104
S.NO CODE ICD CODE SYSTEM PREAUTHORISATION INVESTIGATION TREATMENT PROTOCOL PACKAGE PRICES POST OPERATIVE/PROCEDURE INVESTIGATION S1 GENERAL SURGERY S1.1 HEAD & NECK S1.1.1 NECK 1 S1.1.1.1 29.2 Excision of Branchial Cyst Fine Needle Aspiration Cytology (FNAC) , Clinical Photograph , , USG of the Neck - 24000 Post OP HPE, Intraoperative photos, scar photo 2 S1.1.1.2 29.52.1 Excision of Branchial Sinus Clinical Photograph Sinogram with IV canula in situ & USG of Neck - 24000 POST OP HPE, Intraoperative photos , scar photo 3 S1.1.1.3 39.8.1 Excision of Carotid Body Tumours Cartotid Angiography / MRI Neck / Colour Doppler Study Of Neck Vessels& USG of Neck - 33930 Colour Doppler Study Of Neck Vessels,Post OP HPE, Intraoperative photos , scar photo 4 S1.1.1.4 40.29.1 Excision of Cystic Hygroma -Extensive Clinical Photograph, FNAC, USG of the Local Area / CT Local Area - 23240 POST OP HPE, Intraoperative photos,scar photo 5 S1.1.1.5 40.29.2 Excision of Cystic Hygroma -Major Clinical Photograph, FNAC, USG of the Local Area - 24000 POST OP HPE, Intraoperative photos,scar photo 6 S1.1.1.6 40.29.3 Cystic Hygroma Excision-Minor Fine Needle Aspiration Cytology (FNAC),USG local area,Clinical Photograph - 10000 POST OP HPE, Intraoperative photos , scar photo 7 S1.1.1.7 06.6 Excision of Lingual Thyroid T3, T4, TSH ,USG Neck / Thyroid Uptake Measurements With 131-Iodine, FNAC, Clinical Photograph, ENT Consultation - 30000 POST OP HPE, Intraoperative photos , scar photo 8 S1.1.1.8 06.8.1 Parathyroidectomy -Non Malignant USG Neck, FNAC,TFT, P.T.H Assay, Serum, calcium and phosphorous levels - 30000 POST OP HPE, Intraoperative photos, scar photo 9 S1.1.1.9 06.7 Excision of Thyroglossal Cyst Fistula Clinical Photograph , USG Neck,TFT, Radionucleide Scan - 30000 POST OP HPE, Intraoperative photos , scar photo 10 S1.1.1.10 77.91 Excision of Cervical Rib Color Doppler of subclavian, X-ray of Thoracic inlet AP, clinical photographs of affected limb - 26880 POST OP HPE, Intraoperative photos , scar photo, Post OP X- ray of Thoracic inlet AP 11 S1.1.1.11 26.30.3 Removal Of Submandibular Salivary Gland FNAC, Clinical Photograph, USG of the Neck - 25080 Post OP HPE, Intraoperative photos , scar photo ANNEXURE-I

ANNEXURE-I CODE ICD CODE SYSTEM PREAUTHORISATION …

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Page 1: ANNEXURE-I CODE ICD CODE SYSTEM PREAUTHORISATION …

S.NO

CODE ICD CODE SYSTEM PREAUTHORISATION

INVESTIGATION

TREATMENT PROTOCOL PACKAGE

PRICES

POST

OPERATIVE/PROCEDURE

INVESTIGATION

S1 GENERAL SURGERY

S1.1 HEAD & NECK

S1.1.1 NECK

1 S1.1.1.1 29.2 Excision of Branchial CystFine Needle Aspiration Cytology (FNAC) ,

Clinical Photograph , , USG of the Neck -  24000

Post OP HPE, Intraoperative

photos, scar photo

2 S1.1.1.2 29.52.1 Excision of Branchial SinusClinical Photograph Sinogram with IV

canula in situ & USG of Neck -  24000

POST OP HPE, Intraoperative

photos , scar photo

3 S1.1.1.3 39.8.1 Excision of Carotid Body Tumours

Cartotid Angiography / MRI Neck / Colour

Doppler Study Of Neck Vessels& USG

of Neck

 -  33930

Colour Doppler Study Of Neck

Vessels,Post OP HPE,

Intraoperative photos , scar photo

4 S1.1.1.4 40.29.1 Excision of Cystic Hygroma -ExtensiveClinical Photograph, FNAC, USG of the

Local Area / CT Local Area -  23240

POST OP HPE, Intraoperative

photos,scar photo

5 S1.1.1.5 40.29.2 Excision of Cystic Hygroma -MajorClinical Photograph, FNAC, USG of the

Local Area -  24000

POST OP HPE, Intraoperative

photos,scar photo

6 S1.1.1.6 40.29.3 Cystic Hygroma Excision-Minor

Fine Needle Aspiration Cytology

(FNAC),USG local area,Clinical

Photograph

 -  10000POST OP HPE, Intraoperative

photos , scar photo

7 S1.1.1.7 06.6 Excision of Lingual Thyroid

T3, T4, TSH ,USG Neck / Thyroid Uptake

Measurements With 131-Iodine, FNAC,

Clinical Photograph, ENT Consultation

 -  30000POST OP HPE, Intraoperative

photos , scar photo

8 S1.1.1.8 06.8.1 Parathyroidectomy -Non MalignantUSG Neck, FNAC,TFT, P.T.H Assay,

Serum, calcium and phosphorous levels -  30000

POST OP HPE, Intraoperative

photos, scar photo

9 S1.1.1.9 06.7 Excision of Thyroglossal Cyst FistulaClinical Photograph , USG Neck,TFT,

Radionucleide Scan -  30000

POST OP HPE, Intraoperative

photos , scar photo

10 S1.1.1.10 77.91 Excision of Cervical Rib

Color Doppler of subclavian,

X-ray of Thoracic inlet AP, clinical

photographs of affected limb

 -  26880

POST OP HPE, Intraoperative

photos , scar photo, Post OP X-

ray of Thoracic inlet AP

11 S1.1.1.11 26.30.3 Removal Of Submandibular Salivary GlandFNAC, Clinical Photograph, USG of the

Neck -  25080

Post OP HPE, Intraoperative

photos , scar photo

ANNEXURE-I

Page 2: ANNEXURE-I CODE ICD CODE SYSTEM PREAUTHORISATION …

12 S1.1.1.12 26.4 Parotid Duct Repair Silography&Clinical Photograph  -  26150 Silography , Intra OP photo

13 S1.1.1.13 26.31 Superficial Parotoidectomy(Non-malignant)USG Neck, Fine Needle Aspiration Cytology

(FNAC) , Clinical Photograph - 21260 Post OP HPE, Intra OP photo

S1.1.2 MANDIBLE

14 S1.1.2.1 76.31.1 Hemimandibulectomy X-Ray Facial Bones,CT Head  -  42780

POST OP HPE,Post OP X-Ray

Facial Bones, Intraoperative

photos , scar photo

15 S1.1.2.2 76.31.4 Segmental Mandible Excision X-Ray Facial Bones,CT Head  -  34736

POST OP HPE,Post OP X-Ray

Facial Bones, Intraoperative

photos , scar photo

S1.1.3 TOUNGE

16 S1.1.3.1 25.2.1 Partial Glossectomy Clinical Photograph  -  26646POST OP HPE, Intraoperative

photos , scar photo

S1.1.4 LIP

17 S1.1.4.1 27.54.2 ABBE Operation FNAC, Clinical Photograph  -  20000POST OP HPE, Intraoperative

photos , scar photo

18 S1.1.4.2 27.43.2 Vermilionectomy FNAC, Clinical Photograph  -  21170POST OP HPE, Intraoperative

photos , scar photo

19 S1.1.4.3 27.42.2Wedge Excision of

Lip&Vermilionectomy(27.43)FNAC, Clinical Photograph

 - 17730

POST OP HPE, Intraoperative

photos , scar photo

20 S1.1.4.4 27.42.1 Wedge Excision of Lip FNAC, Clinical Photograph  -  14730POST OP HPE, Intraoperative

photos , scar photo

S1.1.5 THYROID (NO-MALIGNANT)

21 S1.1.5.1 06.2.1 HemithyroidectomyClinical Photograph,FNAC , USG of the

Neck, T F T -  25000

POST OP HPE, Intraoperative

photos , scar photo

22 S1.1.5.1.1 06.2.2 Laproscopic Hemi Thyroidectomy

T3, T4, TSH,USG Neck, Fine Needle

Aspiration Cytology (FNAC), Clinical

Photograph.

- 28330 Post OP HPE, WEBEX

23 S1.1.5.2 06.39.1 Isthmectomy

T3, T4, TSH,USG Neck -, Fine Needle

Aspiration Cytology (FNAC,Clinical

Photograph

 -  24300POST OP HPE, Intraoperative

photos , scar photo

24 S1.1.5.2.1 06.39.3 Laproscopic Isthmectomy

T3, T4, TSH ,USG Neck , Fine Needle

Aspiration Cytology (FNAC), Clinical

Photograph

- 28670Routine Histopathological

Examination

Page 3: ANNEXURE-I CODE ICD CODE SYSTEM PREAUTHORISATION …

25 S1.1.5.3 06.39.2 Partial ThyroidectomyClinical Photograph,FNAC , USG of the

Neck ,T F T -  24210

POST OP HPE, Intraoperative

photos , scar photo

26 S1.1.5.4 06.31.1 Resection Enucleation - ThyroidClinical Photograph,FNAC , USG of the

Neck ,T F T -  25000

POST OP HPE, Intraoperative

photos , scar photo

27 S1.1.5.5 06.31.2 Subtotal ThyroidectomyClinical Photograph,FNAC , USG of the

Neck ,T F T -  28000

POST OP HPE, Intraoperative

photos , scar photo

28 S1.1.5.5.1 06.31.3 Laproscopic Sub total Thyroidectomy T3, T4, TSH ,USG Neck, FNAC - 27780 Post OP HPE, WEBEX

29 S1.1.5.6 06.4.1 Total ThyroidectomyClinical Photograph,FNAC , USG of the

Neck ,T F T -  30000

POST OP HPE, Intraoperative

photos , scar photo

30 S1.1.5.6.1 06.4.2 Laproscopic Total Thyroidectomy

T3, T4, TSH ,USG Neck , Fine Needle

Aspiration Cytology (FNAC) , Clinical

Photograph

- 28810 Post OP HPE, WEBEX

S1.2 BREAST

31 S1.2.1 85.41.1 Simple Mastectomy (Non Malignant) Mammography , USG BreastI, FNAC  -  30000POST OP HPE, Intraoperative

photos , scar photo

S1.3 ABDOMEN

32 S1.3.1.1 53.59.1 Epigastric Hernia repair without MeshUSG of the Abdomen ,Clinical

photograph -  25000

USG Abdomen,Intraoperative

photos, scar photo

33 S1.3.1.2 53.69.1 Epigastric Hernia repair with MeshUSG of the Abdomen ,Clinical

photograph -  40000

USG Abdomen,Intraoperative

photos, scar photo

34 S1.3.1.2.1 53.63Laproscopic Surgical treatment for Epigastric

Hernia repair with Mesh

USG of the Abdomen ,Clinical

photograph - 50000

USG Abdomen,Intraoperative

photos, scar photo

35 S1.3.1.3 53.29.2 Unilateral Femoral Hernia repairUSG of the Abdomen ,Clinical

photograph -  25000

USG Abdomen,Intraoperative

photos, scar photo

36 S1.3.1.3.1 53.04Laproscopic Surgical treatment for Unilateral

Femoral Hernia With Mesh

USG of the Abdomen ,Clinical

photograph - 30000

USG Abdomen,Intraoperative

photos, scar photo

37 S1.3.1.4 53.72 Hiatus Hernia Repair - AbdominalUSG of the Abdomen ,Clinical

photograph -  48000

USG Abdomen,Intraoperative

photos, scar photo

38 S1.3.1.4.1 53.71.1Laproscopic Surgical treatment for Hiatus

Hernia With Mesh

USG of the Abdomen ,Clinical

photograph - 50000

USG Abdomen,Intraoperative

photos, scar photo

39 S1.3.1.5 53.9.1Rare Hernias repair

(Spigalion,Obuturator,Sciatic)USG of the part ,Clinical photograph  -  20000

USG Abdomen,Intraoperative

photos, scar photo

40 S1.3.1.6 53.49.1 Umbilical Hernia repair without MeshUSG of the Abdomen ,Clinical

photograph -  25000

USG Abdomen,Intraoperative

photos, scar photo

41 S1.3.1.7 53.41 Umbilical Hernia repair with MeshUSG of the Abdomen ,Clinical

photograph -  30000

USG Abdomen,Intraoperative

photos, scar photo

Page 4: ANNEXURE-I CODE ICD CODE SYSTEM PREAUTHORISATION …

42 S1.3.1.7.1 53.42.1Laproscopic Surgical treatment for - Umbilical

Hernia With Mesh

USG of the Abdomen ,Clinical

photograph - 50000

USG Abdomen,Intraoperative

photos, scar photo

43 S1.3.1.8 53.59.2 Ventral And Scar Hernia repair without MeshUSG of the Abdomen ,Clinical

photograph -  30000

USG Abdomen,Intraoperative

photos, scar photo

44 S1.3.1.9 53.69.2 Ventral And Scar Hernia repair with MeshUSG of the Abdomen ,Clinical

photograph -  40000

USG Abdomen,Intraoperative

photos, scar photo

45 S1.3.1.10 53.03 Herinoplasty with Mesh Direct Inguinal HerniaUSG Abdomen ,Chest X-Ray PA View(1

Film), Clinical Photograph - 25000

USG Abdomen,Intraoperative

photos, scar photo

46 S1.3.1.11 53.62Laproscopic Surgical treatment for Incisional

Hernia with Mesh

USG Abdomen ,Chest X-Ray PA View(1

Film), Clinical Photograph - 40000

USG Abdomen,Intraoperative

photos, scar photo

S1.3.2 APPENDIX

47 S1.3.2.1 47.01 Laproscopic Appendicectomy CBP, Avagdroscore&USG of the abdomen  -  20910

WEBEX , .POST OP

HPE,Speciman photo along with

the patient's face

48 S1.3.2.2 47.09.2 Surgical treatment for Appendicular Perforation CBP, Avagdroscore&USG of the abdomen  -  25870USG Abdomen,Intraoperative

photos, scar photo

S1.3.3 STOMACH, DUODENUM AND JEJUNUM

49 S1.3.3.1 44.02 Highly Selective Vagotomy  Endoscopy  -  25000  Clinical Photograph

50 S1.3.3.2 44.03 Selective Vagotomy drainage Upper GI endoscopy,USG Abdomen  -  48000WEBEX , POST OP HPE for

Vagus, scar photo

51 S1.3.3.3 44.2 Pyloroplasty & Vagotomy Upper GI endoscopy,USG Abdomen  -  48000POST OP HPE for vagus,

Intraoperative photos, scar photo

52 S1.3.3.4 44.39.2 Gastrojejunostomy & Vagotomy Upper GI endoscopy,USG Abdomen  -  40000POST OP HPE for vagus,

Intraoperative photos, scar photo

53 S1.3.3.5 44.4 Surgical Management for Bleeding Peptic ulcer Upper GI endoscopy,USG Abdomen  -  48000 Intraoperative photos, scar photo

54 S1.3.3.6 43.5.1Partial/Subtotal Gastrectomy with anastomosis

to Esophagus for ulcerUpper GI endoscopy,USG Abdomen  -  40000 Intraoperative photos, scar photo

55 S1.3.3.7 43.3.1 Pyloromyotomy Upper GI endoscopy,USG Abdomen  -  30000POST OP HPE, Intraoperative

photos, scar photo

56 S1.3.3.8 43.1.1 Gastrostomy Lower GI Endoscopy USG Abdomen  -  20000POST OP HPE, Intraoperative

photos, scar photo

57 S1.3.3.9 44.62 Gastrostomy ClosureClinical Photograph, Case sheet with

clinical History  -  22000 Intraoperative photos, scar photo

Page 5: ANNEXURE-I CODE ICD CODE SYSTEM PREAUTHORISATION …

58 S1.3.3.10 44.42 Surgical management of Duodenal perforationUSG Abdomen , CT Scan Abdomen With

Contrast , Plain X-ray erect abdomen -  48000

USG Abdomen,Intraoperative

photos, scar photo

59 S1.3.3.10.1 44.42.1Laproscopic Surgical treatment for Duodenal

Perforation

USG Abdomen , CT Scan Abdomen With

Contrast , Plain X-ray erect abdomen - 48000 WEBEX

S1.3.4 SMALL INTESTINE

60 S1.3.4.1 46.80.1 Surgical treatment for IntususceptionUSG of the abdomen, X-ray of the

abdomen erect -  48000

POST OP HPE, Intraoperative

photos, scar photo

61 S1.3.4.2 45.34.1Surgical treatment for Acute Intestinal

obstrucion

USG of the abdomen, X-ray of the

abdomen erect. Upper GI Study(Double

Contrast),Clinical Photograph

 -  48000POST OP HPE, Intraoperative

photos, scar photo

62 S1.3.4.3 46.73Surgical treatment for Acute Intestinal

perforation

USG of the abdomen, X-ray of the

abdomen erect and X-ray chest -  48000

POST OP HPE, Intraoperative

photos, scar photo

63 S1.3.4.4 44.4.1Surgical management For Haemorrhage Of The

Small Intestine

USG Abdomen ,Upper GI endoscopy ,CT

With Contrast  -  48000

POST OP HPE, Intraoperative

photos, scar photo

64 S1.3.4.5 46.62Surgical treatment For Recurrent Intestinal

obstruction (Noble Plication Other)

USG of the abdomen, X-ray of the

abdomen erect., Upper GI Study(Double

Contrast),Clinical Photograph, CT with

contrast

 -  48000POST OP HPE, Intraoperative

photos, scar photo

65 S1.3.4.6 45.3.2Resection & Anastomosis Of Small

Intestine(45.9)

CT with contrast,plain x-ray abdomen erect

& USG of the abdomen -  65000

POST OP HPE, Intraoperative

photos, scar photo

66 S1.3.4.7 46.2.2 Ileostomy Lower GI Endoscopy ,USG Abdomen  -  20000POST OP HPE, Intraoperative

photos, scar photo

67 S1.3.4.8 46.51.2 Ileostomy ClosureClinical Photograph, Case sheet with

clinical History  -  25000 Intraoperative photos, scar photo

68 S1.3.4.9 45.33.1 Excision of Meckel's Diverticulum

Abdomen Radiograph Supine Or Erect(1

Film),CT Scan Abdomen With

Contrast/USG Abdomen

- 40000POST OP HPE, Intraoperative

photos, scar photo

S1.3.5 LARGE INTESTINE

69 S1.3.5.1 46.81Surgical treatment for Mal-Rotation & Volvulus

Of The Midgut

CT Scan Abdomen With Contrast

,Abdomen Radiograph Supine Or Erect -  48000

Abdomen Radiograph Supine Or

Erect(1 Film), Intraoperative

photos , scar photo

70 S1.3.5.2 46.82 Surgical treatment for Volvulus of Large bowel

CT Scan Abdomen With Contrast ,

Abdomen Radiograph Supine Or

Erect,USG Abdomen

 -  48000

Abdomen Radiograph Supine Or

Erect(1 Film), Intraoperative

photos , scar photo

Page 6: ANNEXURE-I CODE ICD CODE SYSTEM PREAUTHORISATION …

71 S1.3.5.3 45.63 Surgical treatment for Duplication Of Intestines

CT Scan Abdomen With Contrast ,

Abdomen Radiograph Supine Or

Erect,USG Abdomen

 -  48000

Abdomen Radiograph Supine Or

Erect(1 Film), Intraoperative

photos , scar photo

72 S1.3.5.4 45.75 Left Hemi ColectomyCT contrast,USG of the abdomen ,

colonoscopy  -  40000

POST OP HPE, Intraoperative

photos, scar photo

73 S1.3.5.5 45.73 Right Hemi ColectomyCT contrast,USG of the abdomen ,

colonoscopy  -  40000

POST OP HPE, Intraoperative

photos, scar photo

74 S1.3.5.6 45.82 Total ColectomyCT contrast,USG of the abdomen ,

colonoscopy  -  60000

POST OP HPE, Intraoperative

photos, scar photo

75 S1.3.5.6.1 45.81 Laproscopic Colectomy (Total Colectomy)CT contrast,USG of the abdomen ,

colonoscopy - 60000 POST OP HPE,WEBEX

76 S1.3.5.7 46.1.1 ColostomyCT contrast,USG of the abdomen ,

colonoscopy  -  20000 Intraoperative photos, scar photo

77 S1.3.5.8 46.52.2 Colostomy closureClinical Photograph, Case sheet with

clinical History  -  25000 Intraoperative photos, scar photo

78 S1.3.5.9 70.73.2Rectovaginal fistula Management without

Colostomy

CT contrast,USG of the abdomen ,

colonoscopy - 38800 USG Abdomen

79 S1.3.5.10 46.03 Loop Colostomy SigmoidCT contrast,USG of the abdomen ,

colonoscopy - 20000

POST OP HPE, Intraoperative

photos, scar photo

S1.3.6 RECTUM AND ANUS

80 S1.3.6.1 48.49 Pull Through Abdominal Resection Clinical Photograph,CT

contrast,Colonoscopy -  50000

POST OP HPE, Intraoperative

photos

81 S1.3.6.2 48.62.1 Anterior Resection of Rectum

Colonoscopy /Barium Enema (Single

Contrast \ Double Contrast) , Clinical

Photograph

 -  50000POST OP HPE, Intraoperative

photos

82 S1.3.6.3 48.75.1 Rectopexy Open with Mesh for Rectal ProlapseColonoscopy/Sigmoidoscopy (REGID),

USG Abdomen, Clinical Photograph - 40000

USG Abdomen,Intraoperative

photos

83 S1.3.6.3.1 48.75.2Laproscopic Rectopexy With Mesh for Rectal

Prolapse

Colonoscopy/Sigmoidoscopy (REGID),

USG Abdomen, Clinical Photograph - 50000 USG Abdomen, WEBEX

S1.4 LIVER

84 S1.4.1 50.29.2 Surgical treatment For Hydatid cyst of Liver CT contrast,USG of abdomen  -  40000

USG of abdomen ,POST OP

HPE, Intraoperative photos , scar

photo

Page 7: ANNEXURE-I CODE ICD CODE SYSTEM PREAUTHORISATION …

85 S1.4.2 39.1.3 Portocaval AnastomosisUSG of abdomen,UGI endoscopy, Color

doppler of abdomen,LFT -  80000

POST OP USG &

LFT,intraoperative photos , scar

photo,post OP color doppler of

abdomen

S1.5 GALLBLADDER

86 S1.5.1 51.22.3 Cholecystectomy CT of the abdomen , LFT , USG of the

abdomen  -  25000

POST OP USG of the abdomen

and POST OP HPE,

Intraoperative photos , scar photo

87 S1.5.2 51.22.4 Laproscopic Cholecystectomy CT of the abdomen , LFT , USG of the

abdomen  -  30000

POST OP USG of the abdomen

and POST OP HPE,

Intraoperative photos,scar photo

88 S1.5.3 51.22.1 Cholecystectomy With CBD Exploration (51.41) CT of the abdomen , LFT , USG of the

abdomen  -  40000

POST OP USG of the abdomen

and POST OP HPE,

Intraoperative photos including

the face of the patient and scar

photo

89 S1.5.3.1 51.22.2Laproscopic Cholecystectomy With CBD

Exploration (51.41)

USG Abdomen, CT scan Lower Abdomen

Without Contrast/CT Scan Abdomen Without

Contrast, LFT(liver function tests)

- 30000

Routine Histopathological

Examination, USG Abdomen/CT

scan Lower Abdomen Without

Contrast/CT Scan Abdomen Without

Contrast, CT Scan Abdomen With

Contrast, WEBEX

90 S1.5.4 51.02 Cholecystostomy CT of the abdomen , LFT, USG of the

abdomen  -  29660

POST OP USG of the abdomen

and POST OP HPE,

Intraoperative photos including

the face of the patient and scar

photo

91 S1.5.5 52.4.2 PancreaticocystojejunostomyCTof the abdomen ,LFT,USG of the

abdomen , Serum,amylase levels -  50000

POST OP USG of the abdomen ,

Intraoperative photos including

the face of the patient and scar

photo

92 S1.5.6 52.4.4 PancreaticocystogastrostomyCTof the abdomen, LFT,USG of the

abdomen , Serum,amylase levels -  41926

POST OP USG of the abdomen ,

Intraoperative photos including

the face of the patient and scar

photo

Page 8: ANNEXURE-I CODE ICD CODE SYSTEM PREAUTHORISATION …

93 S1.5.7 51.7 Repair Of CBDCTof the abdomen, LFT,USG of the

abdomen , Serum,amylase levels -  48000

POST OP USG of the abdomen ,

Intraoperative photos including

the face of the patient and scar

photo

S1.6 ADRENALS

94 S1.6.1 07.3.1Bilateral Adrenalectomy in nonmalignant

conditions

Adrenal function test ,Urinary VMA ,

Urinary Metanephrine/Nor

metanephrine,Urinary Catecholamines

,,Aldosterone Urine ,24 hour free

cortisol,USG Abdomen , CT Scan

Abdomen With Contrast

 -  40000

POST OP USG of the abdomen

and POST OP HPE,

Intraoperative photos ,scar photo

95 S1.6.2 07.22.1Unilateral Adrenelectopmy in nonmalignant

conditions

Adrenal function test ,Urinary VMA ,

Urinary Metanephrine/Nor

metanephrine,Urinary Catecholamines

,,Aldosterone Urine ,24 hour free

cortisol,USG Abdomen , CT Scan

Abdomen With Contrast

 -  35000

POST OP USG of the abdomen

and POST OP HPE,

Intraoperative photos ,scar photo

S1.7 SPLEEN

96 S1.7.1 41.5.2 Splenectomy For Hypersplenism

CT Abdomen, peripheral blood

smear,USG of the abdomen & special

blood test depending upon diagnosis

 -  40000

POST OP USG of the abdomen

and POST OP HPE,

Intraoperative photos ,scar photo

97 S1.7.2 39.1.1 Splenorenal Anastomosis CT Abdomen,Upper GI endoscopy , USG

Abdomen , LFT,Color doppler abdomen -  70000

POST OP USG of the abdomen ,

Intraoperative photos ,scar

photo,post OP color doppler and

LFT

98 S1.7.3 39.1.2 Warren Shunt for Portal HypertensionCT Abdomen, Upper GI endoscopy , USG

Abdomen , LFT,Color doppler abdomen -  70000

POST OP USG of the abdomen ,

Intraoperative photos , scar

photo,post OP color doppler and

LFT

S1.8 PERIPHERY VESSELS

99 S1.8.1 38.5 Excision and Ligation of Varicose Veins Venous Doppler , Clinical Photograph - 24120 Case Sheet with operation Notes

S2 ENT SURGERY

S2.1 EAR

Page 9: ANNEXURE-I CODE ICD CODE SYSTEM PREAUTHORISATION …

100 S2.1.1 20.79.1 LabyrinthectomyCT-Scan PTI , Impidence Audiometry(IA),

Caloric test, PTA, OTO Endoscopic photos -  20000

Intraoperative photos including

the face of the patient and scar

photo

101 S2.1.2 04.42.2 Facial Nerve DecompressionCT-Scan of Mastoids, Facial nerve

conduction test -  20000

Intraoperative photos , scar photo

, Clinical Photograph - Face

showing normal angle of Mouth

and Eye closure after 6 weeks

102 S2.1.3 76.45 Temporal Bone Excision 3D CT Facial Bones  -  50000POST OP HPE, Intraoperative

photos, scar photo

103 S2.1.4 19.4.1 Myringoplasty Pure Tone Audiometry - 15080 Pure Tone Audiometry

104 S2.1.4.1 19.4.2 Myringoplasty with ossiculoplasty (19.3)

Pure Tone Audiometry, Impedances

Audiometry(With Stepedeal Reflex) , X-Ray

Of Both Mastoids , OTO endoscopy/ OTO

Endoscopy Photos

- 17000 X-Ray Of Both Mastoids

105 S2.1.5 20.01.1 Myringotomy with grommet for one ear

Pure Tone Audiometry , Impedances

Audiometry(With Stepedeal Reflex) ,OTO

endoscopy/ OTO Endoscopy Photos

- 10000

Pure Tone Audiometry ,

Impedances Audiometry(With

Stepedeal Reflex) , Grommet in

Positoin Photo .

S2.2 THROAT

106 S2.2.1 31.98.1 Microlaryngeal SurgeryNasal Endoscopy, Glottis endoscopic

photos with lesion, WEBEX  -  18240

POST OP HPE, Intraoperative

photos, scar photo

107 S2.2.2 30.22 Phono Surgery For Vocal Cord ParalysisLaryngeal endoscopy photos on phonation

and Before WEBEX -  25000

Intraoperative photos ,scar

photo,Post OP normal Gottic

view

108 S2.2.3 31.62 Laryngo FissurectomyCT Scan Neck Includes Chest And Larynx

, DNL(Direct Nasal Laryngoscopy) / DNE  -  24930

POST OP HPE, Intraoperative

photos, scar photo

109 S2.2.4 29.39.1 Exision of Tumors In Pharynx Endoscopic view showing tumor, CT Scan

Neck,FNAC  -  20000

POST OP HPE, Intraoperative

photos, scar photo

110 S2.2.5 29.39.2 Exision of Parapharyngeal Tumour CT-Scan / MRI Scan , FNAC  -  20000POST OP HPE, Intraoperative

photos, scar photo

111 S2.2.6 28.6.1 Adenoidectomy - Gromet Insertion

Pure tone audiometry, Impedance

Audiometry, OTO endoscopic photos, X-

Ray Nasopharynx, X-Ray Mastoids

 -  10000

Post OP Grommet in position,

OTO endoscopic photos and Post

Pure tone audio metry

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112 S2.2.7 27.7 Uvulo Palato - Pharyngoplasty Polysomnography  -  25000 Intraoperative photos , scar photo

S2.3 NOSE

113 S2.3.1 22.5 Endoscopic Sinus Surgery CT PNS , DNE Photo graph  -  16500X-Ray PNS, WEBEX , Nasal

endoscopy Photo, Iscar photo

114 S2.3.2 20.4 MastoidectomyCT Temporal Bone , Pure Tone

Audiometry, OTO endoscopic photos -  16500

X-Ray Mastoids, Post Pure Tone

Audiometry, scar, graft insitu,

Intraoperative photos , scar photo

115 S2.3.3 19.5 TympanoplastyPure Tone Audiometry ,, X-Ray Of Both

Mastoids -  16500

Post PTA , OTO endoscopic graft

insitu,Intraoperative photos,scar

photo

116 S2.3.4 19.11 Stapedectomy - Veingraft

CT Temporal Bone , Impedance

Audiometry ,Pure Tone Audiometry, OTO

Endoscopy Photos

 -  18000

Post PTA, Clinical Photo With

Piston + Vein

Graft,Intraoperative photos ,scar

photo

117 S2.3.5 21.3 Excision of Benign tumours of NoseCT PNS,DNL(Direct Nasal Laryngoscopy)

\ DNE -  15000

POST OP HPE, Intraoperative

photos ,scar photo

118 S2.3.6 21.32 Surgery for Angiofibroma CT PNS , DNE  -  40000POST OP HPE, Intraoperative

photos ,scar photo

119 S2.3.7 09.53 Endoscopic Surgery for DacrocystitisClinical Photograph, DNE and Pre

syringing test -  9910

Endoscopic Photo, WEBEX and

post syringing test, scar photo

120 S2.3.8 21.84 Septo rhinoplasty X-Ray Nasopharynx, Pre DNE Photo - 18490

X-Ray Nasopharynx, DNE PHOTO

3 WEEKS AFTER SURGERY ,

WEBEX Video.

