CODE MAIN CATEGORY Sub SUB CATEGORY NAME CODE SURGERY / THERAPY DESCRIPTION PROCEDURE PACKAGE SPECIAL INVESTIGATION

PROCEDURE PACKAGE SPECIAL INVESTIGATION POST OPERATIVE PROCEDURE INVESTIGATION TREATMENT PROTOCOL
Category ID TYPE AMOUNT
S1 GENERAL SURGERY S1 GENERAL SURGERY S1.21 Treatment with Self Expanding Metalic Stent (SEMS) IP 20420 High Resolution CT Chest,Venous Doppler,ECHO Cardiogram Biopsy report,CT Scan Scan,USG -
S1 GENERAL SURGERY S1 GENERAL SURGERY S1.21.2 MANAGEMENT OF TRAUMA WITH LACERATION DC 3600 Clinical photo postop scar,treatment photo -
S1 GENERAL SURGERY S1.1 HEAD and NECK S1.1.1.1 Excision of Branchial Cyst IP 24629 Clinical Photograph Clinical Photograph,Biopsy -
S1 GENERAL SURGERY S1.1 HEAD and NECK S1.1.1.10 Excision of Cervical Rib IP 27584 Color Doppler,X-RAY Color Doppler,X-RAY -
S1 GENERAL SURGERY S1.1 HEAD and NECK S1.1.1.11 Removal Of Submandibular Salivary Gland IP 25737 FNAC,Clinical Photograph Clinical Photograph,Biopsy -
S1 GENERAL SURGERY S1.1 HEAD and NECK S1.1.1.12 Parotid Duct Repair IP 26835 Silography Silography -
S1 GENERAL SURGERY S1.1 HEAD and NECK S1.1.1.13 Superficial Parotoidectomy(Non-malignant) IP 21817 Clinical Photograph ,USG Neck,Fine Needle Aspiration Cytology (FNAC) Intra OP photo,Post OP HPE -
S1 GENERAL SURGERY S1.1 HEAD and NECK S1.1.1.14 Surgical treatment for Cut Throat Injury IP 33280 Superficia/deep,Contrast Enhanced USG,X-Ray,Clinical Photograph Operative Photos,Clinical Photograph -
S1 GENERAL SURGERY S1.1 HEAD and NECK S1.1.1.15 Aneurysm not Requiring Bypass Techniques t IP 36000 CT ANGIO/MRI report,Clinical Photograph Post OP color doppler report,Intra OP Photo,Scar Photo -
S1 GENERAL SURGERY S1.1 HEAD and NECK S1.1.1.16 Thrombendarterectomy IP 15000 COLOR DOPPER SCAN report,Clinical Photograph COLOR DOPPER SCAN report,Intra Op Photo,Scar Photo -
S1 GENERAL SURGERY S1.1 HEAD and NECK S1.1.1.17 Submandibular Gland Excision IP 20000 FNAC,Clinical Photograph,USG Biopsy report,Intra Op Photo,SCAR Photo -
S1 GENERAL SURGERY S1.1 HEAD and NECK S1.1.1.18 Aspiration of Empyema with ICD IP 5000 X-RAY CHEST,Clinical Photograph X-RAY CHEST,Clinical Photograph -
S1 GENERAL SURGERY S1.1 HEAD and NECK S1.1.1.19 Laryngectomy and Pharyngeal Diverticulum (Throat) IP 40000 Biopsy,Clinical Photograph,ENDOSCOPY report Biopsy,Intra Op Photo,Scar Photo -
S1 GENERAL SURGERY S1.1 HEAD and NECK S1.1.1.2 Excision of Branchial Sinus IP 24629 Clinical Photograph Clinical Photograph,Biopsy -
S1 GENERAL SURGERY S1.1 HEAD and NECK S1.1.1.20 Branchial fistula excision IP 15300 USG NECK,CLINICAL PHOTO POST OP HPE,POST OP SCAR,INTRAOP PHOTOS -
S1 GENERAL SURGERY S1.1 HEAD and NECK S1.1.1.21 Thyroglossal sinus/ fistula/ cyst excision IP 15300 TFT,SINOGRAPHY,CLINICAL PHOTOGRAPH INTRA OP PHOTOS,POST OP HPE,POST OP SCAR,CASE SHEET -
S1 GENERAL SURGERY S1.1 HEAD and NECK S1.1.1.3 Excision of Carotid Body Tumours IP 34819 U S Neck,Clinical Photograph Clinical Photograph,Biopsy -
S1 GENERAL SURGERY S1.1 HEAD and NECK S1.1.1.4 Excision of Cystic Hygroma -Extensive IP 23849 Clinical Photograph Clinical Photograph,Biopsy -
S1 GENERAL SURGERY S1.1 HEAD and NECK S1.1.1.5 Excision of Cystic Hygroma -Major IP 24629 Clinical Photograph Clinical Photograph,Biopsy -
S1 GENERAL SURGERY S1.1 HEAD and NECK S1.1.1.6 Cystic Hygroma Excision-Minor IP 10262 Clinical Photograph Clinical Photograph,Biopsy -
S1 GENERAL SURGERY S1.1 HEAD and NECK S1.1.1.7 Excision of Lingual Thyroid IP 30786 Isotope Scan,Clinical Photograph Clinical Photograph,Biopsy -
S1 GENERAL SURGERY S1.1 HEAD and NECK S1.1.1.8 Parathyroidectomy -Non Malignant IP 30786 USG Clinical Photograph,Biopsy -
S1 GENERAL SURGERY S1.1 HEAD and NECK S1.1.1.9 Excision of Thyroglossal Cyst Fistula IP 30786 Radionucleide Scan,Clinical Photograph Clinical Photograph,Biopsy -
S1 GENERAL SURGERY S1.1 HEAD and NECK S1.1.2.1 Hemimandibulectomy IP 43901 X-RAY X-RAY -
S1 GENERAL SURGERY S1.1 HEAD and NECK S1.1.2.2 Segmental Mandible Excision IP 35646 X-RAY X-RAY -
S1 GENERAL SURGERY S1.1 HEAD and NECK S1.1.3.1 Partial Glossectomy IP 27344 Clinical Photograph Clinical Photograph,Biopsy -
S1 GENERAL SURGERY S1.1 HEAD and NECK S1.1.4.1 ABBE Operation IP 20524 Clinical Photograph Clinical Photograph -
S1 GENERAL SURGERY S1.1 HEAD and NECK S1.1.4.2 Vermilionectomy IP 21724 Clinical Photograph Clinical Photograph -
S1 GENERAL SURGERY S1.1 HEAD and NECK S1.1.4.3 Wedge Excision of LipandVermilionectomy(27.43) IP 18194 Clinical Photograph Clinical Photograph,Biopsy -
S1 GENERAL SURGERY S1.1 HEAD and NECK S1.1.4.4 Wedge Excision of Lip IP 15116 Clinical Photograph Clinical Photograph,Biopsy -
S1 GENERAL SURGERY S1.1 HEAD and NECK S1.1.5.1 Hemithyroidectomy IP 25655 T F T,FNAC,USG Clinical Photograph,Biopsy -
S1 GENERAL SURGERY S1.1 HEAD and NECK S1.1.5.1.1 Laproscopic Hemi Thyroidectomy IP 29072 Clinical Photograph,t3 t4TSH,USG Neck,Fine Needle Aspiration Cytology (FNAC) WEBEX ,Post OP HPE -
S1 GENERAL SURGERY S1.1 HEAD and NECK S1.1.5.2 Isthmectomy IP 24936 T F T,FNAC,USG Clinical Photograph,Biopsy -
S1 GENERAL SURGERY S1.1 HEAD and NECK S1.1.5.2.1 Laproscopic Isthmectomy IP 29421 Clinical Photograph,t3 t4TSH,USG Neck,Fine Needle Aspiration Cytology (FNAC) Routine Histopathological Examination -
S1 GENERAL SURGERY S1.1 HEAD and NECK S1.1.5.3 Partial Thyroidectomy IP 24844 T F T,FNAC,USG Clinical Photograph,Biopsy -
S1 GENERAL SURGERY S1.1 HEAD and NECK S1.1.5.4 Resection Enucleation - Thyroid IP 25655 T F T,FNAC,USG Clinical Photograph,Biopsy -
S1 GENERAL SURGERY S1.1 HEAD and NECK S1.1.5.5 Subtotal Thyroidectomy IP 28734 T F T,FNAC,USG Clinical Photograph,Biopsy -
S1 GENERAL SURGERY S1.1 HEAD and NECK S1.1.5.5.1 Laproscopic Sub total Thyroidectomy IP 28508 Fine Needle Aspiration Cytology (FNAC),t3 t4TSH,USG Neck WEBEX ,Post OP HPE -
S1 GENERAL SURGERY S1.1 HEAD and NECK S1.1.5.6 Total Thyroidectomy IP 30786 T F T,FNAC,USG Clinical Photograph,Biopsy -
S1 GENERAL SURGERY S1.1 HEAD and NECK S1.1.5.6.1 Laproscopic Total Thyroidectomy IP 29565 Clinical Photograph,t3 t4TSH,USG Neck,Fine Needle Aspiration Cytology (FNAC) WEBEX ,Post OP HPE -
S1 GENERAL SURGERY S1.1 HEAD and NECK S1.1.5.7 Laproscopic Thyroid Nodule Excision IP 25970 USG Neck,T3,T4,TSH WEBEX,Routine Histopathological Examination -
S1 GENERAL SURGERY S1.1 HEAD and NECK S1.1.6.1 INFECTED SCALP WOUND IP 4300 CBP,Clinical photo Scar photo -
S1 GENERAL SURGERY S1.1 HEAD and NECK S1.1.6.2 MULTIPLE LACERATION OVER SCALP B/L IP 9400 CT,CT BRAIN,NA,K,CBP,LIVER,BT K,CBP,NA -
S1 GENERAL SURGERY S1.10 Foreign Body Removal(Deep S1.10.1 Foreign Body Removal in Peripheral Region(C ARM guided) IP 10000 X-RAY ,Clinical Photograph POST OP X-RAY SCAR Photo,Intra Op Photo -
region)
S1 GENERAL SURGERY S1.10 Foreign Body Removal(Deep S1.10.2 Foreign Body Removal in Deep Region IP 28620 Clinical Photograph,Contrast Enhanced USG,CT local Area CT local Area,Contrast Enhanced USG -
region)
S1 GENERAL SURGERY S1.10 Foreign Body Removal(Deep S1.10.3 Surgical Management of Superficial Penile Injuries ST 4000 Clinical Photograph,CT Scan Of Lower Abdomen & Scrotum/Doppler And Scrotum & Testes,USG Penis USG Penis, Scar Photo,CT Scan Of Lower Abdomen & Scrotum -
region)
S1 GENERAL SURGERY S1.11 GRANULOMA S1.11.1 Excision of Granuloma / Pyogenic Granuloma IP 9910 Clinical Photograph,Contrast Enhanced USG Operative Photos,Routine Histopathological Examination -
S1 GENERAL SURGERY S1.11 GRANULOMA S1.11.2 Excision of Pyogenic Granuloma IP 7710 RBS,Fine Needle Aspiration Cytology (FNAC),Clinical Photograph Clinical Photograph,Routine Histopathological Examination,Scar Photo -
S1 GENERAL SURGERY S1.12 Excision and Grafting (Skin) S1.12.1 Excision of Keloid IP 25300 RBS,Clinical Photograph Clinical Photograph,Routine Histopathological Examination,Operative Photos -
S1 GENERAL SURGERY S1.12 Excision and Grafting (Skin) S1.12.2 Surgical treatment for Carbuncle back IP 5000 RBS,Clinical Photograph Operative Photos,Clinical Photograph -
S1 GENERAL SURGERY S1.12 Excision and Grafting (Skin) S1.12.3 Exision of Scalp and frantonasan / Peripheral region IP 10380 Clinical Photograph,Fine Needle Aspiration Cytology (FNAC) Clinical Photograph,Routine Histopathological Examination,Intra OP Photos -
S1 GENERAL SURGERY S1.12 Excision and Grafting (Skin) S1.12.4 Exicision of binign lisions IP 12000 RBS,Fine Needle Aspiration Cytology (FNAC),Clinical Photograph Intra OP Photo,Routine Histopathological Examination -
S1 GENERAL SURGERY S1.12 Excision and Grafting (Skin) S1.12.5.1 Free Grafts - Wolfe Grafts IP 14000 Clinical Photograph Post op Photo,USG/FNAC -
S1 GENERAL SURGERY S1.12 Excision and Grafting (Skin) S1.12.5.2 Split thickness skin grafts – Large (> 8% TBSA) IP 25000 Clinical Photograph Operative Photos,clinical notes,Scar Photo -
S1 GENERAL SURGERY S1.12 Excision and Grafting (Skin) S1.12.5.3 Split thickness skin grafts – Medium (4 - 8% TBSA) IP 20000 Clinical Photograph Operative Photos,clinical notes,Scar Photo -
S1 GENERAL SURGERY S1.12 Excision and Grafting (Skin) S1.12.5.4 Split thickness skin grafts – Small (< 4% TBSA) IP 15000 Clinical Photograph Operative Photos,clinical notes,Scar Photo -
S1 GENERAL SURGERY S1.12 Excision and Grafting (Skin) S1.12.5.5 Excision and Skin Graft of Venous Ulcer IP 20000 Clinical Photograph,Operative notes with steps of surgery POST OP SCAR Photo,Operative notes with steps of surgery,Intra Op Photo -
S1 GENERAL SURGERY S1.12 Excision and Grafting (Skin) S1.12.5.6 Release of fibrous bands and grafting -in (OSMF) treatment IP 15000 Clinical assessment and investigations Scar Photo,Clinical assessment and investigations -
under GA
S1 GENERAL SURGERY S1.12 Excision and Grafting (Skin) S1.12.5.7 Skin Grafting IP 20000 Clinical Photograph Scar Photo,Intra Op Photo -
S1 GENERAL SURGERY S1.12 Excision and Grafting (Skin) S1.12.6 Soft Tissue Tumor (small) – Excision IP 5000 FNAC,Clinical Photograph Scar Photo,Intra Op Photo,Biopsy -
S1 GENERAL SURGERY S1.12 Excision and Grafting (Skin) S1.12.7 Debridement of Large Ulcer-Leprosy (5cm to 10 cm) IP 5000 Clinical Photograph Post Clinical Photo,Intra Op Photo,Biopsy -
S1 GENERAL SURGERY S1.12 Excision and Grafting (Skin) S1.12.7.1 CHRONIC NON HEALING ULCER - VACCUM IP 8000 clinical photos intra op photos Showing reduction in ulcer size -
S1 GENERAL SURGERY S1.12 Excision and Grafting (Skin) S1.12.8.1 Operation for carcinoma lip- cheek advancement/ Wedge IP 26800 Clinical picture,Clinical Photograph,Biopsy report POST OP SCAR Photo,Intra Op Photo,Biopsy report -
Excision/ Wedge Excision and Vermilionectomy

S1 GENERAL SURGERY S1.13 Excision of Dermal Growths S1.13.1.1 Haemangioma – Excision (small) IP 5000 USG/DOPPLER,Clinical Photograph Scar Photo,Intra Op Photo,Biopsy -
S1 GENERAL SURGERY S1.13 Excision of Dermal Growths S1.13.1.2 Haemangioma – Excision (large) IP 10000 Color Doppler SCAN,Clinical Photograph SCAR Photo,Intra Op Photo,Biopsy report -
S1 GENERAL SURGERY S1.13 Excision of Dermal Growths S1.13.2 Drainage of Abscess IP 5000 Clinical Photograph,Contrast Enhanced USG Scar Photo,Clinical Photograph,Operative Photos -
S1 GENERAL SURGERY S1.13 Excision of Dermal Growths S1.13.2.1 Laproscopic Surgical treatment for Laporoscopic / Open Intra IP 35000 USG Abdomen/CT scan Lower Abdomen Without Contrast/CT Scan Abdomen Without Contrast/CT Scan Abdomen WEBEX,USG Abdomen,Routine Histopathological Examination -
Abdominal Abscess With Contrast
S1 GENERAL SURGERY S1.13 Excision of Dermal Growths S1.13.3.1 Excision of Small Swelling in Hand DC 10780 USG,X-Ray,Clinical Photograph Biopsy report,Routine Histopathological Examination,X-Ray,INTRA OP PhotoS,Scar Photo -

S1 GENERAL SURGERY S1.13 Excision of Dermal Growths S1.13.3.10 Adventious Burse – Excision IP 10000 USG,Clinical Photograph USG,Intra Op Photo,Biopsy report SCAR Photo -
S1 GENERAL SURGERY S1.13 Excision of Dermal Growths S1.13.3.11 Lipoma excision DC 4000 USG/CT Intra OP Photos,USG/CT/Routine Histopathological Examination,Scar -
S1 GENERAL SURGERY S1.13 Excision of Dermal Growths S1.13.3.12 Cystic Mass – Excision DC 4000 USG/FNAC,Clinical Photograph Biopsy report,Intra OP Photo,SPECIMEN Photo -
S1 GENERAL SURGERY S1.13 Excision of Dermal Growths S1.13.3.13 Swelling in foot (small) – Excision DC 4000 clinical notes Operative Photos,clinical notes,Scar Photo -
S1 GENERAL SURGERY S1.13 Excision of Dermal Growths S1.13.3.14 Excision of Sebaceous Cyst DC 4000 Clinical Photograph,Fine Needle Aspiration Cytology (FNAC),RBS Scar Photo,Routine Histopathological Examination,Clinical Photograph -
S1 GENERAL SURGERY S1.13 Excision of Dermal Growths S1.13.3.15 Excision of Ganglion - large DC 4000 X-Ray,Clinical Photograph Scar Photo,Routine Histopathological Examination,Clinical Photograph -
S1 GENERAL SURGERY S1.13 Excision of Dermal Growths S1.13.3.16 Bursa – Excision IP 4000 Clinical Photograph,USG/FNAC Scar Photo,USG/FNAC,INTRA Op Photo,Biopsy -
S1 GENERAL SURGERY S1.13 Excision of Dermal Growths S1.13.3.2 Excision of Large Swelling in Hand (more than 2 cms) DC 5000 USG,X-Ray,Clinical Photograph Biopsy report,Routine Histopathological Examination,X-Ray,INTRA OP PhotoS -
S1 GENERAL SURGERY S1.13 Excision of Dermal Growths S1.13.3.3 Excision of Fibro Lipoma DC 8950 Clinical Photograph,Contrast Enhanced USG,X-Ray Scar Photo,Routine Histopathological Examination -
S1 GENERAL SURGERY S1.13 Excision of Dermal Growths S1.13.3.4 Excision of Small Dermoid Cyst DC 6930 Clinical Photograph,Fine Needle Aspiration Cytology (FNAC) Operative Photos,Routine Histopathological Examination,Clinical Photograph -
S1 GENERAL SURGERY S1.13 Excision of Dermal Growths S1.13.3.5 Excision of Corn DC 5420 Clinical Photograph Operative Photos,Routine Histopathological Examination,Clinical Photograph,Scar Photo -

S1 GENERAL SURGERY S1.13 Excision of Dermal Growths S1.13.3.6 Excision of swelling Neck DC 11140 Clinical Photograph,Fine Needle Aspiration Cytology (FNAC),USG Neck Scar Photo,Routine Histopathological Examination -
S1 GENERAL SURGERY S1.13 Excision of Dermal Growths S1.13.3.7 Excision of Swelling in Right Cervical Region DC 5000 USG/FNAC,Clinical Photograph Biopsy report,Intra OP Photo,SPECIMEN Photo -
S1 GENERAL SURGERY S1.13 Excision of Dermal Growths S1.13.3.8 Swelling in foot (large) – Excision DC 4000 colonoscopy/not required(clinical Photos,X-RAY) Biopsy,Intra OP Photo,POST OF X-RAY -
S1 GENERAL SURGERY S1.13 Excision of Dermal Growths S1.13.3.9 Excision of Neurofibroma IP 5000 Clinical photograph showing more than 3 leisions,Clinical Photograph,FNAC,Café-au-lat spots Biopsy report,Intra Op Photo,SCAR Photo -
S1 GENERAL SURGERY S1.13 Excision of Dermal Growths S1.13.4 Ganglion Sclerotherapy DC 2000 Clinical Photograph Intra OP Photos -
S1 GENERAL SURGERY S1.13 Excision of Dermal Growths S1.13.5 Surgical treatment for Infected Bunion Foot DC 4000 Clinical Photograph,X- Ray Foot Operative Photos,X- Ray Foot,Clinical Photograph,Scar Photo -
S1 GENERAL SURGERY S1.13 Excision of Dermal Growths S1.13.6 Congential Arteriovenus Fistula (small) IP 10000 Color Doppler SCAN,Clinical Photograph SCAR Photo,Intra Op Photo,Post Op color Doppler report -
S1 GENERAL SURGERY S1.13 Excision of Dermal Growths S1.13.7 Congential Arteriovenus mall formation (large) IP 25000 Color Doppler/MRI/ USG/CT Angio,Post Op color Doppler,Webex Video/Intra OP Photos,USG/CT,Scar Photo -

S1 GENERAL SURGERY S1.14 Nail S1.14.1 Paronychia Drainage DC 2000 Clinical Photograph Operative Photos,Clinical Photograph -
S1 GENERAL SURGERY S1.14 Nail S1.14.2 Surgical treatment for Ingrowing Nail DC 6650 Clinical Photograph,X-Ray Operative Photos,Clinical Photograph -
S1 GENERAL SURGERY S1.15 Lymph nodes S1.15.1 Submandibular Lymph node – Excision IP 8000 Fine Needle Aspiration Cytology (FNAC) Scar Photo,Routine Histopathological Examination -
S1 GENERAL SURGERY S1.15 Lymph nodes S1.15.2 Block dissection Cervical Nodes IP 13000 CT scan,Biopsy,Clinical Photograph CT scan,Biopsy,Clinical Photograph -
S1 GENERAL SURGERY S1.15 Lymph nodes S1.15.3 Cervial Lymphnodes – Excision DC 3000 USG/FNAC,Clinical Photograph Biopsy report,Intra OP Photo,SPECIMEN Photo -
S1 GENERAL SURGERY S1.15 Lymph nodes S1.15.4 Inguinal Node (dissection) - U/L IP 16000 FNAC,Abdomen Radiograph Supine Or Erect,USG Abdomen,Clinical Photograph Biopsy report,Abdomen Radiograph Supine Or Erect,USG Abdomen,Intra Op Photo,POST -
OP SCAR Photo
S1 GENERAL SURGERY S1.15 Lymph nodes S1.15.5 Any Lymph Node Biopsy DC 8770 Fine Needle Aspiration Cytology (FNAC) Intra OP Photo,Routine Histopathological Examination -
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CODE MAIN CATEGORY Sub SUB CATEGORY NAME CODE SURGERY / THERAPY DESCRIPTION PROCEDURE PACKAGE SPECIAL INVESTIGATION POST OPERATIVE PROCEDURE INVESTIGATION TREATMENT PROTOCOL
Category ID TYPE AMOUNT
S1 GENERAL SURGERY S1.16 Sympathectomy S1.16.1 Laproscopic-Lumbar Sympathectomy IP 25000 Doppler Scan Study Of Both Lower Limb Arterial System/Doppler,USG Abdomen,Chest X-Ray PA View(1 Film),Clinical Intra OP Photo,Routine Histopathological Examination,Doppler Scan Study Of Both -
Photograph Lower Limb Arterial System/Doppler
S1 GENERAL SURGERY S1.16 Sympathectomy S1.16.2 Thoracoplasty IP 15000 Clinical Photograph Scar Photo,Intra Op Photo,VIDEO RECORD -
S1 GENERAL SURGERY S1.16 Sympathectomy S1.16.3 Open Lumbar Sympathectomy - IP 18400 Clinical Photograph,USG Abdomen,Chest X-Ray PA View(1 Film), Doppler Scan Study Of Both Lower Limb Arterial Doppler Scan Study Of Both Lower Limb Arterial System/Doppler, Intra OP -
System/Doppler Photo,Routine Histopathological Examination
S1 GENERAL SURGERY S1.17 Thymus S1.17.1 Thymectomy IP 28000 FNAC,Clinical Photograph,CT/MRI Scar Photo,Intra Op Photo,Biopsy -
S1 GENERAL SURGERY S1.18 Scrotum S1.18.1 Orchidectomy -Unilateral IP 18000 Clinical Photograph,USG-Doppler Abdomen,CT Scan Of Lower Abdomen & Scrotum,Ureters,Abdomen And Pelvis For Operative Photos,USG Abdomen,Routine Histopathological Examination -
Kidneys,And Bladder (KUB)
S1 GENERAL SURGERY S1.18 Scrotum S1.18.10 Coccygeal Teratoma Excision IP 15000 CECT report ,Clinical Photograph SCAR Photo,Intra Op Photo,POST OP Biopsy -
S1 GENERAL SURGERY S1.18 Scrotum S1.18.11 Surgical treatment for Filarial Scrotum (without graft) IP 25000 Clinical Photograph,USG Abdomen,CT Scan Lower Abdomen With Contrast Scar Photo,USG Abdomen,Routine Histopathological Examination,Operative Photos -

S1 GENERAL SURGERY S1.18 Scrotum S1.18.11.1 Surgical treatment for Filarial Scrotum (with graft) IP 27900 Clinical Photograph,USG Abdomen,CT Scan Lower Abdomen With Contrast Routine Histopathological,USG Abdomen -
S1 GENERAL SURGERY S1.18 Scrotum S1.18.12 Surgical treatment for Fourniers Gangrene IP 32000 Clinical Photograph,USG Abdomen,CT Scan Lower Abdomen With Contrast Scar Photo,USG Abdomen,Routine Histopathological Examination,Operative Photos -

S1 GENERAL SURGERY S1.18 Scrotum S1.18.13 Excision of multiple Scrotal Cysts DC 8250 Clinical Photograph,USG Abdomen,CT Scan Of Lower Abdomen & Scrotum Scar Photo,Routine Histopathological Examination -
S1 GENERAL SURGERY S1.18 Scrotum S1.18.14 Excision of multiple Scrotal cyst / solid swellings DC 8830 Clinical Photograph,USG Scrotum Scar Photo,USG Abdomen,Routine Histopathological Examination -
S1 GENERAL SURGERY S1.18 Scrotum S1.18.15 Cyst over Scrotum – Excision DC 2000 clinical notes Intra OP Photos,clinical notes,Routine Histopathological Examination,Scar -
S1 GENERAL SURGERY S1.18 Scrotum S1.18.16 Eversion of Hydrocele Sac – Bilateral IP 10000 USG,Clinical Photograph Scar Photo,Intra Op Photo,Biopsy -
S1 GENERAL SURGERY S1.18 Scrotum S1.18.17 Eversion of Hydrocele Sac – Unilateral IP 5000 USG,Clinical Photograph Scar Photo,Intra Op Photo,Biopsy -
S1 GENERAL SURGERY S1.18 Scrotum S1.18.18 Operation for Hydrocele (U/L) IP 8000 USG,Clinical Photograph Scar Photo,Intra Op Photo,Biopsy -
S1 GENERAL SURGERY S1.18 Scrotum S1.18.19 Hydrocele - Excision – Bilateral IP 15000 USG/CT,Clinical Photograph USG/CT,Intra Op Photo,Biopsy,Scar Photo -
S1 GENERAL SURGERY S1.18 Scrotum S1.18.2 Orchidopexy with Eversion of Sac IP 25000 Clinical Photograph,USG-Doppler Abdomen,CT Scan Of Lower Abdomen & Scrotum Operative Photos,USG Abdomen,Routine Histopathological Examination -
S1 GENERAL SURGERY S1.18 Scrotum S1.18.20 Hydrocele + C/L Orchidectomy IP 26000 COLOR DOPPLER SCAN,Clinical Photograph,USG Biopsy report,Intra Op Photo,POST OF SCAR Photo -
S1 GENERAL SURGERY S1.18 Scrotum S1.18.21 Epididymal (Cyst/ solid) Swelling –Excision IP 8000 USG,Clinical Photograph Scar Photo,Intra Op Photo,Biopsy -
S1 GENERAL SURGERY S1.18 Scrotum S1.18.22 Dorsal Slit and Reduction of Paraphimosis IP 8840 Clinical Photograph,USG Penis Operative Photos,Routine Histopathological Examination -
S1 GENERAL SURGERY S1.18 Scrotum S1.18.3 Orchidectomy + Herniorraphy / Hernio plasty IP 30000 Clinical Photograph,USG Abdomen,CT Scan Of Lower Abdomen & Scrotum Operative Photos,USG Abdomen,Routine Histopathological Examination -
S1 GENERAL SURGERY S1.18 Scrotum S1.18.4 Evacuation of Scrotal Hematoma IP 18560 Clinical notes + USG Scar Photo,Clinical notes + USG,Operative Photos -
S1 GENERAL SURGERY S1.18 Scrotum S1.18.5 Laproscopic Excision of Varicocele IP 25000 Clinical Photograph,USG Abdomen/ CT Scan Lower Abdomen With Contrast/ CT Pelvis Operative Photos,USG Abdomen,Routine Histopathological Examination,WEBEX -

