Specialty code |
Package Code |
Package name |
Package Amount per day (drop down) for admission type: Routine ward (Rs 1800)/ HDU (Rs (Rs 2700)/ ICU (without ventilator) (Rs 3600)/ ICU (with ventilator)(Rs 4500) |
Preauth Required or Not (Y/N): after 1st day, 5th day, 10 th day and every 5 day intervals |
Mandatory investigations for pre-auth |
Post-Op investigations for claims submission |
Average length of Stay (Including Days in intensive care units) |
Govt Reserved Procedure (Y/N) |
Medical (M) or Surgical (S) |
M2 |
0001 |
Diarrhoea |
|
N |
|
clinical notes |
|
N |
M |
M2 |
0002 |
Acute dysentery |
|
N |
|
clinical notes |
|
N |
M |
M2 |
0003 |
Pneumonia |
|
N |
|
clinical notes |
5 |
N |
M |
M2 |
0004 |
Urinary tract infection |
|
N |
|
clinical notes |
|
N |
M |
M2 |
0005 |
Acute Exacerbation of asthma |
|
N |
|
clinical notes |
|
N |
M |
M2 |
0006 |
Acute glomerulonephritis |
|
N |
|
clinical notes |
5 |
N |
M |
M2 |
0007 |
Acute urticaria/ Anaphylaxis acute asthma |
|
N |
|
clinical notes |
|
N |
M |
M2 |
0008 |
Poisonings with normal vital signs |
|
N |
|
clinical notes |
|
N |
M |
M2 |
0009 |
Febrile seizures/other seizures |
|
N |
|
clinical notes |
|
N |
M |
M2 |
0010 |
Epileptic encephalopathy |
|
N |
|
clinical notes |
|
N |
M |
M2 |
0011 |
Optic neuritis |
|
N |
|
clinical notes |
5 |
N |
M |
M2 |
0012 |
Aseptic meningitis |
|
N |
|
clinical notes |
|
N |
M |
M2 |
0013 |
Trauma |
|
N |
|
clinical notes |
|
N |
M |
M2 |
0014 |
Pyrexia of unexplained origin |
|
N |
|
clinical notes |
|
N |
M |
M2 |
0015 |
Chronic cough |
|
N |
|
clinical notes |
D |
N |
M |
M2 |
0016 |
Wheezing |
|
N |
|
clinical notes |
|
N |
M |
M2 |
0017 |
Unexplained seizures |
|
N |
|
clinical notes |
D |
N |
M |
M2 |
0018 |
Global developmental delay/ Intellectual disability of unknown etiology |
|
N |
|
clinical notes |
D |
N |
M |
M2 |
0019 |
Dysmorphic children |
|
N |
|
clinical notes |
D |
N |
M |
M2 |
0020 |
Rickets |
|
N |
|
clinical notes |
D |
N |
M |
M2 |
0021 |
Unexplained severe anemia |
|
N |
|
clinical notes |
|
N |
M |
M2 |
0022 |
Short stature |
|
N |
|
clinical notes |
D |
N |
M |
M2 |
0023 |
Musculoskeletal problems |
|
N |
|
clinical notes |
D |
N |
M |
M2 |
0024 |
Developmental and behavioral disorders |
|
N |
|
clinical notes |
D |
N |
M |
M2 |
0025 |
Diabetic ketoacidosis |
|
N |
|
clinical notes |
|
N |
M |
M2 |
0026 |
Nephrotic syndrome with peritonitis |
|
N |
|
clinical notes |
|
N |
M |
M2 |
0027 |
Pyogenic meningitis |
|
N |
|
clinical notes |
|
N |
M |
M2 |
0028 |
Persistent/ Chronic diarrhea |
|
N |
|
clinical notes |
|
N |
M |
M2 |
0029 |
Acute severe malnutrition |
|
N |
|
clinical notes |
|
N |
M |
M2 |
0030 |
Dengue |
|
N |
|
clinical notes |
|
N |
M |
M2 |
0031 |
Enteric fever |
|
N |
|
clinical notes |
|
N |
M |
M2 |
0032 |
Chikungunya |
|
N |
|
clinical notes |
|
N |
M |
M2 |
0033 |
Acute hepatitis |
|
N |
|
clinical notes |
|
N |
M |
M2 |
0034 |
Kala azar |
|
N |
|
clinical notes |