S2.4FOREIGN BODY REMOVAL (BRONCHUS-

OESOPHAGUS)

121 S2.4.198.02 /

98.15.2

Bronchoscopy Foreign Body Removal from

Oesophagus/Bronchous(98.15.2)Relevant X-Ray

 - 10000

Clinical Photograph, WEBEX

S3 OPHTHALMOLOGY SURGERY

S3.2 CORNEA AND SCLERA

122 S3.2.1 11.64 Therapeutic Penetrating Keratoplasty BSCAN, Clinical Photograph  -  19500 Intraoperative photos

123 S3.2.2 11.61 Lamellar Keratoplasty BSCAN, Clinical Photograph  -  22486 Intraoperative photos

124 S3.2.3 11.6 Corneal Patch Graft BSCAN, Clinical Photograph  -  17410 Intraoperative photos

125 S3.2.4 12.87.1 Scleral Patch Graft BSCAN, Clinical Photograph  -  19130 Intraoperative photos

126 S3.2.5 11.63 Penetrating Keratoplasty BSCAN, Clinical Photograph  -  17750 Intraoperative photos

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127 S3.2.6 11.59.1 Double Z-Plasty BSCAN, Clinical Photograph  -  4000 Intraoperative photos

128 S3.2.711.69 /

12.87.2

Amniotic Membrane Graft for Cornea/Sclera

(12.87.2)BSCAN, Clinical Photograph  -  11000 Intraoperative photos

S3.3 VITREO-RETINA

S3.3.1 VITRO

129 S3.3.1.1 14.74.1 VitrectomyB-Scan , Fundus floroscence, Clinical

Photograph  -  23020

BSCAN,Fundus floroscence,

Intraoperative photos

130 S3.3.1.2 14.74.3Vitrectomy - Membrane Peeling - Endolaser -

Silicon oil or Gas - with or without belt bucklingB.Scan , Fundus Photograph  -  30000

BSCAN,Fundus floroscence,

Intraoperative photos

131 S3.3.1.3 14.72 Vitrectomy - Membrane Peeling- Endolaser B.Scan , Fundus Photograph  -  20180BSCAN,Fundus floroscence,

Intraoperative photos

132 S3.3.1.4 14.74.2 Vitrectomy Plus Silicon Oil Or Gas (14.75) B.Scan , Fundus Photograph  -  23320BSCAN,Fundus floroscence,

Intraoperative photos

133 S3.3.1.5 14.79 Removal Of Silicon Oil Or Gas post Vitrectomy B.Scan , Fundus Photograph  -  9726BSCAN,Fundus floroscence,

Intraoperative photos

134 S3.3.1.6 14.75Monthly Intravitreal Anti-Vegf For Macular

Degeneration - Per Injection (Maximum - 6)

Fundus flouroscien angiography,Optical

coherence tomography  -  14290

Fundus floroscence ,

Intraoperative photos

S3.3.2 RETINA

135 S3.3.2.1 14.4 Scleral buckle procedure for Retinal detachment B.Scan , Fundus Photograph  -  28096BSCAN,Fundus floroscence,

Intraoperative photos

136 S3.3.2.2 14.25.1 Photocoagulation for RetinopathyFundus flouroscien angiography,Optical

coherence tomography  -  2000

Fundus floroscence ,

Intraoperative photos

S3.4 ORBIT

137 S3.4.1 16.64 Socket Reconstruction Clinical Photograph,CT Orbits  -  25516 Intra OP photos

138 S3.4.2 16.63 Dermis Fat Graft Clinical Photograph  -  22890 Intra OP photos

139 S3.4.3 16.0 Orbitotomy CT ORBIT, Clinical Photograph  -  27100 Intra OP photos

140 S3.4.4 16.3 Evisceration /Enucleation with Orbital implant CT Skull,Clinical Photograph  -  15506 Intra OP photos

141 S3.4.5 04.42.1Decompression/Excision Of Optic Nerve

Lesions MRI  -  78000 Intra OP photos

142 S3.4.6 16.99 Surgical Management of Proptosis  CT scan/MRI  -  60000 Intra OP photos

143 S3.4.7 16.5 Exenteration of OrbitCT Orbits With Contrast, 3D CT Skull /

MRI Orbits With Contrast - 11980

Routine Histopathological

Examination

S3.5 SQUINT CORRECTION SURGERY

144 S3.5.1 15.2.1 Rectus Muscle Surgery(Single)  Clinical Photograph  -  7920 Intra OP photos

145 S3.5.2 15.4 Rectus Muscle Surgery(TwoThree)  Clinical Photograph  -  10690 Intra OP photos

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146 S3.5.3 15.2.2 Oblique muscle surgery Clinical Photograph  -  7720 Intra OP photos

S3.6 LID SURGERY

147 S3.6.1 08.7 Lid Reconstruction surgery Clinical Photograph  -  10050 Intra OP photos

148 S3.6.2 08.3 Surgical correction of Ptosis Clinical Photograph , ice pack test with

Chin Elevation photo -  30000 Intra OP photos

S3.7 PEDIATRIC OPHTHALMIC SURGERY

149 S3.3.6 14.25.2Photocoagulation For Retinopathy Of

Prematurity

 Fundus Fluorescein Angiography , Fundus

Photograph , Optical Coherence

Tomography

 -  9726Fundus floroscence ,

Intraoperative photos

150 S3.3.7 13.71.3Paediatric Cataract Surgery

(Phacoemulsification IOL) B.Scan , Clinical Photograph  -  17340

Fundus Photograph,

Intraoperative photos

151 S3.3.8 12.79Glaucoma filtering surgery for paediatric

glaucoma

 Fundus Fluorescein Angiography , Fundus

Photograph -  9290

Fundus Photograph,

Intraoperative photos

152 S3.3.9 12.54.1 Glaucoma Surgery Fundus floroscence - 8180 Fundus floroscence

S4GYNAECOLOGY AND OBSTETRICS

SURGERY

S4.1 OBSTETRICS

153 S4.1.1 74.91 Caesarean Hysterectomy with Bladder Repair USG scan (Antenatal)  -  46780

POST OP HPE, Intraoperative

photos ,Speciman photo along

with the patient's face

154 S4.1.2 74.99.1 Surgery for Rupture Uterus with Tubectomy USG scan (Antenatal)  -  32500

Post OP USG, POST OP HPE,

Intraoperative photos, scar photo,

Speciman photo along with the

patient's face

155 S4.1.3 93.9.1Management of Eclampsia with Complications

Requiring Ventilatory Support

Arterial Blood Gas Analysis (ABG) ,

Coagulation Profile , Renal Profile , LFT,

Pulse Oxymetry Chart ,S.Fibrinogen Level

 -  40000

Clinical photograph on

Ventilator, Biochemical

Investigations reports

156 S4.1.4 74.99.2Surgical Management of Abruptio-Placenta with

Coagulation Defects(Dic)

USG scan(Antenatal)), Coagulation

Profile(BT, CT, PT, APTT) -  26820

Clinical Photograph of

Retroplacental clots , Coagulation

Profile, USG if patient has

undergone ISES, Intraoperative

photos

S4.2 GYNAECOLOGY

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157 S4.2.1 68.51 Laproscopic Vaginal HysterectomyUSG scan for pelvis, Pap smear,

Endometral biopsy report -  30000

Post OP USG Abdomen,

Speciman photo along with the

patient's face , WEBEX ,POST

OP HPE

158 S4.2.2 65.23 Laparoscopic Cystectomy USG Abdomen  -  24910

Post OP USG Abdomen,

WEBEX ,POST OP HPE,

Intraoperative photo, Speciman

photo along with the patient's face

159 S4.2.3 66.62 Laparoscopic Ectopic Resection USG scan, Pregnancy test(Urine or B-

HCG levels) -  22130

Post OP USG Abdomen,

WEBEX ,POST OP HPE,

Intraoperative photos,Speciman

photo along with the patient's face

160 S4.2.5 68.29.1 Laparoscopic Myomectomy

USG scan atleast 6 cm size of symptomatic

if the size is less provide evedence of

previous conservative treatment received 6

months

 -  30000

Post OP USG Abdomen,

WEBEX ,POST OP HPE,

Intraoperative photos

161 S4.2.6 66.73 Laparoscopic RecanalisationHSG (Hysterosalpingography) ,

Endometrial Biopsy HPE -  32730

Post OP USG Abdomen,

WEBEX, Intraoperative photos

162 S4.2.7 59.4.4 Laparoscopic Sling Operations Clinical photograph, USG scan  -  32500Post OP USG Abdomen,

Intraoperative photos

163 S4.2.8 54.51 Laparoscopic Adhesiolysis Clinical photograph, USG scan  -  30000Post OP USG Abdomen,

Intraoperative photos

164 S4.2.9 68.5.1 Vaginal HysterectomyUSG scan for pelvis, Pap smear,

Endometral biopsy report -  25000

Post OP USG Abdomen,

Speciman photo along with the

patient's face , POST OP HPE

165 S4.2.10 68.5.2Vaginal Hysterectomy With Pelvic Floor

Repair(70.79)

USG scan for pelvis, Pap smear,

Endometral biopsy report -  30000

Post OP USG Abdomen,

Speciman photo along with the

patient's face , WEBEX ,POST

OP HPE

166 S4.2.12 70.5Repair of Cystocele ,Rectocele

&Perineorraphy(71.71)

USG Abdomen,Clinical photograph  - 20000

Post OP USG Abdomen ,Intra op

photos

167 S4.2.14 70.61 Mc Indoe\'s operation For Vaginal Atresia USG Abdomen, Clinical photo  -  39000Intra op photos, Post OP USG

scan

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168 S4.2.16 70.77.1 Abdominal Repair for Vault Prolapse USG scan for pelvis,Clinical Photograph  -  35000Intra op photos, Post OP USG

scan

169 S4.2.17 70.78Abdominal Repair With Mesh for Vault

ProlapseUSG scan for pelvis,Clinical Photograph  -  40000

Intra op photos with mesh in situ,

USG scan,

S5ORTHOPEDIC SURGERY AND

PROCEDURES

S5.1FRACTURE CORRECTION

SURGERIES/PROCEDURES

170 S5.1.1 78.00.1 Bone Grafting As Exclusive Procedure X-Ray ,Clinical Photograph  -  20000 Post OP X-RAY, Intraoperative

photos

171 S5.1.2 77.64Excision Or Other Operations For Scaphoid

FracturesX-Ray ,Clinical Photograph  -  15000

 Post OP X-RAY, Intraoperative

photos

172 S5.1.3 79.3Open reduction & Internal Fixation Of Fingers

& ToesX-Ray ,Clinical Photograph  -  15480

 Post OP X-RAY, Intraoperative

photos

173 S5.1.4 79.0.1Reduction Of Compound Fractures & External

Fixation(78.10)X-Ray ,Clinical Photograph  -  25000

 Post OP X-RAY, Intraoperative

photos

174 S5.1.5 84.72.1 Ilizarov Ring Fixator Application X-Ray ,Clinical Photograph  -  44000 Post OP X-RAY, Intraoperative

photos

175 S5.1.6 78.10.1 Neglected CTEV. Jess Fixator X-Ray ,Clinical Photograph  -  36000 Post OP X-RAY, Intraoperative

photos

176 S5.1.7 81.96 Joint reconstruction/intraarticular fractures X-Ray - 35000 CT local Area

S5.2 DISLOCATIONS

177 S5.2.1 79.8 Open reduction of Deep dislocations X-Ray ,Clinical Photograph  -  30000 Post OP X-RAY, Intraoperative

photos

S5.3 AMPUTATIONS (NON-TRAUMATIC)

178 S5.3.1 84.09.2 Amputations - Forequarter X-Ray ,Clinical Photograph  -  37070 Post OP X-RAY, Intraoperative

photos

179 S5.3.2 84.19.1Amputations - Hind Quarter And

HemipelvectomyX-Ray ,Clinical Photograph  -  50000

 Post OP X-RAY, Intraoperative

photos

S5.4 BONE AND JOINT SURGERY/PROCEDURES

180 S5.4.1 81.2.1 Arthrodesis Of - Major Joints X-Ray ,Clinical Photograph,Fluid Analysis  -  30000 Post OP X-RAY, Intraoperative

photos

181 S5.4.1.1 81.1.1 Arthrodesis of foot Small joints X- Ray Foot - 15000 X- Ray Foot

182 S5.4.2 80.2 Diagnostic Arthroscopy MRI spine, Clinical Photograph  -  24000 Arthroscopy Picture,

Intraoperative photos

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183 S5.4.3 80.6 Arthroscopy . Operative MeniscectomyMRI Local Area, Clinical Photograph , X-

Ray -  25000

 Arthroscopy Picture,

Intraoperative photos

184 S5.4.4 81.45.1 Anterior cruciate ligamentl reconstruction MRI Knee , X-Ray, Clinical Photograph  -  25000

 Arthroscopy Picture,

Intraoperative photos, Post OP X-

Ray, Clinical Photos

185 S5.4.5 78.95Surgery for Avascular Necrosis Of Femoral

Head (Core Decompression)MRI Pelvis, X-Ray Pelvis  -  29280

 Post OP X-RAY, Intraoperative

photos

186 S5.4.6 86.89.3Soft Tissue Reconstruction Procedures For

Joints/Osteotomy

Clinical Photograph, X-Ray, Webex

Clinical Gait -  30000

 Post OP X-RAY, Intraoperative

photos

S5.5 SPINE SURGERY

187 S5.5.1 77.39 Anterolateral Clearance For Tuberculosis X-Ray , MRI Spine,Clinical Photograph  -  60000 Post OP X-RAY, Intraoperative

photos

188 S5.5.2 77.31 Costo Transversectomy(77.39) X-Ray , MRI Spine,Clinical Photograph  -  40120 Post OP X-RAY, Intraoperative

photos

189 S5.5.3 77.89 Spinal Ostectomy And Internal Fixations(78.59) X-Ray , MRI Spine,Clinical Photograph  -  47616 Post OP X-RAY, Intraoperative

photos

S5.6 SOFT TISSUE SURGERY

190 S5.6.1 04.5.1 Nerve Repair With GraftingENMG ,Nerve conduction study - ,

Clinical Photograph -  41630

Intraoperative photos,Clinical

Photograph

191 S5.6.2 04.3.1 Neurolysis / Nerve SutureENMG ,Nerve conduction study - ,

Clinical Photograph -  25000

Intraoperative photos,Clinical

Photograph

192 S5.6.3 04.0 Surgery for Brachial Plexus & Cervical Rib

Extremities , Bones & Joints AP & Lateral

View(2 Film) -,MRI ,ENMG

(Elektroneuromyography),Nerve

conduction study ,

 -  44760 Post OP X-RAY, Intraoperative

photos

S5.7 TUMOR SURGERY

193 S5.7.1 77.60.4Excision of deep Bone Tumours and Re-

Construction With Conventional Prosthesis MRI, X-Ray  -  48810

 Post OP HPE,Post OP X-RAY,

Intraoperative photos

194 S5.7.2 77.8Bone tumor surgery reconstruction with internal

fixation(78.59)X-Ray, Clinical Photograph - 48020 X-Ray

S6 SURGICAL GASTRO ENTEROLOGY

S6.1 EMERGENCY

195 S6.1.1 44.4.2 Surgery For Bleeding Ulcers Upper GI endoscopy  -  48000 Endoscopy Picture, Intra op

photos, SCAR photos

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196 S6.1.2 44.43 Surgery For Obscure Gi Bleed

Upper GI endoscopy, CT Angiogram

Abdomen / Radionuclide scan(Obscure

Blood)

 -  72000 Endoscopy Picture, Intra op

photos, SCAR photos

S6.2 OESOPHAGUS

197 S6.2.1 42.55 Colonic Pull UpUpper GI endoscopy , CT Scan Abdomen ,

Colono Scopy  -  60000

 Post OP HPE, Intraoperative

photos

198 S6.2.2 42.40.1 Oesophagectomy CT Scan Abdomen , Upper GI endoscopy  -  90000 Post OP HPE, Intraoperative

photos

199 S6.2.3 43.99.1 Oesophago-Gastrectomy CT Scan Abdomen ,Upper GI endoscopy  -  90000 Post OP HPE, Intraoperative

photos

200 S6.2.4 42.7.1 Lap Heller.S MyotomyCT-Scan, Oesophageal manometry/Upper

GI endoscopy  -  28110 WEBEX, Post OP HPE

201 S6.2.5 44.67 Lap FundoplicationsCT-Scan , /Upper GI Endoscopy, 24 hrs

Acidvales -  54000 WEBEX, Post OP HPE

S6.3 STOMACH

202 S6.3.143.5.2 /

43.7.1

Partial Gastrectomy with anastomosis to

esophagus/jejunum(43.6.2)

USG Abdomen , CT Scan Abdomen ,

Upper GI Endoscopy ultrasound -  40000

 Post OP HPE, Intraoperative

photos

203 S6.3.2 43.9 Total Gastrectomy CT-Scan , Endoscopy ,USG Abdomen  -  40000 Post OP HPE, Intraoperative

photos

204 S6.3.3 44 Truncal Vagotomy + Gastro Jejunostomy(44.3) CT-Scan , Endoscopy ,USG Abdomen  -  48000 Post OP HPE, Intraoperative

photos

205 S6.3.4 43.6.2Distal Gastrectomy For Gastric Outlet

ObstructionCT-Scan , Endoscopy ,USG Abdomen  -  40000

 Post OP HPE, Intraoperative

photos

206 S6.3.5 43.4 Surgery for Corrosive Injury Stomach CT-Scan , Endoscopy ,USG Abdomen  -  60000 Post OP HPE, Intraoperative

photos

S6.4 SMALL INTESTINE

207 S6.4.1 46.80.2 Surgical management of VolvulusUSG Abdomen , Abdomen Radiograph

Supine Or Erect, CT Scan Abdomen  -  48000

 Post OP HPE, Intraoperative

photos

208 S6.4.2 46.80.3 Surgical management of MalrotationUSG Abdomen , Abdomen Radiograph

Supine Or Erect, CT Scan Abdomen  -  48000

 Post OP HPE, Intraoperative

photos

209 S6.4.3 54.51 Lap Adhesiolysis CT-Scan , X-Ray Abdomen , Clinical

history of Previous Surgeries -  30000 WEBEX

S6.5 LARGE INTESTINE

210 S6.5.1 45.73 Right Hemicolectomy Lower GI Endoscopy,CT-Scan with

Contrast , Colonoscopy,USG Abdomen -  40000

 Post OP HPE, Intraoperative

photos

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211 S6.5.2 45.75 Left Hemicolectomy Lower GI Endoscopy,CT-Scan with

Contrast , Colonoscopy,USG Abdomen -  40000

 Post OP HPE, Intraoperative

photos

212 S6.5.3 45.73.3 Extended Right Hemicolectomy Lower GI Endoscopy,CT-Scan with

Contrast , Colonoscopy,USG Abdomen -  48000

 Post OP HPE, Intraoperative

photos

213 S6.5.4 48.63.1 Anterior Resection of Large Intestine Lower GI Endoscopy,CT-Scan with

Contrast , Colonoscopy,USG Abdomen -  40000

 Post OP HPE, Intraoperative

photos

214 S6.5.5 48.93 Anterior Resection With Ileostomy Lower GI Endoscopy,CT-Scan with

Contrast , Colonoscopy,USG Abdomen -  60000

 Post OP HPE, Intraoperative

photos

215 S6.5.6 48.5 Abdominoperinial Resection of rectum Lower GI Endoscopy,CT-Scan with

Contrast , Colonoscopy,USG Abdomen -  50690

 Post OP HPE, Intraoperative

photos

216 S6.5.7 48.62.2 Hartman.S Procedure With Colostomy Lower GI Endoscopy,CT-Scan with

Contrast , Colonoscopy,USG Abdomen -  54000

 Post OP HPE, Intraoperative

photos

S6.5.8 ULCERATIVE COLITIS

S6.5.8.1 III STAGE PROCEDURE

217 S6.5.8.1.1 45.8 I Stage-Sub Total Colectomy + Ileostomy(46.2) Lower GI Endoscopy,CT-Scan with

Contrast , Colonoscopy,USG Abdomen -  60000

 Post OP HPE, Intraoperative

photos

218 S6.5.8.1.2 45.95.1 II Stage-J - Pouch Colono Scopy  -  50000 Post OP HPE, Intraoperative

photos

219 S6.5.8.1.3 46.51.5 III Stage-Ileostomy Closure Lower GI Endoscopy,Clinical photograph  -  25000 Intraoperative photos

S6.5.8.2 II STAGE PROCEDURE

220 S6.5.8.2.1 45.83I Stage- Sub Total Colectomy + Ileostomy + J -

Pouch

Lower GI Endoscopy,CT-Scan with

Contrast , Colonoscopy,USG Abdomen -  96000

 Post OP HPE, Intraoperative

photos

221 S6.5.8.2.2 46.51.4 II Stage- Ileostomy Closure Lower GI Endoscopy,CT-Scan with

Contrast , Colonoscopy,USG Abdomen -  25000 Intraoperative photos

S6.6 LIVER

222 S6.6.1 50.26Hepato Cellular Carcinoma(Advanced) Radio

Frequency Ablation

CT scan Lower Abdomen With

Contrast,EndoscopicUltrasound Diagnostic

Laparoscopy, Alpha Feto Protiens Levels,

Fine Needle Aspiration Cytology (FNAC)

report

 -  72000Post OP USG Abdomen,

Intraoperative photos

223 S6.6.2 50.22Haemangioma Sol Liver Hepatectomy + Wedge

Resection

Lower GI Endoscopy, USG Abdomen, CT

Scan Abdomen With Contrast -  90000

 Post OP HPE, Intraoperative

photos

224 S6.6.3 50.21 Hydatid Cyst-MarsupilisationCT scan Lower Abdomen Without

Contrast.USG Abdomen -  40000

 Post OP HPE, Post OP USG

,Intraoperative photos

S6.7 GALL BLADDER

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225 S6.7.1 51.6 Cyst Excision+Hepatic Jejunostomy(51.37)

USG Abdomen, CT scan Lower Abdomen

/ Magnetic Resonance

Cholangiopancreatography (MRCP)

 -  54000 Post OP HPE,Intraoperative

photos

226 S6.7.2 51.22.3 Cholecystectomy CT of the abdomen , LFT , USG of the

abdomen  -  25000

POST OP USG of the abdomen

and POST OP HPE,

Intraoperative photos , scar photo

227 S6.7.3 51.41 GB+ Calculi CBD Stones Or Dilated CBD

USG Abdomen, Magnetic Resonance

Cholangiopancreatography

(MRCP)/ERCP, CT scan Lower Abdomen

 -  50000 Post OP HPE,Intraoperative

photos

228 S6.7.4 51.22.4 Lap.Cholecystectomy

USG Abdomen, CT scan Lower Abdomen

/ Magnetic Resonance

Cholangiopancreatography (MRCP)

 -  30000  Post OP HPE,WEBEX

229 S6.7.5 51.37 Hepatico Jejunostomy

USG Abdomen, CT Scan Lower Abdomen

/ Magnetic Resonance

Cholangiopancreatography (MRCP)

 -  66970 Post OP HPE,Intraoperative

photos

230 S6.7.6 51.39Choledochoduodenostomy Or Choledocho

Jejunostomy

 CT Scan, USG Abdomen, MRI/ Magnetic

Resonance Cholangiopancreatography

(MRCP)

 -  40596 Post OP HPE,Intraoperative

photos

S6.8 SPLEEN

231 S6.8.1 41.5.1 SplenectomyCT Scan Abdomen, USG Abdomen

,Complete Haemogram  -  35000

 Post OP HPE,Intraoperative

photos

232 S6.8.2 41.5.6Splenectomy + Devascularisation + Spleno

Renal Shunt(39.1)

CT Scan Abdomen, USG Abdomen,Color

Doppler Sonography Single Study  -  76560

 Post OP HPE,Intraoperative

photos

233 S6.8.3 41.42 Spleenectomy For Space Occupying Lesion CT Scan Abdomen , USG Abdomen  -  42000 Post OP HPE,Intraoperative

photos

S6.9 PANCREAS

234 S6.9.1 52.22.1 Laproscopic Pancreatic NecrosectomyCT scan Lower Abdomen , ERCP,, Upper

GI endoscopy, USG Abdomen -  112776  Post OP HPE,WEBEX

235 S6.9.2 52.4.3Lateral Pancreaticojejunostomy(Non-

Malignant)

CT scan Lower Abdomen , ERCP,, Upper

GI endoscopy, USG Abdomen -  100000

 Post OP HPE,Intraoperative

photos

236 S6.9.3 52.22.2 Open Pancreatic NecrosectomyCT scan Lower Abdomen , ERCP,, Upper

GI endoscopy, USG Abdomen -  120060

 Post OP HPE,Intraoperative

photos

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237 S6.9.4 52.52.2 Distal Pancreatectomy + Splenectomy(41.5)CT scan Lower Abdomen , ERCP,, Upper

GI endoscopy, USG Abdomen -  120000

 Post OP HPE,Intraoperative

photos

238 S6.9.5 52.59 Central PancreatectomyCT scan Lower Abdomen , ERCP,, Upper

GI endoscopy, USG Abdomen -  120000

 Post OP HPE,Intraoperative

photos

239 S6.9.7 52.4.2 Cysto JejunostomyCT scan Lower Abdomen , ERCP, USG

Abdomen -  50000  Biopsy , Clinical Photograph

240 S6.9.8 52.4.4 Cysto GastrostomyCT scan Lower Abdomen , ERCP, USG

Abdomen -  41926  Biopsy , Clinical Photograph

S6.10 HERNIA

241 S6.10.1 53.75 Diaphragmatic Hernia (Gortex Mesh Repair) Ba.Study , Chest X-Ray , Endoscopy ,

USG Abdomen -  48000

Intra op photos with mesh insitu ,

Scar photo

S6.11 LIVER SURGERIES

242 S6.11.1 50.3.1 Rt.HepatectomyERCP, CT Scan Abdomen , USG

Abdomen, Alpha Feto Protiens Levels -  86580

 Post OP HPE,Intraoperative

photos

243 S6.11.2 50.3.2 Lt.HepatectomyERCP, CT Scan Abdomen , USG

Abdomen, Alpha Feto Protiens Levels -  90000

 Post OP HPE,Intraoperative

photos

244 S6.11.3 50.29.3 SegmentectomyERCP, CT Scan Abdomen , USG

Abdomen -  60000

 Post OP HPE,Intraoperative

photos

S6.12 PANCREATIC SURGERIES

245 S6.12.1 52.52.1 Distal Pancreatectomy

CT scan, Magnetic Resonance

Cholangiopancreatography (MRCP)

/ERCP

 -  120000 Post OP HPE,Intraoperative

photos

246 S6.12.2 52.3 Enucleation Of Cyst CT scan , Sr.Amylase  -  90000 Post OP HPE, Intraoperative

photos

247 S6.12.3 52.7 Whipples Any Type  CT , ERCP  -  100000 Intraoperative photos

248 S6.12.4 52.4.1 Triple Bypass -Pancreas  CT, ERCP/MRCP, LFT  -  60000 Intraoperative photos

249 S6.12.5 52.4.5 Other Bypasses -Pancreas  CT, ERCP/MRCP, LFT  -  39250 Intraoperative photos

S6.13 ANUS

250 S6.13.1 49.7.1 Anal Sphincter Repair -With ColostomyEndo anal scan / MRI Abdomen With

Contrast, USG Abdomen - 33850 Endo anal scan

251 S6.13.2 70.73.1Rectovaginal fistula Management with

Colostomy

CT scan Lower Abdomen Without

Contrast, MRI Local Area, TRUS

(Transrectal Ultrasonography),

Sigmoidoscopy (REGID)

- 39320 Scar Photo

S7CARDIAC AND CARDIOTHORACIC

SURGERY

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S7.1 CARDIAC INTERVENTIONS / PROCEDURES

252 S7.1.1.1 00.66.1Coronary Balloon Angioplasty with Bare Metal

stent(00.45)2D Echo, CAG, ECG  -  55000

PTCA CD, X-RAY, Stent Pouch

with bar code Details

253 S7.1.1.2 00.66.2 PTCA 1 Additional Bare Metal Stent (00.46) 2D Echo, CAG, ECG  -  10000PTCA CD, X-RAY, Stent Pouch

with bar code Details

254 S7.1.1.3 00.66.5Coronary Balloon Angioplasty with Drug eluting

stent(00.45)2D Echo, CAG, ECG - 65000

PTCA CD, X-RAY, Stent Pouch

with bar code Details

255 S7.1.1.4 00.66.6 PTCA 1 Additional Drug eluting Stent (00.46) 2D Echo, CAG, ECG - 20000PTCA CD, X-RAY, Stent Pouch

with bar code Details

S7.1.2 ASD AND VSD

256 S7.1.2.1 35.51 ASD Device Closure 2D ECHO With Device Quantification ,

ECG , Chest X-Ray  -  80000

2D ECHO Cardiogram Showing

Device In Situ, Chest X-Ray

,Procedure CD, Device pouch,

Post OP scar photo

257 S7.1.2.2 35.53 VSD Device Closure 2D ECHO With Device Quantification ,

ECG , Chest X-Ray  -  80000

2D ECHO Cardiogram Showing

Device In Situ, Chest X-Ray

,Procedure CD, Device pouch,

Post OP scar photo

S7.1.3 PTENT DUCTUS ARTERIOUSUS

258 S7.1.3.1 35.83.1 Patent Ductus Arterious - Stenting 2D ECHO , ECG , Chest X-Ray  -  75000

2D ECHO Showing Stent In

Situ, Chest X-Ray ,

ECG,Procedure CD, Device

pouch, Post OP scar photo

259 S7.1.3.2 35.83.2 Patent Ductus Arterious - Device Closure 2D ECHO With Device Quantification ,

ECG , Chest X-Ray  -  72320

2D ECHO Showing Device In

Situ, Chest X-Ray ,Procedure

CD, Device pouch, Post OP scar

photo

S7.1.3.3 COIL CLOSURE

260 S7.1.3.3.1 35.83.3 Patent Ductus Arterious - Single Coil Closure 2D ECHO , ECG , Chest X-Ray  -  25000

2D ECHO ShowingCoil In Situ,

Chest X-Ray ,Procedure CD,

Device pouch, Post OP scar photo

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261 S7.1.3.3.2 35.83.4Patent Ductus Arterious - Multiple Coils

Closrue 2D ECHO , ECG , Chest X-Ray  -  35000

2D ECHO Showing Coil In Situ,

Chest X-Ray ,Procedure CD,

Device pouch, Post OP scar photo

S7.1.4 BALLOON PROCEDURES

262 S7.1.4.1 35.0 Balloon Valvotomy 2D ECHO , ECG , Chest X-Ray  -  26000 2D ECHO, Baloon Pouch, Post

OP scar photo

263 S7.1.4.2 35.41 Balloon Atrial Septostomy 2D ECHO , ECG , Chest X-Ray  -  33380 2D ECHO, Baloon Pouch, Post

OP scar photo

S7.1.5 PACEMAKER IMPLANTATION

264 S7.1.5.1 37.8 Permanent Pacemaker Implantation  CAG , ECG,2D ECHO  -  75000

2D ECHO, Pacemaker Sticker

with bar Code , Chest X-Ray,

Post OP scar photo

265 S7.1.5.2 37.78 Temporary Pacemaker Implantation  CAG , ECG,2D ECHO  -  13000

2D ECHO, Pacemaker Sticker

with bar Code , Chest X-Ray,

Post OP scar photo

S7.1.6COARACTATION OF AORTA REPAIR /

AORTOPLASTY

266 S7.1.6.1 38.44.1Coaractation of Aorta Repair With Stent +

Aortoplasty(35.11) 2D ECHO , ECG.Aortogram  -  80000

2D ECHO Showing stent In Situ,

Chest X-Ray ,Procedure CD,

Device pouch, Post OP scar photo

267 S7.1.6.2 38.34.2Coaractation of Aorta Repair Without Stent+

Aortoplasty(35.11) 2D ECHO , ECG.Aortogram  -  30380

2D ECHO , Chest X-Ray

,Procedure CD, Device pouch,

Post OP scar photo

S7.1.7 ANGIOPLASTY

268 S7.1.7.1 39.50.2 Renal Angioplasty CT Scan Abdomen ,Renal Angiogram  -  60000

Procedure CD, Doppler Of Renal

Arteries, Stent pouch with bar

code Details ,Post OP scar photo

269 S7.1.7.2 39.50.3 Peripheral Angioplasty

Digital Subtraction Angiography(DSA

Peripheral Artery\Arteries) ,Doppler of

Peripheral Vessels,2D ECHO

 -  60000

Doppler of Peripheral Vessels

with stent in situ, Stent pouch

with bar code Details , Procedure

CD,Post OP scar photo

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270 S7.1.7.3 00.61 Vertebral Angioplasty Vertibral Arteries Angiography  -  75000

Doppler , Stent pouch with bar

code Details , Procedure CD,Post

OP scar photo

271 S7.1.7.4 39.50.4 Perpheral Angioplasty - Additional Stent(00.46)

Digital Subtraction Angiography(DSA

Peripheral Artery\Arteries) ,Doppler of

Peripheral Vessels,2D ECHO

 -  9000

Doppler of Peripheral Vessels

with stent in situ, Stent pouch

with bar code Details , Procedure

CD,Post OP scar photo

S7.2CARDIOTHORACIC AND VASCULAR

SURGERIES

S7.2.1 SURGERY FOR CAD

272 S7.2.1.1 36.1.1 Coronary Bypass Surgery 2D ECHO ,CAG, Chest X-Ray , ECG  -  115846Intra OP photos, Post OP scar

photos

273 S7.2.1.2 36.1.2 Coronary Bypass Surgery-Post Angioplasty  POST PTCA-CAG, Chest X-Ray , ECG  -  118720Intra OP photos, Post OP scar

photos

274 S7.2.1.3 36.1.3 Cabg With Iabp Pump

2D ECHO ,CAG, Chest X-Ray , ECG  -

 139678

Clinical Photograph With IABP

IABP chart, Intra OP photos,

Post OP scar photos

275 S7.2.1.4 36.1.4 Cabg With Aneurismal Repair2D ECHO ,CAG, Chest X-Ray , ECG, CT

Scan Chest With Contrast

 - 154250

Intra OP photos, Post OP scar

photos

S7.2.2.1 INTRACARDIAC TUMORS

276 S7.2.2.1 37.34 Surgery For Intracardiac Tumors 2D ECHO , CAG,CT Scan Chest , Chest

X-Ray  -  100000

2D ECHO Cardiogram ,Intra OP

photos, Post OP scar photos,Post

OP HPE

S7.2.3 SINUS OF VALSALVA

277 S7.2.3.1 39.52.3surgical management of Ruptured Sinus Of

Valsalva2D ECHO , CAG,CT Scan Chest  -  130000

2D ECHO Cardiogram ,Intra OP

photos, Post OP scar photos

S7.2.4 TAPVC

278 S7.2.4.1 35.82 surgical management (Correction) of TAPVC2D ECHO , CAG, Chest X-Ray , TEE

(Transesophageal Echocardiogram)  -  119840

2D ECHO Cardiogram ,Intra OP

photos, Post OP scar photos

S7.2.5 TOF

279 S7.2.5.1.1 39.0.1 Systemic Pulmonary Shunts With Graft TOF 2D ECHO , CT Angiography  -  63600

2D ECHO Cardiogram ,Intra OP

photos, Post OP scar

photos,Graft pouch

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280 S7.2.5.1.2 39.0.2 Systemic Pulmonary Shunts Without Graft TOF 2D ECHO , CT Angiography  -  554002D ECHO Cardiogram ,Intra OP

photos, Post OP scar photos

281 S7.2.5.2 35.81 Total Correction of Tetralogy of Fallot 2D ECHO , CT Angiography  -  1042702D ECHO Cardiogram ,Intra OP

photos, Post OP scar photos

S7.2.6 ASD AND VSD

282 S7.2.6.1 35.71 Intra Cardiac Repair Of ASD 2D ECHO , CT Angiography  -  800002D ECHO Cardiogram ,Intra OP

photos, Post OP scar photos

283 S7.2.6.2 35.72 Intracardiac Repair Of VSD 2D ECHO , CT Angiography  -  850002D ECHO Cardiogram ,Intra OP

photos, Post OP scar photos

S7.2.7 PATENT DUCTUS ARTERIOUSUS

284 S7.2.7.1 35.83.5 Surgery for-PDA2D ECHO , ECG , Chest X-Ray,Cath

report/CD  -  40000

2D ECHO Cardiogram ,Intra OP

photos, Post OP scar photos

S7.2.8ROSS PROCEDURE INTRACARDIAC REPAIR OF

COMPLEX CONGENITAL HEART DISEASES

285 S7.2.8.1 35.22.1Ross procedure - Intracardiac repair of complex

congenital heart diseases with Special Conduits

2D ECHO , CT Angiography, Chest X-Ray

,Cath report/CD -  150000

2D ECHO Cardiogram ,Intra OP

photos, Post OP scar photos

286 S7.2.8.2 35.11

Ross procedure - Intracardiac repair of complex

congenitalheart diseases without Special

Conduits

2D ECHO , CT Angiography, Chest X-Ray

,Cath report/CD  -  109510

2D ECHO Cardiogram ,Intra OP

photos, Post OP scar photos

S7.2.9 VALVE REPAIRS

287 S7.2.9.1 35.20.1 Valve repair with Prosthetic Ring  2D ECHO, Chest X-Ray  -  140000

2D ECHO Cardiogram ,Intra OP

photos, Post OP scar photos,

Chest X-Ray

288 S7.2.9.2 35.1 Valve repair without Prosthetic Ring  2D ECHO, Chest X-Ray  -  110000

2D ECHO Cardiogram ,Intra OP

photos, Post OP scar photos,

Chest X-Ray

289 S7.2.9.3 35.13 Open Pulmonary Valvotomy  2D ECHO, Chest X-Ray  -  77000

2D ECHO Cardiogram ,Intra OP

photos, Post OP scar photos,

Chest X-Ray

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290 S7.2.9.4 35.02 Closed Mitral Valvotomy  2D ECHO, Chest X-Ray  -  40000

2D ECHO Cardiogram ,Intra OP

photos, Post OP scar photos,

Chest X-Ray

291 S7.2.9.5 35.12 Mitral valvotomy (Open)  2D ECHO, Chest X-Ray  -  110000

2D ECHO Cardiogram ,Intra OP

photos, Post OP scar photos,

Chest X-Ray

S7.2.10 VALVE REPLACEMENT

292 S7.2.10.1 35.23 Mitral Valve Replacement (With Valve)2D ECHO , ECG,TEE (Transesophageal

Echocardiogram)  -  145000

2D ECHO Showing Valve In Situ

, X-ray , Procedure CD ,Post OP

flouro scopy CD, valve

pouch,Intra OP photos, Post OP

scar photos

293 S7.2.10.2 35.21 Aortic Valve Replacement (With Valve)2D ECHO , ECG,TEE (Transesophageal

Echocardiogram)  -  145000

2D ECHO Showing Valve In Situ

, X-ray , Procedure CD ,Post OP

flouro scopy CD, valve

pouch,Intra OP photos, Post OP

scar photos

294 S7.2.10.3 35.27 Replacement of Tricuspid valve2D ECHO , ECG,TEE (Transesophageal

Echocardiogram)  -  144240

2D ECHO Showing Valve In Situ

, X-ray , Procedure CD ,Post OP

flouro scopy CD, valve

pouch,Intra OP photos, Post OP

scar photos

295 S7.2.10.4 35.20.2 Double valve replacement (With Valve)2D ECHO , ECG,TEE (Transesophageal

Echocardiogram)  -  178000

2D ECHO Showing Valve In Situ

, X-ray , Procedure CD ,Post OP

flouro scopy CD, valve

pouch,Intra OP photos, Post OP

scar photos

S7.2.11 PERICARDIUM

296 S7.2.11.1 37.12 Pericardiostomy 2D ECHO , ECG , Chest X-Ray  -  250002D ECHO,Intra OP photos, Post

OP scar photos, Chest X-Ray

297 S7.2.11.2 37.31 Pericardiectomy2D ECHO , ECG , Chest X-Ray , CT Scan

Chest -  49450

2D ECHO,Intra OP photos, Post

OP scar photos, Chest X-

Ray,Post OP HPE

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298 S7.2.11.3 37.0 Pericardiocentesis 2D ECHO , ECG , Chest X-Ray  -  150002D ECHO,Intra OP photos, Post

OP scar photos, Chest X-Ray

S7.2.12 COARCTATION - AORTA REPAIR

299 S7.2.12.1 38.44.2 Coarctation-Arota Repair With Graft 2D ECHO , CAG, Chest X-Ray  -  100000 Color doppler,Intra OP photos,

Post OP scar photos, Graft pouch

300 S7.2.12.2 38.34.1 Coarctation-Arota Repair Without Graft 2D ECHO , CAG, Chest X-Ray  -  70000 Color doppler,Intra OP photos,

Post OP scar photos

S7.2.13 AORTA REPAIR

301 S7.2.13.1 38.40.1 Aneurysm Resection & Grafting 2D ECHO , CAG, Chest X-Ray  -  181470 Color doppler, Intra OP photos,

Post OP scar photos, Graft pouch

302 S7.2.13.2 38.35Intrathoracic Aneurysm -Aneurysm Not

Requiring Bypass

Pulmonary Angiogram(CT Angio Chest) ,

Color Doppler -  100000

 Color doppler,Intra OP photos,

Post OP scar photos

303 S7.2.13.3 38.45Intrathoracic Aneurysm -Requiring Bypass

(With Graft)

Pulmonary Angiogram(CT Angio Chest) ,

Color Doppler -  180540

 Color doppler, Intra OP photos,

Post OP scar photos, Graft pouch

304 S7.2.13.4 39.54 Surgical management of Dissecting Aneurysms CT Angiogram Abdomen  -  180000 Color doppler,Intra OP photos,