S1 GENERAL SURGERY S1.18 Scrotum S1.18.5.1 Open Excision of Varicocele IP 18400 Clinical Photograph,USG Abdomen/ CT Scan Lower Abdomen With Contrast/ CT Pelvis Routine Histopathological,USG Abdomen -
S1 GENERAL SURGERY S1.18 Scrotum S1.18.6 Excision of Epididymal Cyst IP 15000 USG Abdomen,CT Scan Of Lower Abdomen & Scrotum Operative Photos,Routine Histopathological Examination -
S1 GENERAL SURGERY S1.18 Scrotum S1.18.7 Epididectomy IP 15000 USG Abdomen,CT Scan Of Lower Abdomen & Scrotum Operative Photos,CT Scan Of Lower Abdomen & Scrotum,USG Abdomen,Routine -
Histopathological Examination
S1 GENERAL SURGERY S1.18 Scrotum S1.18.8 Circumcision DC 8200 Clinical Photograph,USG Abdomen Scar Photo,Routine Histopathological Examination -
S1 GENERAL SURGERY S1.18 Scrotum S1.18.9 Vasectomy DC 2500 Clinical Photograph Scar Photo,Intra OP PhotoS,Biopsy report -
S1 GENERAL SURGERY S1.19 Sequestrectomy S1.19.1 Sequestrectomy DC 1500 Clinical assessment and investigations Operative Photos,Clinical assessment and investigations -
S1 GENERAL SURGERY S1.19 Sequestrectomy S1.19.2 Cellulitis Conservative with antibiotics IP 8000 LFT,CBP,RBS,Creatinine Creatinine,CBP -
S1 GENERAL SURGERY S1.19 Sequestrectomy S1.19.3 Cellulitis surgical management IP 25000 surgical profile Casesheet,Intra OP Photos -
S1 GENERAL SURGERY S1.2 BREAST S1.2.1 Simple Mastectomy (Non Malignant) IP 30786 Mammography Clinical Photograph,Biopsy -
S1 GENERAL SURGERY S1.2 BREAST S1.2.2 Excision of Mammary Fistula IP 14040 Clinical Photograph,Fistulogram Operative Photos,Routine Histopathological Examination,Clinical Photograph -
S1 GENERAL SURGERY S1.2 BREAST S1.2.2.1 Wide Excision of Mammary Fistula IP 12820 CT Local Area,Chest X-Ray PA View(1 Film),USG Breast,Clinical Photograph Routine Histopathological Examination,Clinical Photograph -
S1 GENERAL SURGERY S1.2 BREAST S1.2.3 Excision of Fibroma IP 9180 Clinical Photograph,Contrast Enhanced USG Scar Photo,Routine Histopathological Examination -
S1 GENERAL SURGERY S1.2 BREAST S1.2.3.1 Excision of Bilateral Fibroadenoma IP 10000 USG Breast,Fine Needle Aspiration Cytology (FNAC) ,Chest X-Ray PA View(1 Film),Clinical Photograph Operative Photos,Routine Histopathological Examination -
S1 GENERAL SURGERY S1.2 BREAST S1.2.3.2 Excision of Unilateral Fibroadenoma DC 7000 Clinical Photograph,Fine Needle Aspiration Cytology (FNAC) Scar Photo,Routine Histopathological Examination -
S1 GENERAL SURGERY S1.2 BREAST S1.2.4 Bilateral Lumpectomy IP 15000 Clinical Photograph,Chest X-Ray PA View(1 Film)/X-Ray Mammogram Scar Photo,Routine Histopathological Examination -
S1 GENERAL SURGERY S1.2 BREAST S1.2.4.1 Breast Lump – Excision IP 7000 TRUCUT Biopsy,Clinical Photograph Biopsy report,Intra Op Photo,SCAR Photo -
S1 GENERAL SURGERY S1.2 BREAST S1.2.5 Breast Conservation Surgery IP 15000 Clinical Photograph,Chest X-Ray PA View(1 Film),USG Breast Operative Photos,Clinical Photograph -
S1 GENERAL SURGERY S1.2 BREAST S1.2.5.1 Segmental Resection of Breast IP 14870 Clinical Photograph,Chest X-Ray PA View(1 Film),USG Breast Routine Histopathological Examination,Clinical Photograph,Operative Photos -
S1 GENERAL SURGERY S1.2 BREAST S1.2.6 Surgical repair of bilateral Gynaecomastia IP 11800 Clinical Photograph,Fine Needle Aspiration Cytology (FNAC),USG Breast Routine Histopathological Examination,Clinical Photograph,Operative Photos -
S1 GENERAL SURGERY S1.2 BREAST S1.2.6.1 Surgical repair of unilateral Gynaecomastia IP 9200 Clinical Photograph,Fine Needle Aspiration Cytology (FNAC),USG Breast Operative Photos,Routine Histopathological Examination,Clinical Photograph -
S1 GENERAL SURGERY S1.2 BREAST S1.2.7 I and D of Breast Abscess DC 8940 Clinical Photograph,Fine Needle Aspiration Cytology (FNAC) ,USG Breast Scar Photo,Clinical Photograph -
S1 GENERAL SURGERY S1.20 Thorax S1.20.2 Rib Resection and Drainage IP 14000 CT CHEST,Clinical Photograph,X-RAY CHEST Biopsy CHEST,Clinical Photograph,POST OP X-RAY CHEST -
S1 GENERAL SURGERY S1.20 Thorax S1.20.6 RTA Pain in non - traumatic chest injury DC 4100 Clinical Picture,CBP,VIRAL MARKERS,Chest x ray Clinical Picture,CHEST PA -
S1 GENERAL SURGERY S1.21 OTHERS S1.21.1 SUTURE DEHISCENCE - RESUTURING IP 27900 clinical photo,CBP,Blood group scar photo -
S1 GENERAL SURGERY S1.21 OTHERS S1.21.3 USG GUIDED MINOR PROCEDURES (FNAC, BIPOSY, IP 2000 CLINICAL PHOTO,USG FNAC,BIOPSY -
SINOGRAPHY,TAPPING)
S1 GENERAL SURGERY S1.21 OTHERS S1.21.4 Gangrene foot below knee amputation IP 25000 Photo And X-ray Photo And X-ray -
S1 GENERAL SURGERY S1.21 OTHERS S1.21.5 TOE Amputation (Toe Gangrene) IP 8000 Photo And X-ray Photo And X-ray -
S1 GENERAL SURGERY S1.3 ABDOMEN S1.3.1.1 Epigastric Hernia repair without Mesh IP 25655 Clinical Photograph Clinical Photograph -
S1 GENERAL SURGERY S1.3 ABDOMEN S1.3.1.10 Herinoplasty with Mesh Direct Inguinal Hernia IP 25655 Clinical photograph,USG of the Abdomen ,Chest X-Ray PA View(1 Film) scar photo ,USG of the Abdomen ,Intraoperative photos -
S1 GENERAL SURGERY S1.3 ABDOMEN S1.3.1.10.1 All Inguinal Hernia Operation with out Mesh IP 20000 Clinical Photograph,USG Abdomen,Chest X-Ray PA View(1 Film) Scar Photo,Intra OP Photo,POST OP USG -
S1 GENERAL SURGERY S1.3 ABDOMEN S1.3.1.10.2 Hernioplasty - Indirect inguinal hernia IP 25000 surgical profile,usg abdomen with scrotum usg abdomen -
S1 GENERAL SURGERY S1.3 ABDOMEN S1.3.1.10.3 Open Bilateral hernioplasty with mesh IP 42500 Ultra sound abdomen Ultra sound abdomen -
S1 GENERAL SURGERY S1.3 ABDOMEN S1.3.1.11 Laproscopic Surgical treatment for Incisional Hernia with IP 41048 Clinical photograph,USG of the Abdomen ,Chest X-Ray PA View(1 Film) scar photo ,USG of the Abdomen ,Intraoperative photos -
Mesh
S1 GENERAL SURGERY S1.3 ABDOMEN S1.3.1.11.1 Laproscopic Surgical treatment for Incisional Hernia without IP 30000 Clinical Photograph,USG Abdomen,ECHO Cardiogram WEBEX,Routine Histopathological Examination,USG Abdomen/CT scan Lower Abdomen -
Mesh Without Contrast/CT Scan Abdomen With Contrast/CT Scan Abdomen Without Contrast

S1 GENERAL SURGERY S1.3 ABDOMEN S1.3.1.2 Epigastric Hernia repair with Mesh IP 41048 Clinical Photograph Clinical Photograph -
S1 GENERAL SURGERY S1.3 ABDOMEN S1.3.1.2.1 Laproscopic Surgical treatment for Epigastric Hernia repair IP 51310 Clinical photograph,USG of the Abdomen scar photo ,USG of the Abdomen ,Intraoperative photos -
with Mesh
S1 GENERAL SURGERY S1.3 ABDOMEN S1.3.1.3 Unilateral Femoral Hernia repair IP 25655 Clinical Photograph Clinical Photograph -
S1 GENERAL SURGERY S1.3 ABDOMEN S1.3.1.3.1 Laproscopic Surgical treatment for Unilateral Femoral Hernia IP 30786 Clinical photograph,USG of the Abdomen scar photo ,USG of the Abdomen ,Intraoperative photos -
With Mesh
S1 GENERAL SURGERY S1.3 ABDOMEN S1.3.1.4 Hiatus Hernia Repair - Abdominal IP 49258 U S Abdomen,UGI Endoscopy Endoscopy picture -
S1 GENERAL SURGERY S1.3 ABDOMEN S1.3.1.4.1 Laproscopic Surgical treatment for Hiatus Hernia With Mesh IP 51310 Clinical photograph,USG of the Abdomen scar photo ,USG of the Abdomen ,Intraoperative photos -

S1 GENERAL SURGERY S1.3 ABDOMEN S1.3.1.5 Rare Hernias repair (Spigalion,Obuturator,Sciatic) IP 20524 USG,Clinical Photograph Clinical Photograph -
S1 GENERAL SURGERY S1.3 ABDOMEN S1.3.1.6 Umbilical Hernia repair without Mesh IP 25655 Clinical Photograph Clinical Photograph -
S1 GENERAL SURGERY S1.3 ABDOMEN S1.3.1.7 Umbilical Hernia repair with Mesh IP 30786 Clinical Photograph Clinical Photograph -
S1 GENERAL SURGERY S1.3 ABDOMEN S1.3.1.7.1 Laproscopic Surgical treatment for - Umbilical Hernia With IP 51310 Clinical photograph,USG of the Abdomen scar photo ,USG of the Abdomen ,Intraoperative photos -
Mesh
S1 GENERAL SURGERY S1.3 ABDOMEN S1.3.1.8 Ventral And Scar Hernia repair without Mesh IP 30786 USG,Clinical Photograph Clinical Photograph -
S1 GENERAL SURGERY S1.3 ABDOMEN S1.3.1.9 Ventral And Scar Hernia repair with Mesh IP 41048 USG,Clinical Photograph Clinical Photograph -
S1 GENERAL SURGERY S1.3 ABDOMEN S1.3.10 Laparoscopic Adhesinolysis other than interstinal obsession IP 18000 X-RAY ABDOMEN,Clinical Photograph VEDIO RECORD POST OP X-RAY,Intra Op Photo -

S1 GENERAL SURGERY S1.3 ABDOMEN S1.3.2.1 Laproscopic Appendicectomy IP 21458 USG Clinical Photograph,Biopsy -
S1 GENERAL SURGERY S1.3 ABDOMEN S1.3.2.2 Surgical treatment for Appendicular Perforation IP 26548 USG Clinical Photograph,Biopsy -
S1 GENERAL SURGERY S1.3 ABDOMEN S1.3.2.3 Open Appendicectomy IP 20000 Case sheet with clinical History,USG Abdomen,Abdomen Radiograph Supine Or Erect(1 Film),Complete Blood Scar Photo,Clinical Photograph,Routine Histopathological Examination,Intra OP -
Picture,Case sheet with clinical History,USG Abdomen,Abdomen Radiograph Supine Or Erect(1 Film),Complete Photo,Scar Photo,Clinical Photograph,Routine Histopathological Examination,Intra OP
Blood Picture Photo
S1 GENERAL SURGERY S1.3 ABDOMEN S1.3.2.4 Operative drainage of Appendicular Abscess IP 15000 USG ABDOMEN,Clinical Photograph POST OP USG,Intra Op Photo -
S1 GENERAL SURGERY S1.3 ABDOMEN S1.3.3.1 Highly Selective Vagotomy IP 25655 Endoscopy Clinical Photograph -
S1 GENERAL SURGERY S1.3 ABDOMEN S1.3.3.10 Surgical management of Duodenal perforation IP 49258 CT-Abdomen,USG,X-RAY Clinical Photograph -
S1 GENERAL SURGERY S1.3 ABDOMEN S1.3.3.10.1 Laproscopic Surgical treatment for Duodenal Perforation IP 49258 Plain X-ray erect abdomen,USG of the Abdomen ,CT Scan Abdomen With Contrast WEBEX -

S1 GENERAL SURGERY S1.3 ABDOMEN S1.3.3.10.2 Surgical treatment for Duodenal Diverticulum IP 30010 Barium Meal Follow Through,CT Scan Abdomen With Contrast,Upper GI endoscopy USG Abdomen,Intra OP Photo,Routine Histopathological Examination -
S1 GENERAL SURGERY S1.3 ABDOMEN S1.3.3.10.3 Duodenectomy IP 38650 Biopsy,Magnetic Resonance Cholangiopancreatography (MRCP)/ERCP/ CT Scan Abdomen With Contrast /USG Routine Histopathological Examination,USG Abdomen,Intra OP Photo -
Abdomen
S1 GENERAL SURGERY S1.3 ABDOMEN S1.3.3.11 Drainage of Perigastric Abscess IP 35000 Abdomen Radiograph Supine Or Erect(1 Film)/USG Abdomen/CT scan Lower Abdomen Without Contrast,Chest X- Routine Histopathological Examination,USG Abdomen/CT scan Lower Abdomen Without -
Ray PA View(1 Film) Contrast/CT Scan Abdomen With Contrast
S1 GENERAL SURGERY S1.3 ABDOMEN S1.3.3.12 Drainage of Subdiaphragmatic Abscess IP 32000 CT scan Lower Abdomen Without Contrast/CT Scan Abdomen Without Contrast ,Abdomen Radiograph Supine Or Operative Photos,USG Abdomen -
Erect(1 Film),USG Abdomen,Chest X-Ray PA View(1 Film)
S1 GENERAL SURGERY S1.3 ABDOMEN S1.3.3.13 Open Drainage of Pelvic Abscess IP 32000 Abdomen Radiograph Supine Or Erect(1 Film),USG Abdomen,CT Pelvis,CT Scan Abdomen Without Contrast Operative Photos,USG Abdomen -

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CODE MAIN CATEGORY Sub SUB CATEGORY NAME CODE SURGERY / THERAPY DESCRIPTION PROCEDURE PACKAGE SPECIAL INVESTIGATION POST OPERATIVE PROCEDURE INVESTIGATION TREATMENT PROTOCOL
Category ID TYPE AMOUNT
S1 GENERAL SURGERY S1.3 ABDOMEN S1.3.3.15 Excision of Mesenteric Cyst IP 31260 Plain Abdomen X-Ray,USG Abdomen,CT scan Lower Abdomen Without Contrast Operative Photos,Routine Histopathological Examination,USG Abdomen/CT scan Lower -
Abdomen Without Contrast/CT Scan Abdomen With Contrast
S1 GENERAL SURGERY S1.3 ABDOMEN S1.3.3.16 Drainage of Psoas Abscess IP 22000 CT,Clinical Photograph,USG USG,Intra OP Photos,Pus Culture Sensitivity report,Post OP Photo -
S1 GENERAL SURGERY S1.3 ABDOMEN S1.3.3.18 Pyloplasty IP 14000 IVP/DTPA SCAN,Clinical Photograph,USG ABDOMEN POST OP IVP,Intra Op Photo,SCAR Photo -
S1 GENERAL SURGERY S1.3 ABDOMEN S1.3.3.19 Laparoscopic cystogastrostomy IP 27000 CECT,USG,CBC,Viral markers,Sugar,Clinical Photograph Viral markers,USG,CBC,Intra Op Photo,Webex,Sugar -
S1 GENERAL SURGERY S1.3 ABDOMEN S1.3.3.2 Selective Vagotomy drainage IP 49258 Endoscopy Clinical Photograph -
S1 GENERAL SURGERY S1.3 ABDOMEN S1.3.3.20 Exploratory Laparotomy IP 15000 PERITONEAL TAP Photo,Clinical Photograph,USG ABDOMEN SCAR Photo,Intra Op Photo,CS report,POST OP USG -
S1 GENERAL SURGERY S1.3 ABDOMEN S1.3.3.3 Pyloroplasty and Vagotomy IP 49257 Endoscopy Clinical Photograph -
S1 GENERAL SURGERY S1.3 ABDOMEN S1.3.3.4 Gastrojejunostomy and Vagotomy IP 41047 Endoscopy-Video Photo Clinical Photograph -
S1 GENERAL SURGERY S1.3 ABDOMEN S1.3.3.5 Surgical Management for Bleeding Peptic ulcer IP 49258 Endoscopy Clinical Photograph -
S1 GENERAL SURGERY S1.3 ABDOMEN S1.3.3.6 Partial/Subtotal Gastrectomy with anastomosis to Esophagus IP 41048 Endoscopy Clinical Photograph -
for ulcer
S1 GENERAL SURGERY S1.3 ABDOMEN S1.3.3.7 Pyloromyotomy IP 30786 Endoscopy Clinical Photograph -
S1 GENERAL SURGERY S1.3 ABDOMEN S1.3.3.8 Gastrostomy IP 20524 USG,Biopsy,CT,Endoscopy Clinical Photograph -
S1 GENERAL SURGERY S1.3 ABDOMEN S1.3.3.9 Gastrostomy Closure IP 22577 Clinical Photograph Clinical Photograph -
S1 GENERAL SURGERY S1.3 ABDOMEN S1.3.4.1 Surgical treatment for Intususception IP 49258 X-Ray ABD,Endoscopy,USG Clinical Photograph,Biopsy -
S1 GENERAL SURGERY S1.3 ABDOMEN S1.3.4.10 Excision Benign Tumor -Small intestine IP 30000 CECT,Clinical Photograph,USG SCAR Photo,Intra Op Photo,Biopsy report -
S1 GENERAL SURGERY S1.3 ABDOMEN S1.3.4.2 Surgical treatment for Acute Intestinal obstrucion IP 49258 X-Ray ABD,Biopsy,Endoscopy,USG Clinical Photograph,Biopsy -
S1 GENERAL SURGERY S1.3 ABDOMEN S1.3.4.3 Surgical treatment for Acute Intestinal perforation IP 49258 CXR,Biopsy,Endoscopy,USG,X-Ray ABD Clinical Photograph,Biopsy -
S1 GENERAL SURGERY S1.3 ABDOMEN S1.3.4.4 Surgical management For Haemorrhage Of The Small Intestine IP 49258 CT With Contrast,Endoscopy Clinical Photograph,Biopsy -

S1 GENERAL SURGERY S1.3 ABDOMEN S1.3.4.5 Surgical treatment For Recurrent Intestinal obstruction (Noble IP 49257 CT-Contrast Clinical Photograph,Biopsy -
Plication Other)
S1 GENERAL SURGERY S1.3 ABDOMEN S1.3.4.6 Resection and Anastomosis Of Small Intestine(45.9) IP 66703 X-Ray ABD,CT Clinical Photograph,Biopsy -
S1 GENERAL SURGERY S1.3 ABDOMEN S1.3.4.6.1 Surgical management of entero cutanious Fistula IP 40000 Clinical Photograph,Fistulogram,Barium Meal Follow Through Scar Photo,USG Abdomen,Operative Photos -
S1 GENERAL SURGERY S1.3 ABDOMEN S1.3.4.7 Ileostomy IP 20523 USG,Biopsy,Endoscopy Clinical Photograph -
S1 GENERAL SURGERY S1.3 ABDOMEN S1.3.4.7.1 Illieo Sigmoidostomy IP 48000 Colonoscopy,CT Scan Abdomen With Contrast,Barium Enema(Single Contrast\Double Contrast) Scar Photo,CT Scan Abdomen With Contrast,Routine Histopathological -
Examination,Operative Photos
S1 GENERAL SURGERY S1.3 ABDOMEN S1.3.4.8 Ileostomy Closure IP 25655 Clinical Photograph Clinical Photograph -
S1 GENERAL SURGERY S1.3 ABDOMEN S1.3.4.9 Excision of Meckels Diverticulum IP 41048 CT Scan Abdomen With Contrast,USG Abdomen,Abdomen Radiograph Supine Or Erect(1 Film) scar photo,POST OP HPE,Intraoperative photos -
S1 GENERAL SURGERY S1.3 ABDOMEN S1.3.5.1 Surgical treatment for Mal-Rotation and Volvulus Of The IP 49257 X-Ray ABD,CT X-RAY,Clinical Photograph -
Midgut
S1 GENERAL SURGERY S1.3 ABDOMEN S1.3.5.10 Loop Colostomy Sigmoid IP 20524 colonoscopy ,CT contrast,USG of the Abdomen scar photo,POST OP HPE,Intraoperative photos -
S1 GENERAL SURGERY S1.3 ABDOMEN S1.3.5.10.1 Sigmoid Resection IP 21500 COLONOSCPY,Clinical Photograph,BARIUM ENEMA report SCAR Photo,Intra Op Photo,POST OP Biopsy report -
S1 GENERAL SURGERY S1.3 ABDOMEN S1.3.5.2 Surgical treatment for Volvulus of Large bowel IP 49258 X-Ray Abdomen,CT-Contrast X-Ray Abdomen,Clinical Photograph -
S1 GENERAL SURGERY S1.3 ABDOMEN S1.3.5.3 Surgical treatment for Duplication Of Intestines IP 49258 CT-Contrast Clinical Photograph -
S1 GENERAL SURGERY S1.3 ABDOMEN S1.3.5.4 Left Hemi Colectomy IP 41048 USG,Barium,CT,Endoscopy Clinical Photograph,Biopsy -
S1 GENERAL SURGERY S1.3 ABDOMEN S1.3.5.4.1 Laproscopic Left Hemicolectomy IP 40000 Biopsy report,USG Abdomen/CT Scan Lower Abdomen With Contrast,ColonoScopy WEBEX/Intra OP Photo,USG Abdomen,Routine Histopathological Examination -
S1 GENERAL SURGERY S1.3 ABDOMEN S1.3.5.5 Right Hemi Colectomy IP 41048 USG,Barium,CT,Endoscopy Clinical Photograph,Biopsy -
S1 GENERAL SURGERY S1.3 ABDOMEN S1.3.5.6 Total Colectomy IP 61572 USG,Barium,CT,Endoscopy Clinical Photograph,Biopsy -
S1 GENERAL SURGERY S1.3 ABDOMEN S1.3.5.6.1 Laproscopic Colectomy (Total Colectomy) IP 61572 colonoscopy ,CT contrast,USG of the Abdomen WEBEX ,Post OP HPE -
S1 GENERAL SURGERY S1.3 ABDOMEN S1.3.5.7 Colostomy IP 20524 USG,Barium,CT,Endoscopy Clinical Photograph -
S1 GENERAL SURGERY S1.3 ABDOMEN S1.3.5.8 Colostomy Closure IP 25655 Clinical Photograph Clinical Photograph -
S1 GENERAL SURGERY S1.3 ABDOMEN S1.3.5.9 Rectovaginal fistula Management without Colostomy IP 39816 colonoscopy ,CT contrast,USG of the Abdomen USG Abdomen -
S1 GENERAL SURGERY S1.3 ABDOMEN S1.3.6.1 Pull Through Abdominal Resection IP 51310 Clinical Photograph Clinical Photograph -
S1 GENERAL SURGERY S1.3 ABDOMEN S1.3.6.2 Anterior Resection of Rectum IP 51310 Colonoscopy,Biopsy,Clinical Photograph Clinical Photograph,Biopsy -
S1 GENERAL SURGERY S1.3 ABDOMEN S1.3.6.3 Rectopexy Open with Mesh for Rectal Prolapse IP 41047 Clinical photograph,Colonoscopy/Sigmoidoscopy (REGID),USG Abdomen Intraoperative photos,USG Abdomen -
S1 GENERAL SURGERY S1.3 ABDOMEN S1.3.6.3.1 Laproscopic Rectopexy With Mesh for Rectal Prolapse IP 51310 Clinical photograph,Colonoscopy/Sigmoidoscopy (REGID),USG Abdomen WEBEX ,USG Abdomen -
S1 GENERAL SURGERY S1.3 ABDOMEN S1.3.6.3.2 Rectopexy Open with Mesh for Rectal Prolapse IP 30000 Clinical Photograph,Colonoscopy/Sigmoidoscopy (REGID) / Defacogram,USG Abdomen Operative Photos,USG Abdomen,Clinical Photograph -
S1 GENERAL SURGERY S1.3 ABDOMEN S1.3.6.4 Fistulectomy IP 15000 Clinical Photograph,Fistulogram Scar Photo,Clinical Photograph,Routine Histopathological Examination,Intra OP Photo -

S1 GENERAL SURGERY S1.3 ABDOMEN S1.3.6.5 Fissurectomy with lateral spinctorotomy IP 15000 Clinical Photograph Post OP Proctoscopy Photo,Intra OP Photo -
S1 GENERAL SURGERY S1.3 ABDOMEN S1.3.6.6 Drainage of Ischio Rectal Abscess IP 22000 Clinical Photograph Scar Photo,Intra OP Photo -
S1 GENERAL SURGERY S1.3 ABDOMEN S1.3.6.7 Excision of Papilloma Rectum IP 19660 Colonoscopy,Clinical Photograph,Proctoscopy,USG Abdomen Intra OP Photo,Clinical Photograph,Routine Histopathological Examination -
S1 GENERAL SURGERY S1.3 ABDOMEN S1.3.6.8 Anorectoplasty IP 26050 Clinical Photograph,USG Abdomen Intra OP Photo,Clinical Photograph -
S1 GENERAL SURGERY S1.3 ABDOMEN S1.3.6.9.1 Fissurectomy and Haemorrhoidectomy IP 13500 PROCTOPSY Photo,Clinical Photograph Scar Photo,Intra Op Photo,Biopsy -
S1 GENERAL SURGERY S1.3 ABDOMEN S1.3.6.9.2 Lord's Procedure for Haemorrhoids DC 10000 Colonoscopy,USG Abdomen,Proctoscopy Biopsy report,Intra OP Photo -
S1 GENERAL SURGERY S1.3 ABDOMEN S1.3.6.9.3 Fissurectomy with Sphincterotomy IP 15000 PROCTOPSY Photo,Clinical Photograph Scar Photo,Intra Op Photo,Biopsy -
S1 GENERAL SURGERY S1.3 ABDOMEN S1.3.6.9.4 Anal Dilation DC 2500 clinical notes clinical notes -
S1 GENERAL SURGERY S1.3 ABDOMEN S1.3.6.9.4.1 ANAL STRICTURE IP 5000 clinical photos intra op photos -
S1 GENERAL SURGERY S1.3 ABDOMEN S1.3.6.9.5 Haemorroidectomy IP 16670 Clinical Photograph,Proctosopy Routine Histopathological Examination,USG Abdomen -
S1 GENERAL SURGERY S1.3 ABDOMEN S1.3.6.9.6 LASER HAEMORRHOIDDECTOMY / FISTULA ABALATION IP 15000 fistulogram,videosigmoidoscopy po hpe,specimen photo -
S1 GENERAL SURGERY S1.3 ABDOMEN S1.3.6.9.7 Laser internal sphrincterotomy IP 15000 clinical photos Intra op photo -
S1 GENERAL SURGERY S1.3 ABDOMEN S1.3.7.1 Cecopexy IP 30000 Colonoscopy,Barium Enema(Single Contras\Double Contrast) Intra OP Photo,USG Abdomen -
S1 GENERAL SURGERY S1.3 ABDOMEN S1.3.7.2 Caecostomy IP 20000 USG,Clinical Photograph,X-RAY ABDOMEN POST OP SCAR Photo,Intra Op Photo,Biopsy report -
S1 GENERAL SURGERY S1.3 ABDOMEN S1.3.8 Surgical treatment for Minor Intra Abdominal Injuries IP 20290 Plain Abdomen X-Ray,USG Abdomen/CT scan Lower Abdomen Without Contrast/CT Scan Abdomen With Operative Photos,USG Abdomen -
Contrast/CT Scan Abdomen Without Contrast/ ECHO Cardiogram
S1 GENERAL SURGERY S1.3 ABDOMEN S1.3.9 Surgical treatment for Burst Abdomen IP 40000 Plain Abdomen X-Ray,USG Abdomen/CT scan Lower Abdomen Without Contrast/CT Scan Abdomen With USG Abdomen/CT scan Lower Abdomen Without Contrast/CT Scan Abdomen With -
Contrast/CT Scan Abdomen Without Contrast Contrast/CT Scan Abdomen Without Contrast,Routine Histopathological Examination