|
N |
M |
M2 |
0035 |
Tuberculosis |
|
N |
|
clinical notes |
|
N |
M |
M2 |
0036 |
HIV with complications |
|
N |
|
clinical notes |
|
N |
M |
M2 |
0037 |
Infantile cholestasis |
|
N |
|
clinical notes |
|
N |
M |
M2 |
0038 |
Haemolytic uremic syndrome |
|
N |
|
clinical notes |
|
N |
M |
M2 |
0039 |
ITP |
|
N |
|
clinical notes |
|
N |
M |
M2 |
0040 |
Juvenile myasthenia |
|
N |
|
clinical notes |
|
N |
M |
M2 |
0041 |
Kawasaki Disease |
|
N |
|
clinical notes |
|
N |
M |
M2 |
0042 |
Persistent pneumonia |
|
N |
|
clinical notes |
|
N |
M |
M2 |
0043 |
Empyema |
|
N |
|
clinical notes |
|
N |
M |
M2 |
0044 |
Immune haemolytic anemia |
|
N |
|
clinical notes |
|
N |
M |
M2 |
0045 |
Cyanotic spells |
|
N |
|
clinical notes |
|
N |
M |
M2 |
0046 |
Rheumatic fever |
|
N |
|
clinical notes |
|
N |
M |
M2 |
0047 |
Rheumatoid arthritis |
|
N |
|
clinical notes |
|
N |
M |
M2 |
0048 |
Encephalitis |
|
N |
|
clinical notes |
10-15 DAYS |
N |
M |
M2 |
0049 |
Chronic meningitis |
|
N |
|
clinical notes |
10-15 DAYS |
N |
M |
M2 |
0050 |
Intracranial ring enhancing lesion with complication (neurocysticercosis, tuberculoma) |
|
N |
|
clinical notes |
|
N |
M |
M2 |
0051 |
Refractory seizures |
|
N |
|
clinical notes |
|
N |
M |
M2 |
0052 |
Floppy infant |
|
N |
|
clinical notes |
|
N |
M |
M2 |
0053 |
Acute neuroregression |
|
N |
|
clinical notes |
|
N |
M |
M2 |
0054 |
Neuromuscular disorders |
|
N |
|
clinical notes |
|
N |
M |
M2 |
0055 |
Opsoclonus myoclonus syndrome |
|
N |
|
clinical notes |
|
N |
M |
M2 |
0056 |
Acute ataxia |
|
N |
|
clinical notes |
|
N |
M |
M2 |
0057 |
Steven Johnson syndrome |
|
N |
|
clinical notes |
|
N |
M |
M2 |
0058 |
Metabolic encephalopathy |
|
N |
|
clinical notes |
|
N |
M |
M2 |
0059 |
Ketogenic diet initiation in refractory epilepsy |
|
N |
|
clinical notes |
|
N |
M |
M2 |
0060 |
Inborn errors of metabolism |
|
N |
|
clinical notes |
|
N |
M |
M2 |
0061 |
Wilson’s disease |
|
N |
|
clinical notes |
|
N |
M |
M2 |
0062 |
Celiac disease |
|
N |
|
clinical notes |
|
N |
M |
M2 |
0063 |
Unexplained jaundice |
|
N |
|
clinical notes |
|
N |
M |
M2 |
0064 |
Unexplained hepatosplenomegaly |
|
N |
|
clinical notes |
|
N |
M |
M2 |
0065 |
Severe pneumonia |
|
N |
|
clinical notes |
|
N |
M |
M2 |
0066 |
Severe exacerbation of asthma |
|
N |
|
clinical notes |
|
N |
M |
M2 |
0067 |
Acute kidney injury |
|
N |
|
clinical notes |
|
N |
M |
M2 |
0068 |
Poisonings |
|
N |
|
clinical notes |
|
N |
M |
M2 |
0069 |
Serious trauma with unstable vitals |
|
N |
|
clinical notes |
|
N |
M |
M2 |
0070 |
Upper GI hemorrhage |
|
N |
|
clinical notes |
|
N |
M |
M2 |
0071 |
Lower GI hemorrhage |
|
N |
|
clinical notes |
|
N |
M |
M2 |
0072 |
Acute abdomen |
|
N |
|
clinical notes |
|
N |
M |
M2 |
0073 |
Liver abscess |
|
N |
|
clinical notes |
|
N |
M |
M2 |
0074 |
Complicated malaria |
|
N |
|
clinical notes |
|
N |
M |
M2 |
0075 |
Severe dengue with shock |
|
N |
|
clinical notes |