Post OP scar photos

305 S7.2.13.5 35.22.2Surgical management of Annulus Aortic Ectasia

With Valved Conduits

2D ECHO , CT Scan Chest Without

Contrast, CAG , TEE (Transesophageal

Echocardiogram)

 -  158200

 Color doppler,Intra OP photos,

Post OP scar photos,2D ECHO,

Post OP flouroscopy CD

S7.2.14 AORTA - AORTO BYPASS

306 S7.2.14.1 39.23 Aorto-Aorto Bypass With Graft

CT Angiogram Abdomen , Colour Doppler

Study Abdominal Aorta And Both Lower

Limbs

 -  100000 Color doppler,Intra OP photos,

Post OP scar photos,Graft pouch

307 S7.2.14.2 39.26 Aorto-Aorto Bypass Without Graft

CT Angiogram Abdomen , Colour Doppler

Study Abdominal Aorta And Both Lower

Limbs

 -  85000 Color doppler,Intra OP photos,

Post OP scar photos

S7.2.15 FEMORO - POPLITIAL BYPASS

308 S7.2.15.1 39.29.1 Femoro- Poplitial Bypass With GraftCT Angiogram Limbs, Clinical

Photograph ,Doppler Of Peripheral Vessels  -  65000

 Color doppler,Intra OP photos,

Post OP scar photos, Graft pouch

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309 S7.2.15.2 39.29.2 Femoro- Poplitial Bypass Without GraftCT Angiogram Limbs, Clinical

Photograph ,Doppler Of Peripheral Vessels  -  45000

 Color doppler,Intra OP photos,

Post OP scar photos

S7.2.16 FEMORO - ILEAL BYPASS

310 S7.2.16.1 39.25.1 Femoro- Ileal Bypass With GraftCT Angiogram Limbs, Clinical

Photograph ,Doppler Of Peripheral Vessels  -  65000

 Color doppler,Intra OP photos,

Post OP scar photos, Graft pouch

311 S7.2.16.2 39.25.2 Femoro- Ileal Bypass Without GraftCT Angiogram Limbs, Clinical

Photograph ,Doppler Of Peripheral Vessels  -  45000

 Color doppler,Intra OP photos,

Post OP scar photos

S7.2.17 FEMORO - FEMORAL BYPASS

312 S7.2.17.1 39.29.3 Femoro-Femoral Bypass With GraftCT Angiogram Limbs, Clinical

Photograph ,Doppler Of Peripheral Vessels  -  65000

 Color doppler,Intra OP photos,

Post OP scar photos, Graft pouch

313 S7.2.17.2 39.29.4 Femoro-Femoral Bypass Without GraftCT Angiogram Limbs, Clinical

Photograph ,Doppler Of Peripheral Vessels  -  45000

 Color doppler,Intra OP photos,

Post OP scar photos

S7.2.18 TGA

314 S7.2.18.1 35.84 TGA - Arterial Switch2D ECHO ,CT Angiography (Coronary

Angiography), Chest X-Ray PA View -  150000

2D ECHO Cardiogram ,Intra OP

photos, Post OP scar photos

315 S7.2.18.2 35.91 TGA - Sennings Procedure2D ECHO ,CT Angiography (Coronary

Angiography), Chest X-Ray PA View -  150000

2D ECHO Cardiogram ,Intra OP

photos, Post OP scar photos

S7.2.19.1 TGA

316 S7.2.19.1 38.12.1 TGA - Carotid Embolectomy

CT Angiography Neck\Chest(Cartotid

Angiography) - , Colour Doppler Study Of

Neck Vessels

 -  70000 Colour Doppler ,Intra OP photos,

Post OP scar photos

S7.3 LUNGS

317 S7.3.1 32.5.1 Pneumonectomy  CT-Chest , X-RAY, PFT  -  60000

Intra op photos, Post OP scar

photos, Chest X-Ray Post OP

HPE

318 S7.3.2 32.4.2 Lobectomy  CT-Chest , X-RAY, PFT  -  60000

Intra op photos, Post OP scar

photos, Chest X-Ray Post OP

HPE

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319 S7.3.3 34.51 Decortication of lung  CT-Chest , X-RAY, PFT  -  60000

Intra op photos, Post OP scar

photos, Chest X-Ray Post OP

HPE

320 S7.3.4 32.2.1 Surgical management of lung cyst  CT-Chest , X-RAY, PFT  -  40000

Intra op photos, Post OP scar

photos, Chest X-Ray Post OP

HPE

321 S7.3.5 34.3.1Surgical management of SolItary fibrous tumor-

Mediastinum CT-Chest , X-RAY, PFT  -  60000

Intra op photos, Post OP scar

photos, Chest X-Ray Post OP

HPE

S7.3.6SURGICAL CORRECTION OF

BRONCHOPLEURAL FISTULA

322 S7.3.6.1 34.73.1Surgical management of Bronchopleural fistula -

Thorocoplasty CT-Chest , X-RAY  -  67530

Intra op photos, Post OP scar

photos, Chest X-Ray Post OP

HPE

323 S7.3.6.2 34.73.3Surgical management of Bronchopleural Fistula -

Myoplasty CT-Chest , X-RAY  -  75150

Intra op photos, Post OP scar

photos, Chest X-Ray

324 S7.3.6.3 34.73.2 Transpleural Bronchopleural Fistula closure  CT-Chest , X-RAY  -  65000Intra op photos, Post OP scar

photos, Chest X-Ray

S7.4 CHEST SURGERY

325 S7.4.1 34.81Surgical management of Diaphragmatic

Eventeration

USG Abdomen,  BARIUM STUDIES , CT-

Scan, ,Chest X-Ray -  50000

Intra op photos, Post OP scar

photos, Chest X-Ray, Post OP

USG

326 S7.4.2 53.8 Surgical Management of Diaphragmatic Hernia USG Abdomen, CT-Scan, ,Chest X-Ray  -  60000

Intra op photos, Post OP scar

photos, Chest X-Ray, Post OP

USG

327 S7.4.3 42.31Surgical Management of Oesophageal

Diverticula /Achalasia Cardia

USG Abdomen,  BARIUM STUDIES , CT-

Scan, ,Chest X-Ray, Upper GI endoscopy  -  50000

Intra op photos, Post OP scar

photos, Chest X-Ray, Post OP

USG

328 S7.4.4 33.32 Surgical management of Empyema Thoracis

CT Scan Chest With Contrast, Chest X-

Ray PA View(1 Film), PUS Culture &

Sensitivity, Aspirate For Culture,

Pulmonary Function Test(Major)

- 52140 Chest X-Ray PA View(1 Film)

S7.5SURGICAL MANAGEMENT OF

DIAPHRAGMATIC INJURIES

329 S7.5.1 34.82Surgical management of Diaphragmatic injuries,

Thoraco Abdominal approachCT Scan Chest , Chest X-Ray ,  -  55000

Intra op photos, Post OP scar

photos, Chest X-Ray

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S7.6SURGICAL MANAGEMENT OF BRONCHIAL

INJURIES/FB

330 S7.6.1 98.15.1 Bronchoscopic Foreign body removal  Bronchoscopy , CT-Scan  -  20000Intra op photos, Post OP scar

photos, , Endoscopy picture

331 S7.6.2 33.98Surgical management For Bronchial Injuries due

to foreign Body Bronchoscopy , CT-Scan  -  60000

Intra op photos, Post OP scar

photos, , Endoscopy picture

S7.8SURGICAL MANAGEMENT OF

OESOPHAGEAL INJURY/FB

332 S7.8.1 42.9

Gastro Study Followed By Thoracotomy &

Repairs For Oesophageal Injury For Corrosive

Injuries/Fb

 Gastroscopy  -  65000Intra op photos, Post OP scar

photos, , Endoscopy picture

S7.9SURGICAL MANAGEMENT OF VASCULAR

INJURY

333 S7.9.1 39.3.1Surgery for Arterial Injuries, Venous Injuries

Without Graft

Angiogram-, Color Doppler , Clinical

Photograph  -  25000

Intra op photos, Post OP scar

photos, Color Doppler

334 S7.9.1.1 39.56.1

Surgical Management of Vascular Injury In

Upper Limbs - Axillary,Branchial,Radial And

Ulnar -With Vein Graft

Angiogram-, Color Doppler , Clinical

Photograph  -  20000

Intra op photos, Post OP scar

photos, Color Doppler

335 S7.9.1.2 39.3.2 Major Vascular Injury -In Lower Limbs-RepairAngiogram-, Color Doppler , Clinical

Photograph  -  30000

Intra op photos, Post OP scar

photos, Color Doppler

336 S7.9.1.3 39.3.3Surgical Management of Minor Vascular Injury -

Tibial Vessels In Leg

Angiogram-, Color Doppler , Clinical

Photograph  -  20000

Intra op photos, Post OP scar

photos, Color Doppler

337 S7.9.1.4 39.3.4Surgical Management of Minor Vascular Injury -

Vessels In Foot

Angiogram-, Color Doppler , Clinical

Photograph  -  20000

Intra op photos, Post OP scar

photos, Color Doppler

338 S7.9.2 39.56.2Surgical Management of Vascular injuries with

vein graft

Angiogram-, Color Doppler , Clinical

Photograph

 - 30000

Intra op photos, Post OP scar

photos, Color Doppler

339 S7.9.3 39.57.2Surgical Management of Vascular Injury With

Prosthetic Graft

Angiogram-, Color Doppler , Clinical

Photograph  -  40000

Intra op photos, Post OP scar

photos, Color Doppler

340 S7.9.4 39.3.5Surgical Management of Neck Vascular Injury -

Carotid Vessels

Angiogram-, Color Doppler , Clinical

Photograph  -  100000

Intra op photos, Post OP scar

photos, Color Doppler

341 S7.9.6 39.3.6Surgical Management of Abdominal Vascular

Injuries - Aorta, Illac Arteries, Ivc, Iliac Veins

USG Abdomen, Angiogram-, Color

Doppler , Clinical Photograph  -  100000

Intra op photos, Post OP scar

photos, Color Doppler

342 S7.9.7 39.3.7Surgical Management of Thoracic Vascular

Injuries

CT Scan Chest, Angiogram-, Color

Doppler , Clinical Photograph  -  150000

Intra op photos, Post OP scar

photos, Color Doppler

S7.10 CARDIAC INJURES

343 S7.10.1 37.49.1 Surgery for Cardiac injuries Without CPB 2D ECHO, Clinical Photo,Chest X-

Ray,ECG -  70000

Intra OP photos, 2D ECHO, Post

OP scar photo

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344 S7.10.2 37.49.2 Surgery for Cardiac injuries With CPB 2D ECHO, Clinical Photo,Chest X-

Ray,ECG -  91960

Intra OP photos, 2D ECHO, Post

OP scar photo

S7.11 VASCULAR SURGERIES

345 S7.11.1 38.0 Peripheral Embolectomy Without GraftSpiral CT Angiogram,, Doppler Of

Peripheral Vessels -  30000

Intra OP photos,Color Doppler,

Post OP scar photo

346 S7.11.2 39.25.3Aorto Billiac - Bifemoral Bypass With Synthetic

Graft

Spiral CT Angiogram, Colour Doppler

Study Abdominal Aorta And Both Lower

Limbs , Clinical Photograph

 -  125000Intra OP photos, Color Doppler,

Post OP scar photos, Graft pouch

347 S7.11.3 39.29.5 Axillo Bifemoral Bypass With Synthetic Graft

Spiral CT Angiogram, Colour Doppler

Study Abdominal Aorta And Both Lower

Limbs , Clinical Photograph

 -  100000Intra OP photos, Color Doppler,

Post OP scar photos, Graft pouch

348 S7.11.4 39.29.6 Femoro Distal Bypass With Vein Graft

Spiral CT Angiogram, Colour Doppler

Study Abdominal Aorta And Both Lower

Limbs , Clinical Photograph

 -  60000Intra OP photos, Color Doppler,

Post OP scar photos

349 S7.11.5 39.29.7 Femoro Distal Bypass With Synthetic Graft

Spiral CT Angiogram, Colour Doppler

Study Abdominal Aorta And Both Lower

Limbs , Clinical Photograph

 -  80000Intra OP photos, Color Doppler,

Post OP scar photos, Graft pouch

350 S7.11.6 39.29.8Axillo Brachial Bypass Using With Synthetic

Graft

Spiral CT Angiogram, Colour Doppler

Study Thorasic Aorta And both Upper

Limbs , Clinical Photograph

 -  70000Intra OP photos, Color Doppler,

Post OP scar photos, Graft pouch

351 S7.11.7 39.29.9 Brachio - Radial Bypass With Synthetic Graft

Spiral CT Angiogram, Colour Doppler

Study Thorasic Aorta And both Upper

Limbs , Clinical Photograph

 -  59000Intra OP photos, Color Doppler,

Post OP scar photos, Graft pouch

352 S7.11.8 39.8.2Excicion Of Carotid Body Tumor With Vascular

Repair

CT Angiography Neck\Chest, Clinical

Photograph  -  80000

Colour Doppler , Intra OP photos,

Post OP scar photos,Post Op HPE

353 S7.11.9 39.22 Carotid Artery Bypass With Synthetic GraftCT Angiography Neck\Chest, Clinical

Photograph  -  124000

Intra OP photos, Color Doppler,

Post OP scar photos, Graft pouch

354 S7.11.10 38.60.1Excision Of Arterio Venous Malformation -

Large

Color Doppler ,MRI Angiogram , Spiral

CT Angiogram, , Clinical Photograph  -  90000

Intra OP photos, Color Doppler,

Post OP scar photo

355 S7.11.11 38.60.2Excision Of Arterio Venous Malformation -

Small

Color Doppler ,MRI Angiogram , Spiral

CT Angiogram, , Clinical Photograph  -  44000

Intra OP photos, Color Doppler,

Post OP scar photo

356 S7.11.12 38.1 Arterial Embolectomy

Digital Subtraction Angiography(DSA

Peripheral Artery\Arteries),Colour Doppler

- Lower Limbs

 -  30000Intra OP photos, Scar Photo ,

Colour Doppler - Lower Limbs

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357 S7.11.13 39.27.1 A V Fistula surgery (creation) at WristColour Doppler Of Specific Limb- , Renal

Profile, USG Abdomen -  -  10000

Colour Doppler Of Specific

Limb, Intra OP photos, Scar

Photo

358 S7.11.14 39.27.2 A. V Fistula surgery (creation) At ElbowColour Doppler Of Specific Limb- , Renal

Profile, USG Abdomen -  -  10000

Colour Doppler Of Specific

Limb, Intra OP photos, Scar

Photo

359 S7.11.15 38.7.1 DVT - Ivc Filter implantationVenous Doppler , Lung Ventilation &

Perfusion Scan , Clinical Photograph  -  100000

Intra OP photos, Plain X-Ray

Abdomen, Procedure CD, IVC

filter pouch with bar Code

360 S7.11.16 38.3 Surgical management of Vascular Tumors Spiral CT Angiogram, Clinical

Photograph -  40000

Intra OP photos, Color Doppler,

Post OP scar photos,Post OP HPE

361 S7.11.17 39.52.1 Small Arterial Aneurysms - Repair Spiral CT Angiogram, Clinical

Photograph -  20000

Intra OP photos, Color Doppler,

Post OP scar photos

362 S7.11.18 39.52.2 Medium Size Arterial Aneurysms - Repair Spiral CT Angiogram, Clinical

Photograph -  25000

Intra OP photos, Color Doppler,

Post OP scar photos

363 S7.11.19 38.40.2Medium Size Arterial Aneurysms - Repair With

Synthetic Graft

 Spiral CT Angiogram, Clinical

Photograph -  95000

Intra OP photos, Color Doppler,

Post OP scar photos, Graft pouch

S8 PEDIATRIC SURGERIES

S8.1PAEDIATRIC CONGENITAL

MALFORMATIONS

S8.1.1 GI TRACT

364 S8.1.1 42.12Surgical management of Oesophageal Atresia In

Paediatric PatientsChest X-Ray , USG Abdomen -  -  61890

Intra op photos, Post OP scar

photos,

365 S8.1.2 53.72.1Open repair of diaphragmatic hernia in

paediatric patientsChest X-Ray,CT Chest  -  50000

Post OP Chesf X Ray ,Intra op

photos, Post OP scar photos,

366 S8.1.3 45.3.3Surgical Management of Intestinal Atresias &

Obstructions In Paediatric Patients

X-Ray abdomen, USG Abdomen , Lower

GI endoscopy -  65000

Post OP X Ray ,Intra op photos,

Post OP scar photos,

367 S8.1.4 51.63Surgical Management of Biliary Atresia &

Choledochal Cyst In Paediatric Patients

CT Scan Abdomen , USG Abdomen,

Bulida Scan (Hepatobiliary Scan) -  69450

Post OP HPE ,Intra op photos,

Post OP scar photos

368 S8.1.5 46.11.1Stage 1 procedure for Anorectal Malformations

In Paediatric PatientsClinical photoraph, Invertogram  -  48000

Intra op photos, Post OP scar

photos

369 S8.1.6 45.95.2Stage 2 procedure for Anorectal Malformations

In Paediatric PatientsDistal Cologram, Clinical Photograph  -  60000

Intra op photos, Post OP scar

photos

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370 S8.1.7 46.11.2Stage 1 procedure for Hirschprungs Disease In

Paediatric PatientsClinical photo, Barium enema  -  48000

Intra op photos, Post OP scar

photos

371 S8.1.8 46.52.3Stage 2 procedure for Hirschprungs Disease In

Paediatric PatientsClinical photo, Barium enema  -  72000

Intra op photos, Post OP scar

photos

372 S8.2.1 55.8Surgical Management of Congenital

Hydronephrosis in Paediatric PatientsUSG abdomen, Renogram  -  54710

Post OP X-Ray abdomen, Post

OP USG,Intra op photos, Post

OP scar photos

373 S8.2.2 56.74.1Surgical Management of Ureteric

ReimplantationsUSG abdomen, MCUG  -  34770

Post OP X-Ray, Intra op photos,

Post OP scar photos

374 S8.2.3.1 57.86.1Stage 1 procedure for Exstrophy Bladder in

Paediatric PatientsClinical photo, USG abdomen  -  73210

Intra op photos, Post OP scar

photos

375 S8.2.3.2 57.86.2Stage 2 procedure for Exstrophy Bladder in

Paediatric PatientsClinical photo, USG abdomen  -  70230

Intra op photos, Post OP scar

photos

376 S8.2.4 58.39Surgical Management of Posterior Urethral

Valves in Paediatric Patients

USG abdomen, RFT, S.Electrolytes,

MCUG -  30000

Intra op photos, Post OP scar

photos,RFT

377 S8.2.5 58.45.1 Single Stage procedure for Hypospadiasis  Clinical Photograph  -  40000Intra op photos, Post OP scar

photos

378 S8.2.6.1 58.45.2 Stage 1 procedure for Hypospadiasis  Clinical Photograph  -  29360Intra op photos, Post OP scar

photos

379 S8.2.6.2 58.45.3 Stage 2 procedure for Hypospadiasis  Clinical Photograph  -  29860Intra op photos, Post OP scar

photos

380 S8.3.1 16.49.1 Surgical Management of Paediatric Tumors CT Scan, Bone scan,USG Abdomen  -  50000Post OP HPE ,Intra op photos,

Post OP scar photos

381 S8.4.1 27.54.3 Surgical correction of Cleft Lip  Clinical Photograph  -  25000Intra op photos, Post OP scar

photos

382 S8.4.2 27.62Surgical correction of Cleft Palate in pediatric

patients Clinical Photograph  -  25000

Intra op photos, Post OP scar

photos

383 S8.4.3 27.69Surgical corection of Velo-Pharyngeal

IncompetenceEndoscopy  -  35330

Intra op photos, Endoscopy

picture

384 S8.4.4 86.85.1Surgical correction of Syndactyly of Hand For

Each Hand in Paediatric PatientX-Ray , Clinical Photograph  -  25000

Intra op photos, Post OP scar

photos

385 S8.4.5 18.71Surgical correction of Microtia/Anotia In

Paediatric Patient Clinical Photograph  -  32840

Intra op photos, Post OP scar

photos

386 S8.4.6 76.5.2Surgical Management of Tempero mandibular

Joint Ankylosis Clinical Photograph  -  44540

Intra op photos, Post OP scar

photos

S8.2 CONGENITAL MALFORMATIONS

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387 S8.5.1 86.04.1 Surgical Management of Hamartoma Excision IVP , Renogram , USG, Clinical Photo,

Color Doppler -  20000

Intra op photos, Post OP scar

photos,Post OP HPE

388 S8.5.2 39.99 Surgical Management of Hemangioma Excision Clinical Photograph , USG, Clinical

photo, Color Doppler -  18830

Intra op photos, Post OP scar

photos,Post OP HPE

389 S8.5.3 40.29.4Surgical management of Lymphangioma In

Paediatric Patients

 Clinical Photograph , USG, Clinical

photo, Color Doppler -  48000

Intra op photos, Post OP scar

photos,Post OP HPE

S8.3 HEAD AND NECK

390 S8.3.1 05.2 Neuroblastoma Biopsy , CT, USG  -  50000Intra op photos, Post OP scar

photos,Post OP HPE

391 S8.3.2 86.3.13Surgical Management of Congenital Dermal

SinusClinical photo, X-Ray Head  -  30000

Intra op photos, Post OP scar

photos,Post OP HPE

392 S8.3.3 86.09.1Surgical Management of Cystic Lesions Of The

NeckUSG, Clinical photo  -  24000

Intra op photos, Post OP scar

photos,Post OP HPE

393 S8.3.4 02.1 Surgical management of Encephalocele Neurosonogram, Clinical photo,CT  -  42080Intra op photos, Post OP scar

photos,Post OP HPE

394 S8.3.5 29.52.2Surgical management of Sinuses & Fistula of the

neck in Paediatric PatientClinical photo  -  20870

Intra op photos, Post OP scar

photos,Post OP HPE

395 S8.3.6 03.52 Meningo Myelocele Spinal ProcedureX-Ray Dorso Lumbar Spine,

Neurosonogram(NSG), Clinical Photograph - 25000 Case Sheet with operation Notes

S8.4 CHEST

396 S8.7.1 98.15.1 Bronchoscopy for Foreign Body Removal  Clinical Photograph, X-Ray chest  -  20000Intra op photos, ,Post OP X Ray

chest

397 S8.7.2 42.85Surgical Correction of Esophageal Obstructions

In Paediatric Patients

Upper GI endoscopy , Barium Meal

Follow Through -  58500

Intra op photos,Post OP scar

photos

398 S8.7.3 42.89Surgical Correction of Esophageal Substitutions

In Paediatric Patients

Upper GI endoscopy , Barium Meal

Follow Through -  73166

Intra op photos,Post OP scar

photos

399 S8.7.4 32.2 Excision of Thoracoscopic Cysts Clinical Photograph, CT chest, Chest X-

Ray -  40000

Intra op photos, Post OP scar

photos,Post OP HPE ,Chest X

Ray

400 S8.7.5 34.52Thoracoscopic Decortication In Paediatric

Patients Clinical Photograph, X-Ray & CT chest  -  48000

Intra op photos, Post OP scar

photos,Post OP HPE ,Chest X

Ray

401 S8.7.6 42.42.4Surgical Correction of Thoracic Duplications In

Paediatric Patients

Clinical Photograph ,Chest X-Ray CT

Scan Chest -  44540

Intra op photos, Post OP scar

photos,Post OP HPE ,Chest X

Ray

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402 S8.7.7 34.74 Surgical Correction of Thoracic Wall DefectsClinical Photograph ,Chest X-Ray CT

Scan Chest -  65006

Intra op photos, Post OP scar

photos,Post OP HPE ,Chest X

Ray

403 S8.7.8 34.06 Empyema decortication In Paediatric Patients

CT Scan Chest With Contrast/CT Scan

Chest Without Contrast, Chest X-Ray PA

View(1 Film)

- 30630

Chest X-Ray PA View(1 Film),

Routine Histopathological

Examination

S8.5 ABDOMEN

404 S8.8.1 43.3.2Surgical management of - Gastric Outlet

Obstructions In Paediatric PatientsClinical Photograph, USG abdomen  -  30000

Intra op photos, Post OP scar

photos

405 S8.8.2 44.66Surgical management of Gastro Esophageal

Reflux In Paediatric Patients

CT Scan Abdomen, Upper GI Study,

B.M.F.T -  36410

Intra op photos, Post OP scar

photos

406 S8.8.3 50.29.2Surgical Correction of Hydatid Cysts In

Paediatric Patient CT / USG  -  40000

Intra op photos, Post OP scar

photos

407 S8.8.4 45.4Surgical management of Intestinal Polyposis In

Paediatric PatientsUSG, Colonoscopy  -  60000

Intra op photos Post OP scar

photos,Post OP HPE

408 S8.8.5 46.80.1 Surgical Correction of Intususception USG  -  48000 Intra op photos Post OP scar

photos,Post OP HPE

409 S8.8.6 46.99Surgical mangement of Acute Intestinal

Obstruction In Paediatric Patients

USG Abdomen , Abdomen Radiograph

Supine Or Erect -  48000

Intra op photos Post OP scar

photos,Post OP HPE

410 S8.8.7 47.01 Laparoscopic Appendicectomy USG, CBP  -  20910WEBEX Post OP scar

photos,Post OP HPE

411 S8.8.8 51.22.4 Laparoscopic Choleycystectomy USG, LFT  -  30000WEBEX Post OP scar

photos,Post OP HPE

412 S8.8.9 48.41.1Laparoscopic Pull Through For Ano Rectal

Anomalies In Paediatric PatientsDistal Cologram  -  72000

Intra op photos Post OP scar

photos

413 S8.8.10 48.41.2Laparoscopic Pull Through Surgeries For

Hirschprungs Disease In Paediatric PatientsBarium Enema , Clinical Photograph  -  72000

Intra op photos, Post OP scar

photos

414 S8.8.11 41.5.5 Paediatric Splenectomy (Non Traumatic) Chest X-Ray,USG Abdomen  -  42000USG Abdomen, Intra op photos,

Post OP scar photos,Post OP HPE

415 S8.8.12 07.2Adrenal Gland Surgeries In Paediatric

patients(07.3&07.4)

Urinary VMA, Urinary Metanephrine/Nor

metanephrine,Urinary Catecholamines

,Aldosterone - Urine,24 hour free cortisol

,USG Abdomen

 -  47330USG Abdomen, Intra op photos,

Post OP scar photos,Post OP HPE

416 S8.8.13 45.33.2 Meckel's Diverticulectomy In Paediatric PatientsUSG Abdomen /Radio Scintography,

Clinical Photograph - 40000

Routine Histopathological

Examination /Scar Photo

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417 S8.8.14 53.0Unilateral Inguinal Hernia repair In Paediatric

PatientsClinical Photograph - 15000 Scar Photo

418 S8.8.15 53.1Bilateral Inguinal Hernia repair In Paediatric

PatientsClinical Photograph - 20000 Scar Photo

419 S8.8.16 53.9.2 Lumbar Hernia repair In Paediatric Patients Clinical Photograph - 15000 Scar Photo

420 S8.8.17 53.21 Femoral Hernia repair In Paediatric Patients Clinical Photograph - 15000 Scar Photo

421 S8.8.18 53.42.2 Umbilical Hernia repair In Paediatric Patients USG Abdomen - 20000 Scar Photo

422 S8.8.19 53.51.2 Incisional Hernia repair In Paediatric Patients Clinical Photograph - 30000 Scar Photo

S8.6 GENITOURINARY SYSTEM

423 S8.6.4 62.5.2 Undescended testis USG, Clinical Photograph  -  42080 Intra op photos Post OP scar

photos,Post OP HPE

424 S8.9.1 55.5.1 Simple Nephrectomy in pediatric patients  CT , USG, Renogram  -  40000 Intra op photos Post OP scar

photos,Post OP HPE

425 S8.9.2 58.45.4 Surgical Correction of Epispadiasis USG, Clinical Photograph  -  41866 Intra op photos Post OP scar

photos

426 S8.9.3 61.49Surgical Correction of Scrotal Transposition In

Paediatric Patients Clinical Photograph , USG  -  20000

Intra op photos Post OP scar

photos

427 S8.9.5 63.52 Surgical Management for Torsion of Testis  Clinical Photograph , USG  -  25190 Intra op photos Post OP scar

photos

428 S8.9.6 62.5.3 Laparoscopic Orchidopexy In Paediatric Patients  Clinical Photograph , USG  -  25000 Intra op photos Post OP scar

photos

429 S8.9.7 63.1.1 Laparoscopic Varicocele Ligation  Clinical Photograph , USG  -  40000 WEBEX, Post OP scar photos

S9 GENITO URINARY SURGERIES

S9.1 RENAL TRANSPLANTATION

430 S9.1.1 39.27.3A.V. Fistula surgery (creation) [Pre-Transplant

Procedure Only]

Renal Profile , Serum Electrolytes, - Color

dopplar of limb vessels  -  10000

Intra op photos Post OP scar

photos

431 S9.1.2 55.6 Renal Transplantation SurgeryCT Scan Lower Abdomen, USG

Abdomen, HLA Typing,RFT  -  161100

Intra op photos Post OP scar

photos,Post OP USG

432 S9.1.3 99.23.1Post Renal Transplant Immunosuppressive

Treatment From 1st To 6th Months

Renal Profile, USG Abdomen, Latest

Color Dopplar of Transplant Area -  91670  Bills Copy

433 S9.1.4 39.50.1Balloon dialatation of transplant Renal Artery

stenosisRenal Angiogram - 32610 Renal Angiogram, WEBEX

S9.2 SURGERY FOR RENAL CALCULI

434 S9.2.1 55.11.1 Open Pyelolithotomy CT/IVP , KUB , USG  -  21766

Intra op photos Post OP scar

photos,Post OP USG,Post OP X

Ray

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435 S9.2.2 55.01 Open Nephrolithotomy CT/IVP , KUB , USG  -  24100

Intra op photos Post OP scar

photos,Post OP USG,Post OP X

Ray

436 S9.2.3 57.19 Open Cystolithotomy CT/IVP , KUB , USG  -  19130

Intra op photos Post OP scar

photos,Post OP USG,Post OP X

Ray

437 S9.2.4 55.11.2 Laparoscopic Pyelolithotomy  USG, IVP/CT  -  41806

WEBEX, Post OP scar

photos,Post OP USG,Post OP X

Ray

S9.3 LITHOTRIPSY PROCEDURES

438 S9.3.1 57.0 Cystolithotripsy  IVP , KUB , USG  -  13000

Intra op photos Post OP scar

photos,Post OP USG,Post OP X

Ray

439 S9.3.2 55.04 PCNL CT/IVP , KUB , USG  -  34280

Intra op photos Post OP scar

photos,Post OP USG,Post OP X

Ray

440 S9.3.3 98.51 Extracorporeal shockwave lithotripsy (ESWL) CT/IVP , KUB , USG  -  20000

Intra op photos Post OP scar

photos,Post OP USG,Post OP X

Ray,IVP

441 S9.3.4 56.0 ursl CT/IVP , KUB , USG  -  25000

Intra op photos Post OP scar

photos,Post OP USG,Post OP X

Ray

442 S9.3.5 55.02 Nephrostomy - Lithotropsy

CT/IVP , USG  -

 13000

Intra op photos Post OP scar

photos,Post OP USG,Post OP X

Ray

443 S9.3.6 59.8.1 Dj Stent (One Side) CT/IVP , USG  -  5000

Intra op photos Post OP scar

photos,Post OP USG,Post OP X

Ray

S9.4OTHER CORRECTIVE

SURGERIES/PROCEDURES

444 S9.4.1.1 58.45.5 Single Stage Urethroplasty for stricture Urethra Retrograde Urethrogram  -  50000 Intra op photos , Post OP scar

photos

S9.4.1.2 DOUBLE STAGE

445 S9.4.1.2.1 58.49.1 Stage 1 Urethroplasty for stricture Double Stage Retrograde Urethrogram  -  38670 Intra op photos , Post OP scar

photos

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446 S9.4.1.2.2 58.49.2 Stage 2 Urethroplasty for stricture Double Stage Retrograde Urethrogram  -  37500 Intra op photos , Post OP scar

photos

447 S9.4.2 58.46Reconstruction procedure Urethroplasty for

strictureRetrograde Urethrogram  -  37500

Intra op photos , Post OP scar

photos

S9.4.3 HYPOSPADIASIS (ADULT)

448 S9.4.3.1 58.45.1 Single Stage HYPOSPADIASIS (ADULT)  Clinical Photograph  -  40000 Intra op photos , Post OP scar

photos

S9.4.3.2 DOUBLE STAGE

449 S9.4.3.2.1 58.45.2 Stage-1 HYPOSPADIASIS (ADULT)  Clinical Photograph  -  29360 Intra op photos , Post OP scar

photos

450 S9.4.3.2.2 58.45.3 Stage-2 HYPOSPADIASIS (ADULT)  Clinical Photograph  -  29860 Intra op photos , Post OP scar

photos

451 S9.4.4 57.49.1Transurethral resection of bladder tumour

(TURBT)CT Scan Lower Abdomen ,USG Abdomen  -  39000

Intra op photos , Post OP scar

photos,Post OP HPE

S9.5 RENAL TRANSPLANTATION

452 S9.5.1 99.23.2Post Renal Transplant Immunosuppressive

Treatment From 7th To 12 Th Month.