S1 GENERAL SURGERY S1.4 Liver S1.4.1 Surgical treatment For Hydatid cyst of Liver IP 41048 USG,CT USG -
S1 GENERAL SURGERY S1.4 Liver S1.4.2 Portocaval Anastomosis IP 82096 USG,MRI,UGI Endoscopy USG,Endoscopy -
S1 GENERAL SURGERY S1.4 Liver S1.4.3 Drainage/Excision of liver Abscess IP 30000 USG Abdomen/CECT,Clinical Photograph Scar Photo,Intra OP Photo,Post OP USG -
S1 GENERAL SURGERY S1.4 Liver S1.4.3.1 USG GUIDED MAJOR PROCEDURES ( EG.IVER L ABSCESS,POST IP 8000 CT ABDOMEN,USG CLINICAL AND USG GUIDED PROCEDURE PHOTOS,POST OP USG -
OP COLLECTIONS)DRAINAGE PIGTAIL INSERTION

S1 GENERAL SURGERY S1.4 Liver S1.4.4 Lap. Hepatic segmental resection IP 35000 CECT/MRI,Clinical Photograph,USG VIDEO RECORD,Intra Op Photo,Biopsy report,POST OP SCAR Photo -
S1 GENERAL SURGERY S1.5 Gallbladder S1.5.1 Cholecystectomy IP 25655 LFT,CT,USG USG,Clinical Photograph -
S1 GENERAL SURGERY S1.5 Gallbladder S1.5.2 Laproscopic Cholecystectomy IP 30786 LFT,CT,USG USG,Clinical Photograph -
S1 GENERAL SURGERY S1.5 Gallbladder S1.5.3 Cholecystectomy With CBD Exploration (51.41) IP 41048 LFT,CT,USG USG,Clinical Photograph -
S1 GENERAL SURGERY S1.5 Gallbladder S1.5.3.1 Laproscopic Cholecystectomy With CBD Exploration (51.41) IP 30786 LFT(liver function tests),USG Abdomen ,CT scan Lower Abdomen Without Contrast/CT Scan Abdomen Without WEBEX ,Routine Histopathological Examination,USG Abdomen/CT scan Lower Abdomen -
Contrast Without Contrast/CT Scan Abdomen Without Contrast,CT Scan Abdomen With Contrast

S1 GENERAL SURGERY S1.5 Gallbladder S1.5.3.2 Benign Biliary Stricture Repair IP 40000 CECT ABD,USG,MRCP,LFT LFT,INTA OP PHOTOS,POST OP USG -
S1 GENERAL SURGERY S1.5 Gallbladder S1.5.4 Cholecystostomy IP 30437 LFT,CT,USG USG,Clinical Photograph -
S1 GENERAL SURGERY S1.5 Gallbladder S1.5.5 Pancreaticocystojejunostomy IP 51310 LFT,CT,USG USG,Clinical Photograph -
S1 GENERAL SURGERY S1.5 Gallbladder S1.5.6 Pancreaticocystogastrostomy IP 43025 LFT,CT,USG USG,Clinical Photograph -
S1 GENERAL SURGERY S1.5 Gallbladder S1.5.7 Repair Of CBD IP 49257 LFT,CT,USG USG,Clinical Photograph -
S1 GENERAL SURGERY S1.5 Gallbladder S1.5.8 PANCREAS DIVISUM IP 30000 Endoscopy,USG,Biopsy,CT Clinical Photograph,USG,Biopsy -
S1 GENERAL SURGERY S1.6 Adrenals S1.6.1 Bilateral Adrenalectomy in nonmalignant conditions IP 41048 Biochemical Investigations,CT,USG USG -
S1 GENERAL SURGERY S1.6 Adrenals S1.6.2 Unilateral Adrenelectopmy in nonmalignant conditions IP 35917 Biochemical Investigations,CT,USG USG -

S1 GENERAL SURGERY S1.7 Spleen S1.7.1 Splenectomy For Hypersplenism IP 41048 Peripheral Smear,CT,USG USG -
S1 GENERAL SURGERY S1.7 Spleen S1.7.2 Splenorenal Anastomosis IP 71834 USG,MRI,UGI Endoscopy USG,Endoscopy -
S1 GENERAL SURGERY S1.7 Spleen S1.7.3 Warren Shunt for Portal Hypertension IP 71834 USG,MRI,UGI Endoscopy USG,Endoscopy -
S1 GENERAL SURGERY S1.7 Spleen S1.7.4 Laparoscopic Spleenectomy IP 35000 CECT,Clinical Photograph,CBP,USG,PERIPHERAL Webex,Intra Op Photo,VIDEO RECORD,Biopsy report SCAR Photo -
S1 GENERAL SURGERY S1.7 Spleen S1.7.5 Open Spleenectomy IP 23500 CECT,Clinical Photograph,CBP,PERIPHERAL ,USG VIDEO RECORD,Biopsy report SCAR Photo,Webex,Intra Op Photo -
S1 GENERAL SURGERY S1.8 PERIPHERY VESSELS S1.8.1 Excision and Ligation of Varicose Veins IP 24752 Clinical photograph,Venous Doppler,Clinical photograph,Venous Doppler Case Sheet with operation Notes ,Case Sheet with operation Notes -
S1 GENERAL SURGERY S1.8 PERIPHERY VESSELS S1.8.2 Ligation of Perforators incompitence IP 10000 Operative notes with steps of surgery,Color Doppler Scan,Clinical Photograph Post OP Doppler report,Intra Op Photo -
S1 GENERAL SURGERY S1.9 Excision of Sinus S1.9.1 Excision of any Sinus IP 16850 Clinical Photograph,Sinography Operative Photos,Routine Histopathological Examination -
S1 GENERAL SURGERY S1.9 Excision of Sinus S1.9.2 Excision of Umbillical Sinus IP 16700 Sinogram,USG Abdomen,Clinical photo Histopathological Examination,USG Abdomen/Histopethology,Intra op photo -
S1 GENERAL SURGERY S1.9 Excision of Sinus S1.9.3 Excision of Pilonidal Sinus IP 17150 Clinical Photograph Scar Photo,Routine Histopathological Examination,Clinical Photograph -
S2 ENT SURGERY S2 ENT SURGERY S2.9 Cryosurgery DC 10960 DNE,Case sheet with clinical History Post OP DNE,Intra OP Photo -
S2 ENT SURGERY S2.1 EAR S2.1.1 Labyrinthectomy IP 20524 IA,CT-Scan PTI Clinical Photograph -
S2 ENT SURGERY S2.1 EAR S2.1.10 Ear lobe repair - single (daycare) DC 1500 clinical photo Clinical Photographs Showing scar -
3 of 47
CODE MAIN CATEGORY Sub SUB CATEGORY NAME CODE SURGERY / THERAPY DESCRIPTION PROCEDURE PACKAGE SPECIAL INVESTIGATION POST OPERATIVE PROCEDURE INVESTIGATION TREATMENT PROTOCOL
Category ID TYPE AMOUNT
S2 ENT SURGERY S2.1 EAR S2.1.2 Facial Nerve Decompression IP 20524 CT-Scan Clinical Photograph -
S2 ENT SURGERY S2.1 EAR S2.1.3 Temporal Bone Excision IP 51310 CT-Scan MRI Scan Clinical Photograph -
S2 ENT SURGERY S2.1 EAR S2.1.4 Myringoplasty IP 15475 Pure Tone Audiometry Pure Tone Audiometry -
S2 ENT SURGERY S2.1 EAR S2.1.4.1 Myringoplasty with ossiculoplasty (19.3) IP 17446 OTO endoscopy/ OTO Endoscopy Photos,Pure Tone Audiometry ,Impedances Audiometry(With Stepedeal Reflex),X- X-Ray Of Both Mastoids -
Ray Of Both Mastoids
S2 ENT SURGERY S2.1 EAR S2.1.4.2 Ossiculoplasty IP 14000 PTA and IA Intra OP Photos,Otoscopic findings,Post OP PTA/WEBEX -
S2 ENT SURGERY S2.1 EAR S2.1.5 Myringotomy with grommet for one ear IP 10262 OTO endoscopy/ OTO Endoscopy Photos,Pure Tone Audiometry ,Impedances Audiometry(With Stepedeal Reflex) Grommet in Positoin Photo,Pure Tone Audiometry ,Impedances Audiometry(With -
Stepedeal Reflex)
S2 ENT SURGERY S2.1 EAR S2.1.5.1 Myrinogotomy with-grommet for both ears DC 15000 OTO endoscopy/OTO Endoscopy Photos,Pure Tone Audiometry,Impedances Audiometry(With Stepedeal Reflex) Impedances Audiometry(With Stepedeal Reflex) ,Pure Tone Audiometry,Grommet in -
Positoin Photo
S2 ENT SURGERY S2.1 EAR S2.1.5.2 Myringotomy – Unilateral IP 3800 PTA,OTO endoscopy photo PTA,OTO endoscopy photo -
S2 ENT SURGERY S2.1 EAR S2.1.5.3 Myringotomy – Bilateral IP 6500 PTA,OTO endoscopy photo PTA,OTO endoscopy photo -
S2 ENT SURGERY S2.1 EAR S2.1.6 Surgical treatment for Preauricular sinus IP 18550 Clinical Photograph Scar Photo -
S2 ENT SURGERY S2.1 EAR S2.1.7.1 Partial amputation of Pinna (malignancy perichondritis) IP 10000 CT Scan Ear Routine Histopathological Examination -

S2 ENT SURGERY S2.1 EAR S2.1.7.2 Total Amputation and Excision of External Auditory Meatus IP 15000 clinical notes Clinical Photograph& Post OP Photos -

S2 ENT SURGERY S2.1 EAR S2.1.7.3 Excision of Pinna for Growths (Squamous/Basal) Injuries Total IP 6500 CT & Biopsy Routine Histopathological Examination report &Pre& Post Clinical Photos -
Amputation
S2 ENT SURGERY S2.1 EAR S2.1.7.4 Excision of Pinna for Growths (Squamous/Basal) Injuries - IP 10000 CT & Biopsy clinical notes -
Total Amputation and Excision of External Auditory Meatus

S2 ENT SURGERY S2.1 EAR S2.1.8.1 Aural polypectomy +Tympanoplasty IP 20000 Operative notes with steps of surgery,Webex of Endoscopy showing Polyp Post OP webex,Biopsy report,clinical notes -
S2 ENT SURGERY S2.1 EAR S2.1.8.2 Aural polypectomy IP 11000 Webex of Endoscopy showing Polyp Post OP webex -
S2 ENT SURGERY S2.1 EAR S2.1.9 Removal of Impacted Ear wax IP 1500 Clinical Photograph Clinical Photograph -
S2 ENT SURGERY S2.2 THROAT S2.2.1 Microlaryngeal Surgery IP 18718 Nasal Endoscopy Clinical Photograph -
S2 ENT SURGERY S2.2 THROAT S2.2.1.1 Surgical treatment for Laryngotracheal stenosis IP 35000 DNL(Direct Nasal Laryngoscopy)\DNE -Including Biopsy Under GI,CT Scan Neck Includes Chest And Larynx DNL(Direct Nasal Laryngoscopy)\DNE - Including Biopsy Under GI -

S2 ENT SURGERY S2.2 THROAT S2.2.10 Excision of tumour of oral cavity / paranasal sinus / IP 30000 Biopsy,Hematological and radiological investigations Biopsy,Hematological and radiological investigations,Post OP Photos -
laryngopharynx with or without reconstruction
S2 ENT SURGERY S2.2 THROAT S2.2.11 CUT THROAT INJURY NECK - EXPLORATION & REPAIR IP 15000 CLINICAL PHOTO CLINICAL PHOTO -
WITHOUT VASCULAR INTERVENTION
S2 ENT SURGERY S2.2 THROAT S2.2.12 RADIO FREQUENCY ABLATION OF TONGUE IP 30000 MRI Tongue,CT biopsy,endoscopy photo -
S2 ENT SURGERY S2.2 THROAT S2.2.2 Phono Surgery For Vocal Cord Paralysis IP 25655 CT-Scan MRI Scan Clinical Photograph -
S2 ENT SURGERY S2.2 THROAT S2.2.2.1 Vidian neurectomy – Micro IP 9000 Clinical Photograph Clinical Improvement & Nervestimulation test -
S2 ENT SURGERY S2.2 THROAT S2.2.3 Laryngo Fissurectomy IP 25584 CT-Scan Clinical Photograph -
S2 ENT SURGERY S2.2 THROAT S2.2.3.1 Laryngectomy in nonmalignant conditions IP 40000 Video Laryngoscopy,CT Scan Neck Includes Chest And Larynx,DNL(Direct Nasal Laryngoscopy) / DNE - Including Routine Histopathological Examination -
Biopsy Under GI
S2 ENT SURGERY S2.2 THROAT S2.2.3.2 Bilateral Styloidectomy IP 15000 OPG showing styloid process with report Intra OP Photos showing styloid -
S2 ENT SURGERY S2.2 THROAT S2.2.3.3 TRANS ORAL LASER EXCISION OF LARYNGEAL TUMOR IP 40000 CT NECK,PREOP VLS POST OP VLS,BIOPSY -
(TOLMS) – BENIGN
S2 ENT SURGERY S2.2 THROAT S2.2.4 Exision of Tumors In Pharynx IP 20525 FNAC Clinical Photograph,Biopsy -
S2 ENT SURGERY S2.2 THROAT S2.2.5 Exision of Parapharyngeal Tumour IP 20524 FNAC,CT-Scan MRI Scan Clinical Photograph,Biopsy -
S2 ENT SURGERY S2.2 THROAT S2.2.6 Adenoidectomy - Gromet Insertion IP 10262 X-Ray Nasopharynx,Impedance Audiometry Clinical Photograph -
S2 ENT SURGERY S2.2 THROAT S2.2.6.1 Adeno tonsillectomy IP 12000 DNE,X Ray Nasopharynx Post OP DNE,Clinical Photo showing scar -
S2 ENT SURGERY S2.2 THROAT S2.2.6.1.1 Tonsillectomy - U/L(Diptheria/ tumour of tonsills/Ulcer of IP 7500 SURGICAL PROFILE POST OP CLINICAL PHOTO,INTRA OP PHOTOS,CASE SHEET -
Tonsills)
S2 ENT SURGERY S2.2 THROAT S2.2.6.1.2 Tonsillectomy - B/L (Diptheria/ tumour of tonsills/Ulcer of IP 7500 SURGICAL PROFILE POST OP CLINICAL PHOTO,INTRA OP PHOTOS,CASE SHEET -
Tonsills)
S2 ENT SURGERY S2.2 THROAT S2.2.6.2 Peritonsillar abscess drainage / intraoral calculus removal DC 8000 Clinical Photograph,clinical notes Pus for culture sensitivity report,Clinical Photo showing scar -

S2 ENT SURGERY S2.2 THROAT S2.2.7 Uvulo Palato - Pharyngoplasty IP 25655 Polysomnography Clinical Photograph -
S2 ENT SURGERY S2.2 THROAT S2.2.7.1 ZETA PLASTY IP 20000 DICE,SLEEP STUDY endoscopy photo -
S2 ENT SURGERY S2.2 THROAT S2.2.7.2 UPPP AND MODIFICATIONS IP 35000 DICE,SLEEP STUDY endoscopy photo -
S2 ENT SURGERY S2.2 THROAT S2.2.8.1 Surgical treatment for release of tongue tie IP 9990 Clinical Photograph Clinical Photograph -
S2 ENT SURGERY S2.2 THROAT S2.2.8.2 Ranula excision IP 10000 Clinical Photograph,clinical notes Post OP Photos,Operative notes with steps of surgery -
S2 ENT SURGERY S2.2 THROAT S2.2.8.3 Commondo Operation (glossectomy) IP 25000 Pre OP Photos,Clinical Photo showing scar,Biopsy Biopsy report,Clinical Photo showing scar -
S2 ENT SURGERY S2.2 THROAT S2.2.9.1 Surgical treatment for Para / retro pharyngeal abscess IP 12500 X-Ray Nasopharynx Clinical Photograph,X-Ray Nasopharynx,PUS Culture & Sensitivity -
S2 ENT SURGERY S2.2 THROAT S2.2.9.2.1 Neck dissection selective/ comprehensive/ Benign neck IP 35000 US Neck,CT/MRI ,FNAC Biopsy,clinical notes,Scar Photo -
tumour excision/ Pharyngeal diverticulum excision

S2 ENT SURGERY S2.2 THROAT S2.2.9.2.2 Drainage Parapharyngeal abscess DC 10000 X-Ray Nasopharynx Clinical Photograph,X-Ray Nasopharynx,PUS Culture & Sensitivity -
S2 ENT SURGERY S2.2 THROAT S2.2.9.3 Pharyngectomy and reconstruction IP 40000 VLS Photos,CT/MRI,Biopsy Biopsy,clinical notes,VLS -
S2 ENT SURGERY S2.2 THROAT S2.2.9.4 Pharyngeal diverticulum's – Excision IP 22000 CT/ Barium Swallow Clinical Photograph& Post OP Photos -
S2 ENT SURGERY S2.2 THROAT S2.2.9.5 Laryngophayryngectomy IP 45000 VLS Photos,clinical notes,Biopsy Biopsy,clinical notes,VLS Photos -
S2 ENT SURGERY S2.2 THROAT S2.2.9.6 Laryngectomy with block dissection IP 40000 VLS,CT neck contrast/MRI,Biopsy Scar Photo,clinical notes,VLS,Biopsy -
S2 ENT SURGERY S2.2 THROAT S2.2.9.7 Microlaryngeal surgery with or without laser IP 17000 VLC Photos & WEBEX,clinical notes VLC Photos & WEBEX,clinical notes -
S2 ENT SURGERY S2.3 NOSE S2.3.1 Endoscopic Sinus Surgery IP 16932 DNE Photo graph,CT PNS Endoscopy Photo -
S2 ENT SURGERY S2.3 NOSE S2.3.1.1 ENDOSCOPIC SINUS SURGERY-INTERNAL MAXILLARY ARTERY IP 30000 nasal endoscopy,CT PNS-CONTRAST nasal endoscopy -
LIGATION
S2 ENT SURGERY S2.3 NOSE S2.3.10 Youngs operation IP 15000 X-Ray PNS,clinical notes,Webex showing DNE Intra OP Photos,clinical notes,Post OP Photos -
S2 ENT SURGERY S2.3 NOSE S2.3.11 Surgical treatment for Choanal atresia - Unilateral IP 20000 CT-PNS Axial cuts,Nasal endoscopy WEBEX,Nasal endoscopy -
S2 ENT SURGERY S2.3 NOSE S2.3.11.1 Surgical treatment for Choanal atresia - Bilateral IP 25000 ct-pns axial cuts,nasal endoscopy WEBEX,nasal endoscopy -
S2 ENT SURGERY S2.3 NOSE S2.3.12 Surgical treatment for Oro antral fistula IP 18000 PRE DNE Photo,X-Ray Nasopharynx Post OP webex ,X-Ray Nasopharynx -
S2 ENT SURGERY S2.3 NOSE S2.3.13.1 Antrostomy – Bilateral IP 10000 clinical notes post-op x-ray PNS,clinical notes -
S2 ENT SURGERY S2.3 NOSE S2.3.13.2 Antrostomy – Unilateral IP 8500 Xray PNS post-op x-ray PNS,clinical notes -
S2 ENT SURGERY S2.3 NOSE S2.3.13.3 CSF rhinorrhoea - Endoscopic repair IP 35000 Analysis of Nasal Secreation ,Clinical Photograph/ CT Cysternography/ MR Cysternography Intra OP Photos,Clinical Photograph,Post OP Photos -
S2 ENT SURGERY S2.3 NOSE S2.3.13.4 Rhinorrhoea- repair IP 24990 Analysis of Nasal Secreation ,CT PNS Without Contrast,Clinical Photograph/ CT Cysternography/ MR Cysternography Clinical Photograph,CT PNS Without Contrast -

S2 ENT SURGERY S2.3 NOSE S2.3.13.5 Caldwell-luc(unilateral) IP 19000 DNL(Direct Nasal Laryngoscopy)\DNE -Including Biopsy Under GI,CT Scan Of Nasal Sinus,CT PNS Without Contrast DNL(Direct Nasal Laryngoscopy)\DNE-Including Biopsy Under GI ,Routine -
Histopathological Examination,WEBEX
S2 ENT SURGERY S2.3 NOSE S2.3.14.1 Intranasal Diathermy DC 4000 DNE,clinical notes DNE,clinical notes -
S2 ENT SURGERY S2.3 NOSE S2.3.14.2 Intra Nasal Ethmoidectomy DC 5000 DNE,clinical notes DNE,clinical notes -
S2 ENT SURGERY S2.3 NOSE S2.3.14.3 Nasal polypectomy – Unilateral DC 6000 DNE,CT/ X-Ray PNS Biopsy,clinical notes,Post OP Webex -
S2 ENT SURGERY S2.3 NOSE S2.3.15.1 Septoplasty with Turbinectomy Partial – Unilateral DC 5000 CT / DNE DNE,clinical notes -
S2 ENT SURGERY S2.3 NOSE S2.3.15.2 Turbinectomy Partial – Bilateral DC 5700 CT/ DNE DNE,clinical notes -
S2 ENT SURGERY S2.3 NOSE S2.3.16.1 Closed reduction / intermaxillary fixation for fracture of DC 1500 Profile Photo,X Ray Nasal bones Post OP Photo,clinical notes -
maxilla / mandible / zygoma
S2 ENT SURGERY S2.3 NOSE S2.3.16.2 Fracture - setting nasal bone DC 12000 profile photos,clinical notes profile photos,clinical notes -
S2 ENT SURGERY S2.3 NOSE S2.3.17 Ant. Ethmoidal / sphenopalatine artery ligation - Open / IP 25000 CT/ DNE clinical notes -
Endoscopic
S2 ENT SURGERY S2.3 NOSE S2.3.18 Radical fronto ethmo sphenodectomy IP 25000 CT PNS,clinical notes Biopsy,Pre& Post of X-ray,Post OP DNE -
S2 ENT SURGERY S2.3 NOSE S2.3.19 Epistaxis treatment - packing DC 2500 CLINICAL PHOTO CLINICAL PHOTO,CASE SHEET -
S2 ENT SURGERY S2.3 NOSE S2.3.2 Mastoidectomy IP 16932 CT Temporal Bone,PTA X-Ray Mastoids -
S2 ENT SURGERY S2.3 NOSE S2.3.20 oronasal fistula repair IP 20000 nasal endoscopy,oral endoscopy video,ct pns nasal endoscopy -
S2 ENT SURGERY S2.3 NOSE S2.3.3 Tympanoplasty IP 16933 X-Ray Mastoids,PTA Per OP Photo,PTA -
S2 ENT SURGERY S2.3 NOSE S2.3.3.1 Tympanotomy IP 13000 clinical notes Intra OP Photos,clinical notes,Post OP Photos -
S2 ENT SURGERY S2.3 NOSE S2.3.4 Stapedectomy - Veingraft IP 18472 Impedance Audiometry,PTA,CT Temporal Bone Clinical Photo With Piston + Vein Graft -
S2 ENT SURGERY S2.3 NOSE S2.3.5 Excision of Benign tumours of Nose IP 15394 DNE,CT PNS Clinical Photograph -
S2 ENT SURGERY S2.3 NOSE S2.3.6 Surgery for Angiofibroma IP 41049 DNE,CT PNS Clinical Photograph -
S2 ENT SURGERY S2.3 NOSE S2.3.7 Endoscopic Surgery for Dacrocystitis IP 10170 Clinical Photograph Endoscopic Photo -
S2 ENT SURGERY S2.3 NOSE S2.3.8 Septo rhinoplasty IP 18995 Pre DNE Photo,X-Ray Nasopharynx WEBEX Video,X-Ray Nasopharynx,DNE PHOTO 3 WEEKS AFTER SURGERY -
S2 ENT SURGERY S2.3 NOSE S2.3.8.1 Rhinoplasty IP 18000 Profile Photos,X Ray DNE web-x ,X Ray,Post OP Photos,Intra OP Photos -
S2 ENT SURGERY S2.3 NOSE S2.3.8.2 Septoplasty DC 13000 DNE,clinical notes DNE,clinical notes -
S2 ENT SURGERY S2.3 NOSE S2.3.8.3 Septoplasty + FESS IP 16000 DNE,clinical notes,CT PNS Intra OP Webex,clinical notes,Post OP Webex -
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CODE MAIN CATEGORY Sub SUB CATEGORY NAME CODE SURGERY / THERAPY DESCRIPTION PROCEDURE PACKAGE SPECIAL INVESTIGATION POST OPERATIVE PROCEDURE INVESTIGATION TREATMENT PROTOCOL
Category ID TYPE AMOUNT
S2 ENT SURGERY S2.3 NOSE S2.3.8.4 NASAL ENDOSCOPIC SURGERY IP 15000 CT PNS,NASAL ENDOSCOPY DNE -
S2 ENT SURGERY S2.3 NOSE S2.3.9 lateral Rhinotomy IP 25000 CT of Nose \ Nasopharynx\CT PNS Routine Histopathological Examination,Scar Photo -
S2 ENT SURGERY S2.4 FOREIGN BODY REMOVAL S2.4.1 Bronchoscopy Foreign Body Removal from IP 10262 Relevant X-Ray Clinical Photograph -
(BRONCHUS-OESOPHAGUS) Oesophagus/Bronchous(98.15.2)
S2 ENT SURGERY S2.4 FOREIGN BODY REMOVAL S2.4.2 Removal of foreign body in Ear IP 9990 Clinical Photograph Clinical Photograph/Endoscopy -
(BRONCHUS-OESOPHAGUS)
S2 ENT SURGERY S2.5 Parotid Gland S2.5.1 Excision of Benign Parotid gland tumor IP 23500 Ultrasound Neck,Fine Needle Aspiration Cytology (FNAC),Clinical Photograph Scar Photo,Routine Histopathological Examination -
S2 ENT SURGERY S2.5 Parotid Gland S2.5.2 Total Parotidectomy IP 30000 US Neck,clinical notes,FNAC Scar Photo,Histopathological report & Intra Photos -
S2 ENT SURGERY S2.6 Skull S2.6.1 Skull base surgery IP 45000 CT PNS Intra OP Webex,clinical notes,Post OP Webex -
S2 ENT SURGERY S2.8 Maxilla S2.8.1 Fracture - setting maxilla IP 20000 clinical notes Pre& Post of X-ray -
S2 ENT SURGERY S2.8 Maxilla S2.8.2 Exision of Maxilla IP 40000 3D CT Facial Bones / CT-PNS Intra OP Photos,3D CT Facial Bones,Post OP Photos -
S2 ENT SURGERY S2.8 Maxilla S2.8.3 Partial Maxilla – Excision IP 23000 clinical notes post op web-x,Histopathological report -
S2 ENT SURGERY S2.8 Maxilla S2.8.4 Fracture - setting maxilla - Bilateral IP 25000 3D CT facial bones Pre& Post of X-ray -
S3 OPHTHALMOLOGY SURGERY S3 OPHTHALMOLOGY SURGERY S3.12 Corneal embeded Foreign body DC 2500 B-Scan,Fundus floroscence,Clinical Photograph Clinical Photograph(Intra & Post OP),Fundus floroscence -

