaginal fitulas 10, Vulvectomy simple 15,000 2b Laparoscopic hysterectomy (TLH) 20, Laparoscopic myomectomy Laparoscopic adhesiolysis 6, Laparotomy for ruptured ectopic 10, Shirodkar's stitch 4, Tuboplasty Surgeries for Prolapse - Sling Surgeries 16, Diagnostic laparoscopy 11, Laparoscopic cystectomy 15, McDonald's stitch 4, Adhenolysis + Hernia - Ventral - Lipectomy/Incision 16, Adhenolysis+ Ovarian Cystectomy 10,000 Page 5 of 15

6 120 Adhenolysis+ Salpingostomy 10, Brust abdomen repair 14, Cystocele - Anterior repair 12, Diagnostic laparoscopy & hysteroscopy for infertility Exploration of abdominal haematoma (after laparotomy + LSCS) 5,000 14, Chorionic villus sampling 5, Lap. Salphingo-oophorectomy 10, Lap. Assisted Vaginal Hysterectomy (LAVH) GENERAL SURGERY 11, Arteriovenous (AV) Malformation of Soft Tissue Tumour - Excision 15, Branchial Fistula 14,000 2b Drainage of Subdiaphramatic Abscess Drainage Pericardial Effusion Duodenal Diverticulum Duodenal Jejunostomy 20, Duplication of Intestine Excision Benign Tumor -Small intestine 15, Excision Meckel's Diverticulum 15, Excision Small Intestinal Fistula Excision of Growth from Tongue only 6, Excision of Swelling in Right Cervical Region Fibroadenoma Bilateral 8, Gastrojejunostomy 15, Hydatid Cyst of Liver IlieoSigmoidostomy Intestinal Obstruction 15, Jejunostomy 10, Gastric Perforation 15, Page 6 of 15

7 147 Intestinal Perforation (Resection Anastomosis) 20, Appendicular Perforation Laryngectomy & Pharyngeal Diverticulum (Throat) Ileostomy 10, Loop Colostomy Sigmoid 12, Mastectomy 12, Mesenteric Cyst Excision Mesenteric Caval Anastomosis Microlaryngoscopic Surgery Oeshophagoscopy for foreign body removal Pelvic Abscess - Open Drainage Distal Pancreatectomy with PancreaticoJejunostomy t Porto Caval Anastomosis 15, Repair of Common Bile Duct Sigmoid Diverticulum 15, Coloectomy Total Vasovasostomy Cleft lip operation 12, Cholecystectomy & Exploration of CBD Split thickness skin grafts Small (< 4% TBSA) Split thickness skin grafts Large (> 8% TBSA) 5, , Lap. For intestinal obstruction 15, Lap. Hepatic resection 25, Lap. Hydatid of liver surgery Laparoscopic Appendicectomy 18, Laparoscopic Cholecystectomy Laparoscopic cystogastrostomy Laparoscopic Gastrostomy Laparoscopic Hiatus Hernia Repair Page 7 of 15

8 176 Laparoscopic Pyloromyotomy Laparoscopic Rectopexy 15, Laparoscopic Spleenectomy Laparoscopic umbilical hernia repair Laparoscopic ventral hernia repair 20, Laparotomy-peritonitis lavage and drainage Lymphatics Excision of Subcutaneous Tissues In Lymphoedema Coccygeal Teratoma Excision 15, Drainage of perivertebral abscess b Removal of Foreign Body from Trachea or Oesophagus Resection Enucleation of Adenoma (lung) , Rib Resection & Drainage Trendelenburg Operation 10, Tissue Reconstruction Flap Leprosy Tendon Transfer-Leprosy Bleeding Ulcer - Partial Gastrectomy 25, Block dissection Cervical Nodes 10, Excision Bronchial Sinus 8, Fissurectomy with Sphincterotomy 15, Foreign Body Removal in Deep Region requiring GA Graham's Operation for duodenal perforation 5,000 15, Hernia - Repair & release of obstruction 15, Haemorroidectomy+ Fistulectomy 10, Salivary Gland Excision 10, Cleft lip & palate operation 15,000 (for each stage) Page 8 of 15

9 201 Hemi thyroidectomy 10, Laparoscopic Hernia Repair 18, Lap. Cholecystectomy & CBD exploration 20, Operation for Bleeding Peptic Ulcer 15, Thymectomy 20, Operation of Choledochal Cyst 15, Splenectomy - For Trauma 20, Thoracocentesis 1, Endoscopic Retrograde Cholangio Pancreatography (Endoscopic Retrograde Cholangio Pancreatography (ERCP) with Interventions 4, Laproscopic Adrenalectomy 30, Gastro jejuno Colic Fistula 12, Thymectomy 23, Endoscopic Retrograde Cholangio Pancreatography (ERCP) (Endoscopic Retrograde Cholangio Pancreatography) Upper GI Therapeutic(including Varicose Intervention) NEUROSURGERY , Micro discectomy Lumbar 40, Muscle Biopsy with report 7, Laminectomy with Fusion and fixation 50, Lumbar Disc including pre and post Op. MRI Spine - Decompression & Fusion with fixation Burns Management 30,000 50, Post Burn Contracture surgeries for Functional Improvement involving only skin (Package including splints,pressure garment and physiotherapy- Moderate Page 9 of 15