Renal Profile, USG Abdomen, Latest

Color Dopplar of Transplant Area -  61210  Bills Copy

S9.6 RENAL

453 S9.6.1 55.02 Nephrostomy - Renal CT/IVP , USG  -  13000 Intra op photos Post OP scar

photos,Post OP USG

454 S9.6.2 55.4.1 Nephrectomy for Pyonephrosis/Xgp CT/IVP , USG/DTPA  -  40000 Intra op photos Post OP scar

photos,Post OP USG

455 S9.6.3 55.5.1 Simple Nephrectomy  IVP , USG/DTPA  -  40000 Intra op photos , Post OP scar

photos,Post OP USG

456 S9.6.4 55.5.2 Laproscopic Simple Nephrectomy  IVP , USG/DTPA  -  50000WEBEX, Post OP scar

photos,Post OP USG

457 S9.6.5 55.5.3 Laproscopic Radical Nephrectomy  IVP , USG/DTPA  -  61880WEBEX, Post OP scar

photos,Post OP USG

458 S9.6.6 55.4.3 Lap. Partial Nephrectomy CT/IVP , USG  -  60000

WEBEX, Post OP scar

photos,Post OP USG,Post OP

HPE

459 S9.6.7 55.51.2 Bilateral Nephroureterectomy CT/IVP , USG  -  80000

Intra op photos , Post OP scar

photos,Post OP USG,Post OP

HPE

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460 S9.6.8 55.39 Renal Cyst Excision CT/IVP , USG  -  23220

Intra op photos , Post OP scar

photos,Post OP USG,Post OP

HPE

S9.7 RENAL STONE SURGERY/THERAPIES

461 S9.2.5 55.11.3Anatrophic Peylolithotomy For Staghorn

CaliculusCT/IVP , KUB , USG  -  50000

Intra op photos , Post OP scar

photos,Post OP USG,Post OP X

Ray

462 S9.7.1 57.01 Endoscope Removal Of Stone In Bladder  IVP ,USG , X-Ray KUB  -  14000 Endoscopy Picture

S9.8 CORRECTIVE SURGERIES

463 S9.8.1 55.87.2 Anderson Hynes Pyeloplasty CT/IVP , USG , X-RAY/DTPA  -  48000Intra op photos , Post OP scar

photos

464 S9.8.2 57.84.1 Surgical correction of Vesicovaginal Fistula CT/IVP , Scopy , RGU  -  44000Intra op photos , Post OP scar

photos

465 S9.8.3 58.45.4 Epispadiasis - Correction  Clinical Photograph  -  41866Intra op photos , Post OP scar

photos

466 S9.8.4 58.43 Closure Of Urethral Fistula  RGU, Clinical Photos  -  30000Intra op photos , Post OP scar

photos

467 S9.8.5 58.5.1 Optical Urethrotomy  RGU , X-RAY,IVP  -  20930 Endoscopy Picture, WEBEX

Video

468 S9.8.6 58.0 Perineal Urethrostomy  RGU , X-RAY  -  31650  Endoscopy Picture

469 S9.8.7 56.74.1 Ureteric Reimplantations MCUG/IVP , USG , X-RAY  -  34770Intra op photos , Post OP scar

photos,Post OP USG

470 S9.8.8 56.51 Surgical Procedure for Ileal Conduit Formation  IVP , USG , X-RAY  -  40670Intra op photos , Post OP scar

photos

471 S9.8.9 56.4 Surgical corrrection of Ureterocele X-RAY, IVP, USG  -  23660Intra op photos , Post OP scar

photos,Post OP USG

472 S9.8.10 56.41Excision of Ureterocele with Ureteric

Implantation

USG Abdomen, Intra Veneous Pyelogram,

Micturating Cystourethrogram (MCUG),

CT Scan Lower Abdomen With Contrast

- 42370

USG Abdomen, CT Scan Lower

Abdomen With Contrast, Routine

Histopathological Examination,

Abdomen X-Ray (Lateral View)

473 S9.8.11 56.91 Balloon dilatation of Ureteric strictureCT Scan Lower Abdomen With Contrast,

USG Abdomen, Intra Veneous Pyelogram - 20100

Fluoroscopy, CT Scan Lower

Abdomen With Contrast, USG

Abdomen

S9.9 BLADDER and PROSTATE

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474 S9.9.1 60.29.1 Transurethral Resection of Prostate (TURP)USG Abdomen,Cystouretroscopy ,Prostate-

Specific Antigen -  30000

Intra op photos , Post OP scar

photos,Post OP USG,Post OP

HPE

475 S9.9.2 60.29.2Transurethral Resection of Prostate (TURP)

Cyst Lithotripsy

USG Abdomen,Cystouretroscopy ,Prostate-

Specific Antigen -  30000

Intra op photos , Post OP scar

photos,Post OP USG,Post OP

HPE

476 S9.9.3 60.3 Open ProstatectomyUSG Abdomen,Cystouretroscopy ,Prostate-

Specific Antigen -  33000

Intra op photos , Post OP scar

photos,Post OP USG,Post OP

HPE

477 S9.9.3.1 60.5.2 Open radical Prostratectomy

USG Abdomen, CT Scan Lower Abdomen

With Contrast, Prostate-Specific Antigen

(PSA), Cystouretroscopy

- 50000

USG Abdomen, CT Scan Lower

Abdomen With Contrast, Routine

Histopathological Examination

478 S9.9.4 57.88 Caecocystoplasty USG Abdomen, Cystoscopy  -  41840Intra op photos , Post OP scar

photos,Post OP USG

479 S9.9.5 57.7 Total Cystectomy USG Abdomen, Cystoscopy  -  45020Intra op photos , Post OP scar

photos,Post OP USG

480 S9.9.5.1 57.6.1 Partial CystectomyCT Scan Lower Abdomen With Contrast,

USG Abdomen, Cystoscopy, Renal biopsy - 33850

USG Abdomen, CT Scan Lower

Abdomen With Contrast, Routine

Histopathological Examination

481 S9.9.6 57.59 Bladder Diverticulectomy USG Abdomen, Cystoscopy  -  32200Intra op photos , Post OP scar

photos,Post OP USG

482 S9.9.7 59.4.2Surgical Management of Incontinence Urine

(Female)USG Abdomen, Cystoscopy  -  22000

Intra op photos , Post OP scar

photos,Post OP USG

483 S9.9.8 59.4.1Surgical Management of Incontinence Urine

(Male)USG Abdomen, Cystoscopy  -  25600

Intra op photos , Post OP scar

photos,Post OP USG

484 S9.9.9 57.91.2 Bladder neck reconstruction for Incontinence

USG Abdomen, CT Scan Lower Abdomen

With Contrast, Case sheet with clinical

History

- 60000USG Abdomen, CT Scan Lower

Abdomen With Contrast

485 S9.9.10 59.79Mid urethral sling procedure for stress urinary

incontinence

USG Abdomen, CT Scan Lower Abdomen

With Contrast, Case sheet with clinical

History

- 30000USG Abdomen, CT Scan Lower

Abdomen With Contrast

S9.10 TESTIS AND PENIS

486 S9.10.1 62.5 Orchidopexy Bilateral  USG, Clinical Photo  -  22866 Intra op photos Post OP scar

photos

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487 S9.10.2 63.52 Surgical management of Torsion of Testis  USG, Clinical Photo  -  25190 Intra op photos Post OP scar

photos

488 S9.10.3 64.42.1 Surgical correction of Chordee  USG, Clinical Photo  -  32860 Intra op photos Post OP scar

photos

489 S9.10.4 64.3.1 Partial Amputation Of Penis(Non-Malignant)  USG, Clinical Photo  -  36670 Intra op photos Post OP scar

photos,Post OP HPE

490 S9.10.5 64.3.2 Total Penectomy  USG, Clinical Photo  -  36670 Intra op photos Post OP scar

photos,Post OP HPE

S9.11 CAPD

491 S9.11.1 59.8.2 CAPD-Tenchkoff catheter insertionUSG Abdomen, CT Scan Lower Abdomen

With Contrast, Renal Profile - 36520

USG Abdomen, CT Scan Lower

Abdomen With Contrast

492 S9.11.2 97.64 CAPD-Tenchkoff catheter removal

Abdomen And Pelvis For Kidneys,

Ureters, And Bladder (KUB), USG

Abdomen, Clinical Photograph

- 33940

Abdomen And Pelvis For

Kidneys, Ureters, And Bladder

(KUB), USG Abdomen, Scar

Photo

493 S9.11.3 97.64.1 CAPD bags per month Clinical Photograph - 8520Case Sheet with treatment details,

Clinical Photograph

S10 NEUROSURGERY

S10.1 BRAIN

494 S10.1.1 01.24.1Craniotomy And Evacuation of Subdural

HaematomaCT Scan  -  66000

Intra op photos , Post OP scar

photos,Post OP X Ray

495 S10.1.2 01.24.2Craniotomy And Evacuation of Extradural

HaematomaCT Scan  -  60000

Intra op photos , Post OP scar

photos,Post OP X Ray

496 S10.1.3 01.13Burr Hole procedure for evacuation of Brain

AbscessCT Scan  -  32679

Intra op photos , Post OP scar

photos,Post OP X Ray

497 S10.1.4 01.53.3Excision Of Lobe (Frontal,Temporal,Cerebe

llum Etc.)CT Scan  -  40000

Intra op photos , Post OP scar

photos,Post OP X Ray,Post OP

HPE

S10.1.5 EXCISION OF BRAIN TUMOUR

498 S10.1.5.1 01.59.1 Excision of Parasagital Brain tumour CT Scan  -  68890

Intra op photos , Post OP scar

photos,Post OP X Ray,Post OP

HPE

499 S10.1.5.2 01.59.2 Excision of Basal Brain tumour CT Scan  -  70000

Intra op photos , Post OP scar

photos,Post OP X Ray,Post OP

HPE

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500 S10.1.5.3 01.59.3 Excision of Brain Stem Brain tumour CT Scan  -  70000

Intra op photos , Post OP scar

photos,Post OP X Ray,Post OP

HPE

501 S10.1.5.4 01.59.4 Excision of C P Angle Brain tumour CT Scan  -  80000

Intra op photos , Post OP scar

photos,Post OP X Ray,Post OP

HPE

502 S10.1.5.5 01.59.5 Excision of Other Brain tumours CT Scan  -  48250

Intra op photos , Post OP scar

photos,Post OP X Ray,Post OP

HPE

503 S10.1.11 01.59.8 Excision of Subtentorial Brain Tumours CT Scan ,EEG  -  48250Intra op photos , Post OP scar

photos,Post OP HPE

504 S10.1.12 02.34.1 Ventriculoatrial / Ventriculoperitonial shunt CT Scan  -  30000Intra op photos , Post OP scar

photos,Post OP X Ray

505 S10.1.13 01.09.1 Twist Drill Craniostomy CT Scan  -  15000Intra op photos , Post OP scar

photos,Post OP X Ray

506 S10.1.14 01.09.2 Subdural Tapping CT Scan  -  19500Intra op photos , Post OP scar

photos,Post OP X Ray

507 S10.1.15 01.09.3 Ventricular Tapping CT Scan  -  15000Intra op photos , Post OP scar

photos,Post OP X Ray

508 S10.1.16 01.31 Tapping of Brain Abscess CT Scan  -  40000Intra op photos , Post OP scar

photos,Post OP X Ray

509 S10.1.17 39.79.2Surgical Management of Vascular

Malformations MRI Angio  -  60000

Intra op photos , Post OP scar

photos,Post OP X Ray

510 S10.1.18 02.34 Ventriculo Peritoneal Shunt CT Scan  -  30000Intra op photos , Post OP scar

photos,Post OP X Ray

511 S10.1.19 02.32.1 Atrial Shunt CT Scan  -  20000Intra op photos , Post OP scar

photos,Post OP X Ray

512 S10.1.20 02.12Surgical Management of Meningo

Encephalocele MRI  -  40000

Intra op photos , Post OP scar

photos,Post OP X Ray

513 S10.1.21 01.59.10 Surgical Management of Meningomyelocele  MRI  -  40000Intra op photos , Post OP scar

photos,Post OP X Ray

514 S10.1.22 02.31 Surgical Management of C.S.F. Rhinorrhoea CT Scan , Radionuclide Cisternography  -  40000 Endoscopic Video Webex

515 S10.1.23 02.0 Cranioplasty  CT Scan , Clinical Photograph  -  30000Intra op photos , Post OP scar

photos,Post OP X Ray

516 S10.1.23.1 02.05 Cranioplasty With ImpantsCT Scan Head Without Contrast, CT

Angio Of Brain(Head) - 30000 X-Ray Skull

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517 S10.1.24 01.59.12 Meningocele Excision  MRI  -  40000

Intra op photos , Post OP scar

photos,Post OP X Ray,Post OP

HPE

518 S10.1.25 02.32 Ventriculo Atrial Shunt CT Scan  -  20000Intra op photos , Post OP scar

photos,Post OP X Ray

519 S10.1.26 01.59.13 Excision Of Brain Abcess CT Scan  -  70000Intra op photos , Post OP scar

photos,Post OP X Ray

520 S10.1.27 39.51 Aneurysm Clipping  MRI Angio  -  110000Intra op photos , Post OP scar

photos,Post OP X Ray

521 S10.1.28 02.39 External Ventricular Drainage (EVD) CT Scan  -  40000Intra op photos , Post OP scar

photos,Post OP X Ray

S10.2 SPINAL SURGERIES

522 S10.2.1 03.4.1 Surgery for Cord Tumours CT Spine /MRI Spine  -  38000

Intra op photos , Post OP scar

photos,Post OP X Ray,Post OP

HPE

523 S10.2.2 80.51.2 Excision Of Cervical Inter-Vertebral Discs CT Spine /MRI Spine, X-Ray,  -  30000Intra op photos , Post OP scar

photos,Post OP X Ray

524 S10.2.3 80.51.1 Posterior Cervical Discectomy CT Spine /MRI Spine, X-Ray,  -  26650Intra op photos , Post OP scar

photos,Post OP X Ray

525 S10.2.4 80.51.5 Anterior Cervical Discectomy CT Spine /MRI Spine, X-Ray,  -  26650Intra op photos , Post OP scar

photos,Post OP X Ray

526 S10.2.5 81.02 Anterior Cervical Spine Surgery With Fusion CT Spine /MRI Spine, X-Ray,  -  45000Intra op photos , Post OP scar

photos,Post OP X Ray

527 S10.2.6 80.5.1 Anterior Lateral Decompression CT Spine /MRI Spine, X-Ray,  -  30000Intra op photos , Post OP scar

photos,Post OP X Ray

528 S10.2.7 03.09.1 Laminectomy CT Spine /MRI Spine, X-Ray,  -  26650Intra op photos , Post OP scar

photos,Post OP X Ray

529 S10.2.7.1 03.09.2 Laminoplasty With Implants

CT Spine (Cervical, Dorsal,

Lumbar,Sacral) Without Contrast /MRI

Local Area, X-Ray Dorso Lumbar Spine

- 30180 X-Ray Dorso Lumbar Spine

530 S10.2.8 80.51.6 Discectomy CT Spine /MRI Spine, X-Ray,  -  26650Intra op photos , Post OP scar

photos,Post OP X Ray

531 S10.2.9 81.00.2 Spinal Fusion Procedure CT Spine /MRI Spine, X-Ray,  -  50000Intra op photos , Post OP scar

photos,Post OP X Ray

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532 S10.2.10 03.4.2Surgical Management of Intra Medullary Spinal

TumoursCT Spine /MRI Spine  -  50000

Intra op photos , Post OP scar

photos,Post OP X Ray,Post OP

HPE

533 S10.2.11 03.59.1 Surgical Management of Spina Bifida Major CT Spine /MRI Spine  -  35000Intra op photos , Post OP scar

photos,Post OP X Ray

534 S10.2.12 03.59.2 Surgical Management of Spina Bifida Minor CT Spine /MRI Spine  -  30000Intra op photos , Post OP scar

photos,Post OP X Ray

S10.3 OTHER SURGERIES/PROCEDURES

535 S10.3.1 93.59 Stereotactic Procedures CT Scan  -  20000Intra op photos , Post OP scar

photos

536 S10.3.2 07.62 Trans Sphenoidal Surgery CT Scan  -  40000Intra op photos , Post OP scar

photos,Post OP HPE

537 S10.3.3 81.01.1 Trans Oral Surgery CT Scan  -  40000Intra op photos , Post OP scar

photos,Post OP HPE

538 S10.3.4 81.01.2Combined Trans-Oral Surgery & Cv Junction

FusionCT Spine /MRI Spine, X-Ray,  -  51190

Intra op photos , Post OP scar

photos,Post OP X Ray

539 S10.3.5 81.01.3 C.V. Junction Fusion CT Spine /MRI Spine, X-Ray,  -  40000Intra op photos , Post OP scar

photos,Post OP X Ray

S10.4 BRAIN

540 S10.4.1 01.18 Endoscopy Procedures -Brain CT Scan / MRI  -  78000Webex video procedure , Post OP

scar photos,Post OP X Ray

541 S10.4.1.1 01.25 De-Compressive Craniectomy (Non Traumatic) CT Scan / MRI  -  80000Intra op photos , Post OP scar

photos,Post OP X Ray

542 S10.4.2 01.39 Evacuation of Intra-Cerebral Hematoma CT Scan / MRI  -  72000Intra op photos , Post OP scar

photos,Post OP X Ray

543 S10.4.3 02.2 Endoscopic Third Ventriculostomy CT Scan / MRI  -  30000Webex video procedure , Post OP

scar photos,Post OP X Ray

S10.5 SPINE

544 S10.5.1 80.51.3 Anterior Discectomy & Bone Grafting Orthopantomography (OPG), MRI, X-Rays  -  40000Intra op photos , Post OP scar

photos,Post OP X Ray

545 S10.5.2 80.51.4 Discectomy With Implants Orthopantomography (OPG), MRI, X-Rays  -  65000Intra op photos , Post OP scar

photos,Post OP X Ray

546 S10.5.3 80.99 Corpectomy For Spinal Fixation CT/ MRI, X-Rays  -  75000Intra op photos , Post OP scar

photos,Post OP X Ray

547 S10.5.4 78.19Spinal Fixation Rods And Plates, Artificial

DiscsCT/ MRI, X-Rays  -  85000

Intra op photos , Post OP scar

photos,Post OP X Ray

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548 S10.5.5 03.4.3 Surgical Management of Syringomyelia CT/ MRI, X-Rays  -  60000Intra op photos , Post OP scar

photos,Post OP X Ray

S10.6 SOFT TISSUE AND VASCULAR SURGERIES

549 S10.6.1 04.5.2 Surgical treatment for brachial plexus injuries  MRI, EMG - NCV, Clinical Video  -  72000Intra op photos , Post OP scar

photos

550 S10.6.2 05.22 Cervical Sympathectomy  EMG , MRI , Nerve conduction study  -  30000Intra op photos , Post OP scar

photos,Post OP HPE

551 S10.6.3 05.23.1 Lumbar Sympathectomy  EMG , MRI , Nerve conduction study  -  30000Intra op photos , Post OP scar

photos,Post OP HPE

552 S10.6.4 04.42.1Decompression/Excision Of Optic Nerve

Lesions MRI  -  78000 Intra OP photos

553 S10.6.5 04.76.1 Peripheral Nerve Injury Repair EMG , Nerve conduction study, Clinical

Photos -  40000

Intra op photos , Post OP scar

photos

554 S10.6.6 16.99 Proptosis  MRI  -  60000Intra op photos , Post OP scar

photos,Post X Ray

S10.7 EPILEPSY SURGERY

555 S10.7.1 01.53.2 Temporal Lobectomy  MRI, EEG Psychologic assesment  -  75000Intra op photos , Post OP scar

photos,Post X Ray,CT Scan

556 S10.7.2 01.59.6 Lesionectomy Type 1  MRI, EEG Psychologic assesment  -  56859Intra op photos , Post OP scar

photos,Post X Ray,CT Scan

557 S10.7.3 01.59.7 Lesionectomy Type 2  MRI, EEG Psychologic assesment  -  57040Intra op photos , Post OP scar

photos,Post X Ray,CT Scan

558 S10.7.4 01.53.1 Temporal Lobectomy Plus Depth Electrodes  MRI, EEG Psychologic assesment  -  140000Intra op photos , Post OP scar

photos,Post X Ray,CT Scan

S10.8MANAGEMENT OF TRIGEMINAL

NEURALGIA

559 S10.8.1 04.2Radiofrequency Ablation For Trigeminal

Neuralgia EMG , Nerve Conduction  -  30000

Intra op photos , Post OP scar

photos

560 S10.8.2 04.41Microvascular Decompression For Trigeminal

Neuralgia EMG , Nerve Conduction  -  60000

Intra op photos , Post OP scar

photos

S10.9 MANAGEMENT OF ANEYRISMS

561 S10.9.1 39.72.1 Embolization of Aneurysm CT Angio / MRI Angiography  -  75000  Color Doppler, Video Webex

562 S10.9.2 39.79.1 Coil Embolization of Aneurysm (each coil cost) CT Angio of Brain/ MRI Angiography  -  30000Intra op photos , Post OP scar

photos

S11 SURGICAL ONCOLOGY

S11.1 HEAD & NECK

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563 S11.1.1 86.89Composite Resection & Reconstruction - Head

& Neck in malignant conditions

 Biopsy , Clinical Photograph , USG , X-

RAY, CT Scan -  65060

Intra op photos , Post OP scar

photos,Post OP HPE

564 S11.1.2 40.4Neck Dissection Any Type in malignant

conditions

 Biopsy , Clinical Photograph , USG , X-

RAY, CT Scan -  32500

Intra op photos , Post OP scar

photos,Post OP HPE

565 S11.1.3 25.2.2 Hemiglossectomy in malignant conditions  Biopsy , Clinical Photograph , CT Scan  -  41260Intra op photos , Post OP scar

photos,Post OP HPE

566 S11.1.4 76.39 Maxillectomy Any Type in malignant conditions Biopsy , Clinical Photograph , USG , X-

RAY, X-Ray PNS/CT PNS -  30770

Intra op photos , Post OP scar

photos,Post OP HPE

567 S11.1.5 06.4.3 Thyroidectomy any type in malignant conditionsFNAC, Clinical Photograph , USG , X-

RAY -  30000

Intra op photos , Post OP scar

photos,Post OP HPE

568 S11.1.6 26.32.1 Parotidectomy any type in malignant conditionsFNAC, Clinical Photograph , USG , X-

RAY -  25000

Intra op photos , Post OP scar

photos,Post OP HPE

569 S11.1.7 30.4.1Laryngectomy Any Type in malignant

conditions

 Biopsy , Clinical Photograph , USG , X-

RAY, UGIE/DL scopy -  68180

Intra op photos , Post OP scar

photos,Post OP HPE

570 S11.1.8 30.4.2Laryngopharyngo Oesophagectomy in malignant

conditions

 Biopsy , Clinical Photograph , USG , X-

RAY, UGIE -  97000

Intra op photos , Post OP scar

photos,Post OP HPE

571 S11.1.9 76.31 Hemimandibulectomy in malignant conditions Biopsy , Clinical Photograph , USG , X-

RAY, OPG -  37760

Intra op photos , Post OP scar

photos,Post OP HPE

572 S11.1.10 83.49.3 Head and Neck - Wide Excision Biopsy , Clinical Photograph , USG , X-

RAY, CT Scan -  39570

Intra op photos , Post OP scar

photos,Post OP HPE

S11.2 GASTROINTESTINAL TRACT

573 S11.2.1 42.40.2Oesophagectomy Any Type in malignant

conditions Biopsy , CT , Endoscopy , USG  -  78000

Intra op photos , Post OP scar

photos,Post OP HPE,Post OP

USG

574 S11.2.2 43.89 Gastrectomy Any Type in malignant conditions  Biopsy , CT , Endoscopy , USG  -  50000

Intra op photos , Post OP scar

photos,Post OP HPE,Post OP

USG

575 S11.2.3 45.7 Colectomy Any Type in malignant conditions Biopsy , CT , Endoscopy ,

USG,CEA(Carcino Embryonic Antigen) -  52000

Intra op photos , Post OP scar

photos,Post OP HPE,Post OP

USG

576 S11.2.4 48.63.2Anterior Resection of rectum in malignant

conditions Biopsy , CT , Colonoscopy , CEA, USG  -  50000

Intra op photos , Post OP scar

photos,Post OP HPE,Post OP

USG

577 S11.2.5 48.5Abdominoperinial Resection in malignant

conditions Biopsy , CT , Colonoscopy , CEA, USG  -  50690

Intra op photos , Post OP scar

photos,Post OP HPE,Post OP

USG

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578 S11.2.6 52.7 Whipples Any Type In malignant conditions Biopsy , CT , Endoscopy , USG, CA19.9  -  100000

Intra op photos , Post OP scar

photos,Post OP HPE,Post OP

USG

579 S11.2.7 52.4.1 Triple Bypass -Pancreas in malignant conditions  Biopsy , CT , Endoscopy , USG  -  60000

Intra op photos , Post OP scar

photos,Post OP HPE,Post OP

USG

580 S11.2.8 52.96Other Bypasses-Pancreas in malignant

conditions Biopsy , CT , Endoscopy , USG  -  50516

Intra op photos , Post OP scar

photos,Post OP HPE,Post OP

USG

S11.3 GENITO URINARY SYSTEM

581 S11.3.1 55.5.4 Radical Nephrectomy  Biopsy , CT , IVP , KUB , USG  -  50000

Intra op photos , Post OP scar

photos,Post OP HPE,Post OP

USG

582 S11.3.2 57.71.2Open radical cystectomy with Ilealconduit

diversion

CT Scan Lower Abdomen With Contrast-

I32.018, USG Abdomen-I34.006,

Cystoscopy - I59.010, Biopsy I24.022

 -  100000

Intra op photos , Post OP scar

photos,Post OP HPE,Post OP

USG

583 S11.3.3 57.6.2 Other Cystectomies in malignant conditions  Biopsy , CT , IVP , KUB , USG  -  87640

Intra op photos , Post OP scar

photos,Post OP HPE,Post OP

USG

584 S11.3.4 64.3.2 Total Penectomy  USG, Clinical Photo  -  36670 Intra op photos Post OP scar

photos,Post OP HPE

585 S11.3.5 64.3.1 Partial Penectomy  Clinical Photograph, Biopsy, USG  -  36670

Intra op photos , Post OP scar

photos,Post OP HPE,Post OP

USG

586 S11.3.6 40.24Inguinal Block Dissection One Side in

malignant conditions Clinical Photograph, Biopsy, USG  -  29780

Intra op photos , Post OP scar

photos,Post OP HPE,Post OP

USG

587 S11.3.7 60.5.3 Radical Prostatectomy in malignant conditions  CT , KUB , USG, Biopsy, PSA  -  86646

Intra op photos , Post OP scar

photos,Post OP HPE,Post OP

USG

588 S11.3.8 62.3.3 High Orchidectomy  Biopsy , USG, Tumor Markers  -  22000

Intra op photos , Post OP scar

photos,Post OP HPE,Post OP

USG

589 S11.3.9 62.4 Bilateral Orchidectomy  Biopsy , USG, Tumor Markers  -  23340

Intra op photos , Post OP scar

photos,Post OP HPE,Post OP

USG

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590 S11.3.10 64.3 Emasculation in malignant conditions CT Scan , USG, Clinical photo  -  40560

Intra op photos , Post OP scar

photos,Post OP HPE,Post OP

USG

S11.4 GYNAECOLOGICAL ONCOLOGY

591 S11.4.1 68.49 Hysterectomy in malignant conditions  Biopsy , CT Scan , USG  -  32500

Intra op photos , Post OP scar

photos,Post OP HPE,Post OP

USG

592 S11.4.2 68.6 Radical Hysterectomy in malignant conditions  Biopsy , CT Scan , USG  -  55660

Intra op photos , Post OP scar

photos,Post OP HPE,Post OP

USG

593 S11.4.3 65.0 Surgery For Carcinoma Ovary Early Stage  Biopsy , CT Scan , USG  -  31760

Intra op photos , Post OP scar

photos,Post OP HPE,Post OP

USG

594 S11.4.4 65.6 Surgery For Carcinoma Ovary Advance Stage  Biopsy , CT Scan , USG  -  52000

Intra op photos , Post OP scar

photos,Post OP HPE,Post OP

USG

595 S11.4.5 71.5 Vulvectomy in malignant conditions  Biopsy , CT Scan , USG  -  45860

Intra op photos , Post OP scar

photos,Post OP HPE,Post OP

USG

596 S11.4.6 65.4 / 65.6.1Unilateral /BilateralSalpingo Oophorectomy in

malignant conditions(65.6.1)

 Biopsy , CT Scan , USG, CA125  -

 30000

Intra op photos , Post OP scar

photos,Post OP HPE,Post OP

USG

S11.5 TUMORS OF THE FEMALE BREAST

597 S11.5.1 85.4 Mastectomy Any Type in malignant conditions Biopsy , Clinical Photograph , FNAC,

Mammography -  30000

Intra op photos , Post OP scar

photos,Post OP HPE

598 S11.5.2 40.51 Axillary Dissection in malignant conditions Biopsy , Clinical Photograph, CXR,

FNAC, USG Abdomen, Mammography -  39226

Intra op photos , Post OP scar

photos,Post OP HPE

599 S11.5.3 85.22.1 Wide Excision - Breast in malignant conditions Biopsy , Clinical Photograph , FNAC,

Mammography -  5150

Intra op photos , Post OP scar

photos,Post OP HPE

600 S11.5.4 85.21 Lumpectomy Biopsy , Clinical Photograph , FNAC,

Mammography -  3090

Intra op photos , Post OP scar

photos,Post OP HPE

601 S11.5.5 85.7.1 Breast Reconstruction Surgery Clinical Photograph  -  41830Intra op photos , Post OP scar

photos

602 S11.5.6 34.4.1 Chest wall Resection  Biopsy , Clinical Photograph,,X Ray, CT

Chest -  30000

Intra op photos , Post OP scar

photos,Post OP HPE

S11.6 SKIN TUMORS

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603 S11.6.1 86.4.1Skin Tumors Wide Excision in malignant

conditions Biopsy , Clinical Photograph  -  34450

Intra op photos , Post OP scar

photos,Post OP HPE

604 S11.6.2 86.4.2Skin Tumors wide Excision + Reconstruction in

malignant conditions(86.6/86.7) Biopsy , Clinical Photograph  -  40000

Intra op photos , Post OP scar

photos,Post OP HPE

605 S11.6.3 86.9 Skin Tumors amputation in malignant conditions  Biopsy , Clinical Photograph  -  24380Intra op photos , Post OP scar

photos,Post OP HPE

S11.7 SOFT TISSUE AND BONE TUMORS

606 S11.7.1 83.49.1 Soft Tissue And Bone Tumors Wide ExcisionBiopsy , Clinical Photograph, X-Ray Local

parts CT/MRI -  15000

Intra op photos , Post OP scar

photos,Post OP HPE

607 S11.7.2 83.49.2Soft Tissue And Bone Tumors Wide Excision +

Reconstruction

Biopsy , Clinical Photograph, X-Ray Local

parts CT/MRI -  25000

Intra op photos , Post OP scar

photos,Post OP HPE

608 S11.7.3 77.60.3Bone and Soft TissueTumors Amputation in

malignant conditions(83.49)

Biopsy , Clinical Photograph, X-Ray Local

parts CT/MRI -  24420

Intra op photos , Post OP scar

photos,Post OP HPE

S11.8 LUNG CANCER

609 S11.8.1 32.5.2 Pneumonectomy for Carcinoma Lung Biopsy , CT Scan , X-RAY,

Bronchoscopy -  80286

Intra op photos , Post OP scar

photos,Post OP HPE,Post OPX

Ray

610 S11.8.2 32.4.3 Lobectomy for Carcinoma Lung Biopsy , CT Scan , X-RAY,

Bronchoscopy -  77000

Intra op photos , Post OP scar

photos,Post OP HPE,Post OPX

Ray

611 S11.8.3 34.51 Decortication Biopsy , CT Scan , X-RAY,

Bronchoscopy -  60000

Intra op photos , Post OP scar

photos,Post OP HPE,Post OPX

Ray

S11.8.4SURGICAL CORRECTION OF

BRONCHOPLEURAL FISTULA

612 S11.8.4.1 34.73.1Surgical Correction Of Bronchopleural Fistula.

Thoracoplasty

 Biopsy , CT Scan , X-RAY,

Bronchoscopy -  67530

Intra op photos , Post OP scar

photos,Post OP HPE,Post OPX

Ray

613 S11.8.4.2 34.73.3Surgical Correction Of Bronchopleural Fistula.

Myoplasty

 Biopsy , CT Scan , X-RAY,

Bronchoscopy -  75150

Intra op photos , Post OP scar

photos,Post OP HPE,Post OPX

Ray

614 S11.8.4.3 34.73.4

Surgical Correction of Bronchopleural Fistula -

Transpleural BPF Closure in malignant

conditions

 Biopsy , CT Scan , X-RAY,

Bronchoscopy -  75040

Intra op photos , Post OP scar

photos,Post OP HPE,Post OPX

Ray

S11.9 CA.ORAL CAVITY

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615 S11.9.1 76.31.3Marginal Mandibulectomy in malignant

conditions

 CT , Orthopantomogram, Bipsy, Clinical

photo -  44120

Intra op photos , Post OP scar

photos,Post OP

HPE,Orthopantomography (OPG)

616 S11.9.2 76.31.4 Segmental Mandibulectomy  CTScan , Clinical Photo, Biopsy  -  34736

Intra op photos , Post OP scar

photos,Post OP

HPE,Orthopantomography (OPG)

617 S11.9.3 25.3Total Glossectomy + Reconstruction in

malignant conditions(25.59) CTScan , Clinical Photo, Biopsy  -  57850

Intra op photos , Post OP scar

photos,Post OP HPE

618 S11.9.4 27.49.2Full Thickness Buccal Mucosal Resection &

Reconstruction in malignant conditions(27.59) CTScan , Clinical Photo, Biopsy  -  63310

Intra op photos , Post OP scar

photos,Post OP HPE

S11.10SURGICAL MANAGEMENT OF CA.EYE/

MAXILLA/ PARA NASAL SINUS

619 S11.10.1 16.59 Orbital Exenteration in malignant conditions CT Orbits / MRI Orbits  -  42090Intra op photos , Post OP scar

photos,Post OP HPE

620 S11.10.2 16.51Maxillectomy + Orbital Exenteration in

malignant conditions CT Scan, Clinical Photo, Biopsy  -  53860

Intra op photos , Post OP scar

photos,Post OP HPE

621 S11.10.3 76.65.1Maxillectomy + Infratemporal Fossa Clearance

in malignant conditions

3D CT Facial Bones-, Biopsy , X-Ray PNS

- I31.031 -  65680

Intra op photos , Post OP scar

photos,Post OP HPE

622 S11.10.4 76.4 Cranio Facial Resection in malignant conditions 3D CT Facial Bones/ MRI Local Area  -  91000Intra op photos , Post OP scar

photos,Post OP HPE

S11.11 CA. NASOPHARYNX

623 S11.11.1 29.3.2Resection of Nasopharyngeal Tumor in

malignant conditions

CT of Nose \ Nasopharynx - , Biopsy ,

Clinical Photo -  76600

Intra op photos , Post OP scar

photos,Post OP HPE

S11.12 CA. SOFT PALATE

624 S11.12.1 27.32 Palatectomy any type in malignant conditionsCT Scan Neck / MRI Neck,Biopsy ,

Clinical Photograph  -  39786

Intra op photos , Post OP scar

photos,Post OP HPE

S11.13 CA. EAR

625 S11.13.1 18.3 Sleeve Resection of Ear in malignant conditionsCT Scan /MRI Local Area , Biopsy ,

Clinical Photograph  -  44310

Intra op photos , Post OP scar

photos,Post OP HPE

626 S11.13.2 76.5.3Resection of Lateral Temporal Bone in

malignant conditions CT Scan/ MRI, Biopsy, Clinical Photo  -  68120

Intra op photos , Post OP scar

photos,Post OP HPE

627 S11.13.3 76.5.4Subtotal Resection of Temporal Bone in

malignant conditions CT Scan/ MRI, Biopsy, Clinical Photo  -  71970

Intra op photos , Post OP scar

photos,Post OP HPE

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628 S11.13.4 76.5.5Total Resection of Temporal Bone in malignant

conditions CT Scan/ MRI, Biopsy, Clinical Photo  -  78000

Intra op photos , Post OP scar

photos,Post OP HPE

S11.14 CA. SALIVARY GLAND

629 S11.14.1 26.32.2Excision of Submandibular gland in malignant

conditionsCT Scan Neck,Clinical Photograph, FNAC  -  26000

Intra op photos , Post OP scar

photos,Post OP HPE

S11.15 CA. THYROID

630 S11.15.1 31.5Tracheal Resection in malignant conditions(CA.

THYROID) Bronchoscopy , CT, FNAC/BIOPSY  -  65000

Intra op photos , Post OP scar

photos,Post OP HPE

S11.16 CA. TRACHEA

631 S11.16.1 34.3.4Superior Mediastinal Dissection+Sternotomy in

malignant conditions(77.31)

CT Scan Chest , Chest X-Ray ,

Bronchoscopy  -  60750

Intra op photos , Post OP scar

photos,Post OP HPE

632 S11.16.2 31.5Tracheal Resection in malignant conditions(CA.

TRACHEA)

CT Scan Chest , Chest X-Ray ,

Bronchoscopy  -  65000

Intra op photos , Post OP scar

photos,Post OP HPE

S11.17 CA. PARATHYROID

633 S11.17.1 06.8.2 Parathyroidectomy in malignant conditions

USG Neck ,CT Neck ,TC-99 Parathyroid

Scan , Serum Calcium Levels , P.T.H

Assay (Parathyroid Assay)

 -  35000Intra op photos , Post OP scar

photos,Post OP HPE

S11.18 CA. GASTRO INTESTINAL TRACT

634 S11.18.1 45.3.1 Small Bowel Resection in malignant conditionsBarium Meal Follow Through-,CT Scan

Abdomen/MRI Abdomen With Contrast  -  48000

Intra op photos , Post OP scar

photos,Post OP HPE

635 S11.18.2 46.51.1 Ileostomy Closure in malignant conditions  Colonoscopy, Clinical Photo  -  25000Intra op photos , Post OP scar

photos,

636 S11.18.3 46.52.1 Colostomy Closure in malignant conditions  Colonoscopy, Clinical Photo  -  25000Intra op photos , Post OP scar

photos

S11.19 CA. RECTUM

637 S11.19.1 48.52Abdomino Perineal Resection (Apr) +

Sacrectomy in malignant conditions(77.99)