S3 OPHTHALMOLOGY SURGERY S3 OPHTHALMOLOGY SURGERY S3.13 Dermoid cyst excision DC 14220 X-Ray Orbit,Fine Needle Aspiration Cytology (FNAC),Clinical Photograph,CT local Area Clinical Photograph(Intra & Post OP),Triple Markers/Immunohistochemistry(IHC)Three -
Markers,Routine Histopathological Examination

S3 OPHTHALMOLOGY SURGERY S3 OPHTHALMOLOGY SURGERY S3.14 REF ER WITH OD MYALINATED N FIBERSD WITH OS TILTED DC 1000 HVF - -
DISC - EVERY YEAR HVF
S3 OPHTHALMOLOGY SURGERY S3 OPHTHALMOLOGY SURGERY S3.15 GLAUCOMA - HVF DC 1200 HVF - -

S3 OPHTHALMOLOGY SURGERY S3 OPHTHALMOLOGY SURGERY S3.15.1 Aqueous Shunt Procedure (Glaucoma Drainage Device) IP 18000 Slit Lamp Photographs of filtration surgery area Intra-ocular Pressures Fundus Photos (if feasible)Visual Fields Slit lamp Photograph of Filtration area Fundus Photos (If not taken pre-operatively) -
Analysis report
S3 OPHTHALMOLOGY SURGERY S3.1 CONJUNCTIVA S3.1.1 Fornix forming sutures IP 10690 X-Ray Orbit Clinical Photograph(Intra & Post OP) -

S3 OPHTHALMOLOGY SURGERY S3.1 CONJUNCTIVA S3.1.2 Pterigium + conjunctival autograft IP 7500 Clinical Photograph,NLD probing(single eye) Clinical Photograph(Intra & Post OP) -

S3 OPHTHALMOLOGY SURGERY S3.1 CONJUNCTIVA S3.1.3 Surgical treatment for Symblepharon DC 4460 Clinical Photograph Clinical Photograph(Intra & Post OP),Swab Culture and Sensitivity -

S3 OPHTHALMOLOGY SURGERY S3.1 CONJUNCTIVA S3.1.4 Epicanthus repair DC 6810 Clinical Photograph Clinical Photograph(Intra & Post OP) -

S3 OPHTHALMOLOGY SURGERY S3.10 Uvea S3.10.1 Iridectomy-Iridotomy IP 3500 Clinical Photograph,UBM or ASOCT photos Clinical Photograph(Intra & Post OP),UBM or ASOCT photos -

S3 OPHTHALMOLOGY SURGERY S3.10 Uvea S3.10.2 Exision of tumours of iris IP 19240 Clinical Photograph,Fundus floroscence Clinical Photograph(Intra & Post OP),Fundus floroscence -

S3 OPHTHALMOLOGY SURGERY S3.10 Uvea S3.10.3 Surgical treatment for Other disorders of iris and ciliary body DC 3500 Fundus Photo,B Scan UBM or ASOCT photots B Scan UBM or ASOCT photots,Fundus floroscence,Fundus Photo -

S3 OPHTHALMOLOGY SURGERY S3.10 Uvea S3.10.4 Surgical treatment for Iris prolapse DC 6997 Clinical Photograph,B Scan Clinical Photograph(Intra & Post OP) -

S3 OPHTHALMOLOGY SURGERY S3.10 Uvea S3.10.5 Iris cyst removal DC 2500 Clinical Photograph Post Op Photos,Intra Op Photos -

S3 OPHTHALMOLOGY SURGERY S3.10 Uvea S3.10.6 Iridectomy DC 2500 Clinical Photograph Post Op Photos,Intra Op Photos -

S3 OPHTHALMOLOGY SURGERY S3.11 LIMBUS S3.11.1 Limbal Dermoid Removal IP 4500 Clinical Photograph,Hematological and radiological investigations HPE,Intra Op Photos,Post Op Photos -

S3 OPHTHALMOLOGY SURGERY S3.2 CORNEA and SCLERA S3.2.1 Therapeutic Penetrating Keratoplasty IP 20011 BSCAN Clinical Photograph -

S3 OPHTHALMOLOGY SURGERY S3.2 CORNEA and SCLERA S3.2.10 Cyclocryotherapy IP 8000 B Scan,Fundus floroscence,Clinical Photograph,IOP Clinical Photograph (Intra & Post OP),Fundus floroscence -

S3 OPHTHALMOLOGY SURGERY S3.2 CORNEA and SCLERA S3.2.11 Corneal Tear Repair ST 9200 Anteriorsegmant Slit Lamp Photo,Clinical Photo Clinical Photo with Sutures -

S3 OPHTHALMOLOGY SURGERY S3.2 CORNEA and SCLERA S3.2.12 Mucous Membrane Grafting ST 16560 HPE,Clinical Photo (Clear Face Photo),Clinical History MMG photo, Scar Photo,Post Op Clinical Photo -

S3 OPHTHALMOLOGY SURGERY S3.2 CORNEA and SCLERA S3.2.13 COLLAGEN CROSS LINKING FOR KERATOCONUS IP 20000 ORB SCAN ORB SCAN -

S3 OPHTHALMOLOGY SURGERY S3.2 CORNEA and SCLERA S3.2.2 Lamellar Keratoplasty IP 23075 BSCAN Clinical Photograph -

S3 OPHTHALMOLOGY SURGERY S3.2 CORNEA and SCLERA S3.2.3 Corneal Patch Graft IP 17866 Clinical Photograph Clinical Photograph -

S3 OPHTHALMOLOGY SURGERY S3.2 CORNEA and SCLERA S3.2.4 Scleral Patch Graft IP 15000 Clinical Photograph Clinical Photograph -

S3 OPHTHALMOLOGY SURGERY S3.2 CORNEA and SCLERA S3.2.5 Penetrating Keratoplasty IP 18215 Clinical Photograph Clinical Photograph -

S3 OPHTHALMOLOGY SURGERY S3.2 CORNEA and SCLERA S3.2.6 Double Z-Plasty IP 4105 Clinical Photograph Clinical Photograph -

S3 OPHTHALMOLOGY SURGERY S3.2 CORNEA and SCLERA S3.2.7 Amniotic Membrane Graft for Cornea/Sclera (12.87.2) IP 11288 Clinical Photograph Clinical Photograph -

S3 OPHTHALMOLOGY SURGERY S3.2 CORNEA and SCLERA S3.2.7.1 Pterygium repair DC 4000 NLD probing(single eye) Intra OP Photo -

S3 OPHTHALMOLOGY SURGERY S3.2 CORNEA and SCLERA S3.2.8 Surgical treatment for Scleral wound IP 10440 B Scan,Fundus floroscence,Clinical Photograph Clinical Photograph(Intra & Post OP),Fundus floroscence -

S3 OPHTHALMOLOGY SURGERY S3.2 CORNEA and SCLERA S3.2.9 Surgical treatment for Perforating scleral injury IP 18000 B Scan,Fundus floroscence,Clinical Photograph Clinical Photograph(Intra & Post OP),Fundus floroscence -

S3 OPHTHALMOLOGY SURGERY S3.3 VITREO-RETINA S3.3.1.1 Vitrectomy IP 23623 - Clinical Photograph -

S3 OPHTHALMOLOGY SURGERY S3.3 VITREO-RETINA S3.3.1.2 Vitrectomy - Membrane Peeling - Endolaser - Silicon oil or Gas IP 26500 Fundus Photograph,B.Scan Fundus Photograph -
- with or without belt buckling
S3 OPHTHALMOLOGY SURGERY S3.3 VITREO-RETINA S3.3.1.3 Vitrectomy - Membrane Peeling- Endolaser IP 19280 Fundus Photograph,B.Scan Fundus Photograph -

S3 OPHTHALMOLOGY SURGERY S3.3 VITREO-RETINA S3.3.1.4 Vitrectomy Plus Silicon Oil Or Gas (14.75) IP 21520 - - -

S3 OPHTHALMOLOGY SURGERY S3.3 VITREO-RETINA S3.3.1.5 Removal Of Silicon Oil Or Gas post Vitrectomy IP 9981 BSCAN,FUNDUS PHOTOGRAPH BSCAN,FUNDUS PHOTOGRAPH -

S3 OPHTHALMOLOGY SURGERY S3.3 VITREO-RETINA S3.3.1.6 Monthly Intravitreal Anti-Vegf For Macular Degeneration - Per IP 11590 Fundus Photograph,B.Scan Fundus Photograph -
Injection (Maximum - 6)
S3 OPHTHALMOLOGY SURGERY S3.3 VITREO-RETINA S3.3.1.7 INTRAVITREAL TRIAMCINOLONE / ANTIBIOTICS IP 3500 IOP,FUNDUS PHOTO IOP,FUNDUS PHOTO -

S3 OPHTHALMOLOGY SURGERY S3.3 VITREO-RETINA S3.3.2.1 Scleral buckle procedure for Retinal detachment IP 23596 Fundus Photograph,B.Scan Fundus Photograph -

S3 OPHTHALMOLOGY SURGERY S3.3 VITREO-RETINA S3.3.2.2 Photocoagulation for Retinopathy IP 2052 Fundus Photograph,B.Scan Fundus Photograph -

S3 OPHTHALMOLOGY SURGERY S3.3 VITREO-RETINA S3.3.2.3 Pan Retinal Photocoagulation (PRP) - Retinal Laser including 3 DC 7600 Clinical Photograph,Hematological and radiological investigations Peripheral Fundus Photos showing PRP laser Marks,Intra Op Photos -
sittings/ package of retino laser photocoagulation (3 sittings
per eye)
S3 OPHTHALMOLOGY SURGERY S3.3 VITREO-RETINA S3.3.2.4 Scleral Buckle Removal DC 5500 Clinical Photograph,Montage Fundus Photo Post Op Photos,Intra Op Photos -

S3 OPHTHALMOLOGY SURGERY S3.3 VITREO-RETINA S3.3.2.5 Surgical Membranectomy DC 8000 Clinical Photograph,Hematological and radiological investigations Post Op Photos,Intra Op Photos -

S3 OPHTHALMOLOGY SURGERY S3.3 VITREO-RETINA S3.3.2.6 Cryoretinopexy - open DC 11580 Fundus floroscence Fundus floroscence -

S3 OPHTHALMOLOGY SURGERY S3.3 VITREO-RETINA S3.3.2.7 Cryoretinopexy - closed IP 12250 Fundus floroscence Fundus floroscence -

S3 OPHTHALMOLOGY SURGERY S3.3 VITREO-RETINA S3.3.3.1 Central serous chorio retinpathy DC 5000 Fundus Photo,FFA,OCT Fundus Photo,OCT -

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CODE MAIN CATEGORY Sub SUB CATEGORY NAME CODE SURGERY / THERAPY DESCRIPTION PROCEDURE PACKAGE SPECIAL INVESTIGATION POST OPERATIVE PROCEDURE INVESTIGATION TREATMENT PROTOCOL
Category ID TYPE AMOUNT
S3 OPHTHALMOLOGY SURGERY S3.3 VITREO-RETINA S3.3.3.2 DIABETIC MACULAR EDEMA-AVASTIN IP 9000 FUNDUS PHOTO,OCT FUNDUS PHOTO,OCT -

S3 OPHTHALMOLOGY SURGERY S3.3 VITREO-RETINA S3.3.3.3 DIABETIC MACULAR EDEMA-INTRA VITREAL LUCENTIS IP 18000 FUNDUS PHOTO,OCT FUNDUS PHOTO,OCT -

S3 OPHTHALMOLOGY SURGERY S3.4 ORBIT S3.4.1 Socket Reconstruction IP 24616 Clinical Photograph Clinical Photograph -

S3 OPHTHALMOLOGY SURGERY S3.4 ORBIT S3.4.10 Endoscopic orbital decompression IP 9050 CT Orbits Without Contrast / MRI Orbits Without Contrast Routine Histopathological Examination -

S3 OPHTHALMOLOGY SURGERY S3.4 ORBIT S3.4.11 Excision of Benign neoplasm of Eye and Adnexa DC 10620 B-Scan,CT Orbits With Contrast /MRI Orbits With Contrast,Clinical Photograph Clinical Photograph(Intra & Post OP),Routine Histopathological Examination -

S3 OPHTHALMOLOGY SURGERY S3.4 ORBIT S3.4.12 RTA WITH EYE SWELLING ST 4280 CLINICAL NOTES,CLINICAL PHOTO CASE SHEET,POST TREATMENT CLINICAL PHOTO,treatment photo -

S3 OPHTHALMOLOGY SURGERY S3.4 ORBIT S3.4.13 OCULOPLASTY (SKIN GRAFTING) IP 14000 CLINICAL PICTURE CL PHOTO -

S3 OPHTHALMOLOGY SURGERY S3.4 ORBIT S3.4.2 Dermis Fat Graft IP 23489 Clinical Photograph Clinical Photograph -

S3 OPHTHALMOLOGY SURGERY S3.4 ORBIT S3.4.3 Orbitotomy IP 27810 - Clinical Photograph -

S3 OPHTHALMOLOGY SURGERY S3.4 ORBIT S3.4.4 Evisceration /Enucleation with Orbital implant IP 15912 Orbit,Clinical Photograph,CT Skull Clinical Photograph -

S3 OPHTHALMOLOGY SURGERY S3.4 ORBIT S3.4.4.1 Evisceration DC 3700 Clinical Photograph,Hematological and radiological investigations,B-Scan Post Op Photos,Intra Op Photos -

S3 OPHTHALMOLOGY SURGERY S3.4 ORBIT S3.4.5 Decompression/Excision Of Optic Nerve Lesions IP 60000 MRI Photograph -

S3 OPHTHALMOLOGY SURGERY S3.4 ORBIT S3.4.6 Surgical Management of Proptosis IP 50000 CT,MRI Clinical Photograph -

S3 OPHTHALMOLOGY SURGERY S3.4 ORBIT S3.4.7 Exenteration of Orbit IP 10180 3D CT Skull / MRI Orbits With Contrast,CT Orbits With Contrast Routine Histopathological Examination -

S3 OPHTHALMOLOGY SURGERY S3.4 ORBIT S3.4.8 Intraocular foreign body removal IP 31630 X-Ray Orbit,Fundus floroscence,CT Orbit CT Orbit,Fundus floroscence,Clinical Photograph(Intra & Post OP) -

S3 OPHTHALMOLOGY SURGERY S3.4 ORBIT S3.4.9 Anterior chamber reconstruction IP 7690 X-Ray Orbit,USG local area Clinical Photograph(Intra & Post OP),Fundus floroscence -

S3 OPHTHALMOLOGY SURGERY S3.5 SQUINT CORRECTION SURGERY S3.5.1 Rectus Muscle Surgery(Single) IP 8128 Clinical Photograph Clinical Photograph -

S3 OPHTHALMOLOGY SURGERY S3.5 SQUINT CORRECTION SURGERY S3.5.2 Rectus Muscle Surgery(TwoThree) IP 10970 Clinical Photograph Clinical Photograph -

S3 OPHTHALMOLOGY SURGERY S3.5 SQUINT CORRECTION SURGERY S3.5.3 Oblique muscle surgery IP 7922 Clinical Photograph Clinical Photograph -

S3 OPHTHALMOLOGY SURGERY S3.6 LID SURGERY S3.6.1 Lid Reconstruction surgery IP 10313 Clinical Photograph Clinical Photograph -

S3 OPHTHALMOLOGY SURGERY S3.6 LID SURGERY S3.6.10 Chalazion Removal DC 2000 CLINICAL PHOTO CASE SHEET,INTRA OP PHOTOS,POST OP CLINICAL PHOTO -

S3 OPHTHALMOLOGY SURGERY S3.6 LID SURGERY S3.6.2 Surgical correction of Ptosis IP 30786 ICE pack test with Chin Elevation,Clinical Photograph Clinical Photograph -

S3 OPHTHALMOLOGY SURGERY S3.6 LID SURGERY S3.6.3 Surgical treatment for Ankyloblepharon IP 11370 Clinical Phtotograph Clinical Photograph(Intra & Post OP) -

S3 OPHTHALMOLOGY SURGERY S3.6 LID SURGERY S3.6.4 Drainage of Lid Abscess IP 8860 Clinical Photograph Clinical Photograph(Intra & Post OP) -

S3 OPHTHALMOLOGY SURGERY S3.6 LID SURGERY S3.6.5 Surgical treatment for disorders of Eyelid IP 9530 Clinical Photograph Clinical Photograph(Intra & Post OP) -

S3 OPHTHALMOLOGY SURGERY S3.6 LID SURGERY S3.6.6 Exision of Small tumour of lid IP 9840 Clinical Photograph,CT Orbits With Contrast Clinical Photograph(Intra & Post OP),Routine Histopathological Examination -

S3 OPHTHALMOLOGY SURGERY S3.6 LID SURGERY S3.6.7 Ectropion correction IP 11000 Clinical Photograph Clinical Photograph(Intra & Post OP) -

S3 OPHTHALMOLOGY SURGERY S3.6 LID SURGERY S3.6.8 Lagophthalmos correction IP 13210 Clinical Photograph,T3,TSH,T4 Clinical Photograph(Intra & Post OP) -

S3 OPHTHALMOLOGY SURGERY S3.6 LID SURGERY S3.6.9 Entropion correction DC 15000 Clinical Photograph Clinical Photograph(Intra & Post OP) -

S3 OPHTHALMOLOGY SURGERY S3.7 PEDIATRIC OPHTHALMIC SURGERY S3.3.6 Photocoagulation For Retinopathy Of Prematurity IP 9980 Optical Coherence Tomography,Fundus Photograph,Fundus Fluorescein Angiography Optical Coherence Tomography,Fundus Photograph,Fundus Fluorescein Angiography -

S3 OPHTHALMOLOGY SURGERY S3.7 PEDIATRIC OPHTHALMIC SURGERY S3.3.7 Paediatric Cataract Surgery (Phacoemulsification IOL) IP 15500 Fundus Photograph,B.Scan Fundus Photograph -

S3 OPHTHALMOLOGY SURGERY S3.7 PEDIATRIC OPHTHALMIC SURGERY S3.3.8 Glaucoma filtering surgery for paediatric glaucoma IP 9534 Fundus Photograph,Fundus Fluorescein Angiography Fundus Photograph -

S3 OPHTHALMOLOGY SURGERY S3.7 PEDIATRIC OPHTHALMIC SURGERY S3.3.9 Glaucoma Surgery IP 8394 Fundus floroscence Fundus floroscence -

S3 OPHTHALMOLOGY SURGERY S3.8 LENS S3.8.4.1 Lensectomy IP 11920 B-Scan,Fundus floroscence,Clinical Photograph Clinical Photograph(Intra & Post OP),Fundus floroscence -

S3 OPHTHALMOLOGY SURGERY S3.8 LENS S3.8.4.2 Enucleation with / without implant IP 7000 Clinical Photograph,Hematological and radiological investigations Post Op Photos,Intra Op Photos -

S3 OPHTHALMOLOGY SURGERY S3.8 LENS S3.8.5 Posterior capsulotomy/polishing IP 10790 X-Ray Orbit,USG local area Clinical Photograph(Intra & Post OP),Fundus floroscence -

S3 OPHTHALMOLOGY SURGERY S3.8 LENS S3.8.6 Yag laser capsulotomy IP 2500 Anterior segment Clnical Photo,USG local area Clinical Photograph(Intra & Post OP),Fundus floroscence -

S3 OPHTHALMOLOGY SURGERY S3.8 LENS S3.8.7 Secondary IOL-scleral fixation-sulcus fixation of lens ACIOL IP 22000 Amplitude Modulation Scan (A- Scan),X-Ray Orbit,Clinical Photograph Clinical Photograph(Intra & Post OP),Fundus floroscence -

S3 OPHTHALMOLOGY SURGERY S3.8 LENS S3.8.8 Bandage contact lens with glue application IP 4380 X-Ray Orbit,USG local area Clinical Photograph(Intra & Post OP),Fundus floroscence -

S3 OPHTHALMOLOGY SURGERY S3.8 LENS S3.8.9 CATARACT Surgery (SICS) IP 2000 B.SCAN,Clinical Photo,A-SCAN B.SCAN,CLINAL PHOTO FUNDUS PHOTO -

S3 OPHTHALMOLOGY SURGERY S3.8 LENS S3.8.9.1 CATRACT EXTRACTION PHACO WITH FOLODABLE PCIOL IP 7500 FUNDUS PHOTO,Clinical Photo,A-SCAN,B.SCAN B.SCAN,CLINAL PHOTO FUNDUS PHOTO -

S3 OPHTHALMOLOGY SURGERY S3.9 Lacrimal Sac S3.9.1 Surgery for Congenital dacrocystitis IP 8000 Dacryocystography,NLD probing(single eye) Clinical Photograph(Intra & Post OP),NLD probing(single eye) -

S3 OPHTHALMOLOGY SURGERY S3.9 Lacrimal Sac S3.9.2 Congenital NLD probing IP 12000 NLD probing(single eye) Clinical Photograph(Intra & Post OP),NLD probing(single eye) -

S3 OPHTHALMOLOGY SURGERY S3.9 Lacrimal Sac S3.9.2.1 NLD PROBING IP 7000 Syringing Report Syringing Report -

S3 OPHTHALMOLOGY SURGERY S3.9 Lacrimal Sac S3.9.3 External Dacryocysto rhinostomy IP 14050 Dacryocystography,NLD probing(single eye) Clinical Photograph(Intra & Post OP),NLD probing(single eye) -

S3 OPHTHALMOLOGY SURGERY S3.9 Lacrimal Sac S3.9.4 Canaliculo/conjuctivo Dacryocysto rhinostomy IP 18000 Dacryocystography,X-Ray Orbit Clinical Photograph(Intra & Post OP),DNE Photo -

S3 OPHTHALMOLOGY SURGERY S3.9 Lacrimal Sac S3.9.5.1 Canaliculo Dacryocystorhinostomy with Silicon Tube / Stent IP 9000 Clinical Photograph,Hematological and radiological investigations Post Op Photos,Intra Op Photos -
OR Canaliculo Dacryocystorhinostomy without Silicon Tube /
Stent
S3 OPHTHALMOLOGY SURGERY S3.9 Lacrimal Sac S3.9.5.2 Dacrocystectomy DC 7840 NLD probing,Clinical Photo Post OP Photo,Case Sheet with operation Notes,Intra OP Photo -

S4 GYNAECOLOGY AND S4 OBSTETRICS & GYNAECOLOGY S4.5 LLETZ (including PAP smear and colposcopy) IP 15000 Clinical report Intra Op Photos -
OBSTETRICS SURGERY
S4 GYNAECOLOGY AND S4.1 Obstetrics S4.1.1 Caesarean Hysterectomy with Bladder Repair IP 48005 USG Post-op USG,Photograph -
OBSTETRICS SURGERY
S4 GYNAECOLOGY AND S4.1 Obstetrics S4.1.1.1 Hysterectomy - abdominal with OR without Salpingo- IP 23920 D.D.&C,Detailed clinical notes with physical findings,USG Abdomen indications 1.(Large Uterus >12weeks size 2. HPE of the Specimen,Per-Operative photo with patient face,Healed scar photo,Post- -
OBSTETRICS SURGERY Oophrectomy Cervical Fibroids/ Cervical Enlargement 3. Extensive Plevic Endometriosis 4. Plevic Inflammatory Disease),Papsmear Operative USG report

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CODE MAIN CATEGORY Sub SUB CATEGORY NAME CODE SURGERY / THERAPY DESCRIPTION PROCEDURE PACKAGE SPECIAL INVESTIGATION POST OPERATIVE PROCEDURE INVESTIGATION TREATMENT PROTOCOL
Category ID TYPE AMOUNT
S4 GYNAECOLOGY AND S4.1 Obstetrics S4.1.10 Poly Hydramnios Management including LSCS IP 20000 AFI,ROUTINE ANTINATAL CHECK-UPS WITH INVESTIGATIONS,Hb%,1st Trimester/First visit to the hospital Blood Detailed case sheet,Per-operative photo with mother face,mother with baby -
OBSTETRICS SURGERY grouping & Rh typiyin,Viral markers TSH,FBS,urine routine examination USG Abdomen,2nd Trimister Hb%,GTT,3rd photo,Antenatal photo
Trimester Hb%,urine routine examination,USG Abdomen NST
S4 GYNAECOLOGY AND S4.1 Obstetrics S4.1.11 Placenta Previa-type III to IV Management including delivery IP 20000 complete blood picture,ROUTINE ANTINATAL CHECK-UPS WITH INVESTIGATIONS Detailed case sheet,Per-operative photo with mother face,Antenatal photo,mother with -
OBSTETRICS SURGERY LSCS baby photo
S4 GYNAECOLOGY AND S4.1 Obstetrics S4.1.12 Hyperemisis Gravidarum Management IP 8260 Serium Electorlytes,urine Pregnancy Test,USG Abdomen Urine ketone bodies detailed case sheet,Clinical photo -
OBSTETRICS SURGERY
S4 GYNAECOLOGY AND S4.1 Obstetrics S4.1.13 Diabetes complicating pregnancy Management including LSCS IP 20000 Treatmnet details of Diabetes,ROUTINE ANTINATAL CHECK-UPS WITH INVESTIGATIONS Detailed case sheet,Antenatal photo,Per-operative photo with mother face,mother with -
OBSTETRICS SURGERY baby photo
S4 GYNAECOLOGY AND S4.1 Obstetrics S4.1.14 Hepatic Disorder Management in pregnancy including LSCS IP 20000 LFT,ROUTINE ANTINATAL CHECK-UPS WITH INVESTIGATIONS,Coagulation profile mother with baby photo,Antenatal photo,Per-operative photo with mother face,Detailed -
OBSTETRICS SURGERY case sheet
S4 GYNAECOLOGY AND S4.1 Obstetrics S4.1.15 Intra Uterine Growth Retardation Management LSCS IP 20000 2nd Trimester USG must be TIFFA,ROUTINE ANTINATAL CHECK-UPS WITH INVESTIGATIONS Detailed case sheet,Antenatal photo,Per-operative photo with mother face,mother with -
OBSTETRICS SURGERY baby photo
S4 GYNAECOLOGY AND S4.1 Obstetrics S4.1.16 Surgical Management of Ectopic pregnancy IP 21220 Detailed clinical History,USG Abdomen,Pregnancy Test-Urine HPE of the Specimen,Per-Operative photo with patient face,Healed scar photo,Post- -
OBSTETRICS SURGERY Operative USG report
S4 GYNAECOLOGY AND S4.1 Obstetrics S4.1.16.1 LAPROTOMY(RUPTURED OVARIAN CYST/ RUPTURED IP 22710 USG ABDOMEN,CLINICAL NOTES WITH HISTORY HPE OF THE SPECIMEN,PER OP PHOTO WITH PATIENT FACE,POST OP USG,HEALED SCAR -
OBSTETRICS SURGERY ECTOPIC) PHOTO
S4 GYNAECOLOGY AND S4.1 Obstetrics S4.1.17 Abruptio Placenta Management including delivery LSCS IP 20000 Coagalation profile,ROUTINE ANTINATAL CHECK-UPS WITH INVESTIGATIONS,Complete CBP Detailed case sheet,Antenatal photo,Per-operative photo with mother face,mother with -
OBSTETRICS SURGERY baby photo
S4 GYNAECOLOGY AND S4.1 Obstetrics S4.1.17.1 McDonald'S STITCH DC 4000 Clinical notes/ past obstetric history & USG abdomen Photo at the time of procedure -
OBSTETRICS SURGERY
S4 GYNAECOLOGY AND S4.1 Obstetrics S4.1.17.2 Shirodkar's stitch DC 4000 Clinical notes/ past obstetric history & USG abdomen Photo at the time of procedure -
OBSTETRICS SURGERY
S4 GYNAECOLOGY AND S4.1 Obstetrics S4.1.17.3 Cervical Encieclage IP 7000 Detailed case sheet,ROUTINE ANTINATAL CHECK-UPS WITH INVESTIGATIONS Procedure photo/Webex -
OBSTETRICS SURGERY
S4 GYNAECOLOGY AND S4.1 Obstetrics S4.1.18 Heart disease complicating pregnancy Management including IP 20000 Detailed clinical history,ROUTINE ANTINATAL CHECK-UPS WITH INVESTIGATIONS,Cardiologist Detailed case sheet,Antenatal photo,Per-operative photo with mother face,mother with -
OBSTETRICS SURGERY deliveryLSCS Consultation,ECG,ECHO Cardiogram baby photo
S4 GYNAECOLOGY AND S4.1 Obstetrics S4.1.19 PPH-Surgical management IP 31000 HB%,USG Abdomen,Blood Coagulation Analyzer (BCA) Or Coagulation Profile ,Platelet Count ,Bleeding Time And Post Op Photos,USG Abdomen,Case Sheet with operation Notes,Intra OP photos -
OBSTETRICS SURGERY Clotting Time,Complete Blood Picture [CBP]
S4 GYNAECOLOGY AND S4.1 Obstetrics S4.1.2 Surgery for Rupture Uterus with Tubectomy IP 33351 USG USG -
OBSTETRICS SURGERY
S4 GYNAECOLOGY AND S4.1 Obstetrics S4.1.3 Management of Eclampsia with Complications Requiring IP 41048 APTT,ABG,CUE,LFT,RFT,Heamatocrit,Platelet Count,S.Fibrinogen Level,PT Clinical Photograph,Biochemical Investigations -
OBSTETRICS SURGERY Ventilatory Support
S4 GYNAECOLOGY AND S4.1 Obstetrics S4.1.3.1 Eclampsia Management without ventilator support LSCS IP 30000 Coagulation Profile,ROUTINE ANTINATAL CHECK-UPS WITH INVESTIGATIONS,LFT,KIDNEY function test,24 hr Urinary Detailed case sheet,Antenatal photo,Per-operative photo with mother face,mother with -
OBSTETRICS SURGERY protiens,Fundo Scopy baby photo
S4 GYNAECOLOGY AND S4.1 Obstetrics S4.1.3.2 Pre- eclampsia / PIH Management including delivery LSCS IP 20000 Coagulation Profile,ROUTINE ANTINATAL CHECK-UPS WITH INVESTIGATIONS,LFT,KIDNEY function test,24 hr Urinary Detailed case sheet,Antenatal photo,Per-operative photo with mother face,mother with -
OBSTETRICS SURGERY protiens,Fundo Scopy baby photo
S4 GYNAECOLOGY AND S4.1 Obstetrics S4.1.4 Surgical Management of Abruptio-Placenta with Coagulation IP 27522 APTT,USG,Heamatocrit,Platelet Count,S.Fibrinogen Level,PT Clinical Photograph of Retroplacental clots,USG -
OBSTETRICS SURGERY Defects(Dic)
S4 GYNAECOLOGY AND S4.1 Obstetrics S4.1.5 Normal Delivery IP 8000 - - -
OBSTETRICS SURGERY
S4 GYNAECOLOGY AND S4.1 Obstetrics S4.1.5.1 Instrumental Vaginal Delivery - Forceps with or without IP 9200 ROUTINE ANTINATAL CHECK-UPS WITH INVESTIGATIONS Delivary photo with Foeceps application and Traction,Antenatal photo,Intra -
OBSTETRICS SURGERY EPISIOTOMY partam/Immidiate post partam photo with mother face and baby,Detailed case sheet