|
N |
M |
M2 |
0076 |
Congestive cardiac failure |
|
N |
|
clinical notes |
|
N |
M |
M2 |
0077 |
Brain abscess |
|
N |
|
clinical notes |
|
N |
M |
M2 |
0078 |
Acute encephalitic syndrome |
|
N |
|
clinical notes |
|
N |
M |
M2 |
0079 |
Acute demyelinating myelopathy, |
|
N |
|
clinical notes |
|
N |
M |
M2 |
0080 |
Immune mediated CNS disorders such as autoimmune encephalitis |
|
N |
|
clinical notes |
|
N |
M |
M2 |
0081 |
Acute transverse myelitis |
|
N |
|
clinical notes |
|
N |
M |
M2 |
0082 |
Guillain Barre Syndrome |
|
N |
|
clinical notes |
|
N |
M |
M2 |
0083 |
Hydrocephalus |
|
N |
|
clinical notes |
|
N |
M |
M2 |
0084 |
Intracranial space occupying lesion |
|
N |
|
clinical notes |
|
N |
M |
M2 |
0085 |
Cerebral malaria |
|
N |
|
clinical notes |
|
N |
M |
M2 |
0086 |
Acute ischemic stroke |
|
N |
|
clinical notes |
|
N |
M |
M2 |
0087 |
Cerebral sino-venous thrombosis |
|
N |
|
clinical notes |
|
N |
M |
M2 |
0088 |
Respiratory failure due to any causes (pneumonia, asthma, foreign body, poisoning, head injury etc.) |
|
N |
|
clinical notes |
|
N |
M |
M2 |
0089 |
Acute transverse myelitis |
|
N |
|
clinical notes |
|
N |
M |
M2 |
0090 |
Acute encephalitis –infectious/immune-mediated |
|
N |
|
clinical notes |
|
N |
M |
M2 |
0091 |
Convulsive & non convulsive status epilepticus |
|
N |
|
clinical notes |
|
N |
M |
M2 |
0092 |
Cerebral herniation |
|
N |
|
clinical notes |
|
N |
M |
M2 |
0093 |
Intracranial hemorrhage |
|
N |
|
clinical notes |
|
N |
M |
M2 |
0094 |
Hepatic encephalopathy |
|
N |
|
clinical notes |
|
N |
M |
M2 |
0095 |
Complicated bacterial meningitis |
|
N |
|
clinical notes |
|
N |
M |
M2 |
0096 |
Raised intracranial pressure |
|
N |
|
clinical notes |
|
N |
M |
M2 |
0097 |
Hypertensive encephalopathy |
|
N |
|
clinical notes |
|
N |
M |
M2 |
0098 |
CRRT (pre-auth) |
|
N |
|
clinical notes |
|
N |
M |
M2 |
0099 |
Blood and blood component transfusion (admission for a diagnostic procedure leading to treatment requiring admission, e.g. bone marrow and bone biopsy, endoscopy, liver biopsy, bronchoscopy, CT/MRI under GA, broncho-alveolar lavage, lumbar puncture, muscle biopsy, FNAC, pleural aspiration, ascitic tapping, neostigmine challenge test etc.) |
|
|
|
clinical notes |
|
N |
M |
M2 |
0100 |
Blood and blood component transfusion for indications like Thalassemia/Hemoglobinopathies- |
|
|
|
clinical notes |
|
N |
M |
M2 |
0101 |
Unspecified Medical Package |
|
on pre-auth from day 1 |
clinical notes |
clinical notes |
|
N |
M |
M2 |
0102 |
High end radiological diagnostic (CT, MRI, Imaging including nuclear imaging) - can only be clubbed with medical package. Rs 5000 per annum limit to a family |
5000 |
Y |
clinical notes |
clinical notes |
|
N |
M |
M2 |
0103 |
High end histopathology (Biopsies) and advanced serology investigations - can only be clubbed with medical package. Rs 5000 per annum limit to a family |
5000 |
Y |
clinical notes |
clinical notes |
|
N |
M |