CT, Colonoscopy and Biopsy,

CEA(Carcino Embryonic Antigen) -  60000

USG Abdomen - I34.006,

Routine Histopathological

Examination - I24.018

638 S11.19.2 48.64 Posterior Exenteration for Carcinoma RectumCT, Colonoscopy and Biopsy,

CEA(Carcino Embryonic Antigen) -  60000

Intra op photos , Post OP scar

photos,Post OP HPE

639 S11.19.3 48.69 Total Exenteration for Carcinoma RectumCT, Colonoscopy and Biopsy,

CEA(Carcino Embryonic Antigen) -  98000

Intra op photos , Post OP scar

photos,Post OP HPE

S11.20 CA. GALL BLADDER

640 S11.20.1 51.22Radical Cholecystectomy in malignant

conditionsCT scan , UGIE, FNAC  -  78000

Intra op photos , Post OP scar

photos,Post OP HPE,Post OP

USG

Page 50: ANNEXURE-I CODE ICD CODE SYSTEM PREAUTHORISATION …

S11.21 SPLEEN

641 S11.21.1 41.5.7 Splenectomy in malignant conditions CT Scan Abdomen,USG Abdomen -,  -  42800

Intra op photos , Post OP scar

photos,Post OP HPE,Post OP

USG

S11.22SURGICAL MANAGEMENT OF

RETROPERITONEAL TUMOR

642 S11.22.1 54.4Resection Of Retroperitoneal Tumors in

malignant conditions

USG Abdomen, FNAC, CT scan Lower

Abdomen  -  60000

Intra op photos , Post OP scar

photos,Post OP HPE,Post OP

USG

S11.23SURGICAL MANAGEMENT OF

ABDOMINAL WALL TUMOR

643 S11.23.1 54.3.1Abdominal Wall Tumor Resection in malignant

conditions

USG Abdomen, FNAC, CT scan Lower

Abdomen  -  52480

Intra op photos , Post OP scar

photos,Post OP HPE,Post OP

USG

644 S11.23.2 54.3.3Resection With Reconstruction of Abdominal

wall Tumors in malignant conditions

USG Abdomen, FNAC, CT scan Lower

Abdomen  -  59000

Intra op photos , Post OP scar

photos,Post OP HPE,Post OP

USG

S11.24 GYNAEC CANCERS

645 S11.24.1 40.53Bilateral Pelvic Lymph Node

Dissection(BPLND)- Gynaec cancersCT Pelvis/MRI Pelvis  -  51700

Intra op photos , Post OP scar

photos,Post OP HPE

646 S11.24.2 67.4 Radical Trachelectomy in malignant conditions CT scan ,X Ray  -  50570Intra op photos , Post OP scar

photos,Post OP HPE

647 S11.24.3 70.4.1 Radical Vaginectomy in malignant conditions CT Scan / MRI  -  53120Intra op photos , Post OP scar

photos,Post OP HPE

648 S11.24.4 70.4.2 Radical Vaginectomy + Reconstruction(70.62)CT Scan / MRI  -

 60550Intra op photos , Post OP scar

photos,Post OP HPE

S11.25 CA. CERVIX

649 S11.25.1 68.69.2

Radical Hysterectomy +Bilateral Pelvic Lymph

Node Dissection (Bplnd) + Bilateral Salpingo

Ophorectomy (Bso) / Ovarian Transposition in

malignant conditions

CT Scan / MRI  -  50010

Intra op photos , Post OP scar

photos,Post OP USG,Post OP

HPE

650 S11.25.2 68.8.2 Anterior Exenteration - Carcinoma Cervix CT Scan / MRI  -  84750

Intra op photos , Post OP scar

photos,Post OP USG,Post OP

HPE

651 S11.25.3 68.8.3 Posterior Exenteration - Carcinoma Cervix CT Scan / MRI  -  65000

Intra op photos , Post OP scar

photos,Post OP USG,Post OP

HPE

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652 S11.25.4 68.8.4 Total Pelvic Exenteration - Carcinoma Cervix CT Scan / MRI  -  98000

Intra op photos , Post OP scar

photos,Post OP USG,Post OP

HPE

653 S11.25.5 68.8.5 Supra Levator Exenteration - Carcinoma Cervix CT Scan / MRI  -  90000

Intra op photos , Post OP scar

photos,Post OP USG,Post OP

HPE

S11.26 CA. ENDOMETRIUM

654 S11.26.1 68.69.1

Total Abdominal Hysterectomy(Tah) + Bilateral

Salpingo Ophorectomy (Bso) + Bilateral Pelvic

Lymph Node Dissection (Bplnd) +

Omentectomy in malignant conditions

USG Abdomen,CT Scan / MRI  -  62140

Intra op photos , Post OP scar

photos,Post OP USG,Post OP

HPE

S11.27SOFT TISSUE /BONE TUMORS . CHEST

WALL

655 S11.27.1 34.4.1Surgical Resection of Soft tissue /Bone tumors

of Chest wall

 Biopsy , Clinical Photograph,,X Ray, CT

Chest -  30000

Intra op photos , Post OP scar

photos,Post OP HPE

656 S11.27.2 34.4.2

Surgical Resection and Reconstruction of Soft

tissue /Bone tumors of Chest wall in malignant

conditions

CT Scan Chest With Contrast - I32.011,

Chest X-Ray PA View(1 Film) - I31.005 -  70000

Intra op photos , Post OP scar

photos,Post OP X Ray,Post OP

HPE

S11.28SURGICAL MANAGEMENT OF BONE / SOFT

TISSUE TUMORS

657 S11.28.1.1 77.60.11

Surgery (removal) for Bone/Soft tissue tumors-

Without Prosthesis in malignant

conditions(83.49)

 Bone Scan , CT-Chest , CT-Local Part ,

MRI, FNAC, Clinical photo -  49170

Intra op photos , Post OP scar

photos,Post OP X Ray,Post OP

HPE

658 S11.28.1.2 77.60.12

Surgery (removal) for Bone / Soft tissue tumors-

With Custom Made Prosthesis in malignant

conditions(83.49+84.40)

 Bone Scan , CT-Chest , CT-Local Part ,

MRI, FNAC, Clinical photo -  85510

Intra op photos , Post OP scar

photos,Post OP X Ray,Post OP

HPE

659 S11.28.1.3 77.60.13

Surgery (removal) for Bone / Soft tissue tumors-

With Modular Prosthesis in malignant

conditions(83.49+84.40)

 Bone Scan , CT-Chest , CT-Local Part ,

MRI, FNAC, Clinical photo -  98000

Intra op photos , Post OP scar

photos,Post OP X Ray,Post OP

HPE

660 S11.28.2 84.09.1 Forequarter Amputation in malignant conditions Bone Scan , CT-Chest , CT-Local Part ,

MRI, FNAC, Clinical photo -  78230

Intra op photos , Post OP scar

photos,Post OP X Ray,Post OP

HPE

661 S11.28.3 84.19.2 Hemipelvectomy in malignant conditions  CT Scan, MRI-Pelvis  -  78886

Intra op photos , Post OP scar

photos,Post OP X Ray,Post OP

HPE

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662 S11.28.4 84.19.3Internal Hemipelvectomy in malignant

conditions CT Scan, MRI-Pelvis  -  79640

Intra op photos , Post OP scar

photos,Post OP X Ray,Post OP

HPE

663 S11.28.5 84.56Curettage & Bone Cement in malignant

conditionsBone Scan , CT , MRI, FNAC  -  51130

Intra op photos , Post OP scar

photos,Post OP X Ray,Post OP

HPE

664 S11.28.6 77.60.1 Bone Resection in malignant conditions Bone Scan , CT , MRI, FNAC  -  42970

Intra op photos , Post OP scar

photos,Post OP X Ray,Post OP

HPE

665 S11.28.7 77.81Shoulder Girdle Resection in malignant

conditionsBone Scan , CT , MRI, FNAC  -  55090

Intra op photos , Post OP scar

photos,Post OP X Ray,Post OP

HPE

666 S11.28.8 77.99 Sacral Resection in malignant conditions Bone Scan , CT , MRI, FNAC  -  60000

Intra op photos , Post OP scar

photos,Post OP X Ray,Post OP

HPE

S11.29 GENITO URINARY CANCER

667 S11.29.1 55.4.2 Open Partial NephrectomyCT Scan , USG Abdomen, FNAC, Isotope

renogram -  40000

Intra op photos , Post OP scar

photos,Post OP HPE,Post OP

USG

668 S11.29.2 55.51.6

Nephroureterectomy For Transitional Cell

Carcinoma Of Renal Pelvis in malignant

conditions

CT Scan , USG Abdomen, FNAC, Isotope

renogram -  65000

Intra op photos , Post OP scar

photos,Post OP HPE,Post OP

USG

S11.30 TESTES CANCER

669 S11.30.1 40.59.1

Retro Peritoneal Lymph Node

Dissection(Rplnd) (For Residual Disease) in

malignant conditions

 CT-Abdomen + Pelvis , CT-Chest ,

Tumor Markers -  78000

Intra op photos , Post OP scar

photos,Post OP HPE

670 S11.30.2 07.22.2Unilateral Adrenalectomy in malignant

conditions

Adrenal function test,Urinary VMA,

Urinary Metanephrine/Nor

metanephrine,Urinary Catecholamines

,Aldosterone - Urine ,24 hour free

cortisol,USG Abdomen, CT Scan

Abdomen / MRI Abdomen ,

 -  65636Intra op photos , Post OP scar

photos,Post OP HPE

671 S11.30.3 56.5Urinary Diversion in malignant

conditions(56.6/56.7)

Biopsy, CT Scan  -

 63250

Intra op photos , Post OP scar

photos,Post OP HPE,Post OP

USG

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672 S11.30.4 40.5Retro Peritoneal Lymph Node Dissection Rplnd

As Part Of Staging in malignant conditions CT, Tumor Markers  -  40000

Intra op photos , Post OP scar

photos,Post OP HPE

S11.31 CA. URINARY BLADDER

673 S11.31.1 57.79.2Anterior Exenteration (CA. URINARY

BLADDER) CT Scan, Biopsy, Cystoscopy  -  60000

Intra op photos , Post OP scar

photos,Post OP HPE,Post OP

USG

674 S11.31.2 57.79.3Total Exenteration (CA. URINARY

BLADDER) CT Scan, Biopsy, Cystoscopy  -  75000

Intra op photos , Post OP scar

photos,Post OP HPE,Post OP

USG

675 S11.31.3 40.53.1Bilateral Pelvic Lymph Node Dissection(Bplnd)

(CA. URINARY BLADDER) CT Scan  -  40000

Intra op photos , Post OP scar

photos,Post OP HPE

S11.32 THORACIC AND MEDIASTINUM

676 S11.32.1 34.3.2Resection of mediastinal tumors in malignant

conditionsCT Scan Chest , Chest X-Ray  -  63760

Intra op photos , Post OP scar

photos,Post OP X Ray,Post OP

HPE

S11.33 LUNG

677 S11.33.1 32.29.1Solitary Lung Metastatectomy in malignant

conditionsCT Scan Chest /MRI Chest  -  69060

Intra op photos , Post OP scar

photos,Post OP X Ray,Post OP

HPE

678 S11.33.2 32.29.2Lung Metastatectomy multiple in malignant

conditionsCT Scan Chest /MRI Chest  -  78000

Intra op photos , Post OP scar

photos,Post OP X Ray,Post OP

HPE

679 S11.33.3 32.4.1 Sleeve Resection of Lung Cancer Bronchoscopy ,CT Scan Chest /MRI Chest  -  108000

Intra op photos , Post OP scar

photos,Post OP X Ray,Post OP

HPE

S11.34 ESOPHAGUS

680 S11.34.1 42.42.2

Oesophagectomy With Two Field

Lymphadenectomy in malignant

conditions(40.59)

 CT Scan, UGIE, Biopsy  -  117000Intra op photos , Post OP scar

photos,Post OP HPE

681 S11.34.2 42.42.3

Oesophagectomy With Three Field

Lymphadenectomy in malignant

conditions(40.59)

 CT Scan, UGIE, Biopsy  -  120000Intra op photos , Post OP scar

photos,Post OP HPE

S11.35 PALLIATIVE SURGERIES

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682 S11.35.1 31.1 Tracheostomy in malignant conditions  Clinical Photograph  -  6230Intra op photos , Post OP scar

photos

683 S11.35.2 43.1.2 Gastrostomy in malignant conditions Clinical Photograph, UGIE, Biopsy, USG

Abd -  20000

Intra op photos , Post OP scar

photos

684 S11.35.3 46.32.2 Jejunostomy in malignant conditions Clinical Photograph, UGIE, Biopsy, USG

Abd -  31850

Intra op photos , Post OP scar

photos

685 S11.35.4 46.2.1 Ileostomy in malignant conditionsLower GI Endoscopy ,Clinical Photograph,

Biopsy, USG Abd -  32600

Intra op photos , Post OP scar

photos

686 S11.35.5 46.1.2 Colostomy in malignant conditionsClinical Photograph, Colonoscopy, Biopsy,

USG -  20000

Intra op photos , Post OP scar

photos

687 S11.35.6 57.18 Suprapubic cystostomy Clinical Photograph, USG,  -  16990Intra op photos , Post OP scar

photos

688 S11.35.7 34.04Intercostal Drainage(Icd) in malignant

conditions Clinical Photograph, CXR  -  3000

Intra op photos , Post OP scar

photos

689 S11.35.8 44.39.1 Gastro Jejunostomy in malignant conditions Clinical Photograph, UGIE, Biopsy, USG

Abd -  50000

Intra op photos , Post OP scar

photos

690 S11.35.9 45.93Ileotransverse Colostomy in malignant

conditions

Clinical Photograph, Colonoscopy, Biopsy,

USG -  60000

Intra op photos , Post OP scar

photos

691 S11.35.10 42.65Substernal Gastric Bypass in malignant

conditions

 Clinical Photograph, UGIE, Biopsy, USG

Abd -  49770

Intra op photos , Post OP scar

photos

S11.36 RECONSTRUCTION

692 S11.36.1 86.63Reconstructon with Myocutaneous / Cutaneous

Flap in malignant conditions Clinical Photograph  -  35670

Intra op photos , Post OP scar

photos

693 S11.36.2 39.59Micro Vascular Reconstruction in malignant

conditions Clinical Photograph  -  45480

Intra op photos , Post OP scar

photos

S12 MEDICAL ONCOLOGY

S12.1 BREAST CANCER

694 S12.1.1 99.25.1Chemotherapy for Breast Cancer with

Adriamycin / Cyclophosphamide (Ac)

CBP, LFT, RFT, HPE, IHC report for ER,

PR, USG abdomen, Chest X-Ray, Bone

Scan ,Alkaline Phosphatase Levels ,Case

sheet with clinical History,Mammogram

 -  3600

Case Sheet with treatment details

,Drip photo, Clinical Photo,

Pharmacy bills

Page 55: ANNEXURE-I CODE ICD CODE SYSTEM PREAUTHORISATION …

695 S12.1.2 99.25.4Chemotherapy for Breast Cancer with 5-

Fluorouracil A-C (Fac)

CBP, LFT, RFT, HPE, IHC report for ER,

PR, USG abdomen, Chest X-Ray, Bone

Scan ,Alkaline Phosphatase Levels ,Case

sheet with clinical History,Mammogram

 -  3600

Case Sheet with treatment details

,Drip photo, Clinical Photo,

Pharmacy bills

696 S12.1.3 99.25.16Chemotherapy for Breast Cancer with Ac (Ac

Then T)

CBP, LFT, RFT, HPE, IHC report for ER,

PR, USG abdomen, Chest X-Ray, Bone

Scan ,Alkaline Phosphatase Levels ,Case

sheet with clinical History,Mammogram

 -  3600

Case Sheet with treatment details

,Drip photo, Clinical Photo,

Pharmacy bills

697 S12.1.4 99.25.28 Chemotherapy for Breast Cancer with Paclitaxel

CBP, LFT, RFT, HPE, IHC report for ER,

PR, USG abdomen, Chest X-Ray, Bone

Scan ,Alkaline Phosphatase Levels ,Case

sheet with clinical History,Mammogram

 -  7000

Case Sheet with treatment details

,Drip photo, Clinical Photo,

Pharmacy bills

698 S12.1.5 99.25.40

Chemotherapy for Breast Cancer with

Cyclophosphamide/ Methotrexate / 5fluorouracil

(Cmf)

CBP, LFT, RFT, HPE, IHC report for ER,

PR, USG abdomen, Chest X-Ray, Bone

Scan ,Alkaline Phosphatase Levels ,Case

sheet with clinical History,Mammogram

 -  2000

Case Sheet with treatment details

,Drip photo, Clinical Photo,

Pharmacy bills

699 S12.1.6 99.25.52Chemotherapy for Breast Cancer with

Tamoxifen Tabs

CBP, LFT, RFT, HPE, IHC report for ER,

PR, USG abdomen, Chest X-Ray, Bone

Scan ,Alkaline Phosphatase Levels ,Case

sheet with clinical History,Mammogram

 -  500

Case Sheet with treatment details

,Drip photo, Clinical Photo,

Pharmacy bills

700 S12.1.7 99.25.64Chemotherapy for Breast Cancer with

Aromatase Inhibitors

CBP, LFT, RFT, HPE, IHC report for ER,

PR, USG abdomen, Chest X-Ray, Bone

Scan ,Alkaline Phosphatase Levels ,Case

sheet with clinical History,Mammogram

 -  1200

Case Sheet with treatment details

,Drip photo, Clinical Photo,

Pharmacy bills

701 S12.1.8 99.25.72 Chemotherapy for Breast Cancer with Docetaxel

Routine Histopathological Examination,

Prostate-Specific Antigen (PSA), Estrogen

Receptor/Progesterone Receptor, Chest X-

Ray PA View(1 Film), Chest X-Ray

Lateral View(1 Film), USG local area,

Bone Scan

- 9990 Clinical Photograph

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S12.2 CERVICAL CANCER

702 S12.2.1 99.25.73Chemotherapy for Cervical Cancer with Weekly

Cisplatin

CBP, LFT, RFT. U/S abdomen or CT

abdomen, Chest X-Ray, Biopsy, RT chart,

Post op HPE,Case sheet with clinical

History

 -  2000

Case Sheet with treatment details

,Drip photo, Clinical Photo,

Pharmacy bills

S12.3 VULVAL CANCER

703 S12.3.1 99.25.12Chemotherapy for Vulval Cancer with

Cisplatin/5-Fu Biopsy, Chest X-Ray, U/S abdomen  -  5000

Case Sheet with treatment details

,Drip photo, Clinical Photo,

Pharmacy bills

S12.4 VAGINAL CANCER

704 S12.4.1 99.25.23Chemotherapy for Vaginal Cancer with

Cisplatin/5-Fu Biopsy , Chest X-Ray, U/S abdomen  -  6000

Case Sheet with treatment details

,Drip photo, Clinical Photo,

Pharmacy bills

S12.5 OVARIAN CANCER

705 S12.5.1 99.25.34Chemotherapy for Ovarian cancer with

Carboplatin / Paclitaxel Biopsy , CT , USG, Chest X-Ray  -  11000

Case Sheet with treatment details

,Drip photo, Clinical Photo,

Pharmacy bills

S12.6 OVARY- GERM CELL TUMOR

706 S12.6.1 99.25.45

Chemotherapy for Ovarian cancer with Germ

Cell Tumor Bleomycin-Etoposide-Cisplatin

(Bep)

 Biopsy , CT , USG, Tumor Markers,

Chest X-Ray -  8000

Case Sheet with treatment details

,Drip photo, Clinical Photo,

Pharmacy bills

S12.7 GESTATIONAL TROPHOBLAST DS.

S12.7.1CHEMOTHERAPY FOR LOW RISK

GESTATIONAL TROPHOBLAST DS.

707 S12.7.1.1 99.25.56Chemotherapy for low risk Gestational

trophoblast DS with Weekly Methotrexate Biopsy , CT , USG, Tumor Markers  -  2000

Case Sheet with treatment details

,Drip photo, Clinical Photo,

Pharmacy bills

708 S12.7.1.2 99.25.67Chemotherapy for low risk Gestational

trophoblast DS with Actinomycin Biopsy , CT , USG, Tumor Markers  -  5000

Case Sheet with treatment details

,Drip photo, Clinical Photo,

Pharmacy bills

S12.7.2CHEMOTHERAPY FOR HIGH RISK

GESTATIONAL TROPHOBLAST DS.

709 S12.7.2.1 99.25.78

Chemotherapy for high risk Gestational

trophoblast DS with Etoposide-Methotrexate -

Actinomycin / Cyclophosphamide Vincristine

(Ema-Co)

 Biopsy , CT , USG, Tumor Markers  -  7000

Case Sheet with treatment details

,Drip photo, Clinical Photo,

Pharmacy bills

S12.8 TESTICULAR CANCER

Page 57: ANNEXURE-I CODE ICD CODE SYSTEM PREAUTHORISATION …

710 S12.8.1 99.25.83Chemotherapy for Testicular Cancer with

Bleomycin with Etoposide-Cisplatin (Bep)

 Biopsy , CT , USG, Tumor Markers,

Chest X-Ray -  8000

Case Sheet with treatment details

,Drip photo, Clinical Photo,

Pharmacy bills

S12.9 PROSTATE CANCER

711 S12.9.1 99.24 Prostate Cancer with Hormonal Therapy  Biopsy , USG, PSA  -  3710

Case Sheet with treatment details

,Drip photo, Clinical Photo,

Pharmacy bills

S12.10 BLADDER CANCER

712 S12.10.1 99.25.2Chemotherapy for Bladder Cancer with Weekly

Cisplatin.

CBP, LFT, RFT, CT abdomen, Biopsy,

Chest X-Ray, RT Chest,HPE,Case sheet

with clinical History ,USG Abdomen

 -  2000

Case Sheet with treatment details

,Drip photo, Clinical Photo,

Pharmacy bills

713 S12.10.2 99.25.3

Chemotherapy for Bladder Cancer with

Methotrexate Vinblastine Adriamycin

Cyclophosphamide (Mvac)

CBP, LFT, RFT, CT abdomen, Biopsy,

Chest X-Ray, RT Chest,HPE,Case sheet

with clinical History ,USG Abdomen

 -  6000

Case Sheet with treatment details

,Drip photo, Clinical Photo,

Pharmacy bills

S12.11LUNG CANCER NON-SMALL CELL LUNG

CANCER

714 S12.11.1 99.25.5Chemotherapy for Non SMAL cell Lung Cancer

with Cisplatin/Etoposide (Iiib)

CBP, LFT, RFT, CECT Chest, HPE,Case

sheet with clinical History  -  7000

Case Sheet with treatment details

,Drip photo, Clinical Photo,

Pharmacy bills

715 S12.11.2 99.25.6Chemotherapy for Non SMAL cell Lung Cancer

with Erlotinib

Chest X-Ray PA View(1 Film), USG local

area, CT local area without contrast,

Routine histopathological examination,

Clinical Photograph

- 15000Case Sheet with treatment details,

Clinical Photograph

716 S12.11.3 99.25.9Chemotherapy for Non SMAL cell Lung Cancer

with PEM + Cisplatin

Routine Histopathological Examination,

USG local area, SAlkaline Phosphatase

Levels, Bone Scan, CT local area with

contrast, Clinical Photograph

- 19990 Case Sheet with treatment details

717 S12.11.4 99.25.7Chemotherapy for Non SMAL cell Lung Cancer

with GEFITINIB

Routine Histopathological Examination,

CT scan chest with contrast, USG local

area, Alkaline Phosphatase Levels, Case

sheet with clinical History

- 7080Case Sheet with treatment details,

Clinical Photograph

Page 58: ANNEXURE-I CODE ICD CODE SYSTEM PREAUTHORISATION …

718 S12.11.5 99.25.8Chemotherapy for Non SMAL cell Lung Cancer

with Paclitaxel /Carboplatin

Routine Histopathological Examination,

CT chest with contrast/CT upper abdomen

with contrast, Fine Needle Aspiration

Cytology (FNAC)/Routine

histopathological examination, Alkaline

Phosphatase Levels

- 9990Case Sheet with treatment details,

Clinical Photograph

S12.12 OESOPHAGEAL CANCER

719 S12.12.1 99.25.10Chemotherapy for Oesophageal Cancer with

Cisplatin/5fu

CBP, LFT, RFT, Upper GI Endoscopy,

CECT Chest & Abdomen, HPE,Case sheet

with clinical History

 -  6500

Case Sheet with treatment details

,Drip photo, Clinical Photo,

Pharmacy bills

S12.13 GASTRIC CANCER

720 S12.13.1 99.25.11Chemotherapy for Gastric Cancer with 5-Fu

Leucovorin (Mcdonald Regimen)

CBP, LFT, RFT, CT scan abdomen, Chest

X-Ray. Upper GI scopy, Endoscopic

Biopsy, Post op HPE,Case sheet with

clinical History

 -  5000

Case Sheet with treatment details

,Drip photo, Clinical Photo,

Pharmacy bills

721 S12.13.2 99.25.13 Chemotherapy for Gastric Cancer with EOX

Routine Histopathological Examination,

CT Scan Abdomen With Contrast, Upper

GI endoscopy, Chest X-Ray PA View(1

Film), Case sheet with clinical History

- 14990Case Sheet with treatment details,

Clinical Photograph

722 S12.13.3 99.25.14Chemotherapy for Gastric Cancer with

Gemcitabine+Oxaliplatin

Routine Histopathological Examination,

CT scan Lower Abdomen Without

Contrast, Chest X-Ray PA View(1 Film)

- 15990Case Sheet with treatment details,

Clinical Photograph

723 S12.13.4 99.25.15Chemotherapy for Gastric Cancer with

Gemcitabine / Cisplatin

Routine Histopathological Examination,

CT scan Lower Abdomen Without

Contrast, Chest X-Ray PA View(1 Film)

- 12000Case Sheet with treatment details,

Clinical Photograph

724 S12.13.5 99.25.17Chemotherapy for Gastric Cancer with

Imatinib(CML)

Routine Histopathological Examination,

Upper GI endoscopy, Chest X-Ray PA

View(1 Film), BCR-ABL1 Transcripts By

Quantitative PCR, Upper GI endoscopy

- 5630Case Sheet with treatment details

, Clinical Photograph

725 S12.13.6 99.25.18 Chemotherapy for Gastric Cancer with Dcf

Routine Histopathological Examination,

CT scan Abdomen With Contrast, Chest X-

Ray PA View(1 Film), Upper GI

endoscopy , Case sheet with clinical

History

- 17990Case Sheet with treatment details,

Clinical Photograph

Page 59: ANNEXURE-I CODE ICD CODE SYSTEM PREAUTHORISATION …

S12.14 COLORECTAL CANCER

726 S12.14.1 99.25.19Chemotherapy for Colorectal Cancer with

Monthly 5-Fu

CBP, LFT, RFT, CT scan abdomen,

Colonoscopy, Chest X-Ray. Colonoscopic

Biopsy, Post op HPE, CEA, Case sheet

with clinical History

 -  5200

Case Sheet with treatment details

,Drip photo, Clinical Photo,

Pharmacy bills

727 S12.14.2 99.25.20

Chemotherapy for Colorectal Cancer with 5-

Fluorouracil-Oxaliplatin Leucovorin (Folfox)

(Stage III) Only

CBP, LFT, RFT, CT scan abdomen,

Colonoscopy, Chest X-Ray. Colonoscopic

Biopsy, Post op HPE, CEA, Case sheet

with clinical History

 -  11500

Case Sheet with treatment details

,Drip photo, Clinical Photo,

Pharmacy bills

728 S12.14.3 99.25.21Chemotherapy for Colorectal Cancer with

Capecitabine + bevacizumab (metastatic)

Chest X-Ray PA View(1 Film), Colono

Scopy, CEA(Carcino Embryonic Antigen)

125, CT Scan Abdomen With Contrast

Abdomen(Whole)

- 7710Case Sheet with treatment details

, Clinical Photograph

729 S12.14.4 99.25.22

Chemotherapy for Colorectal Cancer with

Capecitabine + Oxalipantia (adjuvant) and

metastatic

Chest X-Ray PA View(1 Film), Colono

Scopy, CEA(Carcino Embryonic Antigen)

125-, CT Scan Abdomen With

ContrastAbdomen(Whole)

- 11990Case Sheet with treatment details,

Clinical Photograph

730 S12.14.5 99.25.24Chemotherapy for Colorectal Cancer with

Capacitabine

Routine Histopathological Examination,

CT Scan Abdomen With Contrast, Chest X-

Ray PA View(1 Film), Colono Scopy,

CEA(Carcino Embryonic Antigen)

- 6990Case Sheet with treatment details,

Clinical Photograph

S12.15 OSTEOSARCOMA/ BONE TUMORS

731 S12.15.1 99.25.25Chemotherapy for Bone Tumors with

Cisplatin/Adriamycin

CBP, LFT, RFT, CT scan/MRI of Bone

lesion, CECT Scan Chest, Biopsy/HPE,

CEA, Case sheet with clinical History

 -  7000

Case Sheet with treatment details

,Drip photo, Clinical Photo,

Pharmacy bills

S12.16.1 LYMPHOMA I) HODGKIN DISEASE

732 S12.16.1.1 99.25.26

Chemotherapy for Bone Tumors - Hodgkin

Lymphoma disease with Adriamycin Bleomycin

Vinblastine Dacarbazine (Abvd)

CBP, LFT, RFT, Lymphnode Biopsy &

IHC, Bone marrow Biopsy, CECT - neck,

chest abdomen, Chest X-Ray, USG - neck

abdomen,Case sheet with clinical History

 -  5000

Case Sheet with treatment details

,Drip photo, Clinical Photo,

Pharmacy bills

S12.16.2 LYMPHOMA II) NHL

Page 60: ANNEXURE-I CODE ICD CODE SYSTEM PREAUTHORISATION …

733 S12.16.2.1 99.25.27

Chemotherapy for Non Hodgkin Lymphoma

with Cyclophosphamide Adriamycin Vincristine

Prednisone (Chop)

CBP, LFT, RFT, Lymphnode Biopsy &

IHC, Bone marrow Biopsy, CECT - neck,

chest abdomen, Chest X-Ray, USG - neck

abdomen,Case sheet with clinical History

 -  4500

Case Sheet with treatment details

,Drip photo, Clinical Photo,

Pharmacy bills

734 S12.16.2.2 99.25.29Chemotherapy for Non Hodgkin Lymphoma

with R - chop

CT Scan Lower Abdomen With Contrast,

CT local Area , CT Scan Neck

(Thyroid,Parathyroid,Softtissues)With

Contrast/ PET Scan BEFORE

TREATMENT AFTER 4 CYCLES, END

OF TREATMENT CT Scan Chest With

Contrast, USG Abdomen, Routine

Histopathological Examination, Bone

Marrow Aspiration,Complete blood

picture(CBP) , LFT(liver function tests),

Renal Profile, IHC

- 44990Case Sheet with treatment details

, Clinical Photograph

S12.17 MULTIPLE MYELOMA

735 S12.17.1 99.25.30Chemotherapy for Multiple Myeloma with

Vincristine, Adriamycin,Dexamethasone(Vad)

CBP, LFT, RFT, Bone marrow, SPE,

Skeletal Survey, Chest X-Ray,SR

PROTEIN ELECTROPHOROSIS,Case

sheet with clinical History

 -  4000

Case Sheet with treatment details

,Drip photo, Clinical Photo,

Pharmacy bills

736 S12.17.2 99.25.31Chemotherapy for Multiple Myeloma with

Thalidomide+Dexamethasone(Oral)

CBP, LFT, RFT, Bone marrow, SPE,

Skeletal Survey, Chest X-Ray,SR

PROTEIN ELECTROPHOROSIS,Case

sheet with clinical History

 -  5000

Case Sheet with treatment details

,Drip photo, Clinical Photo,

Pharmacy bills

737 S12.17.3 99.25.32Chemotherapy for Multiple Myeloma with

Melphalan Prednisone (Oral)

CBP, LFT, RFT, Bone marrow, SPE,

Skeletal Survey, Chest X-Ray,SR

PROTEIN ELECTROPHOROSIS,Case

sheet with clinical History

 -  4500

Case Sheet with treatment details

,Drip photo, Clinical Photo,

Pharmacy bills

S12.18 WILMS TUMOR

738 S12.18.1 99.25.33Chemotherapy for Wilms Tumor with Siopwts

Regimen(Stages I-III)

CBP, LFT, RFT, CT abdomen, U/S

abdomen, Chest X-Ray, Bone scan, Bone

marrow, Biopsy, Biopsy, HPE/FNAC,Case

sheet with clinical History

 -  7000

Case Sheet with treatment details

,Drip photo, Clinical Photo,

Pharmacy bills

S12.19 HEPATOBLASTOMA- OPERABLE

Page 61: ANNEXURE-I CODE ICD CODE SYSTEM PREAUTHORISATION …

739 S12.19.1 99.25.35Chemotherapy for Hepatoblastoma operable

with Cisplatin -Adriamycin

CBP, LFT, RFT, CT abdomen, U/S

abdomen, Chest X-Ray, Bone scan, Bone

marrow, Biopsy, Biopsy, HPE/FNAC,Case

sheet with clinical History

 -  5000

Case Sheet with treatment details

,Drip photo, Clinical Photo,

Pharmacy bills

740 S12.19.2 99.25.84Chemotherapy Chemotherapy for

Hepatoblastoma operable with Sorafenib

Alpha Feto Protiens Levels, Routine

Histopathological Examination, LFT(liver

function tests), USG local area

- 9990 Case Sheet with operation Notes

S12.20 CHILDHOOD B CELL LYMPHOMAS

741 S12.20.1 99.25.36Chemotherapy for Childhood B cell Lymphoma

with variable regimen

CBP, LFT, RFT, Bone marrow,

Lymphnode biopsy with IAC, CECT -

neck chest abdomen, U/S abdomen, Chest

X-Ray, U/S neck,Case sheet with clinical

History

 -  20000

Case Sheet with treatment details

,Drip photo, Clinical Photo,

Pharmacy bills

S12.21 NEUROBLASTOMA ( STAGES I-III )

742 S12.21.1 99.25.37Chemotherapy for Neuroblastoma (Stages I-III )

with Variable Regimen

CBP, LFT, RFT, CECT chest abdomen

neck, U/S neck, Chest X-Ray, U/S

abdomen, FNAC, Bone scan, Bone

marrow,Case sheet with clinical History

 -  10000

Case Sheet with treatment details

,Drip photo, Clinical Photo,

Pharmacy bills

743 S12.21.2 99.25.38Chemotherapy for Neuroblastoma (Stages I-III )

PCV (medulloblastoma)

Routine Histopathological Examination, CT

Scan Head With Contrast, Chest X-Ray PA

View(1 Film), Case sheet with clinical History

- 4990 Case Sheet with operation Notes

S12.22 RETINOBLASTOMA

744 S12.22.1 99.25.39Chemotherapy for Retinoblastoma with

Carbo/Etoposide/Vincristine

CBP, LFT, RFT, CECT Head Orbits, Bone

scan, Bone Marrow, FNAC -  5000

Case Sheet with treatment details

,Drip photo, Clinical Photo,

Pharmacy bills

S12.23 HISTIOCYTOSIS

745 S12.23.1 99.25.41Chemotherapy for Histiocytosis with Variable

Regimen

CBP, LFT, RFT, CECT Head & Neck,

Chest abd, X-Ray skull, chest U/S

abdomen, Bone scan, Bone marrow,

Biopsy/FNAC

 -  5000

Case Sheet with treatment details

,Drip photo, Clinical Photo,

Pharmacy bills

S12.24 RHABDOMYOSARCOMA

746 S12.24.1 99.25.42

Chemotherapy for Rhabdomyosarcoma with

Vincristine-Actinomycin-

Cyclophosphamide(Vactc) Based Chemo

CBP, LFT, RFT, CECT Head & Neck,

Chest abd, X-Ray skull, chest U/S

abdomen, Bone scan, Bone marrow,

Biopsy/FNAC

 -  9000

Case Sheet with treatment details

,Drip photo, Clinical Photo,

Pharmacy bills

Page 62: ANNEXURE-I CODE ICD CODE SYSTEM PREAUTHORISATION …

S12.25 EWINGS SARCOMA

747 S12.25.1 99.25.43Chemotherapy for Ewings Sarcoma with

Variable Regimen

 Biopsy , CT-Scan , U/S abdomen, Bone

scan, Bone marrow -  5000

Case Sheet with treatment details

,Drip photo, Clinical Photo,

Pharmacy bills

S12.26 ACUTE MYELOID LEUKEMIA

748 S12.26.1 99.25.44Chemotherapy for Acute Myeloid Leukemia

with Induction Phase Heamatology, Bone marrow aspiration  -  60000

Case Sheet with treatment details

,Drip photo, Clinical Photo,

Pharmacy bills

749 S12.26.2 99.25.46Chemotherapy for Acute Myeloid Leukemia

with Consolidation PhaseIMA, CBP  -  60000

Case Sheet with treatment details

,Drip photo, Clinical Photo,

Pharmacy bills

750 S12.26.3 99.25.47Chemotherapy for Acute Myeloid Leukemia

with Maintenance phase

CBP, BMA Remission Report , PMLRA

Treatment Report -  3000

Case Sheet with treatment details

,Drip photo, Clinical Photo,

Pharmacy bills

S12.27 ACUTE LYMPHOBLASTIC LEUKEMIA

751 S12.27.1.1 99.25.48Chemotherapy for Acute Lymphoblastic

Leukemia with Induction 1st And 2nd Months

CBP, BMA Remission Report, Immuno

pheno typing/ Cytochemistry  -  100000

Case Sheet with treatment details

,Drip photo, Clinical Photo,

Pharmacy bills

752 S12.27.1.2 99.25.49Chemotherapy for Acute Lymphoblastic

Leukemia with Induction 3rd, 4th, 5thCBP, BMA Remission Report  -  10000

Case Sheet with treatment details

,Drip photo, Clinical Photo,

Pharmacy bills

753 S12.27.1.3 99.25.50Chemotherapy for Acute Lymphoblastic

Leukemia with Induction MaintenanceCBP, BMA Remission Report  -  12000

Case Sheet with treatment details

,Drip photo, Clinical Photo,

Pharmacy bills

S12.28 FOR UNLISTED REGIMEN

754 S12.28.1 99.25.51 Palliative Chemotherapy for unlisted Regimen Biopsy , CT , USG, Ascending to type of

malignancy -  5000

Case Sheet with treatment details

,Drip photo, Clinical Photo,

Pharmacy bills

S12.29ACUTE LYMPHOBLASTIC LEUKEMIA -

FOR TERMINALLY ILL CANCER PATIENT

755 S12.29.1 99.25.53Palliative And Supportive Therapy for

terminally ill cancer patientHPE, CBP, Renal Profile, LFT  -  3000

Case Sheet with treatment details

,Drip photo, Clinical Photo,

Pharmacy bills

S12.30 COLO RECTAL CANCER STAGE 2 AND 3

Page 63: ANNEXURE-I CODE ICD CODE SYSTEM PREAUTHORISATION …

756 S12.30.1 99.25.54

Chemotherapy for Acute Myeloid Leukemia

with Xelox Along With Adjuvant Chemotherapy

Of As-I

 CT-Abdomen + Pelvis , Photograph ,

Tissue Biospy, Chest X-Ray or U/S

abdomen

 -  12000

Case Sheet with treatment details

,Drip photo, Clinical Photo,

Pharmacy bills

S12.31 MULTIPLE MYELOMA

757 S12.31.1 99.25.55

Chemotherapy for Multiple myeloma with

Zoledronic Acid Along With Adjuvant

Chemotherapy Of As-I

Biopsy , Bone marrow aspiration ,

S.Electrolytes , SPE , Skeltal survey -  3000

Case Sheet with treatment details

,Drip photo, Clinical Photo,

Pharmacy bills

758 S12.31.2 99.25.57Chemotherapy for Multiple myeloma with

Lenalidomide dexa

Bone Marrow Profile/Routine

Histopathological Examination, Bence Jones

Protein In Urine, Protein Electrophoresis,

Renal Profile, Complete Blood Picture [CBP]

- 9990 Case Sheet with operation Notes

759 S12.31.3 99.25.58Chemotherapy for Multiple myeloma with

MPT(myeloma)

Bone Marrow Profile/Routine

Histopathological Examination, Bence

Jones Protein In Urine, Skeletal Survey

Protein Electrophoresis

- 5360 Case Sheet with operation Notes

760 S12.31.4 99.25.59Chemotherapy for Multiple myeloma with

Imatinib (GSIT)USG local area - 6990 Case Sheet with operation Notes

S12.32 FEBRILE NEUTROPENIA

761 S12.32.1 99.25.60

Chemotherapy for Febrile Neutropenia with 1st

Line Iv Antibiotics And Other Supportive

Therapy ( Third Generation Cephalosporin,

Aminoglycoside Etc.,)

 Blood Ca/S , Tissue Biospy , X-Ray

Chest,CBP, HPE -  5000

Case Sheet with treatment details

,Drip photo, Clinical Photo,

Pharmacy bills

762 S12.32.2 99.25.61

Chemotherapy for Febrile Neutropenia with 2nd

Line Iv Antibiotics And Other Supportive

Therapy(Carbapenems, Fourth Generation

Cephalosporins, Piperacillin, Anti-Fungal .