S4 GYNAECOLOGY AND S4.1 Obstetrics S4.1.5.2 Normal Vaginal Delivery in Twins(Multiple pregnency) IP 15810 ROUTINE ANTINATAL CHECK-UPS WITH INVESTIGATIONS photo of the mother with twin babies,Antenatal photo,Intra partam/Immidiate post -
OBSTETRICS SURGERY partam photo with mother face and baby,Detailed case sheet

S4 GYNAECOLOGY AND S4.1 Obstetrics S4.1.5.3 Normal Vaginal Delivery HIV +ve Mother IP 20000 evidence of prophylaxis to the baby,ROUTINE ANTINATAL CHECK-UPS WITH INVESTIGATIONS,CD-4 count Intra partam/Immidiate post partam photo with mother face and baby,Detailed case -
OBSTETRICS SURGERY sheet,Antenatal photo
S4 GYNAECOLOGY AND S4.1 Obstetrics S4.1.5.4 Retained Placenta with Manual Removal IP 12000 USG Abdomen Photo of the procedure,USG Abdomen -
OBSTETRICS SURGERY
S4 GYNAECOLOGY AND S4.1 Obstetrics S4.1.5.5 Medical Management of PPH IP 10470 CBP with Coagulation Profile,clinical photo,Detaoled clinical notes evidence 0f blood transfusion,Clinical photo detailed case sheet -
OBSTETRICS SURGERY
S4 GYNAECOLOGY AND S4.1 Obstetrics S4.1.5.6 INSTRUMENTAL VAGINAL DELIVERY - VACCUM EXTRACTION IP 11000 USG,ROUTINE ANTENATAL CHECKUPS,CLINICAL HISTORY ANTENATAL PHOTO,INTRAPARTERM PHOTO WITH VACCUM EXTRACTION,POST -
OBSTETRICS SURGERY (for primi) PARTUM PHOTO WITH MOTHER FACE
S4 GYNAECOLOGY AND S4.1 Obstetrics S4.1.6 Caesarean Section IP 14050 - - -
OBSTETRICS SURGERY
S4 GYNAECOLOGY AND S4.1 Obstetrics S4.1.6.1 Caesarean Section In Rh-Negative Mother With LSCS IP 17000 Indirect coomb s test every trimester,ROUTINE ANTINATAL CHECK-UPS WITH INVESTIGATIONS,HUSBAND BLOOD Card blood for grouping and Rh typing,Antenatal photo,Per-operative photo with -
OBSTETRICS SURGERY GROUPING AND Rh typing mother face,mother with baby photo,Detailed case sheet,Direct Coomb s test,Evidence
of ANT-D GIVEN
S4 GYNAECOLOGY AND S4.1 Obstetrics S4.1.6.2 Cesarean Section in HIV+ve Mother IP 24000 Bio-Physical Profile,USG Abdomen,Complete Clinical Notes,CD-4 count Retro viral Prophylaxis to Baby,Case Sheet with operation Notes -
OBSTETRICS SURGERY
S4 GYNAECOLOGY AND S4.1 Obstetrics S4.1.7.1 Secondary suturing of episiotomy IP 4000 Clinical Photograph Procedure Photo -
OBSTETRICS SURGERY
S4 GYNAECOLOGY AND S4.1 Obstetrics S4.1.7.2 Surgical Management of Post Coital tear / Perineal injury IP 4000 clinical notes with surgical profile,Clinical Photograph Evidence of bloodtransfusion,Procedure Photo/Webex,detailed case sheet -
OBSTETRICS SURGERY
S4 GYNAECOLOGY AND S4.1 Obstetrics S4.1.7.3 Complete perineal tear repaire (After NVD with PPH) IP 5628 Clinical Photograph,clinical notes detailed case sheet,Procedure Photo/Webex -
OBSTETRICS SURGERY
S4 GYNAECOLOGY AND S4.1 Obstetrics S4.1.8 HELLP Syndrome Management in pregnancy IP 20000 LFT,ROUTINE ANTINATAL CHECK-UPS WITH INVESTIGATIONS,detailed case sheet,Coagulation profile Depending upon mode of delivary evidences can be submitted,detailed case sheet -
OBSTETRICS SURGERY
S4 GYNAECOLOGY AND S4.1 Obstetrics S4.1.9 Severe Anemia Management in pregnancy incliding delivery IP 25260 perpheral smear,ROUTINE ANTINATAL CHECK-UPS WITH INVESTIGATIONS,complete blood picture Detailed case sheet,Antenatal photo,Per-operative photo with mother face,mother with -
OBSTETRICS SURGERY LSCS baby photo
S4 GYNAECOLOGY AND S4.2 Gynaecology S4.2.1 Laproscopic Vaginal Hysterectomy IP 30786 USG Post-op USG -
OBSTETRICS SURGERY
S4 GYNAECOLOGY AND S4.2 Gynaecology S4.2.10 Vaginal Hysterectomy With Pelvic Floor Repair(70.79) IP 30786 Scan Post-op USG,Biopsy -
OBSTETRICS SURGERY
S4 GYNAECOLOGY AND S4.2 Gynaecology S4.2.12 Repair of Cystocele ,Rectocele andPerineorraphy(71.71) IP 20524 USG Post-op USG,Biopsy -
OBSTETRICS SURGERY
S4 GYNAECOLOGY AND S4.2 Gynaecology S4.2.12.1 Surgical Management of Cystocoele - Repair IP 14220 Clinical Photo,USG Abdomen Photo of the surgical procedure,USG Abdomen -
OBSTETRICS SURGERY
S4 GYNAECOLOGY AND S4.2 Gynaecology S4.2.14 Mc Indoes operation For Vaginal Atresia IP 40022 Scan,Clinical Photograph Post-op USG,Biopsy -
OBSTETRICS SURGERY
S4 GYNAECOLOGY AND S4.2 Gynaecology S4.2.16 Abdominal Repair for Vault Prolapse IP 35917 USG,Clinical Photograph USG -
OBSTETRICS SURGERY
S4 GYNAECOLOGY AND S4.2 Gynaecology S4.2.17 Abdominal Repair With Mesh for Vault Prolapse IP 41048 USG,Clinical Photograph USG -
OBSTETRICS SURGERY
S4 GYNAECOLOGY AND S4.2 Gynaecology S4.2.18 Laproscopic Sacrospinocolpopexy for vault prolapse IP 40000 ECHO Cardiogram,USG Abdomen,ECHO Cardiogram,USG Abdomen WEBEX,USG Abdomen,Routine Histopathological Examination,WEBEX,USG -
OBSTETRICS SURGERY Abdomen,Routine Histopathological Examination
S4 GYNAECOLOGY AND S4.2 Gynaecology S4.2.19.1 Cone Biopsy Cervix DC 4000 Clinical evidance Photo at the time of procedure -
OBSTETRICS SURGERY
S4 GYNAECOLOGY AND S4.2 Gynaecology S4.2.19.2 Cervical biopsy and Polypectomy DC 3000 Clinical/indication Colposcopy report Photo at the time of procedure & Biopsy report -
OBSTETRICS SURGERY
S4 GYNAECOLOGY AND S4.2 Gynaecology S4.2.19.3 Manchesters Operation + Cervical amputation(67.4) IP 25000 Detailed clinical notes confirming diagnosis with surgical profile HPE of the Specimen,Per-Operative photo with patient face,Healed scar photo,Post- -
OBSTETRICS SURGERY Operative USG report
S4 GYNAECOLOGY AND S4.2 Gynaecology S4.2.2 Laparoscopic Cystectomy IP 25563 USG Post-op USG,Biopsy -
OBSTETRICS SURGERY
S4 GYNAECOLOGY AND S4.2 Gynaecology S4.2.2.1 Lap. Salpingo-oophrectomy IP 14000 USG pelvis & clinical notes Procedure Photo with video -
OBSTETRICS SURGERY
S4 GYNAECOLOGY AND S4.2 Gynaecology S4.2.2.2 Medical Management of Polycystic Ovarian Syndrome for a DC 8000 detailed clinical history,USG Abdomen,Glucose Tolerance Test(GTT),TSH,T4,T3 Case sheet with clinical improvement,USG Abdomen -
OBSTETRICS SURGERY periodev of 6 months
S4 GYNAECOLOGY AND S4.2 Gynaecology S4.2.2.3 Surgery for Bartholin cyst(Marsupilasation,cyst removal) DC 10000 clinical photo,USG Abdomen,PUS culture & sensitvity procedure photo with webex and HPE of trhe specimen -
OBSTETRICS SURGERY
S4 GYNAECOLOGY AND S4.2 Gynaecology S4.2.2.4 Surgical Management of Endometriosis - Excision of IP 23000 Diagnostic Laproscopy,USG Abdomen,Ca125 (Cancer Antigen125 or Carbohydrate Antigen 125),ECHO Photo at the time of surgery & HPE,USG Abdomen,Routine Histopathological -
OBSTETRICS SURGERY Chocolate Cyst Cardiogram,Chest X-Ray PA View(1 Film) Examination

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CODE MAIN CATEGORY Sub SUB CATEGORY NAME CODE SURGERY / THERAPY DESCRIPTION PROCEDURE PACKAGE SPECIAL INVESTIGATION POST OPERATIVE PROCEDURE INVESTIGATION TREATMENT PROTOCOL
Category ID TYPE AMOUNT
S4 GYNAECOLOGY AND S4.2 Gynaecology S4.2.2.5 Cyst -Vaginal Enucleation DC 5000 Clinical Photo Photo at the time of procedure -
OBSTETRICS SURGERY
S4 GYNAECOLOGY AND S4.2 Gynaecology S4.2.2.6 Cyst-Labial DC 5000 Clinical Photo Procedure Photo -
OBSTETRICS SURGERY
S4 GYNAECOLOGY AND S4.2 Gynaecology S4.2.2.7 OPEN CYSTECTOMY (Huge ovarian cyst/tumour >12 cm) IP 27000 BLOOD TESTS,USG BIOPSY,POST OP USG -
OBSTETRICS SURGERY
S4 GYNAECOLOGY AND S4.2 Gynaecology S4.2.20.1 Surgical Treatment for Vulval Heamatoma IP 13500 clinical notes with surgical profile,Clinical Photograph Case Sheet with operation Notes & Photo of the procedure -
OBSTETRICS SURGERY
S4 GYNAECOLOGY AND S4.2 Gynaecology S4.2.20.2 Vulvectomy for simplie Benighn tumors IP 21200 Biopsy report,Clinical photo graph,detailed case sheet with surgical profile HPE of the Specimen,Per-Operative photo with patient face,Healed scar photo -
OBSTETRICS SURGERY
S4 GYNAECOLOGY AND S4.2 Gynaecology S4.2.20.3 Surgical Management of Benighn Cystic Ovarian Tumours IP 23000 Ca 125,USG Abdomen,FNAC,Detailed clinical history with clinical findings Post-Operative USG Abdomen,Per-Operative photo with patient face,Healed scar -
OBSTETRICS SURGERY Open method photo,HPE of the Specimen
S4 GYNAECOLOGY AND S4.2 Gynaecology S4.2.21.1 Laparotomy for broad ligament haematoma IP 17500 Clinical notes & USG abdomen Post-Operative USG Abdomen,Per-Operative photo with patient face,Healed scar -
OBSTETRICS SURGERY photo,HPE of the Specimen
S4 GYNAECOLOGY AND S4.2 Gynaecology S4.2.21.2 Broad Ligment Haemotoma drainage IP 11000 Clinical notes & USG abdomen Procedure Photo -
OBSTETRICS SURGERY
S4 GYNAECOLOGY AND S4.2 Gynaecology S4.2.21.3 Re exploration after laparotomy / Caesarean Section IP 25000 Clinical notes & USG abdomen Procedure Photo -
OBSTETRICS SURGERY
S4 GYNAECOLOGY AND S4.2 Gynaecology S4.2.22.1 D and C (Dilatation and curretage) DC 6000 Clinical notes Procedure Photo -
OBSTETRICS SURGERY
S4 GYNAECOLOGY AND S4.2 Gynaecology S4.2.22.2 Fractional Curretage DC 7000 Clinical evidance procedure Photo & video -
OBSTETRICS SURGERY
S4 GYNAECOLOGY AND S4.2 Gynaecology S4.2.22.3 Surgical Management of Vesicular moles (Benign GTD) Suction IP 5000 Detailed clinical notes,USG Abdomen,T4,T3,Beta HCG(Human Chorionic Gonadotropin) Levels,TSH,Chest X- Ray PA Speciman Photo along with the patients face,USG Abdomen,Beta HCG(Human Chorionic -
OBSTETRICS SURGERY Evacution View(1 Film) Gonadotropin) Levels,Routine Histopathological Examination
S4 GYNAECOLOGY AND S4.2 Gynaecology S4.2.23.1 Surgical management of pelvic abscess (Laparotomy) IP 26140 X-Ray Abdomen(Lateral View),Detailed case sheet with surgical profile,USG Abdomen Detailed case sheet,Per-Operative photo with patient face,Healed scar photo -
OBSTETRICS SURGERY
S4 GYNAECOLOGY AND S4.2 Gynaecology S4.2.23.2 Medical Management of Pelvic Inflammatory Disease IP 7690 Urine Culture & Sensitivity,Complete Blood Picture [CBP],CUE(pH,Specific Gravity,Sugar,Protein And Case sheet with clinical improvement -
OBSTETRICS SURGERY Microscopy),Serum Creatinine Levelse,Spot PR/CR (Protein-Creatinine) Ratio,TSH,USG Abdomen
S4 GYNAECOLOGY AND S4.2 Gynaecology S4.2.24.1 Ablation of Endometrium DC 10980 Deatiled clinical notes,Papsmear,Routine Histopathological Examination (Disfuctional Uterine Blooding/Abnormal WEBEX,USG Abdomen -
OBSTETRICS SURGERY Uterine Blooding)
S4 GYNAECOLOGY AND S4.2 Gynaecology S4.2.24.2 Medical Management of Endometriosis for a periopde of 6 IP 7090 clinical notes,Complete Blood Picture [CBP],CUE(pH,Specific Gravity,Sugar,Protein And Microscopy),Clinical Case sheet with clinical improvement,CUE(pH,Specific Gravity,Sugar,Protein And -
OBSTETRICS SURGERY months Photograph,USG Abdomen,Ca 125(Cancer Antogen 125 or Carbohydrate Antigen 125) Microscopy),Urine Culture and Sensitivity,USG Abdomen