10 ORAL AND MAXILLOFACIAL SURGERY 221 Fixation of fracture of jaw with open reduction (1 jaw) and fixing of plates/ wire under GA 12, Sequestrectomy 1, Mandible Tumour Resection and reconstruction/cancer surgery TM joint ankylosis of both jaws - under GA Release of fibrous bands & grafting -in (OSMF) treatment under GA 6, ,000 3, Drainage of parotid abscess PEDIATRICS MEDICAL CARE PACKAGES 227 Diabetic ketoacidosis Rs 2,000 per day (pre-authorization needs to be sought to continue package beyond 5 and 10 day intervals) If shifted to HDU/ ICU, suitable rates would need to be applied and preauthorization be sought Nephrotic syndrome with peritonitis Rs 2,000 per day (pre-authorization needs to be sought to continue package beyond 5 and 10 day intervals) If shifted to HDU/ ICU, suitable rates would need to be applied and preauthorization be sought Infantile cholestasis Rs 2,000 per day (pre-authorization needs to be sought to continue package beyond 5 and 10 day intervals) If shifted to HDU/ ICU, suitable rates would need to be applied and preauthorization be sought..287 Page 10 of 15

11 230 Intracranial ring enhancing lesion with complication (neurocysticercosis, tuberculoma) Rs 2,000 per day (pre-authorization needs to be sought to continue package beyond 5 and 10 day intervals) If shifted to HDU/ ICU, suitable rates would need to be applied and preauthorization be sought A High end radiological diagnostic (CT, MRI, Imaging including nuclear imaging) - can only be clubbed with medical package Linked to B High end histopathology (Biopsies) and advanced serology investigations - can only be clubbed with medical package Linked to Congestive cardiac failure Rs 4,000 per day (advised to take preauthorization beyond 1 day - up to a limit of 5 days) If shifted to routine ward/ ICU, suitable rates would need to be applied and preauthorization be sought. Extend stay beyond 5 and 10 days as required with pre- authorization Poisonings with normal vital signs Rs 2000 per day (up to a limit of 1 day after which pre- authorization needs to be sought up to a limit of 5 days) 233 Empyema Rs 2,000 per day (pre-authorization needs to be sought to continue package beyond 5 and 10 day intervals) If shifted to HDU/ ICU, suitable rates would need to be applied and preauthorization be sought. Page 11 of 15

12 234 Blood and blood component transfusion (admissionfor a diagnostic procedure leading to treatment requiring admission, e.g. bone marrow and bone biopsy, endoscopy, liver biopsy, bronchoscopy, CT/MRI under GA, broncho-alveolar lavage, lumbar puncture, muscle biopsy, FNAC, pleural aspiration, ascitic tapping, neostigmine challenge test etc.) Rs 1,500 per day (upto a limit of 2 days) - needs mandatory pre-authorization NEO-NATAL PACKAGES 235 Advanced Surgery for Retinopathy of Prematurity 15, Basic neonatal care package (Cobedded with mother) (The mother must be kept in the hospital until the baby is discharged. She is provided a bed and food) Rs.500 per day (maximum Rs.1500) 237 Special Neonatal Care Package (Babies that required admission to SNCU or NICU Rs. 3000/day (maximum of Rs18,000) 238 Intensive Neonatal Care Package Rs. 5,000/day (Maximum of Rs. 50,000) Pre-authorization is needed after 5 days PEDIATRIC SURGERY Gastrostomy + Esophagoscopy+ Threading Undescended Testis - Unilateral- Palpable MEDICAL PACKAGES 20, ,000 3A Congestive heart failure Rs 2000 per day (Admission beyond 1 day requires pre-authorization).292 Page 12 of 15

13 242 Diabetic ketoacidosis Rs 2000 per day (Admission beyond 1 day requires pre-authorization) Upper GI bleeding (endoscopic) Rs 3,000 per day (advised to take preauthorization beyond 5 day - up to a limit of 10 days and also beyond to continue package) If shifted to routine ward/ ICU, suitable rates would need to be applied and preauthorization be sought If only in general ward then Rs Guillian Barre Syndrome Rs 3,000 per day (advised to take preauthorization beyond 5 day - up to a limit of 10 days and also beyond to continue package) If shifted to routine ward/ ICU, suitable rates would need to be applied and preauthorization be sought If only in general ward then Rs Lung abscess/ Empyema Rs 2,000 per day (pre-authorization needs to be sought to continue package beyond 5 and 10 day intervals) 245.A High end radiological diagnostic (CT, MRI, Imaging including nuclear imaging) - can only be clubbed with medical package. Rs 5000 per annum limit to a family 5000 Linked to M B High end histopathology (Biopsies) and advanced serology investigations - can only be clubbed with medical package. Rs 5000 per annum limit to a family 5000 Linked to M Page 13 of 15

14 246 Acute gastroenteritis with severe dehydration Rs 3,000 per day (advised to take preauthorization beyond 5 day - up to a limit of 10 days and also beyond to continue package) If shifted to routine ward/ ICU, suitable rates would need to be applied and preauthorization be sought If only in general ward then Rs.2000 ONCOLOGY 247 Total Thyroidectomy with central compartment LN dissection 20,000 MENTAL DISORDERS PACKAGES 248 F00-F09 Organic, including symptomatic, mental disorders Rs per day (up to a limit of 10 days after which preauthorization needs to be sought up to a limit of 10 days) 249 F40-F48 Neurotic, stress-related and somatoform disorders Rs per day (up to a limit of 10 days after which preauthorization needs to be sought up to a limit of 10 days) 250 F50-F59 Behavioural syndromes associated with physiological disturbances and physical factors Rs per day (up to a limit of 10 days after which preauthorization needs to be sought up to a limit of 10 days) 251 F Mental Retardation Rs per day (up to a limit of 10 days after which preauthorization needs to be sought up to a limit of 10 days) 252 Pre- Electro Convulsive Therapy (ECT) and Pre- rtranscranial Magnetic Stimulation (TMS)Package * Rs. 10,000 /- 253 Electro Convulsive Therapy (ECT) Rs. 3000/- per session Page 14 of 15

15 254 Transcranial Magnetic Stimulation (TMS) Rs. 1000/- per session Page 15 of 15