Azoles Etc.,)

 Blood Ca/S , Tissue Biospy , X-Ray

Chest,CBP, HPE -  40000

Case Sheet with treatment details

,Drip photo, Clinical Photo,

Pharmacy bills

S12.33 CHRONIC LYMPHOID LEUKAMIA

763 S12.33.1 99.25.62Chemotherapy for Chronic lymphoid leukemia

with Benadamustine

Bone Marrow Aspiration, Renal Profile,

Complete Blood Picture [CBP] , LFT(liver

function tests), Abdomen X-Ray (Lateral

View) , USG Abdomen , Immuno pheno

typing

- 16000Clinical Photograph , Case Sheet

with operation Notes

Page 64: ANNEXURE-I CODE ICD CODE SYSTEM PREAUTHORISATION …

764 S12.33.2 99.25.63Chemotherapy for Chronic lymphoid leukemia

with Chilorambucil

Bone Marrow Aspiration, Renal Profile,

Complete Blood Picture [CBP] , LFT(liver

function tests)\, Immuno pheno typing

- 2990Clinical Photograph , Case Sheet

with operation Notes

765 S12.33.3 99.25.65Chemotherapy for Chronic lymphoid leukemia

with IA

LFT(liver function tests), Routine

Histopathological Examination, CT local

area without contrast, Chest X-Ray PA

View(1 Film), Chest X-Ray Lateral

View(1 Film)

- 10000Clinical Photograph, Case Sheet

with operation Notes

766 S12.33.4 99.25.66Chemotherapy for Chronic lymphoid leukemia

with Imatinib(CML)

Bone Marrow Aspiration/ Routine

Histopathological Examination - 6990

Routine Histopathological

Examination, CT local area

without contrast, USG local area,

Case Sheet with operation Notes

767 S12.33.5 99.25.68Chemotherapy for Chronic lymphoid leukemia

with Sunitinib

LFT(liver function tests), USG local area,

Chest X-Ray PA View(1 Film), Chest X-

Ray Lateral View(1 Film)

- 14990 Clinical Photograph

S12.34 BRAIN TUMORS

768 S12.34.1 99.25.69Chemotherapy With Temozolamide (brain

tumours)

Routine Histopathological Examination, CT

Brain Plain and Contrast /MRI Brain with

contrast

- 10000Clinical Photograph , Case Sheet

with operation Notes

S12.35 OTHERS

769 S12.35.1 99.25.70Chemotherapy With Benadamustin -

RITUXIMAB

LFT(liver function tests), Routine

Histopathological Examination, Chest X-Ray

PA View(1 Film), USG local area, Bone

Marrow Profile, CT Brain Plain and Contrast ,

CT Scan Chest With Contrast/CT Scan

neck(thyroid, para thyroid, soft tissues) with

contrast /CT Scan with Abdomen with contrast

, Renal Profile, Complete Blood Picture [CBP]

- 59990Clinical Photograph , Case Sheet

with operation Notes

770 S12.35.2 99.25.71 Chemotherapy With TIP (GCT 2nd line)

Beta HCG(Human Chorionic Gonadotropin)

Levels, Alpha Feto Protiens Levels, Lactate

Dehydrogenase (LDH), CT Scan Chest With

Contrast, CT Scan with Abdomen with

contrast

- 20000Clinical Photograph , Case Sheet

with operation Notes

Page 65: ANNEXURE-I CODE ICD CODE SYSTEM PREAUTHORISATION …

771 S12.35.3 99.25.85 Chemotherapy with Capeiri (metastatic)

CT Scan Abdomen Without

Contrast,Routine Histopathological

Examination

- 7710 Case Sheet with operation Notes

772 S12.35.4 99.25.86Chemotherapy with Capeox (adjuvant) and

metastatic

CT Scan Abdomen Without

Contrast,Routine Histopathological

Examination

- 7190 Case Sheet with operation Notes

S13 RADIATION ONCOLOGY

S13.1COBALT 60 EXTERNAL BEAM

RADIOTHERAPY

773 S13.1.1 92.23.1Radical Treatment with Cobalt 60 External

Beam Radiotherapy

 Biopsy , CT , USG , CXR, Case Sheet

with Clinical History,HPE -  26000

 RT Treatment Charts , Clinical

Photograph, Check Films,

DRR/DVH/TPR - Reports

774 S13.1.2 92.23.2Palliative Treatment with Cobalt 60 External

Beam Radiotherapy

 Biopsy , CT , USG , CXR, Case Sheet

with Clinical History,HPE -  13000

 RT Treatment Charts , Clinical

Photograph, Check Films,

DRR/DVH/TPR - Reports

775 S13.1.3 92.23.3Adjuvant Treatment with Cobalt 60 External

Beam Radiotherapy

 Biopsy , CT , USG , CXR, Case Sheet

with Clinical History,HPE -  15000

 RT Treatment Charts , Clinical

Photograph, Check Films,

DRR/DVH/TPR - Reports

S13.2EXTERNAL BEAM RADIOTHERAPY (ON

LINEAR ACCELERATOR)

776 S13.2.1 92.24.1Radical Treatment With Photons External Beam

Radiotherapy (on Linear Accelerator)

 Biopsy , CT , USG , CXR, Case Sheet

with Clinical History,HPE -  65000

 RT Treatment Charts , Clinical

Photograph, Check Films,

DRR/DVH/TPR - Reports

777 S13.2.2 92.24.2Palliative Treatment With Photons External

Beam Radiotherapy (on Linear Accelerator)

 Biopsy , CT , USG , CXR, Case Sheet

with Clinical History,HPE -  26000

 RT Treatment Charts , Clinical

Photograph, Check Films,

DRR/DVH/TPR - Reports

778 S13.2.3 92.24.3

Adjuvant Treatment With Photons/Electrons /

(92.25)External Beam Radiotherapy (on Linear

Accelerator)

 Biopsy , CT , USG , CXR, Case Sheet

with Clinical History,HPE -  45000

 RT Treatment Charts , Clinical

Photograph, Check Films,

DRR/DVH/TPR - Reports

S13.3.1 BRACHYTHERAPY A) INTRACAVITARY

779 S13.3.1.1 92.20.1Brachytherapy Intracavitary I. Ldr Per

Application

 Biopsy , CT , USG , CXR, Case Sheet

with Clinical History,HPE -  5850

 RT Treatment Charts , Clinical

Photograph

780 S13.3.1.2 92.20.2Brachytherapy Intracavitary II. Hdr Per

Application

 Biopsy , CT , USG , CXR, Case Sheet

with Clinical History,HPE -  3250

 RT Treatment Charts , Clinical

Photograph, Bladder/Rectal dose

chart

S13.3.2 BRACHYTHERAPY B) INTERSTITIAL

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781 S13.3.2.1 92.27.1 Brachytherapy Interstitial I. Ldr Per Application Biopsy , CT , USG , CXR, Case Sheet

with Clinical History,HPE -  16330

 RT Treatment Charts , Clinical

Photograph

782 S13.3.2.2 92.27.2Brachytherapy Interstitial II. Hdr One

Application And Multiple Dose Fractions

 Biopsy , CT , USG , CXR, Case Sheet

with Clinical History,HPE -  25000

 RT Treatment Charts , Clinical

Photograph, Isodose Chart/DVH

charts

S13.4.1SPECIALIZED RADIATION THERAPY - IMRT

(Intensity modulated radiotherapy)

783 S13.4.1.1 92.29.1

Specialized Radiation therapy- IMRT (Intensity

modulated radiotherapy) Upto 40 Fractions

IMRT In 8 Weeks

 Biopsy , CT , USG , CXR, Case Sheet

with Clinical History,HPE -  115700

 RT Treatment Charts , CT ,

Tumor Markers , USG,

DVH/DRR/TPR/Isodose charts

S14.4.2SPECIALIZED RADIATION THERAPY - 3DCRT(3-

D conformational radiotherapy)

784 S13.4.2.1 92.29.2

Specialized Radiation therapy - 3DCRT(3-D

conformational radiotherapy)Upto 30 Fractions

3DCRT In 6 Weeks

 Biopsy , CT , USG , CXR, Case Sheet

with Clinical History,HPE -  95000

 CT , USG,

DVH/DRR/TPR/Isodose charts

S14.4.3 SPECIALIZED RADIATION THERAPY - SRS/SRT

785 S13.4.3.1 92.29.3Specialized Radiation therapy - SRS/SRT Upto

30 Fractions In SRS/SRT 6 Weeks

 Biopsy , CT , USG , CXR, Case Sheet

with Clinical History,HPE -  95000

 RT Treatment Charts , Tumor

Markers,

DVH/DRR/TPR/Isodose charts

S14 PLASTIC SURGERY

S14.1 PLASTIC REPAIR

786 S14.1.1 27.54.1 Surgical Management Of Cleft Lip  Clinical Photograph  -  20000

Intraoperative photos including

the face of the patient and scar

photo

787 S14.1.2 27.62 Surgical correction of Cleft Palate  Clinical Photograph  -  25000

Intraoperative photos including

the face of the patient and scar

photo

788 S14.1.3 27.69Surgical corection of Velo-Pharyngeal

IncompetenceEndoscopy  -  35330

Intra op photos, Endoscopy

picture

789 S14.1.4 86.85Surgical Management of Syndactyly of Hand

For Each Hand Clinical Photograph & X-ray of the part  -  32746

Intraoperative photos including

the face of the patient and scar

photo

790 S14.1.5 18.71.1Reconstruction or prosthetic appliance for

absent ear Clinical Photograph  -  30000

Intraoperative photos including

the face of the patient and scar

photo

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791 S14.1.6 76.5.2 Surgery for Tm Joint Ankylosis  Clinical Photograph & X-ray of the part  -  44540

Intraoperative photos including

the face of the patient and scar

photo

S14.2 BURNS

792 S14.2.1.1 96.5.1 Conservative management of 40% burns  Clinical Photographs & Burns chart  -  60000Management photos and scar

photos

793 S14.2.1.2 86.28.1 Surgical Management of 40% mixed burns  Clinical Photographs & Burns chart  -  65000

Skin grafting Intraoperative

photos including the face of the

patient and scar photo

794 S14.2.1.3 96.5.2 Conservative management of 50% burns  Clinical Photographs & Burns chart  -  120000Management photos and scar

photos

795 S14.2.1.4 86.28.2 Surgical Management of 50% mixed burns  Clinical Photographs & Burns chart  -  115260

Skin grafting Intraoperative

photos including the face of the

patient and scar photo

796 S14.2.2.1 96.59.5 Conservative management of 60% burns  Clinical Photographs & Burns chart -  90525Management photos and scar

photos

797 S14.2.2.2 86.28.3 Surgical Management of 60% mixed burns  Clinical Photographs & Burns chart  -  133540

Skin grafting Intraoperative

photos including the face of the

patient and scar photo

798 S14.2.2.3 86.28.4Surgical Management of above 60% mixed

burns Clinical Photographs & Burns chart  -  131580

Skin grafting Intraoperative

photos including the face of the

patient and scar photo

S14.3

POST BURN CONTRACTURE SURGERIES

FOR FUNCTIONAL

IMPROVEMENT(PACKAGE INCLUDING

SPLINTS, PRESSURE GARMENTS AND

PHYSIOTHERAPY)

799 S14.3.1 83.91.1 Post Burn Contracture Surgeries - Mild  Clinical Photograph  -  38570

Skin grafting Intraoperative

photos including the face of the

patient and scar photo

800 S14.3.2 83.91.2 Post Burn Contracture Surgeries - Moderate  Clinical Photograph  -  40596

Skin grafting Intraoperative

photos including the face of the

patient and scar photo

801 S14.3.3 83.91.3 Post Burn Contracture Surgeries - Severe  Clinical Photograph  -  48000

Skin grafting Intraoperative

photos including the face of the

patient and scar photo

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S14.4 PLASTIC SURGERY

802 S14.4 82.48Surgical correction for Congenital Deformity of

Hand (Per Hand)Clinical Photograph and X-ray of the part  -  23510

Intraoperative photos including

the face of the patient and scar

photo

803 S14.5 02.01 Surgical correction for Craniosynostosis  3D CT , MRI  -  87870

Intraoperative photos including

the face of the patient and scar

photo ,post op 3D CT

804 S14.6 18.79Surgical Correction of anamolies of Ear (cup &

bat ears)Clinical Photographs  -  25000

Intraoperative photos including

the face of the patient and scar

photo

805 S14.7 83.99.1Management of electrical burns with vitals

exposed with flap coverClinical Photographs  -  50000

Skin grafting Intraoperative

photos including the face of the

patient and scar photo

806 S14.8 86.04 Reduction Surgery For Filarial Lymphoedema Clinical Photographs  -  39610

Intraoperative photos including

the face of the patient and scar

photo

807 S14.9 86.81.2 Surgical Correction of Hemifacial Atrophy  3D CT , MRI  -  88330

Intraoperative photos including

the face of the patient and scar

photo ,post op 3D CT

808 S14.10 86.81.4 Surgical Correction of hemifacial microsomia  3D CT , MRI  -  81010

Intraoperative photos including

the face of the patient and scar

photo

809 S14.11 82.8Surgical Correction of Leprosy Reconstructive

Surgery

 Clinical Photographs & nerve conduction

study -  21400

Intraoperative photos including

the face of the patient and scar

photo

810 S14.12 04.3.2Surgical Correction of Nerve and Tendon Repair

+ Vascular Repair (82.4+39.3)

 Clinical Photographs , nerve conduction

study report,color doppler of part & X-ray

of the part

 -  46790

ntraoperative photos including the

face of the patient and scar photo

& color doppler of the part,and

clinical photographs showing

functional improvement

811 S14.13 76.41.1 Correction of lid retraction Clinical Photograph,ICE pack test with

chin elevation -  25000

Intraoperative photos including

the face of the patient and scar

photo

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812 S14.14 76.41Surgical Correction of lid retraction with

Tumour of Mandible And Maxilla

 Clinical Photograph,Biopsy,CT or X-ray

of the part,OPG film and report -  58850

post op HPE report,Intraoperative

photos including the face of the

patient and scar photo & X-ray of

the part

813 S14.15 70.62 Reconstructive procedures for vaginal atresia

 Clinical Photograph,Ultrasound of the

abdomen and pelvis and gynaec

consultation

 -  37450

Intraoperative photos including

the face of the patient and scar

photo & post operative gynaec

assembly by gynaecologist

814 S14.16 39.7 Surgical correction for Vascular malformationsClinical Photograph,color doppler,USG of

the part -  32950

Intraoperative photos including

the face of the patient and scar

photo & post op HPE report and

color doppler

815 S14.17 08.52

Tarsorrhaphy surgery to prevent exposure

keratitis to prevent loss or impairment of vision

especially in facial burns

Clinical Photograph - 10000Clinical Photograph , Case Sheet

with operation Notes

816 S14.18 76.7.2 Panfacial fractures combination with polytrauma3D CT Facial Bones, X-Ray Facial Bones,

Clinical Photograph - 102510 X-Ray Facial Bones

817 S14.19 82.6.1Aplasia / hypoplasia / post traumatic loss of

thumb for reconstruction - conventional surgeryX-Ray , Clinical Photograph - 63540 CT Local Area Without Contrast,

818 S14.20 84.22.2 Reimplantation / revascularization - single digit X-Ray, Clinical Photograph - 83920 X-Ray , Clinical Photograph

819 S14.21 84.22.1Reimplantation / revascularization - multiple

digits per fingerX-Ray, Clinical Photograph - 83920 X-Ray , Clinical Photograph

820 S14.22 86.74.1

Flap cover for trauma of the hand / forearm /

arm / foot / leg / thigh etc., with exposure of

the underlying vital structures like tendons,

nerves, vessels, bone, with or without any

fracture- flap insert

Clinical Photograph - 60000 Clinical Photograph

S15 POLY TRAUMA

S15.1 ORTHOPEDIC TRAUMA

821 S15.1.1 79.0 Surgical Correction Of Longbone Fracture  Clinical Photograph, X-Ray  -  30000 Intraoperative photos, scar photo

,post OP X Ray

822 S15.1.2 84.91.1 Amputation Surgery  X-RAY, Clinical Photos, Doppler  -  10000 Intraoperative photos, scar photo

,post OP X Ray

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823 S15.1.3 83.6 Management of Soft Tissue Injury  Clinical Photograph, X-Ray  -  6500 Intraoperative photos, scar photo

S15.2 NEURO-SURGICAL TRAUMA

824 S15.2.1.1 96.59.1Medical Management in General Ward @

Rs.900/-Neuro surgical trauma

 CT , X-RAY,Clinical Photograph,Case

sheet with clinical History  -  10800

Daily Clinical Photograph , Case

Sheet with Clinical Notes

825 S15.2.1.2 96.7.1Intesive care managementof Neuro Surgical

Trauma in Neuro Icu @Rs.4000/Day

 CT , X-RAY,Clinical Photograph,Case

sheet with clinical History  -  48000

Daily Clinical Photograph , Case

Sheet with Clinical Notes

826 S15.2.2 05.9Surgical Treatment (Up To) for Neuro Surgical

Trauma

 CT , X-RAY,Clinical Photograph,Case

sheet with clinical History  -  150000

Daily Clinical Photograph , Case

Sheet with Clinical Notes,Post

OP X-Ray,

S15.3 CHEST INJURIES

827 S15.3.1.1 96.59.2Conservative management for Chest Injuries In

General [email protected]/Day

 CT , X-RAY,Clinical Photograph,Case

sheet with clinical History  -  5400

Daily Clinical Photograph , Case

Sheet with Clinical Notes

828 S15.3.1.2 93.9.2Intesive care management for Chest injuries in

RICU Rs. 4000/- per day

 CT , X-RAY,Clinical Photograph,Case

sheet with clinical History  -  35000

Daily Clinical Photograph , Case

Sheet with Clinical Notes

829 S15.3.2 34.71 Surgical Treatment for Chest injuries CT , X-RAY,Clinical Photograph,Case

sheet with clinical History  -  28810

Daily Clinical Photograph , Case

Sheet with Clinical Notes,Post

OP X-Ray,

S15.4 ABDOMINAL INJURIES

830 S15.4.1.1 96.59.3Conservative management for Abdominal

Injuries In General [email protected]/Day

 CT , USG , X-RAY,Clinical

Photograph,Case sheet with clinical

History

 -  5400

Daily Clinical Photograph , Case

Sheet with Clinical Notes,Post

OP USG

831 S15.4.1.2 96.7.2Intensive care management for abdominal

injuries in surgical ICU @ Rs.4000/-

 CT , USG , X-RAY,Clinical

Photograph,Case sheet with clinical

History

 -  28000

Daily Clinical Photograph , Case

Sheet with Clinical Notes,Post

OP USG

832 S15.4.2 54.7.1 Surgical Management for Abdominal Injuries

 CT , USG , X-RAY,Clinical

Photograph,Case sheet with clinical

History

 -  75000

Daily Clinical Photograph , Case

Sheet with Clinical Notes,Post

OP USG

S15.5 EMERGENCY ROOM PROCEDURES

833 S15.5.1 31.1 Tracheostomy  Clinical Photograph, X-Ray  -  6230  Clinical Photograph, X-Ray

834 S15.5.2 34.32 Thoracostomy  Clinical Photograph, X-Ray  -  10520  Clinical Photograph, X-Ray

S15.6WOUND MANAGEMENT FOR COMPOUND

FRACTURES

835 S15.6.1 79.6.1Surgical Management of Grade I&II Compound

Fractures Clinical Photograph , X-Ray  -  15000

Post OP X Ray,Intra OP photos,

Scar Photo

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836 S15.6.2 79.6.2Surgical Management of Grade III Compound

Fractures Clinical Photograph , X-Ray  -  26000

Post OP X Ray,Intra OP photos,

Scar Photo

837 S15.6.3 79.6.3Surgical Management of wound In Compound

Fracture with Flap cover(86.7) Clinical Photograph , X-Ray  -  26000

Post OP X Ray,Intra OP photos,

Scar Photo

S15.7

OTHER SMALL BONE FRACTURES-K-

WIRING (TO BE COVERED ALONG WITH

OTHER INJURIES ONLY AND NOT AS

EXCLUSIVE PROCEDURE)

838 S15.7.1 78.16

Surgical Management of Patella Fracture (To Be

Covered Along With Other Injuries Only And

Not As Exclusive Procedure)

 X-Ray  -  5000Post OP X Ray,Intra OP photos,

Scar Photo

839 S15.7.2 78.10.3

Surgical management with K-Wiring for Small

bone fractures (To Be Covered Along With

Other Injuries Only And Not As Exclusive

Procedure)

 X-Ray  -  5000Post OP X Ray,Intra OP photos,

Scar Photo

S15.8SURGICAL MANAGEMENT WITH FACIAL

INJURIES

840 S15.8.1 76.7.1Surgical Management with Facial Bone

Fractures (Facio- Maxillary Injuries)Clinical Photograph , X-Ray Facial Bones  -  15000

Post OP X Ray,Intra OP photos,

Scar Photo

S15.9 PELVIC BONE FRACTURE

841 S15.9.1 78.59 Surgical Correction Of Pelvic Bone Fractures. Clinical Photograph , X-Ray  -  34900Post OP X Ray,Intra OP photos,

Scar Photo

S16 COCHLEAR IMPLANT SURGERY

S16.1COCHLEAR IMPLANT SURGERY FOR

CHILDREN BELOW 2 YEARS

842 S16.1 20.96 Cochlear Implant Surgery Cochlear committee approval report -  520000 -

S16.2 AUDITORY-VERBAL THERAPY

843 S16.2.1 95.49.7Initial Mapping/Switch On for Auditory - Verbal

Therapy Progress Reports , Mapping Charts -  50000

 Progress Reports , Mapping

Charts

844 S16.2.2 95.49.8

Post Switch On Mapping/Initiation Of AVT And

Training Of Child And Mother - First

Installment

 Progress Reports , Mapping Charts -  20000 Progress Reports , Mapping

Charts

845 S16.2.3 95.49.3

Post Switch On Mapping/Initiation Of AVT And

Training Of Child And Mother - Second

Installment

 Progress Reports , Mapping Charts -  20000 Progress Reports , Mapping

Charts

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846 S16.2.4 95.49.4

Post Switch On Mapping/Initiation Of AVT And

Training Of Child And Mother - Third

Installment

 Progress Reports , Mapping Charts -  20000 Progress Reports , Mapping

Charts

847 S16.2.5 95.49.5

Post Switch On Mapping/Initiation Of AVT And

Training Of Child And Mother - Fourth

Installment

 Progress Reports , Mapping Charts -  20000 Progress Reports , Mapping

Charts

S16.3 HEARING IMPAIRED

848 S16.3.1 20.95Behind Ear Analogue Hearing Aid for Hearing

impaired Audiometry -  10000  Clinical Photograph

S17 PROSTHESES

S17.1.1 SYMES PROSTHESES

849 S17.1.1.1 84.40.1SYMES Prostheses - High Density

Ppolyethylene (HDP) / Polypropylene (PP)

 Clinical Photograph,X-Ray  - 1000

 Clinical Photograph,X-Ray

850 S17.1.1.2 84.40.2 SYMES Prostheses - Fibre  Clinical Photograph,X-Ray  -  1200  Clinical Photograph,X-Ray

851 S17.1.1.3 84.40.3 SYMES Prostheses - Modular  Clinical Photograph,X-Ray  -  1500  Clinical Photograph,X-Ray

S17.1.2 BELOW KNEE(BK/PTB) PROSTHESES

852 S17.1.2.1 84.46.1

Below Knee/ Petellar Tendon Bearing - High

Density Ppolyethylene (HDP) / Polypropylene

(PP)

 Clinical Photograph,X-Ray  -

 1200

 Clinical Photograph,X-Ray

853 S17.1.2.2 84.46.2 Below Knee/Petellar Tendon Bearing - Fibre  Clinical Photograph,X-Ray  -  1500  Clinical Photograph,X-Ray

854 S17.1.2.3 84.46.3 Below Knee/Petellar Tendon Bearing - Modular  Clinical Photograph,X-Ray  -  3000  Clinical Photograph,X-Ray

S17.1.3 THROUGH KNEE PROSTHESES

855 S17.1.3.1 84.47.1Through Knee - High Density Ppolyethylene

(HDP) / Polypropylene (PP)

 Clinical Photograph,X-Ray  - 1500

 Clinical Photograph,X-Ray

856 S17.1.3.2 84.47.2 Through Knee - Fibre  Clinical Photograph,X-Ray  -  1800  Clinical Photograph,X-Ray

857 S17.1.3.3 84.47.3 Through Knee - Modular  Clinical Photograph,X-Ray  -  3500  Clinical Photograph,X-Ray

S17.1.4 ABOVE KNEE(AK) PROSTHESES

858 S17.1.4.1 84.45.1Above Knee - High Density Ppolyethylene

(HDP) / Polypropylene (PP)

 Clinical Photograph,X-Ray  - 1500

 Clinical Photograph,X-Ray

859 S17.1.4.2 84.45.2 Above Knee - Fibre  Clinical Photograph,X-Ray  -  1800  Clinical Photograph,X-Ray

860 S17.1.4.3 84.45.3 Above Knee - Modular  Clinical Photograph,X-Ray  -  3500  Clinical Photograph,X-Ray

861 S17.1.5.1 84.47.4 Hip disarticulation prostheses - Hdp/Pp  Clinical Photograph,X-Ray  -  2500  Clinical Photograph,X-Ray

862 S17.1.5.2 84.47.5 Hip disarticulation prostheses - Fibre  Clinical Photograph,X-Ray  -  3000  Clinical Photograph,X-Ray

863 S17.1.5.3 84.47.6 Hip disarticulation prostheses - Modular  Clinical Photograph,X-Ray  -  6000  Clinical Photograph,X-Ray

864 S17.1.5.4 84.45.4 Above Knee - Partial Foot Prostheses  Clinical Photograph,X-Ray  -  500  Clinical Photograph,X-Ray

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S17.2 UPPERLIMB

865 S17.2.1.1 84.41.1Upper Limb - High Density Ppolyethylene

(HDP) / Polypropylene (PP)

 Clinical Photograph,X-Ray  - 1500

 Clinical Photograph,X-Ray

866 S17.2.1.2 84.41.2 Upper Limb - Fibre  Clinical Photograph,X-Ray  -  1800  Clinical Photograph,X-Ray

867 S17.2.1.3 84.41.3 Upper Limb - Modular  Clinical Photograph,X-Ray  -  3500  Clinical Photograph,X-Ray

S17.2.2 ABOVE ELBOW PROTHESES

868 S17.2.2.1 84.44.1Above Elbow - High Density Ppolyethylene

(HDP) / Polypropylene (PP)

 Clinical Photograph,X-Ray  - 1500

 Clinical Photograph,X-Ray

869 S17.2.2.2 84.44.2 Above Elbow - Fibre  Clinical Photograph,X-Ray  -  2000  Clinical Photograph,X-Ray

870 S17.2.2.3 84.44.3 Above Elbow - Modular  Clinical Photograph,X-Ray  -  4000  Clinical Photograph,X-Ray

S17.2.3 WHOLE UPPERLIMB PROSHESES

871 S17.2.3.1 84.43.1Whole Upper Limb - High Density

Ppolyethylene (HDP) / Polypropylene (PP)

 Clinical Photograph,X-Ray  - 1000

 Clinical Photograph,X-Ray

872 S17.2.3.2 84.43.2 Whole Upper Limb - Fibre  Clinical Photograph,X-Ray  -  1200  Clinical Photograph,X-Ray

873 S17.2.3.3 84.43.3 Whole Upper Limb - Modular  Clinical Photograph,X-Ray  -  1500  Clinical Photograph,X-Ray

M1 CRITICAL CARE

874 M1.1 J46Medical Management of Acute Severe Asthma

With Acute Respiratory Failure

 ABG , Serum IgE , Spirometry , clinical

photo intubated with ventilator, CBP, ESR,

RBS, S.Electrolytes, RFT, Chest X-Ray

film & Report, sputum/ET culture if

required

 Asthma Guide lines - GINA

/India, Ventilatory Care 50000

ABG, Case Sheet with treatment

details

875 M1.2 J44.0Medical Management of COPD with

Respiratory Failure (Infective Exacerbation)

 Blood gases , HRCT Chest, Chest X-Ray

and report , ventilator when necessary,

CBP, ESR, RBS, S.Electrolytes, RFT,

sputum/ET culture with sensitivity

report,ICU Photo on Ventilator,ABG

 According to International

Guide lines, Ventilatory Care 80000

ABG , other lab investigation,

PFT, 2D ECHO, FOB, CBP,

ESR, Sputum for AFB, Case

sheet with clinical improvement

876 M1.3 J20.0Medical Management of Acute Bronchitis with

Pneumonia and Respiratory Failure

 Clinical photo HRCT, Chest X-Ray film

with report, sputum AFB, FOB , ICU

Photo on Ventilator

 IP 10 days, Inhalers, LABA,

Ventilatory Care 60000

 ABG , CBP, ESR, sputum AFB,

other lab investigation, Case sheet

with clinical improvement

877 M1.4 J80.A Medical Management of ARDS

 Clinical photo,HRCT Scan , FOB ,

SputumC/S , Ventilator, Chest X-Ray film

and report, 2D ECHO, FIO2/ pa O2 ratio

 Antimicrobials, MICU, O2,

Ventilatory Care 100000

 ABG , CBP, ESR, sputum AFB,

other lab investigation, Case sheet

with clinical improvement

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878 M1.5 J80.BMedical Management of ARDS with Multi

Organ failure (R65.1)

 ABGS , Clinical photoHRCT Scan , FOB

, SputumC/S, , Ventilator, Chest X-Ray

film and report, 2D ECHO, FIO2/ pa O2

ratio

 Antimicrobials, MICU, O2,

Ventilatory Care 115000

 ABG , CBP, ESR, sputum AFB,

other lab investigation, Case sheet

with clinical improvement

879 M1.6 J80.CMedical Management of ARDS with DIC

(Blood and Blood Products) (D65)

 ABGS , Clinical photoHRCT Scan , FOB

, SputumC/S , Ventilator, Chest X-Ray

film and report, 2D ECHO, FIO2/ pa O2

ratio

 Cryo precipitate, FFP,

Ventilatory Care 140000

 ABG , CBP, ESR, sputum AFB,

other lab investigation, Case sheet

with clinical improvement

880 M1.7 T63Medical Management of Poisioning Requiring

Ventilatory Assistance

 Clinical photo ,Renal chemistry

Drug/Poison level in blood,Blood gases ,

Intubation , Ventilatory assistance,ABG

 MICU, O2, Ventilatory Care,

atropine 50000

 ABG , CBP, ESR, other lab

investigation, Case sheet with

clinical improvement

881 M1.8 R57.2 Intensive care management of Septic Shock

 Blood Culture , Blood gases , Clinical

phot Renal Chemistry , Intubation , USG ,

Urine Culture , Ventilatory assistance

 Antimicrobials, MICU, O2,

Ventilatory Care and other

supportive measures

 60000

 ABG , CBP, ESR, other lab

investigation, Case sheet with

clinical improvement

M2 GENERAL MEDICINE

882 M2.1 D69.5Medical Management of Thrombocytopenia

With Bleeding Diathesis

 Aspiration / BiopsyReport , Bone Marrow

, Leptospira , PT APTT , Parasite F / V ,

Platelet count , Report and Clinical photo

 Factor -VIII, IV fluids, PRP,

SDPIV - IgIV antimicrobials 30000

 ABG , CBP, ESR, other lab

investigation, Case sheet with

clinical improvement

883 M2.2.1 D66Medical Management of Hemophilia

(D67/D68.0)Factor VIII / IX , PT APTT , Webex -  Factor -VIII, IV-FPP  60000

Case sheet with clinical

improvement ,Lab Investigations

884 M2.2.2 D69.9Medical Management of Other Coagulation

DisordersFactor VIII & IX, Von willi brands factor

 Factor - VIII -

Cryoprecipitate, IV FFP 44000

Case sheet with clinical

improvement ,Lab Investigations

885 M2.3 D56.1Medical Management of Chelation Therapy For

Thalassemia Major

 Ferritin , Heamatocrit , Heamogram ,

Peripheral Smear , S.Iron , Serum Chelation Theraphy  15000

Case sheet with clinical

improvement ,Lab Investigations

886 M2.4 B50.0 Medical Management of Cerebral Malaria

Cerebrospinal Fluid (CSF) Analysis Cell

Count, Parasite F Test and Quantitative

Buffy Coat (QBC), CBP, CT-Scan Brain

,LFT, Renal Profile

 Blood and Platelet

Transfusion, IV antibiotics, IV

fluids, Mefloquine, Oral

Chloroquine or IV quinine or

IV artesunate, Paracetamol,

Ventilatiory Support

 25000

Case sheet with clinical

improvement, Serial ABGs,

S.Electrolytes, CT Scan

Brain, Clinical and Lab

Investigations

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887 M2.5 A17.0 Medical Management of TB MeningitisX-Ray PA View, CSFADA Analysis ,

Sputum for AFB , LFT-,CT Scan Brain

 Anticonvulsants (Midazolam

or Lorazepam, Phenobarbitone

or Phenytoin), Antitubercular

theraphy, IV Mannitol, IV

antibiotics, IV dexamethasone

and oral steroids, IV fluids,

Mechanical Ventilatory

support, Naso gastric feeds,

Paracetamol

 30000Case sheet with clinical

improvement ,Lab Investigations

888 M2.6 T63.0Medical Management of Snake Bite Requiring

Ventilator Support

CBP, RFT, PT/INR, APTT BT/CT, ABG 8

hrly (3-day X 7-days) , Blood Sugar 4 hrly

, CT Scan Brain , EEG

 Anticonvulsants

(Inj.Lorazepam,

Inj.Phenobarbitone,

Inj.Phenytoin), Antisnake

Venom, IV fluids,

Inj.Meropenem,

Inj.Midazolam infusion,

Inj.Vancomycin,

Inotropes(Dobutamine,

Dopamine, Adrenaline,

Noradrenaline), Mechanical

Ventilation, Oxygen

 60000

Case sheet with clinical

improvement ,Lab Investigations

,Serial ABG

889 M2.7 T63.2.AMedical Management of Scorpion Sting

Requiring Ventilator Support

 ABG 8 hrly (3-day X 7-days) , Arterial

Blood Pressure , Blood Sugar 8 hrly , CVP

monitoring , ECG , 2D ECHO

 Antiscorption Venom, IV

fluids, Inj.Meropenem,

Inj.Midazolam infusion,

Inj.Vancomycin,

Inotropes(Dobutamine,

Dopamine, Adrenaline,

Noradrenaline), Mechanical

Ventilation, Oxygen

 25000

Case sheet with clinical

improvement ,Lab Investigations

,Serial ABG

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890 M2.8 R40.2Medical Management of Metabolic Coma

Requiring Ventilatory Support

S.Electrolytes, ABG , Arterial Blood

Pressure , Blood Sugar , Blood Urea , CVP

monitoring , ECG , Echo , S.Creatininine ,

Thyroid Profile,Serum Ammonia

Levels,Urine ketone bodies,CSF

Analysis,ICU Photo on Ventilator

 Adrenaline, Antiscorption

Venom, Dobutamine,

Dopamine, IV antibiotics, IV

fluids, Inj.Midazolam infusion,

Mechanical Ventilation,

Noradrenaline, Oxygen,

Sodium Nitroprusside

 35000

Case sheet with clinical

improvement ,Lab Investigations

,Serial ABG

891 M2.9 A91Medical Management of Dengue Haemorrhagic

Fever

Complete Blood Picture [CBP] ,Platelet

Count ,CUE (pH , Specific Gravity , Sugar

, Protein And Microscopy) , Renal profile ,

LFT(liver function tests) , ICU Photo on

Ventilator

Antibiotics, IV fluids, Platelet

transfusion 35000

Platelet Count , PCV, Dengue

Serology ,Stool For Microscopy,

Case Sheet with treatment details

M3 INFECTIOUS DISEASES

892 M3.1 A35 Medical Management of Severe TetanusABG, Skin Swab For Culture &

Sensitivity, ICU Photo on Ventilator

 MEDICAL, Tracheostomy,

ventilator 27970

 Clinical Photograph, Serial

ABGs, Lab Investigations

893 M3.2 A36.AMedical Management of Complicated

Diphtheria

 ECG-5 times , Throat swab for c/s-3 times

, Urine for ketone bodies

 MEDICAL, Tracheostomy,

ventilator 26800

Case sheet with clinical

improvement ,Lab Investigations

894 M3.3 B45.1Medical Management of Cryptococcal

Meningitis

 Cryptococcal antigen , CSF analysis,

HIV,, CT-Scan Brain Amphoterecin B, Fluconazole  29800

Case sheet with clinical

improvement ,Lab Investigations

M4 PEDIATRICS

M4.1 NEONATAL INTENSIVE CARE

895 M4.1.1 P22.0.B

Medical management of term Baby With

Septicemia Culture Positive,Hyperbili rubinemia

Not requiring Ventilatory support.