S4 GYNAECOLOGY AND S4.2 Gynaecology S4.2.25 Medical Management of AUB IP 10010 Detailed case sheet,Complete Blood Picture [CBP],USG Abdomen,Urine Culture & Sensitivity,Papsmear,Renal Endometrial Biopsy Routine Histopathological Examination -
OBSTETRICS SURGERY Profile,Diagnostic Dilatation & Curettage
S4 GYNAECOLOGY AND S4.2 Gynaecology S4.2.26.1 Intra abdominal IUCD retrival - Lap IP 25000 USG Pelvis,Abdomen Radiograph Supine or Erect( 1 Film),Clinical Photograph per - Operative WEBEX,Clinical Photograph -
OBSTETRICS SURGERY
S4 GYNAECOLOGY AND S4.2 Gynaecology S4.2.26.2 Intra abdominal IUCD retrival - Open IP 20000 Detailed casev sheet with surgical profile,Abdomen Radiograph Supine or Erect( 1 Film),Clinical Photograph,USG Detailed cas sheet,Per-Operative photo with patient face -
OBSTETRICS SURGERY Pelvis
S4 GYNAECOLOGY AND S4.2 Gynaecology S4.2.27.1 Hysteroscopic IUCD removal IP 10560 Clinical history,Clinical Photograph Detailed case sheet,Procedure WEBEX -
OBSTETRICS SURGERY
S4 GYNAECOLOGY AND S4.2 Gynaecology S4.2.27.2 Excision - Vaginal Septum IP 10500 Clinical Photograph Procedure Photo -
OBSTETRICS SURGERY
S4 GYNAECOLOGY AND S4.2 Gynaecology S4.2.27.3 Hysteroscopic septal resection IP 17490 Clinical notes with surgical profile,HSG(Hysterosalpingography),Hysteroscopy Detailed case sheet,WEBEX -
OBSTETRICS SURGERY
S4 GYNAECOLOGY AND S4.2 Gynaecology S4.2.28.1 Diagnostic hysteroscopy DC 6000 Clinical evidance procedure Photo -
OBSTETRICS SURGERY
S4 GYNAECOLOGY AND S4.2 Gynaecology S4.2.28.2 Diagnostic hysteroscopy with / without biopsy DC 8000 Clinical report Procedure Photo -
OBSTETRICS SURGERY
S4 GYNAECOLOGY AND S4.2 Gynaecology S4.2.28.3 Diagnostic / Staging laparoscopy IP 11000 Clinical report clinical notes,Webex Video,Operative Photo -
OBSTETRICS SURGERY
S4 GYNAECOLOGY AND S4.2 Gynaecology S4.2.28.4 Diagnostic laparoscopy and hysteroscopy for infertility DC 5250 Clinical evidance procedure Photo with biopsy report -
OBSTETRICS SURGERY
S4 GYNAECOLOGY AND S4.2 Gynaecology S4.2.29.1 Intrauterine transfusions DC 11000 Clinical evidance,ROUTINE ANTINATAL CHECK-UPS WITH INVESTIGATIONS Procedure Photo/WEBEX -
OBSTETRICS SURGERY
S4 GYNAECOLOGY AND S4.2 Gynaecology S4.2.29.2 Intra Uterine Insemination IP 10010 Deatiled clinical notes,USG Abdomen,Semen Analysis Intra OP Photo -
OBSTETRICS SURGERY
S4 GYNAECOLOGY AND S4.2 Gynaecology S4.2.3 Laparoscopic Ectopic Resection IP 22710 USG Post-op USG,Biopsy -
OBSTETRICS SURGERY
S4 GYNAECOLOGY AND S4.2 Gynaecology S4.2.30.1 Polypectomy DC 1500 Clinical Indication Procedure Photo -
OBSTETRICS SURGERY
S4 GYNAECOLOGY AND S4.2 Gynaecology S4.2.30.2 Hysteroscopic polypectomy IP 7200 Clinical notes,Clinical/indication Colposcopy report Photo at the time of procedure & Biopsy report -
OBSTETRICS SURGERY
S4 GYNAECOLOGY AND S4.2 Gynaecology S4.2.31.1 Laproscopic Tubectomy DC 7000 Clinical History with surgical profile clinical notes,Photo at the time of procedure/Webex -
OBSTETRICS SURGERY
S4 GYNAECOLOGY AND S4.2 Gynaecology S4.2.31.2 Laparoscopic tubal surgeries (for any indication including IP 13900 USG pelvis & clinical notes Procedure Photo with video -
OBSTETRICS SURGERY ectopic pregnancy)
S4 GYNAECOLOGY AND S4.2 Gynaecology S4.2.31.3 LAPROSCOPIC TUBECTOMY(for Previous LSCS) IP 16000 SURGICAL PROFILE,USG,DETAILED CLINICAL HISTORY WEBEX,CLINICAL NOTES,PHOTO AT THE PROCEDURE -
OBSTETRICS SURGERY
S4 GYNAECOLOGY AND S4.2 Gynaecology S4.2.31.4 TUBAL RECANALISATION IP 28000 HSG,CLINICAL NOTES,USG DETAILED CASE SHEET,PER OP PHOTO WITH DYE TEST WITH PATIENT FACE,WEBEX -
OBSTETRICS SURGERY
S4 GYNAECOLOGY AND S4.2 Gynaecology S4.2.32 Amniocentesis including Karyotyping DC 14500 Clinical notes with indication & genetic counsilling Procedure Photo/WEBEX -
OBSTETRICS SURGERY
S4 GYNAECOLOGY AND S4.2 Gynaecology S4.2.33 Cordocentesis including Karyotyping DC 14500 USG abdomen,Clinical notes with indication Procedure Photo/WEBEX -
OBSTETRICS SURGERY
S4 GYNAECOLOGY AND S4.2 Gynaecology S4.2.34 Chorionic villus sampling DC 14500 USG abdomen & Clinical evidance Procedure Photo -
OBSTETRICS SURGERY
S4 GYNAECOLOGY AND S4.2 Gynaecology S4.2.35.1 Pelvic Abscess Management including Colpotomy DC 2500 Clinical report Photo at the time of procedure -
OBSTETRICS SURGERY
S4 GYNAECOLOGY AND S4.2 Gynaecology S4.2.35.2 HaematoColpo DC 14500 USG & Clinical history Procedure Photo -
OBSTETRICS SURGERY
S4 GYNAECOLOGY AND S4.2 Gynaecology S4.2.36.1 Electro Cauterisation / Cryo Surgery DC 4000 Clinical History Photo at the time of procedure -
OBSTETRICS SURGERY
S4 GYNAECOLOGY AND S4.2 Gynaecology S4.2.36.2 Cryo Surgery DC 5000 colposcopy,Papsmear,Clinical Photograph WEBEX,Clinical Photograph -
OBSTETRICS SURGERY
S4 GYNAECOLOGY AND S4.2 Gynaecology S4.2.37 Vulvo vaginal cyst enucleation / drainage DC 3150 Clinical phoito,Clinical notes Photo at the time of procedure -
OBSTETRICS SURGERY
S4 GYNAECOLOGY AND S4.2 Gynaecology S4.2.38 Trans-vaginal tape/ Trans-obturator tape DC 15200 Clinical evidance Procedure Photo -
OBSTETRICS SURGERY
S4 GYNAECOLOGY AND S4.2 Gynaecology S4.2.5 Laparoscopic Myomectomy IP 30786 USG Post-op USG,Biopsy -
OBSTETRICS SURGERY
S4 GYNAECOLOGY AND S4.2 Gynaecology S4.2.5.1 Abdominal Myomectomy IP 25820 surgical profile,USG Abdomen,Clinica notes with Reprodutive History Post-operative USG,Per-operative photo with patient face,Detailed case sheet,HPE of the -
OBSTETRICS SURGERY Specimen
S4 GYNAECOLOGY AND S4.2 Gynaecology S4.2.5.2 Hysteroscopic submucus fibroid resection DC 15000 Clinica notes with Reprodutive History,USG Abdomen Procedure WEBEX,USG Abdomen,HPE of the Specimen -
OBSTETRICS SURGERY
S4 GYNAECOLOGY AND S4.2 Gynaecology S4.2.5.3 Medical Management of Fibroids IP 8000 Papsmear,USG Abdomen Case Sheet with treatment details -
OBSTETRICS SURGERY
S4 GYNAECOLOGY AND S4.2 Gynaecology S4.2.6 Laparoscopic Recanalisation IP 33587 USG Post-op USG,Biopsy -
OBSTETRICS SURGERY
S4 GYNAECOLOGY AND S4.2 Gynaecology S4.2.6.1 Tuboplasty/Open Tubal Recanalisation IP 26590 Clinical notes,USG Abdomen,HSG Post-operative HSG,Per-Operative photo with patient face,Detailed case sheet -
OBSTETRICS SURGERY
S4 GYNAECOLOGY AND S4.2 Gynaecology S4.2.7 Laparoscopic Sling Operations IP 33352 USG Post-op USG,Biopsy -
OBSTETRICS SURGERY
S4 GYNAECOLOGY AND S4.2 Gynaecology S4.2.7.1 Purandares Sling operations - Open IP 25450 Clinical notes,USG Abdomen,Endometrial Biopsy,Papsmear,Routine Histopathological Examination WEBEX,USG Abdomen -
OBSTETRICS SURGERY
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CODE MAIN CATEGORY Sub SUB CATEGORY NAME CODE SURGERY / THERAPY DESCRIPTION PROCEDURE PACKAGE SPECIAL INVESTIGATION POST OPERATIVE PROCEDURE INVESTIGATION TREATMENT PROTOCOL
Category ID TYPE AMOUNT
S4 GYNAECOLOGY AND S4.2 Gynaecology S4.2.8 Laparoscopic Adhesiolysis IP 30786 USG Post-op USG,Biopsy -
OBSTETRICS SURGERY
S4 GYNAECOLOGY AND S4.2 Gynaecology S4.2.8.1 Hysteroscopic adhesiolysis DC 8000 Clinical report & Routine Histopathological Examination Procedure Photo -
OBSTETRICS SURGERY
S4 GYNAECOLOGY AND S4.2 Gynaecology S4.2.8.2 Adhenolysis+ Salpingostomy IP 20000 Clinical notes & USG Procedure Photo -
OBSTETRICS SURGERY
S4 GYNAECOLOGY AND S4.2 Gynaecology S4.2.8.3 Adhenolysis+ Ovarian Cystectomy IP 10000 Clinical notes & USG Procedure Photo -
OBSTETRICS SURGERY
S4 GYNAECOLOGY AND S4.2 Gynaecology S4.2.9 Vaginal Hysterectomy IP 25655 Scan Post-op USG,Biopsy -
OBSTETRICS SURGERY
S4 GYNAECOLOGY AND S4.3 ABORTIONS AND MTP S4.3.1.1 Hysterotomy DC 15000 USG Abdomen & clinical markers as per MTP rules Per-op Photo with womens face -
OBSTETRICS SURGERY
S4 GYNAECOLOGY AND S4.3 ABORTIONS AND MTP S4.3.1.2 First Trimester Medically Induced Abortion DC 4050 Detailed clinical notes,USG Abdomen,Blood Grouping And RH Typing,Complete Blood Picture [CBP],Pregnancy Test- Procedural Photo ,Case Sheet with operation Notes -
OBSTETRICS SURGERY Urine
S4 GYNAECOLOGY AND S4.3 ABORTIONS AND MTP S4.3.2 MTP upto 8 weeks Medical/ Surgical DC 6000 USG abdomen & clinical evidance as per MTP rules Photo at the time of procedure -
OBSTETRICS SURGERY
S4 GYNAECOLOGY AND S4.3 ABORTIONS AND MTP S4.3.3 MTP upto 12 weeks DC 7000 USG abdomen & clinical evidance as per MTP rules Photo of the MTP procedure -
OBSTETRICS SURGERY
S4 GYNAECOLOGY AND S4.3 ABORTIONS AND MTP S4.3.4 MTP > 12 weeks up to 20 weeks DC 8500 USG abdomen & clinical evidance as per MTP rules Photo of the fetus with mother -
OBSTETRICS SURGERY
S4 GYNAECOLOGY AND S4.3 ABORTIONS AND MTP S4.3.5 Incomplete Abortion DC 8850 Case sheet with clinical History,USG Abdomen,Surgical Profile Procedural Photo ,USG Abdomen -
OBSTETRICS SURGERY
S4 GYNAECOLOGY AND S4.3 ABORTIONS AND MTP S4.3.6 Surgical Management of Septic Abortion IP 15000 Sepsis Profile,USG Abdomen,Cervical and High Vaginal Swab,Abdomen X-Ray (Lateral View) procedure Photo,Case Sheet with operation Notes -
OBSTETRICS SURGERY
S4 GYNAECOLOGY AND S4.3 ABORTIONS AND MTP S4.3.7 Surgical Management of Missed abortion DC 10000 Serum Fibrinogen,USG Abdomen USG Abdomen -
OBSTETRICS SURGERY
S4 GYNAECOLOGY AND S4.3 ABORTIONS AND MTP S4.3.8 Inevitable abortion Management (D and C) DC 5000 USG Abdomen/clinical evidance of pregnancy Photo at the time of procedure -
OBSTETRICS SURGERY
S4 GYNAECOLOGY AND S4.4 Intra Uterine Device S4.4.1 LNG-IUS (Levonorgestrene Intautrine system) DC 10000 Clinical Photograph,USG Abdomen Clinical Photograph,Case sheet with clinical(obstetric & Past) History,Case Sheet with -
OBSTETRICS SURGERY operation Notes
S5 ORTHOPEDIC SURGERY AND S5 ORTHOPAEDICS S5.16 Drainage of cold abscess IP 30010 MRI Local Area,X-Ray MRI Local Area,X-Ray -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5 ORTHOPAEDICS S5.17 Drainage of perivertebral abscess IP 10000 USG,Clinical Photograph CS report,Intra Op Photo,Pus,Scar Photo -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.1 Fracture Correction S5.1.1 Bone Grafting As Exclusive Procedure IP 20525 X-RAY Post opX-RAY -
PROCEDURES Surgeries/Procedures
S5 ORTHOPEDIC SURGERY AND S5.1 Fracture Correction S5.1.10 Closed Reduction and Percutaneous Pinning IP 15000 X Ray Clinical Photograph -
PROCEDURES Surgeries/Procedures
S5 ORTHOPEDIC SURGERY AND S5.1 Fracture Correction S5.1.11.1 Closed Reduction and Percutaneous Nailing IP 33000 X Ray Clinical Photograph -
PROCEDURES Surgeries/Procedures
S5 ORTHOPEDIC SURGERY AND S5.1 Fracture Correction S5.1.11.2 Closed reduction with percutaneous screw fixation(78.10) IP 20000 Clinical Photograph,X-Ray X-Ray -
PROCEDURES Surgeries/Procedures
S5 ORTHOPEDIC SURGERY AND S5.1 Fracture Correction S5.1.13 Fracture Fibula - Internal Fixation IP 30000 X Ray X Ray -
PROCEDURES Surgeries/Procedures
S5 ORTHOPEDIC SURGERY AND S5.1 Fracture Correction S5.1.14 Diaphyseal Fracture - Long Bone - ORIF - Plating IP 30000 X Ray X Ray -
PROCEDURES Surgeries/Procedures
S5 ORTHOPEDIC SURGERY AND S5.1 Fracture Correction S5.1.15 Fracture Radius Internal Fixation - Forearm IP 30000 X Ray X Ray -
PROCEDURES Surgeries/Procedures
S5 ORTHOPEDIC SURGERY AND S5.1 Fracture Correction S5.1.16 Fracture - Both Bones - Forearm - ORIF/CRIF -Plating IP 42000 X Ray X Ray -
PROCEDURES Surgeries/Procedures
S5 ORTHOPEDIC SURGERY AND S5.1 Fracture Correction S5.1.17 Distal femur Fracture - ORIF/CRIF IP 40000 X Ray X Ray -
PROCEDURES Surgeries/Procedures
S5 ORTHOPEDIC SURGERY AND S5.1 Fracture Correction S5.1.18 Fracture - Ulna Internal Fixation - Forearm IP 20000 X Ray X Ray -
PROCEDURES Surgeries/Procedures
S5 ORTHOPEDIC SURGERY AND S5.1 Fracture Correction S5.1.19 Excision of Radial head IP 20000 X-Ray X-Ray -
PROCEDURES Surgeries/Procedures
S5 ORTHOPEDIC SURGERY AND S5.1 Fracture Correction S5.1.2 Excision Or Other Operations For Scaphoid Fractures IP 15393 X-RAY Post opX-RAY -
PROCEDURES Surgeries/Procedures
S5 ORTHOPEDIC SURGERY AND S5.1 Fracture Correction S5.1.2.1 HERBERT SCREW / AO SCREW IP 13000 X-Ray,Surgical Profile Post OP X-Ray,Intra OP Photos -
PROCEDURES Surgeries/Procedures
S5 ORTHOPEDIC SURGERY AND S5.1 Fracture Correction S5.1.20 ORIF with Proximal Humerus Fracture fixation (PHILOS) IP 38000 CT(If require),clinical notes,X Ray Scar Photo,clinical notes,X Ray -
PROCEDURES Surgeries/Procedures
S5 ORTHOPEDIC SURGERY AND S5.1 Fracture Correction S5.1.22 Distal Radius Fracture - Forearm IP 25000 clinical notes clinical notes -
PROCEDURES Surgeries/Procedures
S5 ORTHOPEDIC SURGERY AND S5.1 Fracture Correction S5.1.23 External fixation - Fracture of both bones of forearms IP 25000 clinical notes clinical notes -
PROCEDURES Surgeries/Procedures
S5 ORTHOPEDIC SURGERY AND S5.1 Fracture Correction S5.1.24 Fracture intercondylarHumerus + olecranon osteotomy IP 45000 X Ray,clinical notes Scar Photo,clinical notes,X Ray -
PROCEDURES Surgeries/Procedures
S5 ORTHOPEDIC SURGERY AND S5.1 Fracture Correction S5.1.27 CRIF/ORIF - Hand Bones IP 6100 X Ray Clinical Photograph -
PROCEDURES Surgeries/Procedures
S5 ORTHOPEDIC SURGERY AND S5.1 Fracture Correction S5.1.28 CRIF/ORIF - Foot Bones IP 7100 X Ray Clinical Photograph -
PROCEDURES Surgeries/Procedures
S5 ORTHOPEDIC SURGERY AND S5.1 Fracture Correction S5.1.29 Closed Interlock Nailing/Plating + Bone Grafting for non union IP 40000 X Ray Clinical Photograph -
PROCEDURES Surgeries/Procedures
S5 ORTHOPEDIC SURGERY AND S5.1 Fracture Correction S5.1.3 Open reduction and Internal Fixation Of Fingers and Toes IP 15886 X-RAY Post opX-RAY -
PROCEDURES Surgeries/Procedures
S5 ORTHOPEDIC SURGERY AND S5.1 Fracture Correction S5.1.30 Bone grafting for Non union IP 20000 Clinical Notes + X-Rays Clinical Notes + X-Rays -
PROCEDURES Surgeries/Procedures
S5 ORTHOPEDIC SURGERY AND S5.1 Fracture Correction S5.1.30.1 Phemister grafting IP 26000 X-Ray X-Ray -
PROCEDURES Surgeries/Procedures
S5 ORTHOPEDIC SURGERY AND S5.1 Fracture Correction S5.1.31 Patellectomy/Fixation IP 25000 Clinical Notes + X-Rays Clinical Notes + X-Rays -
PROCEDURES Surgeries/Procedures
S5 ORTHOPEDIC SURGERY AND S5.1 Fracture Correction S5.1.32 Internal Fixation of Small Bones IP 10000 clinical notes XRAY,clinical notes -
PROCEDURES Surgeries/Procedures
S5 ORTHOPEDIC SURGERY AND S5.1 Fracture Correction S5.1.33 External fixation - Small bone IP 10000 X Ray X Ray,Clinical Photograph -
PROCEDURES Surgeries/Procedures
S5 ORTHOPEDIC SURGERY AND S5.1 Fracture Correction S5.1.34 Open Reduction of Small Joint DC 15000 Clinical Notes + X-Rays Clinical Notes + X-Rays -
PROCEDURES Surgeries/Procedures
S5 ORTHOPEDIC SURGERY AND S5.1 Fracture Correction S5.1.35 Bipolar hemiarthroplasty of Hip with cement IP 42000 X-Ray Hip Lateral View X-Ray Hip Lateral View -
PROCEDURES Surgeries/Procedures
S5 ORTHOPEDIC SURGERY AND S5.1 Fracture Correction S5.1.36 Hemiarthroplasty of Hip cemented IP 35010 X-Ray Hip Lateral View X-Ray Hip Lateral View -
PROCEDURES Surgeries/Procedures
S5 ORTHOPEDIC SURGERY AND S5.1 Fracture Correction S5.1.36.1 B/L HIP DYSPLACIA IP 38000 X-Ray,Surgical Profile Post OP X-Ray,Intra OP Photos -
PROCEDURES Surgeries/Procedures
S5 ORTHOPEDIC SURGERY AND S5.1 Fracture Correction S5.1.37 Limb lengthening IP 44000 X Ray X Ray -
PROCEDURES Surgeries/Procedures
S5 ORTHOPEDIC SURGERY AND S5.1 Fracture Correction S5.1.38 Cancecllous screw/pins fixations for fracture neck of Femur IP 35000 X-Ray X-Ray -
PROCEDURES Surgeries/Procedures
S5 ORTHOPEDIC SURGERY AND S5.1 Fracture Correction S5.1.39 Clavicle surgery IP 23000 X-ray X-Ray -
PROCEDURES Surgeries/Procedures
S5 ORTHOPEDIC SURGERY AND S5.1 Fracture Correction S5.1.4 Reduction Of Compound Fractures and External IP 25655 X-RAY Post opX-RAY -
PROCEDURES Surgeries/Procedures Fixation(78.10)
S5 ORTHOPEDIC SURGERY AND S5.1 Fracture Correction S5.1.40 Internal fixation lateral/Medial condyle Humerus fractures IP 26460 clinical notes,X-Ray Scar Photo,X-Ray,clinical notes -
PROCEDURES Surgeries/Procedures

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CODE MAIN CATEGORY Sub SUB CATEGORY NAME CODE SURGERY / THERAPY DESCRIPTION PROCEDURE PACKAGE SPECIAL INVESTIGATION POST OPERATIVE PROCEDURE INVESTIGATION TREATMENT PROTOCOL
Category ID TYPE AMOUNT
S5 ORTHOPEDIC SURGERY AND S5.1 Fracture Correction S5.1.42 Limb reconstruction system(lrs) IP 38000 X-Ray X-Ray -
PROCEDURES Surgeries/Procedures
S5 ORTHOPEDIC SURGERY AND S5.1 Fracture Correction S5.1.43 Bipolar hemiarthroplastyof Hip without cement IP 38000 X-Ray Hip Lateral View X-Ray Hip Lateral View -
PROCEDURES Surgeries/Procedures
S5 ORTHOPEDIC SURGERY AND S5.1 Fracture Correction S5.1.44 Inter Trocanteric Fracture IP 32900 AP lateral,X Ray Hip with Proxymal Femur AP lateral,X Ray Hip with Proxymal Femur -
PROCEDURES Surgeries/Procedures
S5 ORTHOPEDIC SURGERY AND S5.1 Fracture Correction S5.1.45 Sub Trocanteric Fracture IP 32900 AP lateral,X Ray Hip with Proxymal Femur AP lateral,X Ray Hip with Proxymal Femur -
PROCEDURES Surgeries/Procedures
S5 ORTHOPEDIC SURGERY AND S5.1 Fracture Correction S5.1.46 Fracture - Ankle Internal Fixation Bi/Tri Malleolar IP 45000 Lateral and MORTIS,X Ray Ankle,AP Lateral and MORTIS,X Ray Ankle,AP -
PROCEDURES Surgeries/Procedures
S5 ORTHOPEDIC SURGERY AND S5.1 Fracture Correction S5.1.47 CMR Nailing IP 30000 - - -
PROCEDURES Surgeries/Procedures
S5 ORTHOPEDIC SURGERY AND S5.1 Fracture Correction S5.1.5 Ilizarov Ring Fixator Application IP 45153 X-RAY X-RAY,Clinical Photograph -
PROCEDURES Surgeries/Procedures
S5 ORTHOPEDIC SURGERY AND S5.1 Fracture Correction S5.1.5.1 Ilizarov fixator with joint arthrolysis IP 50000 X-Ray Clinical Photograph,X-Ray -
PROCEDURES Surgeries/Procedures
S5 ORTHOPEDIC SURGERY AND S5.1 Fracture Correction S5.1.6 Neglected CTEV. Jess Fixator IP 36944 Clinical Photograph X-RAY,Clinical Photograph -
PROCEDURES Surgeries/Procedures
S5 ORTHOPEDIC SURGERY AND S5.1 Fracture Correction S5.1.7 Joint reconstruction/intraarticular fractures IP 35918 X-Ray CT local Area -
PROCEDURES Surgeries/Procedures
S5 ORTHOPEDIC SURGERY AND S5.1 Fracture Correction S5.1.8 Proximal Tibial fracture IP 31000 X Ray Clinical Photograph -
PROCEDURES Surgeries/Procedures
S5 ORTHOPEDIC SURGERY AND S5.1 Fracture Correction S5.1.9 Long bone - Diaphyseal Fracture - ORIF / CRIF - Nailing/Plating IP 30000 X Ray Clinical Photograph -
PROCEDURES Surgeries/Procedures
S5 ORTHOPEDIC SURGERY AND S5.1 Fracture Correction S5.1.9.1 ENDERS Nailing IP 30000 X-Ray,Surgical Profile Post OP X-Ray,Intra OP Photos -
PROCEDURES Surgeries/Procedures
S5 ORTHOPEDIC SURGERY AND S5.10 Osteomyelitis S5.10.1 Sequestrectomy and Saucerizations with Antibotic Beads IP 38000 X-Ray X-Ray -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.10 Osteomyelitis S5.10.2 Sequestrectomy and bone grafting IP 39010 X-Ray X-Ray -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.10 Osteomyelitis S5.10.3 Sequestrectomy of Long Bones + anti-biotics + dressing IP 30000 Clinical Notes + X-Rays XRAY,clinical notes -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.10 Osteomyelitis S5.10.4 Debridement and Closure of Minor injuries - contused DC 5000 Clinical Notes + X-Rays Clinical Notes + X-Rays -
PROCEDURES lacerated wounds (anti-biotic + dressing) - minimum of 2
sessions
S5 ORTHOPEDIC SURGERY AND S5.10 Osteomyelitis S5.10.5 Drainage of acute osteomyelitis IP 28000 MRI Local Area,X-Ray ,Clinical Photograph CT Local Area Without Contrast/MRI Local Area -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.10 Osteomyelitis S5.10.6 Cellulitis Conservative with antibiotics IP 8000 LFT,CBP,RBS,Creatinine Creatinine,CBP -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.10 Osteomyelitis S5.10.6.1 Cellulitis surgical management IP 25000 surgical profile Casesheet,Intra OP Photos -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.11 Excision of Bone / Sinus S5.11.1 Excision of Accessory bone IP 20000 X-Ray X-Ray -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.11 Excision of Bone / Sinus S5.11.2 Excision of Sinus over Sacrum DC 16000 Sinography,X-Ray Pelvis (1 Film)y,Clinical Photograph CT Local Area Without Contrast -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.11 Excision of Bone / Sinus S5.11.3 Osteochondroma excision / Excision of Exostosis and Fixation IP 25000 Clinical report X Ray,Clinical report -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.11 Excision of Bone / Sinus S5.11.4 Excision of Lower end Ulna IP 15000 X-Ray X-Ray -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.11 Excision of Bone / Sinus S5.11.5 Excision of Patella IP 16330 X-Ray X-Ray -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.12 Osteotomy S5.12.1 Long bone osteotomy with internal fixation IP 30000 X-Ray X-Ray -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.12 Osteotomy S5.12.2 Corrective osteotomy Acetabulum IP 40000 Bones & Joints AP & Lateral View(2 Film)/CT Scan Limbs Without Contrast,Extremities Bones & Joints AP & Lateral View(2 Film),Extremities -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.12 Osteotomy S5.12.3 High tibial osteotomy IP 31000 X Ray,clinical notes clinical notes -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.12 Osteotomy S5.12.4 Osteotomy -Small Bone IP 17000 Clinical Notes + X-Rays Clinical Notes + X-Rays -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.12 Osteotomy S5.12.5 Long bone osteotomy with POP application and k-wires IP 30010 X-Ray X-Ray -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.13 Exostosis S5.13.1 Surgical Management of Exostosis of small joints IP 22000 Clinical Photograph,X-Ray Routine Histopathological Examination,X-Ray -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.13 Exostosis S5.13.2 Surgical Management of Exostosis of long bones IP 28000 Clinical Photograph,X-Ray Routine Histopathological Examination,X-Ray -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.14 Replacement S5.14.1 Shoulder replacement IP 40010 X-Ray X-Ray -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.14 Replacement S5.14.2 Elbow replacement IP 40010 X-Ray X-Ray -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.15 AMPUTATIONS S5.15.1 Fingers amputations IP 10000 Clinical Photograph,X-Ray X-ray -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.15 AMPUTATIONS S5.15.2 Below Elbow amputations IP 23000 Clinical Photograph,X-Ray ,Colour Doppler Of Specific Limb Clinical Photo -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.15 AMPUTATIONS S5.15.3 Above Elbow amputations IP 25000 Clinical Photograph,X-Ray ,Colour Doppler Of Specific Limb Clinical Photo -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.15 AMPUTATIONS S5.15.4 Below Knee amputations IP 26860 Clinical Photograph,X-Ray ,Colour Doppler Of Specific Limb Clinical Photo -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.15 AMPUTATIONS S5.15.5 Above Knee amputations IP 27000 Clinical Photograph,X-Ray Clinical Photo -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.15 AMPUTATIONS S5.15.6 Amputation – Wrist IP 15000 Clinical Photograph Clinical Photograph -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.2 Dislocations S5.2.1 Open reduction of Deep dislocations IP 30787 X-RAY Post opX-RAY -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.2 Dislocations S5.2.10 Closed reduction of Wrist dislocation DC 7800 Clinical Photograph,X-Ray X-Ray -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.2 Dislocations S5.2.11 Closed reduction of fingers small joint dislocation DC 5000 Clinical Photograph,X-Ray X-Ray -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.2 Dislocations S5.2.12 Closed reduction of Hip dislocation DC 7800 Clinical Photograph,X-Ray Hip Lateral View X-Ray Hip Lateral View -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.2 Dislocations S5.2.13 Acromioclavicular joint dislocation open reconstruction IP 25770 X-Ray Intra OP Photo -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.2 Dislocations S5.2.14 Reconstruction procedure for recurrent dislocation shoulder IP 30010 MRI Shoulder,X-Ray X-Ray -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.2 Dislocations S5.2.15 Closed reduction of Shoulder dislocation DC 7800 Clinical Photograph,X-Ray X-Ray -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.2 Dislocations S5.2.2 Closed Reduction of the Hip (including hip Spika)/ Pediatric IP 7000 X Ray Clinical Photograph -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.2 Dislocations S5.2.3 AC joint reconstruction/ Stabilization/ Acromionplasty IP 25000 X rays of affected limb/ MRI of shoulder - -
PROCEDURES (Nonoperative management for Rockwood type I and II
injuries, whereas surgical reconstruction for type IV and VI
separations. The management for type III and V injuries is
determined on a case-by-case basis)
S5 ORTHOPEDIC SURGERY AND S5.2 Dislocations S5.2.4 Closed reduction of dislocation (Hip) DC 7400 Clinical Notes + X-Rays Clinical Notes + X-Rays -
PROCEDURES

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CODE MAIN CATEGORY Sub SUB CATEGORY NAME CODE SURGERY / THERAPY DESCRIPTION PROCEDURE PACKAGE SPECIAL INVESTIGATION POST OPERATIVE PROCEDURE INVESTIGATION TREATMENT PROTOCOL
Category ID TYPE AMOUNT
S5 ORTHOPEDIC SURGERY AND S5.2 Dislocations S5.2.5 Closed reduction of dislocation (Shoulder/ Elbow/Knee) DC 7000 Clinical Notes + X-Rays Clinical Notes + X-Rays -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.2 Dislocations S5.2.6 Close Reduction - Small Joints DC 2000 X Ray Clinical Photograph -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.2 Dislocations S5.2.7 Closed reduction of Elbow dislocation IP 7800 Clinical Photograph,X-Ray Elbow X-Ray -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.2 Dislocations S5.2.8 Closed reduction of Knee dislocation IP 7800 Clinical Photograph,X-Ray X-Ray -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.2 Dislocations S5.2.9 Closed reduction of Ankle dislocation IP 7800 Clinical Photograph,X-Ray Ankle - Lateral View/AP View X-Ray Ankle - Lateral View/AP View -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.3 Amputations (Non-Traumatic) S5.3.1 Amputations - Forequarter IP 38041 X-RAY X-RAY,Clinical Photograph -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.3 Amputations (Non-Traumatic) S5.3.2 Amputations - Hind Quarter And Hemipelvectomy IP 51310 X-RAY X-RAY,Clinical Photograph -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.4 Bone and Joint Surgery/Procedures S5.4.1 Arthrodesis Of - Major Joints IP 30786 Fluid Analysis,X-RAY Post opX-RAY -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.4 Bone and Joint Surgery/Procedures S5.4.1.1 Arthrodesis of foot Small joints IP 15393 X- Ray Foot X- Ray Foot -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.4 Bone and Joint Surgery/Procedures S5.4.1.2 Triple arthrodesis IP 35000 X-Ray Ankle-Lateral View/AP View,CT Local Area Without Contrast,MRI Local X-Ray Ankle-Lateral View/AP View,CT Local Area Without Contrast,MRI Local Area -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.4 Bone and Joint Surgery/Procedures S5.4.1.3 Subtalar arthrodesis IP 35010 X-Ray Ankle-Lateral View/AP View,CT Local Area Without Contrast,MRI Local Area X-Ray Ankle-Lateral View/AP View,CT Local Area Without Contrast,MRI Local Area -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.4 Bone and Joint Surgery/Procedures S5.4.1.4 Arthrodesis Ankle Triple IP 15000 Clinical report X Ray,Clinical report -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.4 Bone and Joint Surgery/Procedures S5.4.1.5 Arthrodesis of Knee (with implant) IP 40000 Clinical report X Ray,Clinical report -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.4 Bone and Joint Surgery/Procedures S5.4.1.5.1 SEPTIC ARTHRITIS- ARTHROTOMY/ JOINT LAVAGE IP 35000 CRP XRAY JOINT,CLINICAL PICTURE,CBP REPEAT X-RAY,CULTURE SENSITIVITY -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.4 Bone and Joint Surgery/Procedures S5.4.10 Arthroplasty of Shoulder IP 40000 X-Ray CT local Area -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.4 Bone and Joint Surgery/Procedures S5.4.2 Diagnostic Arthroscopy IP 24629 MRI Arthroscopy Picture -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.4 Bone and Joint Surgery/Procedures S5.4.3 Arthroscopy . Operative Meniscectomy IP 25656 MRI Arthroscopy Picture -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.4 Bone and Joint Surgery/Procedures S5.4.4 Anterior cruciate ligamentl reconstruction IP 25656 MRI Arthroscopy Picture -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.4 Bone and Joint Surgery/Procedures S5.4.4.1 Release of Stiff knee IP 25000 Clinical Photograph,X-Ray X-Ray -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.4 Bone and Joint Surgery/Procedures S5.4.4.2 Posterior cruciate ligament reconstruction IP 38000 X-Ray,MRI Knee Single Joint Without Contrast CT Local Area Without Contrast/MRI For Ligament Injuries -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.4 Bone and Joint Surgery/Procedures S5.4.5 Surgery for Avascular Necrosis Of Femoral Head (Core IP 30048 X-RAY,MRI Post opX-RAY -
PROCEDURES Decompression)
S5 ORTHOPEDIC SURGERY AND S5.4 Bone and Joint Surgery/Procedures S5.4.6 Soft Tissue Reconstruction Procedures For Joints Osteotomy IP 30786 Clinical Photograph X-RAY,Clinical Photograph -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.4 Bone and Joint Surgery/Procedures S5.4.7 Arthorotomy of any joint(Major) IP 15000 Clinical Photograph& Blood Investigation clinical notes -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.4 Bone and Joint Surgery/Procedures S5.4.8 Fixator with Joint Arthrolysis IP 20000 Clinical Notes + X-Rays Clinical Notes + X-Rays -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.4 Bone and Joint Surgery/Procedures S5.4.9 Excision arthroplasty(81.8) IP 30000 X-Ray CT local Area -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.5 Spine Surgery S5.5.1 Anterolateral Clearance For Tuberculosis IP 61572 MRI Post opX-RAY -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.5 Spine Surgery S5.5.2 Costo Transversectomy(77.39) IP 41172 MRI Post opX-RAY -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.5 Spine Surgery S5.5.3 Spinal Ostectomy And Internal Fixations(78.59) IP 48864 MRI Post opX-RAY -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.5 Spine Surgery S5.5.4 Anterior Spine Fixation IP 35000 Clinical report MRI & X-Ray,Clinical report -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.5 Spine Surgery S5.5.5 Mossmiami instrumentation for vertebral fractures IP 48870 MRI Local Area,CT Local Area Without Contrast,Neuro evaluation notes X-Ray -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.5 Spine Surgery S5.5.6 Lamiectomy and Discectomy IP 27348 MRI xray intra Op photos -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.5 Spine Surgery S5.5.7 Laminectomy and Discectomy-lumbar Spine fusion/ fixation IP 51309 MRI Clinical photo,Intra OP Photos,X-Ray -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.6 Soft Tissue Surgery S5.6.1 Nerve Repair With Grafting IP 42721 Clinical Photograph Clinical Photograph -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.6 Soft Tissue Surgery S5.6.10 Fasciotomy IP 20000 clinical notes Clinical notes,Clinical Photograph -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.6 Soft Tissue Surgery S5.6.11 Fasciotomy with skin graft IP 25000 Clinical Photograph,X-Ray Scar Photo,X-Ray -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.6 Soft Tissue Surgery S5.6.12 Tendon transfer procedure around ankle IP 32000 Clinical Photograph,X-Ray Ankle - Lateral View/AP View X-Ray Ankle-Lateral View/AP View -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.6 Soft Tissue Surgery S5.6.13 Tendon transfer with graft IP 32000 Clinical Photograph,X-Ray X-Ray -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.6 Soft Tissue Surgery S5.6.14 Hamstrings release IP 15010 Clinical Photograph,X-Ray CT Local Area Without Contrast -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.6 Soft Tissue Surgery S5.6.15 Quadricepsplasty IP 35000 Clinical Photograph,X-Ray CT Local Area Without Contrast -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.6 Soft Tissue Surgery S5.6.16 Tricepsplasty IP 30000 Clinical Photograph,X-Ray CT Local Area Without Contrast -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.6 Soft Tissue Surgery S5.6.17 Fasciotomy with skin graft with fixator IP 40000 Clinical Photograph,X-Ray CT Local Area Without Contrast,X-Ray -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.6 Soft Tissue Surgery S5.6.18 CDH soft tissue reconstruction IP 40000 X-Ray Pelvis (1 Film),Contrast Enhanced USG CT local Area,X-Ray -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.6 Soft Tissue Surgery S5.6.19 Tendon transfer procedure for wrist drop IP 32000 Clinical Photograph,Nerve conduction study Clinical Photograph,CT Local Area Without Contrast -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.6 Soft Tissue Surgery S5.6.2 Neurolysis / Nerve Suture IP 25655 Clinical Photograph Clinical Photograph -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.6 Soft Tissue Surgery S5.6.20 Synovial cyst excision/ganglion/Bakers Cyst DC 19790 Clinical Photograph,Contrast Enhanced USG Contrast Enhanced USG -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.6 Soft Tissue Surgery S5.6.22 Tendon Grafting IP 30000 clinical notes clinical notes -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.6 Soft Tissue Surgery S5.6.23 Excision of Bursa/Ganglion IP 3000 Clinical Photograph,clinical notes clinical notes -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.6 Soft Tissue Surgery S5.6.24 Release of Stiff Elbow IP 30000 X-Ray Elbow Scar Photo,X-Ray Elbow -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.6 Soft Tissue Surgery S5.6.25 Synovectomy IP 35000 Synovial Fluid analysis and USG Biopsy report and Clinical Photograph -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.6 Soft Tissue Surgery S5.6.26 Surgical management Dequerenstenosynovities IP 6510 HR USG Clinical Photograph -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.6 Soft Tissue Surgery S5.6.27 Flexion construction of hip release IP 40000 Clinical Photograph,X-Ray Hip Lateral View X-Ray Hip Lateral View -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.6 Soft Tissue Surgery S5.6.28 Arthrotomy and joint lavage IP 25000 Erythrocyte Sedimentation Rate (ESR),X-Ray ,Cbp(HB%,TC,DC,WBC,Platelets),Clinical Photograph,Complete Blood Routine Histopathological Examination,X-Ray -
PROCEDURES Count (CBC)