 Lumbar Puncture CSF analysis ,

Neurosonogram, CRP, S.Bilerubin, Blood

culture

 25 % dextrose, Calcium

gluconate, Fluconazole, IV

antibiotics -Meropenem -

500mg, Maintenance IV Fluids

- Isolyte P, Nasogastric tube

feeds, Phototherapy,

Tobramycin -80mg

 35000Case sheet with clinical

improvement ,Lab Investigations

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896 M4.1.2 P22.0.D

Medical Management of Preterm Baby 33 To 34

Weeks with Severe Hyaline Membrane Disease

Clinically evident septicemia

Hyperbilirubinemia requiring Bubble Cpap.

2D ECHO , Neurosonogram(NSG)

3,CSFanalysis, ABG,Chest X-Ray PA

View, Serum Bilirubin Levels - , Blood

Culture & Sensitivity - Automated ,

Aspirate Culture (Tracheal )

 25 % dextrose, Aminoven,

Calcium gluconate, Heparin,

IV antibiotics (Piperacillin

Tazobactum-1, Tobramycin -

80 mg), Midazolam,

Nasogastric tube feeds,

Phototherapy-Umbilical

venous and arterial lines,

Supplemental Oxygen

 60000Case sheet with clinical

improvement ,Lab Investigations

897 M4.1.3 P22.0.D

Medical Management of pre term baby of 33 To

34 Weeks with Severe Hyaline Membrane

Disease Clinically evident septicemia

Hyperbilirubinemia requiring ventilatory

support.

2D ECHO , Neurosonogram(NSG)

3,CSFanalysis, ABG,Chest X-Ray PA

View, Serum Bilirubin Levels - , Blood

Culture & Sensitivity - Automated ,

Aspirate Culture (Tracheal )

 25 % dextrose, Aminoven,

Calcium gluconate, FFP,

Heparin, IV antibiotics

(Piperacillin Tazobactum-1,

Tobramycin - 80 mg),

Maintenance IV Fluids -

Isolyte P, Mechanical

ventilation, Midazolam,

Nasogastric tube feeds, PRBC,

PRP, Phototherapy-Umbilical

venous and arterial lines,

Supplemental Oxygen

 60000Case sheet with clinical

improvement ,Lab Investigations

898 M4.1.4 P22.0.B

Medicalmanagement of Preterm baby of 35 To

36 Weeks with Mild Hyaline Membrane Disease

septicemia Culture Positive Hyperbilirubinem ia

not requiring ventilatory support.

2D ECHO , Neurosonogram(NSG)

3,CSFanalysis, Chest X-Ray PA View,

Serum Bilirubin Levels - , Blood Culture

& Sensitivity - Automated , Aspirate

Culture (Tracheal )

 25 % dextrose, Calcium

gluconate, Fluconazole, IV

antibiotics -Meropenem -

500mg, Maintenance IV Fluids

- Isolyte P, Nasogastric tube

feeds, Phototherapy,

Supplemental Oxygen,

Tobramycin -80mg

 35000Case sheet with clinical

improvement ,Lab Investigations

Page 78: ANNEXURE-I CODE ICD CODE SYSTEM PREAUTHORISATION …

899 M4.1.5 P22.0.A

Medicalmanagement of Preterm baby of 33 To

34 Weeks with Mild Hyaline Membrane Disease

septicemia Culture Positive Hyperbilirubinem ia

not requiring ventilatory support.

2D ECHO , Neurosonogram(NSG)

3,CSFanalysis, ABG, Chest X-Ray PA

View, Serum Bilirubin Levels - , Blood

Culture & Sensitivity - Automated ,

Aspirate Culture (Tracheal )

 25 % dextrose, Calcium

gluconate, FFP, Fluconazole,

IV antibiotics -Meropenem -

500mg, Maintenance IV Fluids

- Isolyte P, Nasogastric tube

feeds, PRBC, PRP,

Phototherapy, Supplemental

Oxygen, Tobramycin -80mg

 35000Case sheet with clinical

improvement ,Lab Investigations

900 M4.1.6 P22.0.D

Medical management of Preterm baby of 33 To

34 Weeks with severe Hyaline Membrane

Disease septicemia Culture Positive

Hyperbilirubinem requiring ventilatory support/

bubble Cpap.

2D ECHO , Neurosonogram(NSG)

3,CSFanalysis, ABG, Chest X-Ray PA

View, Serum Bilirubin Levels - , Blood

Culture & Sensitivity - Automated ,

Aspirate Culture (Tracheal )

 25 % dextrose, Aminoven,

Calcium gluconate,

Dobutamine, Dopamine, FFP,

Fluconazole, Heparin, IV

antibiotics -Meropenem -

500mg, Maintenance IV Fluids

- Isolyte P, Mechanical

ventilation, Nasogastric tube

feeds, Normal saline, PRBC,

PRP, Phototherapy,

Supplemental Oxygen,

Surfactant therapy - Neosurf,

Tobramycin -80mg,

Vecuronium

 60000Case sheet with clinical

improvement ,Lab Investigations

Page 79: ANNEXURE-I CODE ICD CODE SYSTEM PREAUTHORISATION …

901 M4.1.7 P22.0.D

Medical management of Preterm baby of 30 To

32 Weeks with severe Hyaline Membrane

Disease septicemia Culture Positive

Hyperbilirubinem ia requiring Mechanical

ventilatory support.

2D ECHO , Neurosonogram(NSG)

3,CSFanalysis, ABG, Chest X-Ray PA

View, Serum Bilirubin Levels - , Blood

Culture & Sensitivity - Automated ,

Aspirate Culture (Tracheal )

 25 % dextrose, Aminoven,

Calcium gluconate,

Dobutamine, Dopamine, FFP,

Heparin, IV antibiotics

(Meropenem - 500mg ,

Tobramycin -

80mgFluconazole),

Maintenance IV Fluids -

Isolyte P, Mechanical

ventilation, Midazolam,

Nasogastric tube feeds, PRBC,

PRP, Phototherapy-Umbilical

venous and arterial lines,

Supplemental Oxygen,

Surfactant therapy - Neosurf,

Vecuronium

 60000Case sheet with clinical

improvement ,Lab Investigations

902 M4.1.8 P22.0.E

Medical management of Preterm baby of<30

Weeks with severe Hyaline Membrane Disease

septicemia Culture PositiveHyperbilirubinem ia

requiring Mechanical ventilatory support.

2D ECHO , Neurosonogram(NSG)4

,CSFanalysis, ABG, Chest X-Ray PA

View, Serum Bilirubin Levels - , Blood

Culture & Sensitivity - Automated ,

Aspirate Culture (Tracheal )

 25 % dextrose, Aminoven,

Calcium gluconate,

Dobutamine, Dopamine, FFP,

Heparin, IV antibiotics

(Meropenem - 500mg ,

Tobramycin -

80mgFluconazole),

Maintenance IV Fluids -

Isolyte P, Mechanical

ventilation, Midazolam,

Nasogastric tube feeds,

Normal saline, PRBC, PRP,

Phototherapy-Umbilical

venous and arterial lines,

Supplemental Oxygen,

Surfactant therapy - Neosurf,

Vecuronium

 90000Case sheet with clinical

improvement ,Lab Investigations

Page 80: ANNEXURE-I CODE ICD CODE SYSTEM PREAUTHORISATION …

903 M4.1.9 P22.0.D

Medical management of Preterm baby of 33 To

34 Weeks with severe Hyaline Membrane

Disease septicemia Culture Positive

Hyperbilirubinem ia Patent Ductus Arteriosus-

requiring Mechanical ventilatory support.

2D ECHO , Neurosonogram(NSG)4

,CSFanalysis, ABG, Chest X-Ray PA

View, Serum Bilirubin Levels - , Blood

Culture & Sensitivity - Automated ,

Aspirate Culture (Tracheal )

 25 % dextrose, Aminoven,

Calcium gluconate,

Dobutamine, Dopamine, FFP,

Frusemide, Heparin, IV

antibiotics (Meropenem -

500mg , Tobramycin -

80mgFluconazole),

Maintenance IV Fluids -

Isolyte P, Mechanical

ventilation, Midazolam,

Nasogastric tube feeds,

Normal saline, PRBC, PRP,

Phototherapy-Umbilical

venous and arterial lines,

Supplemental Oxygen,

Surfactant therapy - Neosurf,

Vecuronium

 60000Case sheet with clinical

improvement ,Lab Investigations

904 M4.1.10 P22.0.D

Medical management of pre-term Baby of 30 To

32 Weeks Septi cemia Ductus Arteriosus -

requiring Mechanical Ventilation.

 2D ECHO -TWICE , Neurosonogram on

day 2 and 5, X-Ray chest, Ventilator

photo, CRP, ABG, CSF analysis, TSB

Blood culture

 25 % dextrose, Aminoven,

Calcium gluconate,

Dobutamine, Dopamine, FFP,

Frusemide, Heparin, IV

antibiotics (Meropenem -

500mg , Tobramycin -

80mgFluconazole),

Maintenance IV Fluids -

Isolyte P, Mechanical

ventilation, Midazolam,

Nasogastric tube feeds, PRBC,

PRP, Phototherapy-Umbilical

venous and arterial lines,

Supplemental Oxygen,

Surfactant therapy - Neosurf,

Vecuronium

 60000Case sheet with clinical

improvement ,Lab Investigations

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905 M4.1.11 P22.0.E

Medical management of pre-term Baby of <30

Weeks Severe Hyaline Membrane Disease Septi

cemia Culture Positive,Hyperbili rubinemia

Patent Ductus Arteriosus -requiring Mechanical

Ventilation.

 2D ECHO -TWICE , Neurosonogram on

day 2 and 5, X-Ray chest, Ventilator

photo, CRP, ABG, CSF analysis, TSB

Blood culture

 25 % dextrose, Aminoven,

Calcium gluconate,

Dobutamine, Dopamine, FFP,

Frusemide, Heparin, IV

antibiotics (Meropenem -

500mg , Tobramycin -

80mgFluconazole),

Maintenance IV Fluids -

Isolyte P, Mechanical

ventilation, Midazolam,

Nasogastric tube feeds,

Normal saline, PRBC, PRP,

Phototherapy-Umbilical

venous and arterial lines,

Supplemental Oxygen,

Surfactant therapy - Neosurf,

Vecuronium

 90000Case sheet with clinical

improvement ,Lab Investigations

906 M4.1.12 P22.0.C

Medical Management of Term Baby With

Persistent Pulmonary Hypertension Ventilation-

Hfo Hyperbilirubinem ia Clinically evident

septicemia.

 2D ECHO - 4 , Neurosonogram 2

 25 % dextrose, Aminoven,

Calcium gluconate,

Dobutamine, Dopamine, FFP,

Frusemide, Heparin, IV

antibiotics (Meropenem -

500mg , Tobramycin -

80mgFluconazole),

Maintenance IV Fluids -

Isolyte P, Mechanical

ventilation, Midazolam,

Nasogastric tube feeds,

Normal saline, PRBC, PRP,

Phototherapy-Umbilical

venous and arterial lines,

Sodium bicarbonate,

Supplemental Oxygen,

Surfactant therapy - Neosurf,

Vecuronium

 50000Case sheet with clinical

improvement ,Lab Investigations

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907 M4.1.13 P22.0.B

Medical Management of Term Baby With

Severe Perinatal Asphyxia Clinically evident

septicemia, Hyperbilirubinem ia - Not requiring

Ventilatory support.

 BERA CSF analysis(LP) , CT-Scan ,

Neurosonogram 2

 25 % dextrose, Calcium

gluconate, IV Phenobarbitone,

IV Phenytoin, IV antibiotics

(Piperacillin Tazobactum,

Tobramycin - 80 mg ),

Maintenance IV Fluids -

Isolyte P, Midazolam,

Nasogastric tube feeds,

Normal saline, Phisiotherapy,

Supplemental Oxygen

 35000Case sheet with clinical

improvement ,Lab Investigations

908 M4.1.14 P22.0.C

Medical Management of Term Baby With

Severe Perinatal Asphyxia Clinically evident

septicemia, Hyperbilirubinemia - requiring

Ventilatory support.

 BERA CSF analysis(LP) , CT-Scan ,

Neurosonogram 3

 25 % dextrose, Aminoven,

Calcium gluconate,

Dobutamine, Dopamine, FFP,

Heparin, IV Phenobarbitone,

IV Phenytoin, IV antibiotics

(Meropenem - 500mg ,

Tobramycin -

80mgFluconazole),

Maintenance IV Fluids -

Isolyte P, Midazolam,

Nasogastric tube feeds,

Normal saline, PRBC, PRP,

Phisiotherapy, Phototherapy-

Umbilical venous and arterial

lines, Supplemental Oxygen,

Vecuronium

 50000Case sheet with clinical

improvement ,Lab Investigations

Page 83: ANNEXURE-I CODE ICD CODE SYSTEM PREAUTHORISATION …

909 M4.1.15 P22.0.B

Medical Management of Term Baby Severe

Hyperbilirubinemia Clinically evident

Septicemia.

 Neurosonogram

 Whole blood, 25 % dextrose,

Calcium gluconate, Double

surface Phototherapy, Double

volume exchange transfusion,

IV antibiotics (Piperacillin

Tazobactum, Tobramycin - 80

mg ), Maintenance IV Fluids -

Isolyte P, Nasogastric tube

feeds

 35000Case sheet with clinical

improvement ,Lab Investigations

910 M4.1.16 P22.0.CMedical management of Seizures in term baby

requiring ventilatory support.

 Blood ammonia , CT-Scan , Lumbar

Puncture CSF analysis , Metabolilc

screening-blood and urine ABG ,

Neurosonogram , Ultra sound of abdomin ,

lactate

 25 % dextrose, Aminoven,

Calcium gluconate,

Dobutamine, Dopamine, FFP,

Heparin, IV Phenobarbitone,

IV Phenytoin, IV antibiotics

(Meropenem - 500mg ,

Tobramycin -

80mgFluconazole),

Maintenance IV Fluids -

Isolyte P, Mechanical

ventilation, Midazolam,

Nasogastric tube feeds, PRBC,

PRP, Phisiotherapy,

Phototherapy-Umbilical

venous and arterial lines,

Supplemental Oxygen

 50000Case sheet with clinical

improvement ,Lab Investigations

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911 M4.1.17 P22.0.B

Medical Management of Necrotising

Enterocolitis, Clinically evident Septicemia,

Hyperbilirubinem ia not requiring ventilatory

support.

 Abdomen radiograph, , LFT ,

Neurosonogram , Stool for occult blood ,

Ultra sound of abdomin

 Metronidazole, 25 %

dextrose, Albumin, Aminoven,

Calcium gluconate, Central

line, Heparin, IV antibiotics

(Meropenem - 500mg ,

Tobramycin -

80mgFluconazole),

Maintenance IV Fluids -

Isolyte P, Nasogastric tube

feeds, Normal saline,

Phototherapy, Total parenteral

nutrition

 35000Case sheet with clinical

improvement ,Lab Investigations

912 M4.1.18 P22.0.C

Medical Management of Term Baby, Fulminant

septicemia Culture Positive with Septic Shock,

Hyperbilirubinem ia Renal Failure requiring

ventilatory support.

 2D ECHO , Abdomen radiograph, ,

BERA CSF analysis(LP) , LFT ,

Neurosonogram , Stool for occult blood ,

Ultra sound of abdomin

 25 % dextrose, Adrenaline,

Albumin, Aminoven, Calcium

gluconate, Dobutamine,

Dopamine, FFP, Frusemide,

Heparin, IV antibiotics

(Meropenem - 500mg ,

Tobramycin -

80mgFluconazole),

Maintenance IV Fluids -

Isolyte P, Midazolam,

Nasogastric tube feeds,

Nonadrenaline, Normal saline,

PRBC, PRP, Peritoneal

dialysis, Phototherapy-

Umbilical venous and arterial

lines, Sodium bicarbonate,

Supplemental Oxygen, Total

parenteral nutrition,

Vecuronium

 50000Case sheet with clinical

improvement ,Lab Investigations

M4.2 PEDIATRIC INTENSIVE CARE

M4.2.1 RESPIRATORY

Page 85: ANNEXURE-I CODE ICD CODE SYSTEM PREAUTHORISATION …

913 M4.2.1.1 P22.9.AMedical management of Severe

Bronchiolitis(Non Ventilated)

 ABG OD , Clinical Photograph,Chest X

Ray

 Budesonide, IV fluids, Inj.

Ceftriaxone, Inj.

Hydrocortisone, Oxygen,

Salbutamol

 15000

Case sheet with clinical

improvement ,Lab

Investigations, ABG , X-RAY ,

pulse oxymetry Chart

914 M4.2.1.2 P22.9.BMedical Management of Severe

Bronchiolitis(Ventilated)

 ABG 8th hrly , Clinical Photograph,Chest

X Ray, ICU Photo on Ventilator

 Budesonide, IV fluids, Inj.

Amikacin, Inj. Methyl

prednisolone, Inj. Midazolam

Infusion ., Inj. Pipracillin

Tazobactum, Oxygen,

Salbutamol, nebulisations

 20000

Case sheet with clinical

improvement ,Lab

Investigations, ABG , X-RAY ,

pulse oxymetry Chart

915 M4.2.1.3 P22.9.AMedical Management of Severe

Bronchopneumon ia(Non Ventilated)

 ABG OD , Clinical Photograph,Chest X

Ray Oxygen  15000

Case sheet with clinical

improvement ,Lab

Investigations, ABG , X-RAY ,

pulse oxymetry Chart

916 M4.2.1.4 P22.9.BMedical Management of Severe

Bronchopneumon ia(Ventilated)

 ABG 8th hrly , Clinical Photograph,Chest

X Ray , ICU Photo on Ventilator

 Budesonide, IV fluids, Inj.

Amikacin, Inj. Midazolam

Infusion ., Inj. Pipracillin

Tazobactum, Mechanical

ventilation, Oxygen,

Salbutamol, nebulisations

 20000

Case sheet with clinical

improvement ,Lab

Investigations, ABG , X-RAY ,

pulse oxymetry Chart

917 M4.2.1.5 P22.9.BMedical Management of Acute Severe Asthma

(Ventilated)

 ABG 8th hrly , Clinical Photograph,Chest

X Ray, ICU Photo on Ventilator

 Budesonide, IV fluids, Inj.

Amikacin, Inj. Midazolam

Infusion ., Inj. Pipracillin

Tazobactum, Mechanical

ventilation, Oxygen,

Salbutamol, nebulisations

 20000

Case sheet with clinical

improvement ,Lab

Investigations, ABG , X-RAY ,

pulse oxymetry Chart

918 M4.2.1.6 P22.9.AMedical Management of Severe Aspiration

Pneumonia (Non Ventilated)

 ABG OD , Clinical Photograph,Chest X

Ray

 IV fluids, Inj. Amikacin, Inj.

Pipracillin Tazobactum,

Oxygen, Salbutamol,

nebulisations

 15000

Case sheet with clinical

improvement ,Lab

Investigations, ABG , X-RAY ,

pulse oxymetry Chart

919 M4.2.1.7 P22.9.BMedical Management of Severe Aspiration

Pneumonia ( Ventilated)

 ABG 8th hrly , Clinical Photograph,Chest

X Ray, ICU Photo on Ventilator

 IV fluids, Inj. Amikacin, Inj.

Midazolam Infusion ., Inj.

Pipracillin Tazobactum,

Mechanical ventilation,

Oxygen, Salbutamol,

nebulisations

 20000

Case sheet with clinical

improvement ,Lab

Investigations, ABG , X-RAY ,

pulse oxymetry Chart

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920 M4.2.1.8 J80.BMedical Management of ARDS With Multi-

Organ Failure

 ABGS , Clinical Photo , FOB , HRCT

Scan , Sputum C-S , Ventilator

 Antimicrobials, MICU, O2,

Ventilatiory Care 115000

Case sheet with clinical

improvement ,Lab

Investigations, ABG

921 M4.2.1.9 J80.CMedical Management of ARDS Plus DIC

(Blood & Blood Products)

 ABGS , Clinical Photo , FOB , HRCT

Scan , Sputum C-S , Ventilator

 Cryp Precipitate, FFP,

Ventilatiory Care 140000

Case sheet with clinical

improvement ,Lab

Investigations, ABG

922 M4.2.2.1 I40Medical Management of Severe Myocarditis in

Paediatric patient

Holter/24 Hr ECG (Monitering) - ,

Arterial Blood Gas Analysis (ABG) - 12

Hrly, 2D ECHO ,Chest X Ray

 IV fluids, Inj. Adrenaline, Inj.

Amikacin, Inj. Lasix, Inj.

Midazolam Infusion ., Inj.

Pipracillin Tazobactum,

Mechanical ventilation,

Oxygen, Syp. Digoxin, T.

Captopril, T.lasilactone, inj.

Milrinone, inj.Dobutamine,

inj.Dopamine, inotropes

 40000

Case sheet with clinical

improvement ,Lab

Investigations, ABG , X-RAY ,

pulse oxymetry Chart

923 M4.2.2.2 Q24.9.B

Medical Management of Congenital Heart

Disease With Infection (Non Ventilated) in

Paediatric patient

2D ECHO , Sepsis profile-I12.008, Blood

Culture & Sensitivity - Automated, C-

Reactive Protein, Pulse Oxymetry Chart

 IV fluids, Inj. Ceftriaxone,

Oxygen, inj.Dobutamine,

inj.Dopamine, inj.Tobramycin

 25000

Case sheet with clinical

improvement ,Lab

Investigations, ABG , X-RAY ,

pulse oxymetry Chart

924 M4.2.2.3 Q24.9.C

Medical Management of Congenital Heart

Disease With Infection And Cardiogenic Shock

(Ventilated) in Paediatric patients

ABG 8th hrly, Blood Culture & Sensitivity

- Automated-, ECG, 2D ECHO , Serum

Electrolytes Serum Calcium , Serum

Magnesium, ICU Photo on Ventilator

 Adrenaline, Dobutamine,

Dopamine, IV fluids, Inj.

Midazolam, Inj. Vancomycin,

Mechanical ventilation X,

Nonadrenaline, Oxygen, inj.

Meropenem, inotropes,

milirinone

 50000

Case sheet with clinical

improvement ,Lab

Investigations, ABG , X-RAY ,

pulse oxymetry Chart

925 M4.2.2.4 R57.0.AMedical Management of Cardiogenic Shock in

Paediatric patients

ABG 8th hrly, ECG, 2D ECHO , Serum

Electrolytes Serum Calcium , Serum

Magnesium, ICU Photo on Ventilator

 Adrenaline, Dobutamine,

Dopamine, IV fluids,

Nonadrenaline, Oxygen, inj.

Meropenem, inotropes,

milirinone

 50000

Case sheet with clinical

improvement ,Lab

Investigations, ABG , X-RAY ,

pulse oxymetry Chart

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926 M4.2.2.5 I33.0 Medical Management of Infective Endocarditis

2D ECHO , Sepsis profile-I12.008, Blood

Culture & Sensitivity - Automated, C-

Reactive Protein, Pulse Oxymetry Chart

 Adrenaline, Dobutamine,

Dopamine, IV fluids, Inj.

Midazolam, Low molecular

weight Heparin, Mechanical

ventilation, Nonadrenaline,

Oxygen, inj. Meropenem,

inj.Heparin, inotropes,

milirinone

 25000

Case sheet with clinical

improvement ,Lab

Investigations, ABG , X-RAY ,

pulse oxymetry Chart

927 M4.2.2.6 I05Medical Management of Rheumatic heart

disease in Paediatric patient

ECHO Cardiogram , Anti-Streptolysin O

(ASO) Titres , Erythrocyte Sedimentation

Rate (ESR) , CUE (pH , Specific Gravity ,

Sugar , Protein And Microscopy) , Blood

Culture & Sensitivity - Automated , Chest

X Ray , ECG (Electro Cardiogram) ,

Complete Blood Picture [CBP] , Throat

Swab For KLB , Anti Nuclear Anti Body

(ANA) Indirect Immunofluorescence (IIF)

/Anti Nuclear Anti Body (ANA) Titres

Inj Procain pencillin,

Antipuretics, Steroid,

Lasix/Dijoxil if CCF

15000Chest X-Ray PA View(1 Film),

Case Sheet with treatment details

928 M4.2.3.1 G04.2.AMedical Management of Meningo- Encephalitis

(Non Ventilated)

Sepsis profile , CSF Analysis.CT-Scan

Brain EEG , Blood Culture & Sensitivity -

Automatedplete Blood Picture [CBP]

I23.014, Serum Electrolytes , Serum

Magnesium Levels, Serum Calcium Levels

 Anticonvulsants, IV fluids,

Inj. Midazolam Infusion ., Inj.

Vancomycin, Oxygen,

inj.Acyclovir, inj.Lorazapem,

inj.Phenibarbitone,

inj.Phenytoin, inj.cefepime

 40000Case sheet with clinical

improvement ,Lab Investigations

929 M4.2.3.2 G04.2.BMedical Management of Meningo- Encephalitis

in Paediatric patients (Ventilated)

Sepsis profile , CSF Analysis.CT-Scan

Brain EEG , Blood Culture & Sensitivity -

Automatedplete Blood Picture [CBP]

I23.014, Serum Electrolytes , Serum

Magnesium Levels, Serum Calcium

Levels,ABG 8th hrly, ICU Photo on

Ventilator

 Anticonvulsants, IV fluids,

Inj. Midazolam Infusion ., Inj.

Vancomycin, Oxygen,

inj.Acyclovir, inj.Lorazapem,

inj.Phenibarbitone,

inj.Phenytoin, inj.cefepime

 60000

Case sheet with clinical

improvement ,Lab

Investigations, ABG

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930 M4.2.3.3 G41 Medical Management of Status Epilepticus

CSF Analysis.CT-Scan Brain EEG , Serum

Electrolytes , Serum Magnesium Levels,

Serum Calcium Levels,ABG 8th hrly

 Anticonvulsants, IV fluids,

Inj. Midazolam Infusion ., Inj.

Vancomycin, Mechanical

ventilation, Oxygen,

inj.Acyclovir, inj.Lorazapem,

inj.Phenibarbitone,

inj.Phenytoin, inj.cefepime

 21510

Case sheet with clinical

improvement ,Lab

Investigations, ABG

931 M4.2.3.4 R56.0

Medical Management of Febrile Seizures

(Atypical- Mechanical Ventilated) in Paediatric

patients

CSF Analysis.CT-Scan Brain EEG , Serum

Electrolytes , Serum Magnesium Levels,

Serum Calcium Levels,ABG 8th hrly ,

Temperature Chart , ICU Photo on

Ventilator

 Anticonvulsants, IV fluids,

Inj. Amikacin, Inj. Midazolam

Infusion ., Mechanical

ventilation, Oxygen,

inj.Lorazapem,

inj.Phenibarbitone,

inj.Phenytoin, inj.cefepime

 25000

Case sheet with clinical

improvement ,Lab

Investigations, ABG

932 M4.2.3.5 I62.9Medical Management of Intra Cranial Bleed in

Paediatric patient

 ABG 8th hrly , Blood sugar 4 hrly , CT

Brain ,Carotid doppler

 Adrenaline, Anticonvulsants,

IV fluids, Inj. Midazolam

Infusion ., Mechanical

ventilation, Nonadrenaline,

Oxygen, inj. Meropenem,

inj.Calcium, inj.Dobutamine,

inj.Dopamine, inj.Lorazapem,

inj.Phenibarbitone,

inj.Phenytoin, inj.Tobramycin,

inotropes, milirinone

 50000

Case sheet with clinical

improvement ,Lab

Investigations, ABG

933 M4.2.4.1 K92.2.AMedical Management of Acute Gastro Intestinal

Bleed in Paediatric patients

 ABG OD,Upper GI Endoscopy , USG

abdomen

 Antibiotics (Inj. Ceftriaxone ,

Inj. Ofloxacin, Inj. Amikacin),

Dobutamine, Dopamine, IV

fluids, Inj. Midazolam Infusion

., Mechanical ventilation,

Oxygen, endoscopic

sclerotherapy, inotropes

 25000

Case sheet with clinical

improvement ,Lab

Investigations, ABG

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934 M4.2.4.2 K85.AMedical management of Acute Pancreatitis

(Mild) in pediatric patients

S.Amylase+ Lypase, ABG, CT-Scan ,

USG abdomen

 Adrenaline, Antibiotics ( Inj.

Meropenem , Inj.

Vancomycin), Dobutamine,

Dopamine, IV fluids, Inj.

Midazolam Infusion ., Insulin,

Mechanical ventilation,

Nonadrenaline, Oxygen, TPN,

inj.Calcium, inotropes,

milirinone

 50000

Case sheet with clinical

improvement ,Lab

Investigations, ABG,Sr Amylase,

Lypase

935 M4.2.4.3 K72.0.AMedical Management of Acute Hepatitis With

Hepatic Encephalopathy in Paediatric patient

LFT, CT , ABG 8th hrly , Blood sugar 4

hrly , CT-Scan , Hepatic viral studies (

Hepatitis B, Hepatitis C, Hepatitis A) ,

USG abdomen,Serum Ammonia Levels

 Inj. N- Acetyl Cystein,

Adrenaline,

Antibiotic(inj.Meropenem),

Anticonvulsants, IV fluids, Inj.

L-ornathine, Inj. Midazolam

Infusion ., L- Carnitine,

Mechanical ventilation,

Nonadrenaline, Oxygen,

inj.Calcium, inj.Dobutamine,

inj.Dopamine, inj.Lorazapem,

inj.Phenibarbitone,

inj.Phenytoin, inotropes,

milirinone

 50000

Case sheet with clinical

improvement ,Lab

Investigations, ABG,

936 M4.2.5.1 N17.9.A Medical Management of Acute Renal Failure

CBP, S.Electrolytes, PH and bicorbonate,

ECG for hyperkalemia and X-Ray for

cardiac enlargement, ABG 8th hrly , Blood

Urea cum Serum Creatinine 4 hrly , USG

abdomen

 Antibiotics(inj.Meropenem,inj

.ofloxacin), Dobutamine,

Dopamine, IV fluids, Inj.

Midazolam Infusion .,

Mechanical ventilation,

Oxygen, Peritoneal dialysis,

inj.Calcium, inotropes

 20000

Case sheet with clinical

improvement ,Lab

Investigations, ABG,

937 M4.2.6.1 E10.1Medical Management of Diabetic Ketoacidosis

in Paediatric patient

 ABG 8 hrly , , Blood sugar 4 hrly , Serum

Electrolytes, CVP monitoring, csf, chest X-

Ray

 Calcium, Dobutamine,

Dopamine, IV antibiotics

(Piperacillin Tazobactum,

Tobramycin - 80 mg ), IV

fluids, Oxygen, inotropes,

insulin infusion

 30000

Case sheet with clinical

improvement ,Lab

Investigations, ABG,

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938 M4.2.7.1 R57.2 Medical management of Septic shock

ABG 8 hrly, ECG, CT Brain, X-Ray chest,

Blood culture, CRP, ECHO , EEG , USG

abdomen, Blood sugar 4th hour

 Adrenaline, Anticonvulsants,

Dobutamine, Dopamine, IV

fluids, Inj. Midazolam Infusion

., Inj. Vancomycin,

Mechanical ventilation,

Nonadrenaline, Oxygen, TPN,

inj. Meropenem,

inj.Lorazapem,

inj.Phenibarbitone,

inj.Phenytoin, inotropes,

milirinone

 60000

Case sheet with clinical

improvement ,Lab

Investigations, ABG,

939 M4.2.8.1 T63.0Medical Management of Snake Bite Requiring

Ventilatory Assistance

BT CT, platelet count, HB%, Urea,  ABG

4 hrly (3/day X 4 days) , ABG 8 hrly

(3/day X 4 days) , CT Brain , ECHO ,

EEG, ICU Photo on Ventilator

 Adrenaline, Anticonvulsants,

Dobutamine, Dopamine, IV

fluids, Inj. Midazolam Infusion

., Inj. Vancomycin,

Mechanical ventilation,

Nonadrenaline, Oxygen,

antisnake Venom, inj.

Meropenem,

inj.Phenibarbitone,

inj.Phenytoin, inotropes

 60000

Case sheet with clinical

improvement ,Lab

Investigations, ABG,

940 M4.2.8.2 T63.2.B

Medical Management of Scorpion Sting With

Myocarditis And Cardiogenic Shock Requiring

Ventilatory Assistance in Paediatric patients

ABG 8 hrly (3/day X 4 days) , Blood

sugar 8 hrly , CVP monitoring , ECG ,

ECHO , ICU Photo on Ventilator ,Serum

Electrolytes

 Adrenaline, Antiscorpion

Venom, Dobutamine,

Dopamine, IV fluids, Inj.

Midazolam Infusion ., Inj.