11 of 47
CODE MAIN CATEGORY Sub SUB CATEGORY NAME CODE SURGERY / THERAPY DESCRIPTION PROCEDURE PACKAGE SPECIAL INVESTIGATION POST OPERATIVE PROCEDURE INVESTIGATION TREATMENT PROTOCOL
Category ID TYPE AMOUNT
S5 ORTHOPEDIC SURGERY AND S5.6 Soft Tissue Surgery S5.6.29 Subacromial decompression IP 30000 X-Ray/MRI Synovial Fluid Analysis X-Ray -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.6 Soft Tissue Surgery S5.6.3 Surgery for Brachial Plexus and Cervical Rib IP 45933 MRI X-RAY,Clinical Photograph -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.6 Soft Tissue Surgery S5.6.30 Reconstruction around Radial head IP 32000 X-Ray X-Ray -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.6 Soft Tissue Surgery S5.6.31 Rotator cuff repair- Open/Scopic IP 30000 MRI,X-Ray Shoulder - Lateral View/AP View,Clinical Photograph Scopy video Webex -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.6 Soft Tissue Surgery S5.6.32 Congenital ankle deformity correction IP 50000 Clinical Photograph,X-Ray Ankle - Lateral View/AP View X-Ray Ankle-Lateral View/AP View -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.6 Soft Tissue Surgery S5.6.33 CTEV correction IP 50000 Clinical Photograph,X-Ray Clinical Photograph -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.6 Soft Tissue Surgery S5.6.34 Trigger Finger release IP 6500 Clinical Photograph,Contrast Enhanced USG Clinical Photograph,X-Ray -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.6 Soft Tissue Surgery S5.6.35 Tenolysis IP 10000 clinical notes Intra Op Photo -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.6 Soft Tissue Surgery S5.6.36 Tension band wirings IP 25000 X-Ray X-Ray -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.6 Soft Tissue Surgery S5.6.37 Dupuytrens contracture release IP 20000 Clinical Photograph,Contrast Enhanced USG Clinical Photograph -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.6 Soft Tissue Surgery S5.6.38 Multiple Tendon Repair IP 30000 Clinical report Clinical Photograph/Video showing scar -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.6 Soft Tissue Surgery S5.6.39 Obturatorneurectomy IP 20000 Clinical Photograph,ENMG (Elektroneuromyography) ,Nerve conduction study Scar Photo -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.6 Soft Tissue Surgery S5.6.4 Exploration and Ulnar nerve Repair IP 10000 electro-diagnostic studies Clinical Video,electro-diagnostic studies -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.6 Soft Tissue Surgery S5.6.40 Surgical management Carpal tunnel syndrome IP 10000 ENMG (Elektroneuromyography) ,Nerve conduction study Case Sheet with operation Notes,Scar Photo -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.6 Soft Tissue Surgery S5.6.41 Primary suturing with Debridment (with GA/SA) IP 14000 CBP,RBS,Creatinine,LFT Creatinine,CBP -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.6 Soft Tissue Surgery S5.6.42 Primary suturing with Debridment (with LA) IP 4000 LFT,CBP,RBS,Creatinine Creatinine,CBP -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.6 Soft Tissue Surgery S5.6.5 Tendon transfer procedure for claw hand IP 32000 Clinical Photograph,Nerve conduction study Clinical Photograph -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.6 Soft Tissue Surgery S5.6.6 Maxpage release for Volkmann IP 30010 Clinical Photograph,X-Ray Clinical Photograph -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.6 Soft Tissue Surgery S5.6.7 Excision of Retrocalcaneal bursa IP 15010 Clinical Photograph,X-Ray X-Ray -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.6 Soft Tissue Surgery S5.6.8 Adductor release IP 15000 Clinical Photograph,X-Ray Case Sheet with operation Notes -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.6 Soft Tissue Surgery S5.6.9 Tenotomy IP 15010 Clinical Photograph,Nerve conduction study Case Sheet with operation Notes -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.7 TUMOR SURGERY S5.7.1 Excision of deep Bone Tumours and Re-Construction With IP 50088 MRI X-RAY,Clinical Photograph -
PROCEDURES Conventional Prosthesis
S5 ORTHOPEDIC SURGERY AND S5.7 TUMOR SURGERY S5.7.2 Bone tumor surgery reconstruction with internal IP 49279 Clinical Photograph ,X-Ray X-Ray -
PROCEDURES fixation(78.59)
S5 ORTHOPEDIC SURGERY AND S5.7 TUMOR SURGERY S5.7.3 Bone tumor curettage and bone graft(78.00) IP 30000 MRI Local Area,X-Ray ,Bone Marrow Biopsy Needle Routine Histopathological Examination,X-Ray -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.7 TUMOR SURGERY S5.7.4 Bone tumor curettage IP 24430 X-Ray Scar Photo,X-Ray ,Routine Histopathological Examination -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.8 CONSERVATIVE METHODS S5.8.1 Removal of implants plates and nail IP 15000 X-Ray X-Ray -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.8 CONSERVATIVE METHODS S5.8.1.1 Removal of implants wires and screws IP 15000 X-Ray X-Ray -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.8 CONSERVATIVE METHODS S5.8.10.1 POP application above Knee DC 5000 Clinical Photograph Physiotherapy report -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.8 CONSERVATIVE METHODS S5.8.10.2 POP application below Knee DC 4000 Clinical Photograph Physiotherapy report -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.8 CONSERVATIVE METHODS S5.8.10.3 POP application below Elbow DC 3000 Clinical Photograph Physiotherapy report -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.8 CONSERVATIVE METHODS S5.8.10.4 Application of P.O.P. Spikas and Jackets DC 3500 Clinical Notes + X-Rays Clinical Notes + X-Rays -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.8 CONSERVATIVE METHODS S5.8.10.5 Application of P.O.P. casts for Upper and Lower Limbs DC 3000 Clinical Notes + X-Rays Clinical Notes + X-Rays -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.8 CONSERVATIVE METHODS S5.8.11 Application of skin traction DC 3000 Clinical Notes + X-Rays Clinical Notes + X-Rays -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.8 CONSERVATIVE METHODS S5.8.12 Application of functional cast brace DC 2500 Clinical Photograph,X-Ray Physiotherapy report -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.8 CONSERVATIVE METHODS S5.8.13 Cervical spine injury(skull traction) treatment IP 20000 MRI Local Area,CT Spine (Cervical,Dorsal,Lumbar,Sacral) Without Contrast / X-Ray X-Ray -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.8 CONSERVATIVE METHODS S5.8.14 Hip spica IP 8000 Clinical Photograph,X-Ray Physiotherapy report -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.8 CONSERVATIVE METHODS S5.8.15 Clavicle fracture management - conservative (daycare) DC 1800 clinical notes clinical notes -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.8 CONSERVATIVE METHODS S5.8.16 Early OA Hip/ Knee BMAC Injection, Age >50yrs IP 10000 CBP X-RAY -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.8 CONSERVATIVE METHODS S5.8.17 INTRA ARTICULAR INJECTIONS OF PLATELET RICH IP 5000 Indication,X-Ray Vial Photo,Clinical Photo -
PROCEDURES PLASMA/STEROID/HYALURUNIC ACID (SHOULDER / ELBOW /
WRIST / HIP / KNEE / ANKLE / JOINTS OF FOOT AND HAND)

S5 ORTHOPEDIC SURGERY AND S5.8 CONSERVATIVE METHODS S5.8.18 PRP Injections for Tendonitis IP 5000 CBP X-RAY -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.8 CONSERVATIVE METHODS S5.8.19 SPINAL FRACTURE - CONSERVATIVE MANAGEMENT IP 15000 CT,XRay Clinical Photo,BRACE Photo -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.8 CONSERVATIVE METHODS S5.8.2 U-slab application IP 4500 Clinical Photograph,X-Ray Physiotherapy report -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.8 CONSERVATIVE METHODS S5.8.3 Synthetic cast application below Elbow DC 5550 Clinical Photograph,X-Ray Physiotherapy Advice at the time of Discharge -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.8 CONSERVATIVE METHODS S5.8.4 Synthetic cast application below Knee DC 5000 Clinical Photograph,X-Ray Physiotherapy Advice at the time of Discharge -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.8 CONSERVATIVE METHODS S5.8.5 Synthetic cast application above Knee DC 8000 Clinical Photograph,X-Ray Physiotherapy Advice at the time of Discharge -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.8 CONSERVATIVE METHODS S5.8.6 Synthetic cast application above Elbow DC 7000 Clinical Photograph,X-Ray X-Ray,Physiotherapy Advice at the time of Discharge -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.8 CONSERVATIVE METHODS S5.8.7 Bandages and strapping procedures for fractures DC 2000 X-Ray Clinical Photograph,X-Ray -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.8 CONSERVATIVE METHODS S5.8.8 Application of skeletal traction DC 6000 X-Ray X-Ray -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.8 CONSERVATIVE METHODS S5.8.9 POP application above Elbow DC 4000 Clinical Photograph Physiotherapy report -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.9 DISARTICULATIONS S5.9.1 Disarticulation at wrist level IP 23000 Doppler and Clinical Photograph,X-Ray X-ray and Scar Photo -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.9 DISARTICULATIONS S5.9.2 Disarticulation at elbow level IP 25010 Doppler and Clinical Photograph,X-Ray X-ray and Scar Photo -
PROCEDURES

12 of 47
CODE MAIN CATEGORY Sub SUB CATEGORY NAME CODE SURGERY / THERAPY DESCRIPTION PROCEDURE PACKAGE SPECIAL INVESTIGATION POST OPERATIVE PROCEDURE INVESTIGATION TREATMENT PROTOCOL
Category ID TYPE AMOUNT
S5 ORTHOPEDIC SURGERY AND S5.9 DISARTICULATIONS S5.9.3 Disarticulation at Shoulder level IP 40010 Doppler and Clinical Photograph,X-Ray X-ray and Scar Photo -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.9 DISARTICULATIONS S5.9.4 Disarticulations at small joints Foot IP 10010 Clinical Photograph,X-Ray X-ray and Scar Photo -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.9 DISARTICULATIONS S5.9.5 Disarticulation at ankle level IP 25010 Clinical Photograph,X-Ray ,Colour Doppler Of Specific Limb X-ray and Scar Photo -
PROCEDURES
S5 ORTHOPEDIC SURGERY AND S5.9 DISARTICULATIONS S5.9.6 Disarticulations at knee level IP 27010 Clinical Photograph,X-Ray ,Colour Doppler Of Specific Limb X-ray and Scar Photo -
PROCEDURES
S6 SURGICAL GASTRO S6.1 Emergency S6.1.1 Surgery For Bleeding Ulcers IP 49258 Endoscopy Endoscopy Picture -
ENTEROLOGY
S6 SURGICAL GASTRO S6.1 Emergency S6.1.2 Surgery For Obscure Gi Bleed IP 73886 Endoscopy Endoscopy Picture -
ENTEROLOGY
S6 SURGICAL GASTRO S6.10 Hernia S6.10.1 Diaphragmatic Hernia (Gortex Mesh Repair) IP 49258 Ba.Study,Endoscopy,USG,CXR Clinical Photograph,Biopsy -
ENTEROLOGY
S6 SURGICAL GASTRO S6.11 LIVER SURGERIES S6.11.1 Rt.Hepatectomy IP 88848 ERClinical Photograph,CT,USG Clinical Photograph -
ENTEROLOGY
S6 SURGICAL GASTRO S6.11 LIVER SURGERIES S6.11.2 Lt.Hepatectomy IP 92358 ERClinical Photograph,CT,USG Clinical Photograph -
ENTEROLOGY
S6 SURGICAL GASTRO S6.11 LIVER SURGERIES S6.11.3 Segmentectomy IP 61572 ERClinical Photograph,CT,USG Clinical Photograph -
ENTEROLOGY
S6 SURGICAL GASTRO S6.12 PANCREATIC SURGERIES S6.12.1 Distal Pancreatectomy IP 123144 ERCP,CT Clinical Photograph -
ENTEROLOGY
S6 SURGICAL GASTRO S6.12 PANCREATIC SURGERIES S6.12.2 Enucleation Of Cyst IP 92358 CT Clinical Photograph -
ENTEROLOGY
S6 SURGICAL GASTRO S6.12 PANCREATIC SURGERIES S6.12.3 Whipples Any Type IP 102620 ERCP,CT Clinical Photograph -
ENTEROLOGY
S6 SURGICAL GASTRO S6.12 PANCREATIC SURGERIES S6.12.4 Triple Bypass -Pancreas IP 61571 CT Clinical Photograph -
ENTEROLOGY
S6 SURGICAL GASTRO S6.12 PANCREATIC SURGERIES S6.12.5 Other Bypasses -Pancreas IP 40278 CT Clinical Photograph -
ENTEROLOGY
S6 SURGICAL GASTRO S6.13 ANUS S6.13.1 Anal Sphincter Repair -With Colostomy IP 34737 USG Abdomen ,Endo anal scan / MRI Abdomen With Contrast Endo anal scan -
ENTEROLOGY
S6 SURGICAL GASTRO S6.13 ANUS S6.13.1.1 Anal Sphincter Repair -Without Colostomy IP 31320 USG Abdomen,Endo anal scan/MRI Abdomen With Contrast Endo anal scan,clinical Photo -
ENTEROLOGY
S6 SURGICAL GASTRO S6.13 ANUS S6.13.2 Rectovaginal fistula Management with Colostomy IP 40350 Sigmoidoscopy (REGID),CT scan Lower Abdomen Without Contrast,MRI Local Area,TRUS (Transrectal Scar Photo -
ENTEROLOGY Ultrasonography)
S6 SURGICAL GASTRO S6.13 ANUS S6.13.3 Rectopexy Open without Mesh for Rectal Prolapse IP 30000 Clinical Photograph,Colonoscopy/Sigmoidoscopy (REGID) / Defacogram,USG Abdomen USG Abdomen,Clinical Photograph -
ENTEROLOGY
S6 SURGICAL GASTRO S6.2 Oesophagus S6.2.1 Colonic Pull Up IP 61571 Endoscopy,Biopsy,CT-Scan Clinical Photograph,Biopsy -
ENTEROLOGY
S6 SURGICAL GASTRO S6.2 Oesophagus S6.2.2 Oesophagectomy IP 92358 Endoscopy,Biopsy,CT-Scan Endoscopy Picture,Biopsy -
ENTEROLOGY
S6 SURGICAL GASTRO S6.2 Oesophagus S6.2.3 Oesophago-Gastrectomy IP 92358 Endoscopy,Biopsy,CT-Scan Endoscopy Picture,Biopsy -
ENTEROLOGY
S6 SURGICAL GASTRO S6.2 Oesophagus S6.2.4 Lap Heller.S Myotomy IP 28847 Endoscopy,Biopsy,CT-Scan Endoscopy Picture,Biopsy -
ENTEROLOGY
S6 SURGICAL GASTRO S6.2 Oesophagus S6.2.5 Lap Fundoplications IP 55415 Endoscopy,Biopsy,CT-Scan Endoscopy Picture,Biopsy -
ENTEROLOGY
S6 SURGICAL GASTRO S6.3 Stomach S6.3.1 Partial Gastrectomy with anastomosis to IP 41048 USG,Biopsy,EUS Clinical Photograph,Biopsy -
ENTEROLOGY esophagus/jejunum(43.6.2)
S6 SURGICAL GASTRO S6.3 Stomach S6.3.1.1 Partial Gastrectomy with anastomosis to duodenum IP 40000 Upper GI endoscopy,USG Abdomen/ CT Scan Abdomen With Contrast USG Abdomen,Routine Histopathological -
ENTEROLOGY
S6 SURGICAL GASTRO S6.3 Stomach S6.3.2 Total Gastrectomy IP 41048 USG,Biopsy,CT-Scan,Endoscopy Clinical Photograph,Biopsy -
ENTEROLOGY
S6 SURGICAL GASTRO S6.3 Stomach S6.3.3 Truncal Vagotomy + Gastro Jejunostomy(44.3) IP 49257 USG,Biopsy,CT-Scan,Endoscopy Clinical Photograph,Biopsy -
ENTEROLOGY
S6 SURGICAL GASTRO S6.3 Stomach S6.3.4 Distal Gastrectomy For Gastric Outlet Obstruction IP 41047 USG,Biopsy,CT-Scan,Endoscopy Clinical Photograph,Biopsy -
ENTEROLOGY
S6 SURGICAL GASTRO S6.3 Stomach S6.3.5 Surgery for Corrosive Injury Stomach IP 61572 USG,Biopsy,CT-Scan,Endoscopy Clinical Photograph,Biopsy -
ENTEROLOGY
S6 SURGICAL GASTRO S6.4 Small Intestine S6.4.1 Surgical management of Volvulus IP 49257 X-Ray ABD,CT-Scan Clinical Photograph,Biopsy -
ENTEROLOGY
S6 SURGICAL GASTRO S6.4 Small Intestine S6.4.2 Surgical management of Malrotation IP 49258 X-Ray ABD,CT-Scan Clinical Photograph,Biopsy -
ENTEROLOGY
S6 SURGICAL GASTRO S6.4 Small Intestine S6.4.3 Lap Adhesiolysis IP 30786 X-Ray ABD,CT-Scan Clinical Photograph,Biopsy -
ENTEROLOGY
S6 SURGICAL GASTRO S6.5 Large Intestine S6.5.1 Right Hemicolectomy IP 41048 Endoscopy,Biopsy,Colonoscopy,CT-Scan Clinical Photograph,Biopsy -
ENTEROLOGY
S6 SURGICAL GASTRO S6.5 Large Intestine S6.5.2 Left Hemicolectomy IP 41048 Endoscopy,Biopsy,Colonoscopy,CT-Scan Clinical Photograph,Biopsy -
ENTEROLOGY
S6 SURGICAL GASTRO S6.5 Large Intestine S6.5.3 Extended Right Hemicolectomy IP 49257 Endoscopy,Biopsy,Colonoscopy,CT-Scan Clinical Photograph,Biopsy -
ENTEROLOGY
S6 SURGICAL GASTRO S6.5 Large Intestine S6.5.4 Anterior Resection of Large Intestine IP 41048 Endoscopy,Biopsy,Colonoscopy,CT-Scan Clinical Photograph,Biopsy -
ENTEROLOGY
S6 SURGICAL GASTRO S6.5 Large Intestine S6.5.5 Anterior Resection With Ileostomy IP 61572 Endoscopy,Biopsy,Colonoscopy,CT-Scan Clinical Photograph,Biopsy -
ENTEROLOGY
S6 SURGICAL GASTRO S6.5 Large Intestine S6.5.6 Abdominoperinial Resection of rectum IP 52017 Endoscopy,Biopsy,Colonoscopy,CT-Scan Clinical Photograph,Biopsy -
ENTEROLOGY
S6 SURGICAL GASTRO S6.5 Large Intestine S6.5.7 Hartman.S Procedure With Colostomy IP 55414 Endoscopy,Biopsy,Colonoscopy,CT-Scan Clinical Photograph,Biopsy -
ENTEROLOGY
S6 SURGICAL GASTRO S6.5 Large Intestine S6.5.8.1.1 I Stage-Sub Total Colectomy + Ileostomy(46.2) IP 61572 Endoscopy,Colonoscopy,CT-Scan with Contrast Clinical Photograph,Biopsy -
ENTEROLOGY
S6 SURGICAL GASTRO S6.5 Large Intestine S6.5.8.1.2 II Stage-J - Pouch IP 51310 Colonoscopy Clinical Photograph,Biopsy -
ENTEROLOGY
S6 SURGICAL GASTRO S6.5 Large Intestine S6.5.8.1.3 III Stage-Ileostomy Closure IP 25655 Endoscopy Clinical Photograph,Biopsy -
ENTEROLOGY
S6 SURGICAL GASTRO S6.5 Large Intestine S6.5.8.1.4 LAP TOTAL PROCTOCOLECTOMY+ ILEOSTOMY IP 65000 CEA,ct,usg po hpe,video,po usg -
ENTEROLOGY
S6 SURGICAL GASTRO S6.5 Large Intestine S6.5.8.2.1 I Stage- Sub Total Colectomy + Ileostomy + J - Pouch IP 98515 Endoscopy,Colonoscopy,CT-Scan with Contrast Clinical Photograph,Biopsy -
ENTEROLOGY
S6 SURGICAL GASTRO S6.5 Large Intestine S6.5.8.2.2 II Stage- Ileostomy Closure IP 25655 Endoscopy,Colonoscopy,CT-Scan with Contrast Clinical Photograph,Biopsy -
ENTEROLOGY
S6 SURGICAL GASTRO S6.6 Liver S6.6.1 Hepato Cellular Carcinoma(Advanced) Radio Frequency IP 73887 Intra operative Ultrasound,Biopsy,CT-Scan,EUSDiagnostic Laparoscopy USG,Clinical Photograph -
ENTEROLOGY Ablation
S6 SURGICAL GASTRO S6.6 Liver S6.6.2 Haemangioma Sol Liver Hepatectomy + Wedge Resection IP 92357 USG,CT-Scan,Endoscopy USG,Biopsy,Clinical Photograph -
ENTEROLOGY
S6 SURGICAL GASTRO S6.6 Liver S6.6.3 Hydatid Cyst-Marsupilisation IP 41048 USG,Biopsy,CT-Scan USG,Clinical Photograph -
ENTEROLOGY
S6 SURGICAL GASTRO S6.7 Gall Bladder S6.7.1 Cyst Excision+Hepatic Jejunostomy(51.37) IP 55414 USG,CT Clinical Photograph,Biopsy -
ENTEROLOGY
S6 SURGICAL GASTRO S6.7 Gall Bladder S6.7.2 Cholecystectomy IP 25655 USG,CT Clinical Photograph,Biopsy -
ENTEROLOGY
S6 SURGICAL GASTRO S6.7 Gall Bladder S6.7.3 GB+ Calculi CBD Stones Or Dilated CBD IP 51310 USG,CBD,ERClinical Photograph Clinical Photograph,Biopsy -
ENTEROLOGY

13 of 47
CODE MAIN CATEGORY Sub SUB CATEGORY NAME CODE SURGERY / THERAPY DESCRIPTION PROCEDURE PACKAGE SPECIAL INVESTIGATION POST OPERATIVE PROCEDURE INVESTIGATION TREATMENT PROTOCOL
Category ID TYPE AMOUNT
S6 SURGICAL GASTRO S6.7 Gall Bladder S6.7.4 Lap.Cholecystectomy IP 30786 USG,CT Clinical Photograph,Biopsy -
ENTEROLOGY
S6 SURGICAL GASTRO S6.7 Gall Bladder S6.7.5 Hepatico Jejunostomy IP 68725 CT-Scan,Biopsy Clinical Photograph,Biopsy -
ENTEROLOGY
S6 SURGICAL GASTRO S6.7 Gall Bladder S6.7.6 Choledochoduodenostomy Or Choledocho Jejunostomy IP 41659 USG,CT Clinical Photograph,Biopsy -
ENTEROLOGY
S6 SURGICAL GASTRO S6.8 Spleen S6.8.1 Splenectomy IP 35917 USG,CT USG,Clinical Photograph -
ENTEROLOGY
S6 SURGICAL GASTRO S6.8 Spleen S6.8.2 Splenectomy + Devascularisation + Spleno Renal Shunt(39.1) IP 78566 USG,CT Clinical Photograph,Biopsy -
ENTEROLOGY
S6 SURGICAL GASTRO S6.8 Spleen S6.8.3 Spleenectomy For Space Occupying Lesion IP 43100 USG,CT USG,Clinical Photograph -
ENTEROLOGY
S6 SURGICAL GASTRO S6.8 Spleen S6.8.4 SPLENECTOMY WITH DEVASCULARISATION- NON TRAUMATIC IP 38000 CBP,CECT,Clinical Photograph SCAR Photo,Webex,Intra Op Photo,Biopsy report -
ENTEROLOGY
S6 SURGICAL GASTRO S6.8 Spleen S6.8.5 LAP SPLENECTOMY WITH DEVASCULARISATION IP 38000 Clinical Photograph,CBP,CECT SCAR Photo,Webex,Intra Op Photo,Biopsy report -
ENTEROLOGY
S6 SURGICAL GASTRO S6.9 Pancreas S6.9.1 Laproscopic Pancreatic Necrosectomy IP 115730 ERCP,CT-Scan,Endoscopy,ERClinical Photograph Clinical Photograph,Biopsy -
ENTEROLOGY
S6 SURGICAL GASTRO S6.9 Pancreas S6.9.2 Lateral Pancreaticojejunostomy(Non- Malignant) IP 102619 ERCP,CT-Scan,Endoscopy,ERClinical Photograph Clinical Photograph,Biopsy -
ENTEROLOGY
S6 SURGICAL GASTRO S6.9 Pancreas S6.9.3 Open Pancreatic Necrosectomy IP 123205 ERCP,CT-Scan,Endoscopy,ERClinical Photograph Clinical Photograph,Biopsy -
ENTEROLOGY
S6 SURGICAL GASTRO S6.9 Pancreas S6.9.4 Distal Pancreatectomy + Splenectomy(41.5) IP 123143 ERCP,CT-Scan,Endoscopy,ERClinical Photograph Clinical Photograph,Biopsy -
ENTEROLOGY
S6 SURGICAL GASTRO S6.9 Pancreas S6.9.5 Central Pancreatectomy IP 123143 ERCP,CT-Scan,Endoscopy,ERClinical Photograph Clinical Photograph,Biopsy -
ENTEROLOGY
S6 SURGICAL GASTRO S6.9 Pancreas S6.9.7 Cysto Jejunostomy IP 51310 USG,CT Clinical Photograph,Biopsy -
ENTEROLOGY
S6 SURGICAL GASTRO S6.9 Pancreas S6.9.8 Cysto Gastrostomy IP 43025 USG,CT Clinical Photograph,Biopsy -
ENTEROLOGY
S7 CARDIAC AND S7 CARDIAC & CARDIOTHORACIC S7.13 Congenital Cystic Lesions of lung /mediastinum IP 35000 Pre Op X-ray / CT Scan Post Op X-ray/CT Scan -
CARDIOTHORACIC SURGERY SURGERY