Vancomycin, Mechanical

ventilation, Nonadrenaline,

Oxygen, Sodium nitroprusside,

inj. Meropenem, inotropes

 40000

Case sheet with clinical

improvement ,Lab

Investigations, ABG,

941 M4.2.8.3 T65.9

Medical Management of Poison Ingestion/

Aspiration Requiring Ventilatory Assistance in

Paediatric patients

 Blood sugar 8 hrly , CVP monitoring ,

ABG 8 hrly (3/day X 4 days) , ECG ,

ECHO , arterial blood pressure, ICU Photo

on Ventilator

 Dobutamine, Dopamine, IV

fluids, Inj. Midazolam Infusion

., Mechanical ventilation,

Oxygen, Specific antidote,

inotropes

 40000

Case sheet with clinical

improvement ,Lab

Investigations, ABG,

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M4.3MEDICAL MANAGEMENT OF GENERAL

PEDIATRICS

942 M4.3.1 J18.0.A

Medical Management of Acute Broncho Lobar

pneumonia With Empyema/ Pleural Effusion in

Paediatric patients(J18.1/J43/J90)

Rapid AFB Culture, Chest X-Ray, Blood

Culture & Sensitivity - Automated, LFT, C-

Reactive Protein, Fluid analysis culture

and sensitivity

 IV Antibiotics (Amoxycillin

clavulanate or ceftriaxone ,

Amikacin ,vancomycin),

Mechanical ventilation if

required and oral antibiotics,

Anti tubercular drugs after

discharge, IV fluids, Oxygen,

chest physiotherapy

 25000

Case sheet with clinical

improvement ,Lab

Investigations, Chest X Ray

943 M4.3.2 J18.0.B

Medical Management of Acute Broncho Lobar

pneumonia With Pyo Pneumothorax in

Paediatric patient(J18.1/J86/J93)

Rapid AFB Culture, Chest X-Ray, Blood

Culture & Sensitivity - Automated, LFT, C-

Reactive Protein, Fluid analysis culture

and sensitivity

 Mechanical ventilation if

required and oral antibiotics,

Anti tubercular drugs after

discharge, ICD chest drain, IV

antibiotics, IV fluids, Oxygen,

chest physiotherapy,

nebulisations

 20000

Case sheet with clinical

improvement ,Lab

Investigations, Chest X Ray

944 M4.3.3.2 N39.0.B

Medical Management of Urinary Tract Infection

With Complications Like Pyelonephritis And

Renal Failure in Paediatric patient(N13.617.9)

 MCUG ( Micturating cysto urethrogram),

Urine for Culture and Sensitivity,

Ultrasound , Renal Profile

 Amikacin and ofloxacin

paracetamol, Dialysis, IV

Antibiotics (Amoxycillin

clavulanate or ceftriaxone ,

Amikacin ,vancomycin), IV

fluids, oral antibiotics

(Amoxycillin clavulanate or

Cefixime)

 14160

Urine Culture & Sensitivity-Case

sheet with clinical improvement

,Lab Investigations

945 M4.4.1 Q24.9.A

Medical Management of Congenital Heart

Disease With Congestive Cardiac Failure in

Paediatric patients

ECG , 2D ECHO, Chest X-Ray

 Digoxin, IV Antibiotics

(Ceftriaxone , Amikacin or

ofloxacin), IV fluids,

Mechanical ventilation,

Oxygen, diuretics,

nebulisations

 15000

Case sheet with clinical

improvement ,Lab

Investigations, Chest X Ray,2D

ECHO , ECG

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946 M4.4.2 I50.9.DMedical Management of Acquired Heart

Disease With Congestive Cardiac FailureECG , 2D ECHO, Chest X-Ray

 Ace inihibitors, Digoxin, IV

Antibiotics (Ceftriaxone ,

Amikacin or ofloxacin), IV

fluids, Mechanical ventilation,

Oxygen, diuretics,

nebulisations

 15000

Case sheet with clinical

improvement ,Lab

Investigations, Chest X Ray,2D

ECHO , ECG

947 M4.4.3 I41.1Medical Management of Viral Myocarditis in

Paediatric patient

ECG , 2D ECHO, Chest X-Ray , Blood

Culture & Sensitivity

 IV Antibiotics (Ceftriaxone ,

Amikacin or ofloxacin), IV

fluids, Oxygen, diuretics,

inotropes, steroids

 20000

Case sheet with clinical

improvement ,Lab

Investigations, Chest X Ray,2D

ECHO , ECG

948 M4.5.1 N04.A

Medical Management of Steroid Resistant

Nephrotic Syndrome Complicated Or Resistant

in Paediatric patients

Renal Biopsy, Urine Culture & Sensitivity,

Renal Profil, 24 Hrs Urinary Protein

 Antihypertensives, IV

Antibiotics (Ceftriaxone ,

Amikacin or ofloxacin),

Immunosuppressives ., ascitic

tap, diuretics, pleural tap

 25000

Case sheet with clinical

improvement ,Renal profile,Post

OP HPE

949 M4.5.3 N17.9.AMedical Management of Acute Renal Failure in

Paediatric patient

Collagen vascular profile , Complement

levels c1 , c3, , RFT , Serum Electrolytes ,

 Antibiotics,

Antihypertensives, Haemo

dialysis, Peritoneal dialysis,

Supportive management,

diuretics

 20000Case sheet with clinical

improvement ,Renal profile

950 M4.5.4 N17.9.DMedical Management of Acute Renal Failure

With Dialysis in Paediatric patients

Collagen vascular profile , Complement

levels c1 , c3, , RFT , Serum Electrolytes ,

 Antibiotics,

Antihypertensives, Haemo

dialysis, Peritoneal dialysis,

Supportive management,

diuretics

 20000Case sheet with clinical

improvement ,Renal profile

951 M4.6.1 D56.1Medical Management of Thalassemia Major

Requiring Chelation Therapy

 Hb electrophoresis , Osmotic fragility test

, Serum Ferritin

 Blood transfusion., Chelating

Agents, IV fluids 15000

Case sheet with clinical

improvement ,Lab investigations

952 M4.6.2 D68.0Medical Management of Haemophillia Including

Von Willibrands disease in Paediatric patients

Factor VIII & IX, VWF I,Prothrombin

Time , Activated Partial Thrombo Plastin

Time (APTT)

 Blood and Blood products,

Factor concentrate 20000

Case sheet with clinical

improvement ,Lab investigations

953 M4.6.3 D64.9.AMedical Management of Anemia Of Unknown

Cause

Hemoglobin Electrophoresis - ,Bone

Marrow Aspiration, Hemogram Iron

studies

 Bloods transfusion,

Hemantinics etc, IV fluids 10000

Case sheet with clinical

improvement ,Lab investigations

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954 M4.6.4 D59.1Medical Management of Auto immune

hemolytic anemia in Paediatric patient

Coomb s Test Direct, Bone Marrow

Aspiration ,Serum Bilirubin Levels ,

Platelet Count , Complete Blood Picture

[CBP] , Reticulocyte Count , Blood

Grouping And RH Typing ,Anti Nuclear

Anti Body (ANA) Titres, Double Stranded

(DS) DNA

Blood/Blood product

trasfusion, steroids, IVIG,

Cyclosporise A or Dinazole

14990Complete Blood Picture [CBP],

Case Sheet with treatment details

955 M4.7.1 G00.9 Medical Management of Pyogenic Meningitis CT-Scan , Lumbar Puncture CSF analysis,

Hemogram, Iron studies, Bone marrow

 IV dexamethasone for below 5

yr old children,

Anticonvulsants (midazolam

or lorazepam, Phenobarbitone

or Phenytoin), IV antibiotics

(Amoxycillin clavulanate

,ceftriaxone , Amikacin or

ofloxacin,vancomycin), IV

fluids, Paracetamol,

Ventilatory Support

 27980

Case sheet with clinical

improvement,  Repeat CSF, X-

Ray chest, Blood C/S

956 M4.7.2 A17.AMedical Management of Neuro Tuberculosis in

Paediatric patient

Brain CSF ADA analysis , CT-Scan, Blood

C/S, X-Ray chest, CT scan , Acid-Fast

Bacilli (AFB) Staining-

 IVMannitol, Anticonvulsants

(midazolam or lorazepam,

Phenobarbitone or Phenytoin),

IV antibiotics, IV

dexamethasone and oral

steroids, IV fluids, Nasogastric

tube feeds, Paracetamol, anti

tubercular therapy, ventilatory

support

 15000Case sheet with clinical

improvement,  Repeat CSF

Page 94: ANNEXURE-I CODE ICD CODE SYSTEM PREAUTHORISATION …

957 M4.7.3 A17.BMedical Management of Neuro Tuberculosis

With Ventilation in Paediatric patient

Brain CSF ADA analysis , CT-Scan, Blood

C/S, X-Ray chest, CT scan , Acid-Fast

Bacilli (AFB) Staining-Montoux test, ABG

 IVMannitol, Anticonvulsants

(midazolam or lorazepam,

Phenobarbitone or Phenytoin),

IV antibiotics, IV

dexamethasone and oral

steroids, IV fluids, Nasogastric

tube feeds, Paracetamol, anti

tubercular therapy, mechanical

ventilation SUPPORT

 25000Case sheet with clinical

improvement,  lab investigation

958 M4.7.4 A01.BMedical Management of Enteric Fever

Complicated in Paediatric patient

Blood Culture & Sensitivity - Automated,

USG Abdomen, Widal Test-, Temperature

Chart -

 Paracetamol, followed by oral

antibiotics ( Cefixime,

Ofloxacin), IV antibiotics

ceftriaxone, Amikacin ,

ofloxacin, IV fluids

 10733Case sheet with clinical

improvement,  lab investigation

959 M4.7.5 B50.0Medical Management of Cerebral Malaria

(Falciparum)

 Lumbar Puncture CSF analysis , Parasite

F Test and QBC

 IV antibiotics ceftriaxone,

Amikacin , ofloxacin, IV

artesunate, IV artesunate, IV

fluids, IV quinine, Mechanical

ventilation, Oral chloroquine,

blood and platelet transfusion,

mefloquine

 25000Case sheet with clinical

improvement,  lab investigation

960 M4.7.6 A36.BMedical Management of Diphtheria in

Paediatric patient

ECG (Electro Cardiogram) -3Times,

Throat Swab For KLB -3 Times, ECHO

Cardiogram ,Chest X-Ray PA View(1

Film) ,Renal Profile

Diph Anti toxin, Anti pyrelits,

IV fluids, Blood transfusion, in

CCF dijoxin, inj

Pencillin.Erithromycin

15000Case sheet with clinical

improvement

961 M4.8.1 G41.9

Medical Management of Convulsive

Disorders/Status Epilepticus (Fits)in Paediatric

patient

CSF analysis,EEG ,CT-Scan Brain ,

Serum Electrolytes, Serum Magnesium

Levels , Serum Calcium Levels , Serum

Phosphorus Levels

 Anticonvulsants, IV fluids,

Oxygen, ventilator 10000

Case sheet with clinical

improvement,  lab investigation

962 M4.8.2 G46Medical Management of Stroke Syndrome in

Paediatric patient 2D ECHO , ANGIOGRAM , CT , EEG

 Anti Epieptics, IV fluids, Low

molecular weight Heparin,

Oxygen

 20000

Post treatment CT,Case sheet

with clinical improvement,  lab

investigation

963 M4.8.3 G05Medical Management of Encephalitis /

Encephalopathy in Paediatric patient

 CT , Lumbar Puncture CSF analysis,Viral

studies

 Anticonvulsants, IV fluids,

Mannitol, inj.Acyclovir 25000

Viral studies,Case sheet with

clinical improvement,  lab

investigation

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964 M4.8.4 G61.0Medical Management of Guillian-Barre

Syndrome

 ABG , ENMG , Lumbar Puncture CSF

analysis , Nerve Conduction studies

 IV fluids, immunoglobin,

physiotherapy, ventilary and

supportive care

 80000Case sheet with clinical

improvement, lab investigation

M5 CARDIOLOGY

965 M5.1.1 I21.9.A

Medical Management of Acute Mi

(Conservative Management Without

Angiogram)

 2DEcho , CPKMB , Troponin, RFT,

S.Electrolytes, Daily ECG, STK chart

mandatory

 Medical  10000 2DEcho , ECG , Lab

Investigations

966 M5.1.2 I21.9.B Management Of Acute MI With Angiogram

 2DEcho , CPKMB , Coronary

Angiodraphy , Troponin, Daily ECG till

discharge, STK chart mandatory,

 Medical  30000 2DEcho , ECG , Lab

Investigations, STK vial photo

967 M5.1.3 I21.9.EMedical Management of Acute MI With

Cardiogenic Shock

 2DEcho CD, CPKMB , Coronary

Angiodraphy , ECG , Troponin, RFT,

S.Electrolytes, Daily ECG

 Medical  30000 2DEcho , ECG , Lab

Investigations

968 M5.1.4 I21.9.FMedical Management of Acute MI Requiring

IABP Pump

 2DEcho CD, CPKMB , Coronary

Angiodraphy , ECG , Troponin, RFT,

S.Electrolytes, Daily ECG, CXR on

flouroscopy showing in situ

 Medical  55000 2DEcho , ECG , Lab

Investigations

969 M5.1.5 I50.9.BMedical Management of Refractory Cardiac

Failure

 2DEcho CD(showing LVEF<35% or LV

disfunction), CPKMB , Coronary

Angiodraphy , ECG , Troponin, CXR, JVP

photo, RFT, S.Electrolytes, CAG CD and

report

 Medical  40000 2DEcho CD and Report, ECG ,

Lab Investigations

970 M5.2 I33.0 Medical Management of Infective Endocarditis

2D ECHO , Sepsis profile-I12.008, Blood

Culture & Sensitivity - Automated, C-

Reactive Protein, Pulse Oxymetry Chart

 Adrenaline, Dobutamine,

Dopamine, IV fluids, Inj.

Midazolam, Low molecular

weight Heparin, Mechanical

ventilation, Nonadrenaline,

Oxygen, inj. Meropenem,

inj.Heparin, inotropes,

milirinone

 25000

Case sheet with clinical

improvement ,Lab

Investigations, ABG , X-RAY ,

pulse oxymetry Chart

971 M5.3 I26 Medical Management of Pulmonary Embolism

CT Scan Chest With Contrast - I32.011,

Pulmonary Angiogram 2D ECHO With

Colour Doppler , D-Dimer Test

 Medical  35000 Color Doppler , Lung Ventilation

& Perfusion Scan-

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972 M5.4 I49.9.A Medical Management of Complex Arrhythmias2D ECHO With Colour Doppler With

Tracing, ECG , Procedure CD  Cartoguided  140000

2D ECHO , ECG , Lab

Investigations, RF Ablation/Carto

Mapping , Webex

973 M5.5 I49.9.B Ablation Therapy for Simple Arrythmias2D ECHO With Colour Doppler With

Tracing, ECG , Procedure CD  Focus Ablation  91000

2D ECHO , ECG , Lab

Investigations, RF Ablation/Carto

Mapping , Webex

974 M5.6 I31.3Medical Management of Pericardial Effusion,

Tamponade with¿Aspiration

 2D ECHO CD, Blood c/s , ECG,

Pericardial fluid analysis, CXR Aspiration  16000

 2D ECHO , ECG , Lab

Investigations,Chest X Ray

M6 NEPHROLOGY

975 M6.1 N17.A Medical Management of AKI

 2D ECHO , Calicum , ECG , Electolytes ,

HBSAG , HCD , HIV , Phosphate , RFT ,

S.Protein , USG , Urine protein , uric

acid,ABG

 Dialysis and supportive

therapy 19710 Renal Profile-I02.060

976 M6.2 N04.C Medical Management of Nephrotic Syndrome

 HIV , RFT , Serum Total Proteins

Levels,Spot PR/CR (Protein-Creatinine)

Ratio ,, 24 Hrs Urinary Protein, Anti

Nuclear Anti Body (ANA) Titres

 Immunosuppressive RX  16890  RFT , other lab investigation

977 M6.3 N17.9.BMedical Management of Rapidly Progressive

Renal Failure

Renal Profile, Serum Total Proteins

Levels,Serum Albumin Levels-, Anti

Nuclear Anti Body (ANA), Complement

Levels (C3, C4)-,Anti-DNA Antibodies

I15.018

 Medicines, Steroids parenteral  30766  RFT , other lab investigation

978 M6.4 N18.5Medical Management of Chronic Renal Failure

1 (Crf )

 24 hrs urine , HCV , Alb/Globulin ratio ,

HB Sag , RFT , S.Calcium , S.Protein ,

S.Uric acid , S.electrolytes , Spot

Urine/Creatinine ratio , X-Ray Chest

 Dialysis and supportive

therapy, Initial treatment 30870  RFT , other lab investigation

979 M6.5 N18.6.A Maintenance Hemodialysis For Crf

 24 hrs urine , Spot Urine/Creatinine ratio ,

2D ECHO , Alb/Globulin ratio , HB Sag ,

HCV , RFT , S.Calcium , S.Po4 , S.Protein

, S.Uric acid , S.electrolytes , X-Ray Chest

 Dialysis and supportive

therapy (Minimum of 10

dialysis)

 12500 HB%, RFT ,Dialysis chart

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980 M6.6 N00Medical Management of Acute Glomerulo

Nephritis

Renal Profile, LFT(liver function tests),

Complete Blood Picture [CBP], ECG

(Electro Cardiogram), USG Abdomen,

Blood Culture & Sensitivity - Automated,

CUE (pH , Specific Gravity , Sugar ,

Protein And Microscopy), Spot PR/CR

(Protein-Creatinine) Ratio, Anti-

Streptolysin O (ASO) Titres, ANA, ANCA

(Anti Neutrophil Cyto Plasmic Anti Body),

24 Hrs Urinary Protein

Antibiotics, Supportive

Management 26020

Renal Profile, CUE (pH , Specific

Gravity , Sugar , Protein And

Microscopy)

M7 NEUROLOGY

981 M7.1 G04.0 Medical Management of ADEM

 Evoked Potentials , CSF Monoclonal

Bands, , CSF analysis , HIV profile , MRI

Brain

 antacids, Dialysis and

supportive therapy (Minimum

of 8 dialysis), Inj.

Methylprednisolone, Oral

steroids for 4 weeks,

Ventilatory Support,

physiotherapy, supportive care,

vitamin supplementaion

 20000

 Case sheet with clinical

improvement ,clinical and lab

investigation

982 M7.2 G61.8Medical Management of Chronic Inflammatory

Demyelinating Polyneuropathy(CIDP)

 Carotid and vertebral Doppler etc. special

tests for Evaluation of cause ,

Echocardiography , Nerve Biopsy . , CSF

analysis , CT Brain , ECG , EMG , Lipid

profile , MRI Brain , MRV /MRA , NCS ,

Serum Protein electropheresis , repeated

blood tests for electrolytes and glucose

 Ajathioprine, Oral steroids,

physiotherapy, vitamin

supplementaion

 14340

 Case sheet with clinical

improvement ,clinical and lab

investigation

983 M7.3 I60Medical Management of Hemorrhagic

Stroke/Strokes(I61/I62/I63/I64)

 4-Vessel Cerebral Angio if necessary

(DSA) , CT BRAIN , Carotid and

Vertebral Doppler etc. , ECG ,

Enchocardiography , Lipid profile , MRA ,

MRI BRAIN , MRV , Special tests for

Evaluation of Cause

 Antidiabetics, IVMannitol,

Surgery if necessary, antacids,

Antihypertensives, IV fluids

 31030

 Case sheet with clinical

improvement ,clinical and lab

investigation

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984 M7.4 I63 Medical Management of Ischemic Strokes

 Carotid and vertebral Doppler etc. special

tests for Evaluation of cause ,

Echocardiography , CT Brain , ECG ,

Lipid profile , MRI Brain , MRV /MRA ,

repeated blood tests for electrolytes and

glucose

 Antidiabetics, IVMannitol,

antacids, Antihypertensives,

Heparanoids for 5 days, IV

fluids, surgery in some cases

 20000

 Case sheet with clinical

improvement ,clinical and lab

investigation

985 M7.5 G72 Medical Management of Acquired Myopathies

 Serum calcium , Muscle Biopsy , NCS,

/EMG , Phosphate and alkaline phophatase

, Serum CPK , endocrine evaluation

 Azathiaprine, Calcium

supplementation,

Prednisolone, endocrine

therapy, vitamin

supplementation

 19460

 Case sheet with clinical

improvement ,clinical and lab

investigation

986 M7.6 G02.1Medical Management of Neuroinfections -

Fungal Meningitis

 CSF serology for tuberculous antigens ,

ADA , CSF analysis , CT Brain , Cell

count , Fungal studies , MRI Brain scan ,

culture

 IVMannitol, antacids,

Antifungal drugs, IV fluids,

steroids

 54330

 Case sheet with clinical

improvement ,clinical and lab

investigation

987 M7.7 G00.9Medical Management of Neuroinfections -

Pyogenic Meningitis(Bacterial)

 ADA , CSF analysis , CT Brain , Cell

count , MRI Brain scan , culture

 IVMannitol, Surgery if

necessary, Higher antibiotics,

IV fluids, antacids, steroids

 27980

 Case sheet with clinical

improvement ,clinical and lab

investigation

988 M7.8 G05.1

Medical Management of Neuroinfections -Viral

Meningoencephalitis (Including Herpes

Encephalitis)

 ADA , CSF analysis , CSF antibodies for

HSV , CT Brain , Cell count , MRI Brain

scan , culture

 IVMannitol, Methyl

prednisolone, antacids, IV

fluids, acyclovir

 37520

 Case sheet with clinical

improvement ,clinical and lab

investigation

989 M7.9 G70.0Medical Management of Neuromuscular

disorders (Myasthenia Gravis)

 CT-Abdomen , CT-Chest , Neostgmine

test , RNS , Thyroid profile

 Azathiaprine, Calcium

supplementation,

Prednisolone, Ventilatory

Care, neostignime

 21350

 Case sheet with clinical

improvement ,clinical and lab

investigation

990 M7.10 G61.0Medical Management of Guillian-Barre

Syndrome

 ABG , ENMG , Lumbar Puncture CSF

analysis , Nerve Conduction studies

 IV fluids, immunoglobin,

physiotherapy, ventilary and

supportive care

 80000Case sheet with clinical

improvement, lab investigation

991 M7.11 H46 Medical Management of Optic Neuritis Lumbar Puncture CSF analysis , MRI

Brain and Optic nerves , VEPs

 antacids, Inj. Methyl

prednisolone, oral steroids for

2 weeks, vitamin

supplementation

 10890

 Case sheet with clinical

improvement ,clinical and lab

investigation

992 M7.12 99.14.1 Management with Immunoglobulin Therapy - Iv  Investigations indicative of diseases  -  100000

 Case sheet with clinical

improvement ,clinical and lab

investigation

M8 PULMONOLOGY

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993 M8.1 J47Medical Management of Bronchiectasis with

Repeated Hospitalisation>6per Year

 FOB - Procedure video, HRCT Chest ,

Spirometry , Sputum culture/BAL , drug

susceptability, Brochial Washing Culture

sensitivety, CXR PA view, CBP, ESR

 According to International

Guide lines 30000

CBP, ESR, CXR PA view, stable

clinical condition

994 M8.2 J85Medical Management of Lung Abscess ,Non

Resolving

 CT-Chest , FOB - Procedure video, HRCT

Chest, PUS c/s/ Bronchial washings c/s,

CXR PS view, CBP, ESR, Sputum for

AFB

Injectable Antibiotics,

Bronchial toilet 35000

CBP, ESR, CXR PA view, stable

clinical condition

995 M8.3 J93.9Medical Management of Pneumothorax

(Large/Recurrent)

 HRCT Chest , VATS, CXR Chest, CBP,

ESR

 Antimicrobials, MICU stay,

Oxygen, Pleuredesis if

required, Thoracostomy

 30000 CBP, ESR, CXR PA view

996 M8.4 J84.9Medical Management of Interstitial Lung

Diseases

FOB - Procedure video, 2D ECHO, HRCT

Chest, Spirometry, Collagen profile, BAL

report, CXR PA view, CBP, ESR, LFT,

RFT

 Antimicrobials if required,

MICU stay, Steroids,

Immunosuppressants O2

inhalation

 30000CBP, ESR, CXR PA view, stable

clinical condition

997 M8.5 J64 Medical Management of Pneumoconiosis

FOB - Procedure video + Report, 2D

ECHO, HRCT Chest, Collagen profile,

BAL report, CXR PA view,

 MICU stay, O2 inhalation,

Medical management 35000

CBP, ESR, CXR PA view, stable

clinical condition

998 M8.6 J96.9.AMedical Management of Acute Respiratory

Failure (Without Ventilator)

2D ECHO, ABG, CXR PA view, ECG,

CBP, ESR, Electrolytes, Sputum, FOB if

required

MICU stay, O2 inhalation,

NIV if required,

Antimicrobials.

 25000

CBP, ESR, CXR PA view, Daily

ABG reports, stable clinical

condition

999 M8.7 J96.9.BMedical Management of Acute Respiratory

Failure (With Ventilator)

2D ECHO, ABG, CXR PA view/Bedside

Electrolytes, ECG, Sputum, FOB if

required, LFT, RFT

MICU stay, Antimicrobials,

Oxygen, Supportive therapy 50000

CBP, ESR, CXR PA view, Daily

ABG reports, LFT, RFT, stable

clinical condition

1000 M8.8 J18.9 Medical Management of Pneumonias

Complete Blood Picture [CBP] ,

Erythrocyte Sedimentation Rate (ESR),

Random Blood Sugar (RBS) Test ,, Chest

X-Ray PA View(1 Film), Arterial Blood

Gas Analysis (ABG), C-Reactive Protein,

Sputum For Culture & Sensitivity, Fluid

for Fungal Stain, Aspirate For

Culture(Barium, Fungus, Anaerobic),

Blood Culture & Sensitivity

Antibiotics, IV fluids,

Supportive Management 30000

Chest X-Ray PA View(1 Film),

Complete Blood Picture [CBP], C-

Reactive Protein4

M9 DERMATOLOGY

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1001 M9.1 L10 Medical management of Pemphigus  DIF , Skin biopsy - HPE , Tzanck Smear IV antibiotics, IV fluids, IV

steroids, Pulse therapy 27770

 Case sheet with clinical

improvement ,clinical and lab

investigation

1002 M9.2 L51.2Medical management of Toxic Epidermal

Necrolysis

 Blood culture , Echo-Cardiogram , LFT ,

Skin biopsy - HPE, , Skin swab, , USG

abdomen , urine culture

 IV antibiotics, IV fluids, IV

steroids 37800

 Case sheet with clinical

improvement ,clinical and lab

investigation

1003 M9.3 L51.1Medical management of Stevens- Johnson

Syndrome

 Blood culture , Echo-Cardiogram , LFT ,

Skin biopsy - HPE , Skin swab, , USG

abdomen , urine culture

 IV antibiotics, IV fluids, IV

steroids 21656

 Case sheet with clinical

improvement ,clinical and lab

investigation

M10 RHEUMATOLOGY

1004 M10.1.1 M32Medical management of SLE (Systemic Lupus

Erythematosis)

 24 Hrs URINARY PROTEIN , ACL

ANTIBODIES , ANA PROFILE , EN

ANTIGEN , HR CT , KIDNEYBIOPSY ,

dSDNA, Antids DNA levels

 As per American College of

Rheumatology Guidelines. 25651

clinical and lab investigation,

CBP, RFT, Renal Biopsy

1005 M10.1.2 M32.1Medical management of Sle (Systemic Lupus

Erythematosis) with sepsisANA, Antids DNA levels  -  71250  clinical and lab investigation

1006 M10.2 L94.0 Medical management of Scleroderma

 2D ECHO , ANA PROFILE , RENAL

DOPPLER , SKIN BIOPSY WITH HPE

REPORT, Antitopoisomerace 1 ab,

anticentromere ab, anti RNP ab

 As per American College of

Rheumatology Guidelines. 30000 CBP, RFT, Biopsy

1007 M10.3 M35.1Medical management of Mctd Mixed

Connective Tissue Disorder

 24 Hrs URINARY PROTEIN , CPK ,

ENMG , KIDNEYBIOPSY , LDH , MRI

OF HANDS , MRI OF MUSCLES, Anti

RNP antibodies

 As per American College of

Rheumatology Guidelines. 25000 CBP, RFT, Biopsy

1008 M10.4 M35.0Medical management of Primary Sjogren\'S

Syndrome

 24 Hrs URINARY PROTEIN , ANA

PROFILE , CANCA , CPK , ENMG ,

KIDNEYBIOPSY , LDH , MRI OF

HANDS , MRI OF MUSCLES , pANCA,

Anti Ro ab, Anti La ab

 As per American College of

Rheumatology Guidelines. 20000 CBP, HCV, HIV

1009 M10.5 I77.9 Medical management of Vasculitis CBP, ESR, RFT As per American College of

Rheumatology Guidelines. 30000

HIV, HCV, Biopsy, RFT, CBP,

ESR

M11 ENDOCRINOLOGY

M11.1UNCONTROLLED DIABETES MELLITUS

WITH INFECTIOUS EMERGENCIES

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1010 M11.1.1 E11.2Medical management of Pyelonephritis in

uncontrolled Diabetes melitus

 USG , Urine C and S, FBS, PLBS, HB

A/C

 Antibiotics, IV fluids, other

therapy with treatment of

Diabetics

 21510FBS, PLBS, clinical and lab

investigation

1011 M11.1.2 J22Medical management of Lower Respiratoy Tract

Infection CXR , Sputum C/S, FBS, PLBS, HB A/C

 Antibiotics, IV fluids, other

therapy with treatment of

Diabetics

 23000FBS, PLBS, Chest X-Ray,

clinical and lab investigation

1012 M11.1.3 J32.9 Medical management of Fungal Sinusitis  CT PNS, FBS, PLBS, HB A/C

 Anti-fingal agents,

Antibiotics, IV fluids, other

therapy with treatment of

Diabetics

 40940X-Ray, PNS,  clinical and lab

investigation

1013 M11.1.4 K81 Medical management of Cholecystitis CT-Abdomen , USG, FBS, PLBS, HB

A/C, LFT

 Antibiotics, IV fluids, other

therapy with treatment of

Diabetics

 29700USG abdomen,  clinical and lab

investigation

1014 M11.1.5 E11.5Medical management of Cavernous Sinus

Thrombosis in uncontrolled Diabetes melitus MRI , Venogram, FBS, PLBS, HB A/C

 Antibiotics, IV fluids, other

therapy with treatment of

Diabetics

 41010  clinical and lab investigation

1015 M11.1.6 B46.1Medical management of Rhinocerebral

Mucormycosis CT-Scan, FBS, PLBS, HB A/C

 Anti-fingal agents,

Antibiotics, IV fluids, other

therapy with treatment of

Diabetics

 51620  clinical and lab investigation

M11.2 OTHER ENDOCRINAL DISORDERS

1016 M11.2.1 E23.1Initial evaluation and management of

Hypopituitarism with growth harmone

 FSH , LH , estradiol , t3 t4TSH ,

testosterone

 Hormone Therapy for three

months 26000  clinical and lab investigation

1017 M11.2.2 E22.0 Hormonal therapy for Pituitary - Acromegaly

 t3 t4TSH , 2D ECHO , Basal cortisal cost

ACTH , FSH , LH , MRI colonoscopy if

needed, , Post glucose on assay , Visual

field , estradiol , prolactin , testosterone ,

water deprivation test(if needed),

 Hormone Therapy for three

months 18440

ACTH assay, clinical and lab

investigation

1018 M11.2.3 E24.9 Medical Management of Cushings Syndrome

 ACTH assay , CT Chest , Cortisol assay

after dexamethasone , DHEAS , Dexa of

Hip spine , MRI pituitary CT ABD

 Diabetis mellitus drugs,

Hypertension, Osteoporesis,

infection with antibiotics,

surgery

 30000ACTH assay, clinical and lab

investigation

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1019 M11.2.4 Q96 / Q98.4

Hormonal therapy for Delayed Puberty

Hypogonadism-Turners Syndrome/Kleinfelter

Syndrome(Q98.4)

 testosterone , 2D ECHO , FSH , LH , MRI

brain DEXA , T4 TSH X-ray bone age ,

USG pelvis karyotyping , X-ray skull ,

estradiol

 Inj Testosterone250mg/ 3

wks, oc pills 14500  clinical and lab investigation

1020 M11.2.5 E23.1Hypopiturasim Initial Evaluation And

Management With Growth Hormone

T3, T4, TSH, Basal Cortisol Levels

(Adrenal Corticotrophin Stimulation Test),

Cortisol Assay After

Dexamethasone,Growth Hormone (Basal,

Post Glucose Load) ,

 Hormone Therapy for three

months

26000T4, Case sheet with clinical

improvement

1021 M11.2.6 E23.2Hypopiturasim Maintanance Phase Monthly

Package For Growth Hormone

T3, T4, TSH, Basal Cortisol Levels

(Adrenal Corticotrophin Stimulation Test),

Cortisol Assay After

Dexamethasone,Growth Hormone (Basal,

Post Glucose Load)

Harmone Therapy life long 13560T4,Case sheet with clinical

improvement

1022 M11.2.7 E05.0 Medical Management of Grave'S Disease T3, T4, TSH Antithypoid medication 10060 Case Sheet with treatment details

M12 GASTROENTEROLOGY

1023 M12.1 K22.1Medical management of Corrosive Oesophageal

Injury Endoscopic dilatation-video/photo  MICU stay, Medical treatment  21310  Barium swallow

1024 M12.2 K22.2Conservative management of Oesophageal

Foreign Body

 Foreign body removal - photo of the

procedure Conservative  7930  Endoscopic photograph

1025 M12.3 K22.3.AConservative management of Oesophageal

Perforation CT scan thorax,and abdomen,  Conservative, MICU stay  50000  -

1026 M12.4 K22.0 Medical management of Achalasia Cardia  UGI Endoscopy Botulinum, Dilatation, Taxim

inj. 13290  Endoscopic photograph

1027 M12.5 I85.1Medical Management of Oesophageal Varices

using Variceal Banding UGI Endoscopy  Endoscopic variceal banding  12190  Endoscopic photograph

1028 M12.6 I85Medical Management of Oesophageal Varices

with Sclerotherapy UGI Endoscopy

 Endoscopic sclerotherapy

injection 10100  Endoscopic photograph

1029 M12.7 J95.0 Medical management of Oesophageal Fistula  CT Thorax Gastrograffin contrast picture Covered esophageal stent -

MICU 30000  Photograph of stent in position

1030 M12.8 K31.8Medical management of GAVE(Gastric Antral

Vascular Ectasia)

 Argon laser coagulation , UGI

Endoscopyphoto Argon laser, MEDICAL  20000  Endoscopic photograph

1031 M12.9 I86.4 Medical management of Gastric Varices Endoscopic Glue injection , UGI

Endoscopy MICU  14900  Endoscopic photograph

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1032 M12.10 K85.AMedical management of Acute Pancreatitis

(Mild)

 CT-Abdomen + Pelvis , EUS , MRCP,

S.Amylase, lypase MICU  50000  Lab Investigations , USG

1033 M12.11 K85.BMedical management of Acute Pancreatitis

(Severe)

 CT-Abdomen + Pelvis, S.Electrolytes,

Serial ABG at admission and following O2

supplementaries

 MICU  150000  Lab Investigations , USG

1034 M12.12 K86.3.AConservative management of Acute Pancreatitis

With Pseudocyst (Infected)

 CT-Abdomen + Pelvis , EUS , Post

procedure USG

 Endoscopy drainage, MICU,

Percutaneous drainage,

surgical drainage

 30000  Lab Investigations , USG

1035 M12.13 K86.1Conservative management of Chronic

Pancreatitis with Severe Pain CT-Abdomen + Pelvis , EUS

 Celiac ganglion block,

Conservative, ERCP,

ERCP+Stenting, EUS guided,

MICU

 30000  Lab Investigations

1036 M12.14 K92.2.B Conservative management of Obscure GI Bleed BMFT , Capsule Endoscopy , Enteroscopy

biopsy Argon Laser Rx  50000  Endoscopic photograph

1037 M12.15 K72Conservative management of Cirrhosis with

Hepatic Encephalopathy

 Ascitic fluid analysis , UGI Endoscopy,

USG abdomen, S.animonia levels, LFT EVL-EST, MICU 10 days  40000  Lab Investigations

1038 M12.16 K76.7Medical management of Cirrhosis with Hepato

Renal Syndrome Reports of Serum Chemistry

 EVL-EST, MEDICAL, MICU

10 days 40000  Lab Investigations

1039 M12.17.1 K91.8 Medical management of Post op stent  ERCP , EUS , MRCP , PTBD  Biliary stent, MEDICAL  46830 Radiological and endoscopic

image

1040 M12.17.2 K91.9 Medical management of Post op leaks  ERCP , EUS , MRCP , PTBD  Biliary stent, MEDICAL  47300 Radiological and endoscopic

image

1041 M12.17.3 K83.0 Medical management of Sclerosing Cholangitis  ERCP , EUS , MRCP , PTBD  Biliary stent, MEDICAL  75000 Radiological and endoscopic

image

1042 M12.18 K74.6.A

Medical Management of Cirrhosis

Decompensated Including SBP, Portal HTN,

Bleed

LFT(liver function tests), USG Abdomen,

Upper GI endoscopy, Fluid Analysis, HBs

Ag, HCV Geno Type/HCV, Rna

Quantitative

Antibiotics, Betablockers,

Banding of varices, Lactulose,

Ritaximin

36870Case sheet with clinical History,

Case Sheet with treatment details

1043 M12.19 K75.9Medical Management of Acute Hepatitis (Viral,

Alcohol, Drugs, Misc. Infections)

LFT(liver function tests), USG Abdomen,

HBs Ag, HCV Geno Type /HCV, Rna

Quantitative, Anti-Endomysial Antibodies

,IgA/IgG/IgM, Anti-HAV IgM (IgM

Antibody To Hepatitis A Antigen), Case

sheet with clinical History

Supportive Mgmt, Antiviral

Drugs, Stop offending agent. 15000

LFT(liver function tests), Case

sheet with clinical improvement

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1044 M12.20 R18

Medical Management of Ascities Of Any

Etiology (Tubercolor, Melignant, Pancreatic,

Biliary)

USG Abdomen, Ascitic Fluid Analysis-

RoutineParacentesis, treat the cause 15010 Fluid Analysis