S7 CARDIAC AND S7 CARDIAC & CARDIOTHORACIC S7.14 Medical Management Of Congenital Heart Diseases -Requiring IP 17660 ECG (Electro Cardiogram),ECHO Cardiogram Post procedure cath study,ECHO Cardiogram -
CARDIOTHORACIC SURGERY SURGERY Cardiac Catheterization

S7 CARDIAC AND S7 CARDIAC & CARDIOTHORACIC S7.15 Medical Management Of Valvular Heart Diseases -Requiring IP 17650 ECG (Electro Cardiogram),ECHO Cardiogram Post procedure cath study,ECHO Cardiogram -
CARDIOTHORACIC SURGERY SURGERY Cardiac Catheterization

S7 CARDIAC AND S7.1 CARDIAC INTERVENTIONS / S7.1.1.1 Coronary Balloon Angioplasty with stent(00.45) IP 56441 2 CAD,2 CAD X-RAY,X-RAY -
CARDIOTHORACIC SURGERY PROCEDURES

S7 CARDIAC AND S7.1 CARDIAC INTERVENTIONS / S7.1.1.2 PTCA 1 Additional Stent (00.46) IP 7974 CAG,CAG X-RAY,X-RAY -
CARDIOTHORACIC SURGERY PROCEDURES

S7 CARDIAC AND S7.1 CARDIAC INTERVENTIONS / S7.1.1.3 Coronary Balloon Angioplasty with Drug eluting stent(00.45) IP 66713 ECG,2D Echo,CAG, ECG,2D Echo,CAG Stent Pouch with bar code Details,PTCA CD, X-RAY,Stent Pouch with bar code -
CARDIOTHORACIC SURGERY PROCEDURES Details,PTCA CD, X-RAY

S7 CARDIAC AND S7.1 CARDIAC INTERVENTIONS / S7.1.1.4 PTCA 1 Additional Drug eluting Stent (00.46) IP 20524 ECG,2D Echo,CAG, ECG,2D Echo,CAG Stent Pouch with bar code Details,PTCA CD, X-RAY,Stent Pouch with bar code -
CARDIOTHORACIC SURGERY PROCEDURES Details,PTCA CD, X-RAY

S7 CARDIAC AND S7.1 CARDIAC INTERVENTIONS / S7.1.2.1 ASD Device Closure IP 82096 2D ECHO,2D ECHO X-RAY,2D ECHO,X-RAY,2D ECHO -
CARDIOTHORACIC SURGERY PROCEDURES

S7 CARDIAC AND S7.1 CARDIAC INTERVENTIONS / S7.1.2.2 VSD Device Closure IP 82096 2D ECHO,2D ECHO X-RAY,2D ECHO,X-RAY,2D ECHO -
CARDIOTHORACIC SURGERY PROCEDURES

S7 CARDIAC AND S7.1 CARDIAC INTERVENTIONS / S7.1.2.3 MINIMAL ACCESS SURGERY- ASD/VSD IP 90000 SURGICAL PROFILE,2D ECHO INTRA PHOTOS,INTRA WEBEX,POST OF 2D ECHO -
CARDIOTHORACIC SURGERY PROCEDURES

S7 CARDIAC AND S7.1 CARDIAC INTERVENTIONS / S7.1.3.1 Patent Ductus Arterious - Stenting IP 76964 2D ECHO,2D ECHO 2D ECHO,2D ECHO -
CARDIOTHORACIC SURGERY PROCEDURES

S7 CARDIAC AND S7.1 CARDIAC INTERVENTIONS / S7.1.3.2 Patent Ductus Arterious - Device Closure IP 74215 2D ECHO,2D ECHO 2D ECHO,2D ECHO -
CARDIOTHORACIC SURGERY PROCEDURES

S7 CARDIAC AND S7.1 CARDIAC INTERVENTIONS / S7.1.3.3.1 Patent Ductus Arterious - Single Coil Closure IP 25654 - - -
CARDIOTHORACIC SURGERY PROCEDURES

S7 CARDIAC AND S7.1 CARDIAC INTERVENTIONS / S7.1.3.3.2 Patent Ductus Arterious - Multiple Coils Closrue IP 35916 - - -
CARDIOTHORACIC SURGERY PROCEDURES

S7 CARDIAC AND S7.1 CARDIAC INTERVENTIONS / S7.1.4.1 Balloon Valvotomy IP 26681 2D ECHO,2D ECHO 2D ECHO,2D ECHO -
CARDIOTHORACIC SURGERY PROCEDURES

S7 CARDIAC AND S7.1 CARDIAC INTERVENTIONS / S7.1.4.2 Balloon Atrial Septostomy IP 34254 2D ECHO,2D ECHO 2D ECHO,2D ECHO -
CARDIOTHORACIC SURGERY PROCEDURES

S7 CARDIAC AND S7.1 CARDIAC INTERVENTIONS / S7.1.5.1 Permanent Pacemaker Implantation IP 76964 ECG,CAG,ECG,CAG X-RAY,ECHO,X-RAY,ECHO -
CARDIOTHORACIC SURGERY PROCEDURES

S7 CARDIAC AND S7.1 CARDIAC INTERVENTIONS / S7.1.5.2 Temporary Pacemaker Implantation IP 13341 ECG,CAG,ECG,CAG X-RAY,ECHO,X-RAY,ECHO -
CARDIOTHORACIC SURGERY PROCEDURES

S7 CARDIAC AND S7.1 CARDIAC INTERVENTIONS / S7.1.5.3 CARDIAC RESYNCHRONISATION THERAPY - HOCM IP 100000 ECHO,ECG ECHO,WEBEEX,ECG,FIOROSCOPY -
CARDIOTHORACIC SURGERY PROCEDURES

S7 CARDIAC AND S7.1 CARDIAC INTERVENTIONS / S7.1.6.1 Coaractation of Aorta Repair With Stent + Aortoplasty(35.11) IP 82096 CAG,2D ECHO,CAG,2D ECHO DOPPLER,DOPPLER -
CARDIOTHORACIC SURGERY PROCEDURES

S7 CARDIAC AND S7.1 CARDIAC INTERVENTIONS / S7.1.6.2 Coaractation of Aorta Repair Without Stent+ IP 31176 Aortogram,Aortogram DOPPLER,DOPPLER -
CARDIOTHORACIC SURGERY PROCEDURES Aortoplasty(35.11)

S7 CARDIAC AND S7.1 CARDIAC INTERVENTIONS / S7.1.7.1 Renal Angioplasty IP 61571 ANGIOGRAM,ANGIOGRAM X-RAY,DOPPLER,X-RAY,DOPPLER -
CARDIOTHORACIC SURGERY PROCEDURES

S7 CARDIAC AND S7.1 CARDIAC INTERVENTIONS / S7.1.7.2 Peripheral Angioplasty IP 61572 ANGIOGRAM,2D ECHO,ANGIOGRAM,2D ECHO DOPPLER,DOPPLER -
CARDIOTHORACIC SURGERY PROCEDURES

S7 CARDIAC AND S7.1 CARDIAC INTERVENTIONS / S7.1.7.3 Vertebral Angioplasty IP 76964 ANGIOGRAM,ANGIOGRAM DOPPLER,DOPPLER -
CARDIOTHORACIC SURGERY PROCEDURES

S7 CARDIAC AND S7.1 CARDIAC INTERVENTIONS / S7.1.7.4 Perpheral Angioplasty - Additional Stent(00.46) IP 9236 ANGIOGRAM,ANGIOGRAM X-RAY,DOPPLER,X-RAY,DOPPLER -
CARDIOTHORACIC SURGERY PROCEDURES

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CODE MAIN CATEGORY Sub SUB CATEGORY NAME CODE SURGERY / THERAPY DESCRIPTION PROCEDURE PACKAGE SPECIAL INVESTIGATION POST OPERATIVE PROCEDURE INVESTIGATION TREATMENT PROTOCOL
Category ID TYPE AMOUNT
S7 CARDIAC AND S7.1 CARDIAC INTERVENTIONS / S7.1.7.5 Balloon Dilatation of Pulmonary Artrey Stenosis IP 40000 Angiogram,2D ECHO Post procedure Angio stills -
CARDIOTHORACIC SURGERY PROCEDURES

S7 CARDIAC AND S7.1 CARDIAC INTERVENTIONS / S7.1.7.6 Right ventricular outflow tract (RVOT) stenting IP 50000 Angiogram,2D ECHO Post procedure Angio stills -
CARDIOTHORACIC SURGERY PROCEDURES

S7 CARDIAC AND S7.1 CARDIAC INTERVENTIONS / S7.1.8 Treatment with Self Expanding Metalic Stent (SEMS) IP 20420 High Resolution CT Chest,Venous Doppler,ECHO Cardiogram Biopsy report,CT Scan Scan,USG -
CARDIOTHORACIC SURGERY PROCEDURES

S7 CARDIAC AND S7.10 CARDIAC INJURES S7.10.1 Surgery for Cardiac injuries Without CPB IP 71833 2D ECHO 2D ECHO -
CARDIOTHORACIC SURGERY

S7 CARDIAC AND S7.10 CARDIAC INJURES S7.10.2 Surgery for Cardiac injuries With CPB IP 94369 2D ECHO 2D ECHO -
CARDIOTHORACIC SURGERY

S7 CARDIAC AND S7.11 VASCULAR SURGERIES S7.11.1 Peripheral Embolectomy Without Graft IP 30786 Spiral CT Angiogram,ANGIOGRAM Color Doppler -
CARDIOTHORACIC SURGERY

S7 CARDIAC AND S7.11 VASCULAR SURGERIES S7.11.10 Excision Of Arterio Venous Malformation - Large IP 92357 Spiral CT Angiogram,MRI Angiogram Color Doppler -
CARDIOTHORACIC SURGERY

S7 CARDIAC AND S7.11 VASCULAR SURGERIES S7.11.11 Excision Of Arterio Venous Malformation - Small IP 45152 Spiral CT Angiogram,MRI Angiogram Color Doppler -
CARDIOTHORACIC SURGERY

S7 CARDIAC AND S7.11 VASCULAR SURGERIES S7.11.12 Arterial Embolectomy IP 30786 ANGIOGRAM,Color Doppler PVR,ANGIOGRAM,SBP -
CARDIOTHORACIC SURGERY

S7 CARDIAC AND S7.11 VASCULAR SURGERIES S7.11.12.1 Embolization - Arteriovenous Malformation (AVM) in the IP 40000 Angiogram,USG Abdomen Color Doppler,USG Abdomen -
CARDIOTHORACIC SURGERY Limbs (large)

S7 CARDIAC AND S7.11 VASCULAR SURGERIES S7.11.12.2 Thromboembolectomy (pre-auth not required, usually done IP 28000 Duplex ultrasound Scar Photo,Color Doppler -
CARDIOTHORACIC SURGERY as emergency)

S7 CARDIAC AND S7.11 VASCULAR SURGERIES S7.11.12.3 Thrombolysis for acute ischemia of limb due to arterial IP 10000 Peripheral Angiogram /Doppler report with Stills Doppler,Post procedure Angio stills -
CARDIOTHORACIC SURGERY abstruction

S7 CARDIAC AND S7.11 VASCULAR SURGERIES S7.11.12.4 TRANS ARTERIAL CHEMOEMBOLIZATION IP 91750 doppler,Angiogram post of angiogram or colour doppler,webex procedure -
CARDIOTHORACIC SURGERY

S7 CARDIAC AND S7.11 VASCULAR SURGERIES S7.11.13 A V Fistula surgery (creation) at Wrist IP 10261 Color Doppler Color Doppler -
CARDIOTHORACIC SURGERY

S7 CARDIAC AND S7.11 VASCULAR SURGERIES S7.11.14 A. V Fistula surgery (creation) At Elbow IP 10261 Color Doppler Color Doppler -
CARDIOTHORACIC SURGERY

S7 CARDIAC AND S7.11 VASCULAR SURGERIES S7.11.15 DVT - Ivc Filter implantation IP 102619 Color Doppler Plain X-Ray Abdomen -
CARDIOTHORACIC SURGERY

S7 CARDIAC AND S7.11 VASCULAR SURGERIES S7.11.16 Surgical management of Vascular Tumors IP 41048 Spiral CT Angiogram,ANGIOGRAM Color Doppler -
CARDIOTHORACIC SURGERY

S7 CARDIAC AND S7.11 VASCULAR SURGERIES S7.11.17 Small Arterial Aneurysms - Repair IP 20523 Spiral CT Angiogram,ANGIOGRAM Color Doppler -
CARDIOTHORACIC SURGERY

S7 CARDIAC AND S7.11 VASCULAR SURGERIES S7.11.18 Medium Size Arterial Aneurysms - Repair IP 25654 Spiral CT Angiogram,ANGIOGRAM Color Doppler -
CARDIOTHORACIC SURGERY

S7 CARDIAC AND S7.11 VASCULAR SURGERIES S7.11.19 Medium Size Arterial Aneurysms - Repair With Synthetic Graft IP 97489 Spiral CT Angiogram,ANGIOGRAM Color Doppler -
CARDIOTHORACIC SURGERY

S7 CARDIAC AND S7.11 VASCULAR SURGERIES S7.11.2 Aorto Billiac - Bifemoral Bypass With Synthetic Graft IP 128275 Spiral CT Angiogram,ANGIOGRAM Color Doppler -
CARDIOTHORACIC SURGERY

S7 CARDIAC AND S7.11 VASCULAR SURGERIES S7.11.20 Pulmonary artero venous malformation IP 45000 Pre Op X-ray / CT Scan Post Op X-ray/CT Scan -
CARDIOTHORACIC SURGERY

S7 CARDIAC AND S7.11 VASCULAR SURGERIES S7.11.21 Operations for Congenital Arteriovenous Fistula IP 15000 Regional Angiogram & Stills Scar Photo -
CARDIOTHORACIC SURGERY

S7 CARDIAC AND S7.11 VASCULAR SURGERIES S7.11.23 B/L MANAGEMENT OF VARICOSE VEINS - VARICOSE ULCER - IP 35000 Surgical profile,Colour doppler,Clinical photo Post of doppler & SCAR PHOTO,WEBEX VIDEO -
CARDIOTHORACIC SURGERY VENOUS MALFORMATIONS -RFA/EVLT

S7 CARDIAC AND S7.11 VASCULAR SURGERIES S7.11.24 U/L MANAGEMENT OF VARICOSE VEINS - VARICOSE ULCER - IP 25000 Surgical profile,Colour doppler,Clinical photo INTRA OP PROCEDURE WITH WEBEX VIDEO,Post of doppler & SCAR PHOTO -
CARDIOTHORACIC SURGERY VENOUS MALFORMATIONS -RFA/EVLT

S7 CARDIAC AND S7.11 VASCULAR SURGERIES S7.11.25 COMPLEX AV ACCESS WITH GRAFT FOR HEMODIALYSIS IP 28500 colour Doppler vein and artery,CKD profile,U/S abdomen POST OPCOLOUR DOPPLER,INTRA OP PROCEDURE WITH GRAFT -
CARDIOTHORACIC SURGERY

S7 CARDIAC AND S7.11 VASCULAR SURGERIES S7.11.26 THROMBIN INJECTION UNDER DUPLEX GUIDANCE FOR IP 16000 COLOUR DOPPLER PROCEDURE WEBEX,COLOUR DOPPLER -
CARDIOTHORACIC SURGERY PSEUDOANEURYSM AND USG GUIDED COMPRESSION
THERAPY
S7 CARDIAC AND S7.11 VASCULAR SURGERIES S7.11.3 Axillo Bifemoral Bypass With Synthetic Graft IP 102619 Spiral CT Angiogram,ANGIOGRAM Color Doppler -
CARDIOTHORACIC SURGERY

S7 CARDIAC AND S7.11 VASCULAR SURGERIES S7.11.4 Femoro Distal Bypass With Vein Graft IP 61571 Spiral CT Angiogram,ANGIOGRAM Color Doppler -
CARDIOTHORACIC SURGERY

S7 CARDIAC AND S7.11 VASCULAR SURGERIES S7.11.5 Femoro Distal Bypass With Synthetic Graft IP 82096 Spiral CT Angiogram,ANGIOGRAM Color Doppler -
CARDIOTHORACIC SURGERY

S7 CARDIAC AND S7.11 VASCULAR SURGERIES S7.11.6 Axillo Brachial Bypass Using With Synthetic Graft IP 71834 Spiral CT Angiogram,ANGIOGRAM Color Doppler -
CARDIOTHORACIC SURGERY

S7 CARDIAC AND S7.11 VASCULAR SURGERIES S7.11.7 Brachio - Radial Bypass With Synthetic Graft IP 60545 Spiral CT Angiogram,ANGIOGRAM Color Doppler -
CARDIOTHORACIC SURGERY

S7 CARDIAC AND S7.11 VASCULAR SURGERIES S7.11.8 Excicion Of Carotid Body Tumor With Vascular Repair IP 82096 Spiral CT Angiogram,ANGIOGRAM Color Doppler -
CARDIOTHORACIC SURGERY

S7 CARDIAC AND S7.11 VASCULAR SURGERIES S7.11.9 Carotid Artery Bypass With Synthetic Graft IP 127249 Spiral CT Angiogram,ANGIOGRAM Color Doppler -
CARDIOTHORACIC SURGERY

S7 CARDIAC AND S7.12 Cath lab procedures S7.12.1 CATH IP 9000 Chest X ray – PA view,ECG,2D ECHO Cath CD -
CARDIOTHORACIC SURGERY

15 of 47
CODE MAIN CATEGORY Sub SUB CATEGORY NAME CODE SURGERY / THERAPY DESCRIPTION PROCEDURE PACKAGE SPECIAL INVESTIGATION POST OPERATIVE PROCEDURE INVESTIGATION TREATMENT PROTOCOL
Category ID TYPE AMOUNT
S7 CARDIAC AND S7.12 Cath lab procedures S7.12.10 ROTABLATION IP 48875 Coronary Angioplasty,Coronary angiography CD CD of Coronary Angioplasty with the visibility of Rota burr -
CARDIOTHORACIC SURGERY

S7 CARDIAC AND S7.12 Cath lab procedures S7.12.11 VERTEBRAL ARTERY STENTING WITH EMBOLIC PROTECTION IP 65000 SURGICAL PROFILE,CT ANGIOGRM POST PROCEDURE ANGIOGRAM,PROCEDURAL WEBEX,INTRA OPERTAIVE PHOTOS -
CARDIOTHORACIC SURGERY DEVICE

S7 CARDIAC AND S7.12 Cath lab procedures S7.12.12 CAROTID ARTERY STENTING WITH EMBOLIC PROTECTION IP 65000 Carotid doppler Carotid doppler -
CARDIOTHORACIC SURGERY DEVICE

S7 CARDIAC AND S7.12 Cath lab procedures S7.12.2 ENDOMYOCARDIAL BIOPSY IP 9000 Blood Investigations,ECG,2D ECHO CD of Procedure -
CARDIOTHORACIC SURGERY

S7 CARDIAC AND S7.12 Cath lab procedures S7.12.3 INTRA VASCULAR COILS IP 45000 CT-Scan CD of Procedure,DSA CD -
CARDIOTHORACIC SURGERY

S7 CARDIAC AND S7.12 Cath lab procedures S7.12.4 DIGITAL SUBSTRACTION ANGIOGRAPHY- (PERIPHERAL IP 11500 CT-Scan,DOPPLER DSA CD -
CARDIOTHORACIC SURGERY ARTERY)

S7 CARDIAC AND S7.12 Cath lab procedures S7.12.5 DIGITAL SUBSTRACTION ANGIOGRAPHY- (VENOGRAM) IP 11500 DOPPLER DSA CD -
CARDIOTHORACIC SURGERY

S7 CARDIAC AND S7.12 Cath lab procedures S7.12.6 EMBOLISATION IP 16200 CT-Scan,DOPPLER Embolization CD -
CARDIOTHORACIC SURGERY

S7 CARDIAC AND S7.12 Cath lab procedures S7.12.7 IVUS IP 22500 ANGIOGRAM CD of Catheter in Coronary artery,IVUS Imaging CD -
CARDIOTHORACIC SURGERY

S7 CARDIAC AND S7.12 Cath lab procedures S7.12.8 CARONARY ANGIOGRAPHY IP 11500 2D ECHO,ECG Coronary angiogram CD -
CARDIOTHORACIC SURGERY

S7 CARDIAC AND S7.12 Cath lab procedures S7.12.9 CAROTID STENTING IP 42263 DSA of Carotid Arteries CD of Procedure -
CARDIOTHORACIC SURGERY

S7 CARDIAC AND S7.2 CARDIOTHORACIC AND VASCULAR S7.2.1.1 Coronary Bypass Surgery IP 118881 CAG Clinical Photograph -
CARDIOTHORACIC SURGERY SURGERIES

S7 CARDIAC AND S7.2 CARDIOTHORACIC AND VASCULAR S7.2.1.1.1 MINIMAL ACCESS SURGERY- CABG IP 115846 SURGICAL PROFILE,ANGIOGRAM,2D ECHO POST OF 2D ECHO,INTRA PHOTOS,INTRA WEBEX -
CARDIOTHORACIC SURGERY SURGERIES

S7 CARDIAC AND S7.2 CARDIOTHORACIC AND VASCULAR S7.2.1.2 Coronary Bypass Surgery-Post Angioplasty IP 121830 POST PTCA-CAG Clinical Photograph -
CARDIOTHORACIC SURGERY SURGERIES

S7 CARDIAC AND S7.2 CARDIOTHORACIC AND VASCULAR S7.2.1.3 Cabg With Iabp Pump IP 143338 CAG,2D ECHO Clinical Photograph -
CARDIOTHORACIC SURGERY SURGERIES

S7 CARDIAC AND S7.2 CARDIOTHORACIC AND VASCULAR S7.2.1.4 Cabg With Aneurismal Repair IP 158291 CAG Clinical Photograph -
CARDIOTHORACIC SURGERY SURGERIES

S7 CARDIAC AND S7.2 CARDIOTHORACIC AND VASCULAR S7.2.10.1 Mitral Valve Replacement (With Valve) IP 148799 2D ECHO X-RAY,2D ECHO -
CARDIOTHORACIC SURGERY SURGERIES

S7 CARDIAC AND S7.2 CARDIOTHORACIC AND VASCULAR S7.2.10.2 Aortic Valve Replacement (With Valve) IP 148799 2D ECHO X-RAY,2D ECHO -
CARDIOTHORACIC SURGERY SURGERIES

S7 CARDIAC AND S7.2 CARDIOTHORACIC AND VASCULAR S7.2.10.3 Replacement of Tricuspid valve IP 148019 2D ECHO X-RAY,2D ECHO -
CARDIOTHORACIC SURGERY SURGERIES

S7 CARDIAC AND S7.2 CARDIOTHORACIC AND VASCULAR S7.2.10.4 Double valve replacement (With Valve) IP 182663 2D ECHO X-RAY,2D ECHO -
CARDIOTHORACIC SURGERY SURGERIES

S7 CARDIAC AND S7.2 CARDIOTHORACIC AND VASCULAR S7.2.10.5 MINIMAL ACCESS SURGERY- VALVE REPLACEMENT IP 100000 2D ECHO,SURGICAL PROFILE POST OF 2D ECHO,INTRA PHOTOS,INTRA WEBEX -
CARDIOTHORACIC SURGERY SURGERIES

S7 CARDIAC AND S7.2 CARDIOTHORACIC AND VASCULAR S7.2.10.6 Surgical Treatment For MVR And Atrial Fibrillation- Maze IP 150000 SURGICAL PROFILE,ANJIO,ECHO,ECG FLUROSCOPY,INTRA OPERATIVE PROCEDURE -
CARDIOTHORACIC SURGERY SURGERIES Method/ Cryoablation Method / Hifu Method

S7 CARDIAC AND S7.2 CARDIOTHORACIC AND VASCULAR S7.2.11.1 Pericardiostomy IP 25655 2D ECHO 2D ECHO -
CARDIOTHORACIC SURGERY SURGERIES

S7 CARDIAC AND S7.2 CARDIOTHORACIC AND VASCULAR S7.2.11.2 Pericardiectomy IP 50745 2D ECHO 2D ECHO -
CARDIOTHORACIC SURGERY SURGERIES

S7 CARDIAC AND S7.2 CARDIOTHORACIC AND VASCULAR S7.2.11.3 Pericardiocentesis IP 15393 2D ECHO 2D ECHO -
CARDIOTHORACIC SURGERY SURGERIES

S7 CARDIAC AND S7.2 CARDIOTHORACIC AND VASCULAR S7.2.12.1 Coarctation-Arota Repair With Graft IP 102620 CAG,2D ECHO DOPPLER -
CARDIOTHORACIC SURGERY SURGERIES

S7 CARDIAC AND S7.2 CARDIOTHORACIC AND VASCULAR S7.2.12.2 Coarctation-Arota Repair Without Graft IP 71834 CAG,2D ECHO DOPPLER -
CARDIOTHORACIC SURGERY SURGERIES

S7 CARDIAC AND S7.2 CARDIOTHORACIC AND VASCULAR S7.2.12.3 Balloon Dilatation of Coartication of Aorta IP 38600 2D ECHO report 2D ECHO report + stills of Angio -
CARDIOTHORACIC SURGERY SURGERIES

S7 CARDIAC AND S7.2 CARDIOTHORACIC AND VASCULAR S7.2.13.1 Aneurysm Resection and Grafting IP 186225 CAG,2D ECHO DOPPLER -
CARDIOTHORACIC SURGERY SURGERIES

S7 CARDIAC AND S7.2 CARDIOTHORACIC AND VASCULAR S7.2.13.2 Intrathoracic Aneurysm -Aneurysm Not Requiring Bypass IP 102620 CT-Angio,Cath DOPPLER -
CARDIOTHORACIC SURGERY SURGERIES

S7 CARDIAC AND S7.2 CARDIOTHORACIC AND VASCULAR S7.2.13.3 Intrathoracic Aneurysm -Requiring Bypass (With Graft) IP 185270 CT-Angio,Cath DOPPLER -
CARDIOTHORACIC SURGERY SURGERIES

S7 CARDIAC AND S7.2 CARDIOTHORACIC AND VASCULAR S7.2.13.4 Surgical management of Dissecting Aneurysms IP 184716 CT-Angio,Cath DOPPLER -
CARDIOTHORACIC SURGERY SURGERIES

S7 CARDIAC AND S7.2 CARDIOTHORACIC AND VASCULAR S7.2.13.5 Surgical management of Annulus Aortic Ectasia With Valved IP 162345 angio ECHO,DOPPLER -
CARDIOTHORACIC SURGERY SURGERIES Conduits

S7 CARDIAC AND S7.2 CARDIOTHORACIC AND VASCULAR S7.2.14.1 Aorto-Aorto Bypass With Graft IP 102620 angio DOPPLER -
CARDIOTHORACIC SURGERY SURGERIES

S7 CARDIAC AND S7.2 CARDIOTHORACIC AND VASCULAR S7.2.14.2 Aorto-Aorto Bypass Without Graft IP 87227 angio DOPPLER -
CARDIOTHORACIC SURGERY SURGERIES

16 of 47
CODE MAIN CATEGORY Sub SUB CATEGORY NAME CODE SURGERY / THERAPY DESCRIPTION PROCEDURE PACKAGE SPECIAL INVESTIGATION POST OPERATIVE PROCEDURE INVESTIGATION TREATMENT PROTOCOL
Category ID TYPE AMOUNT
S7 CARDIAC AND S7.2 CARDIOTHORACIC AND VASCULAR S7.2.15.1 Femoro- Poplitial Bypass With Graft IP 66703 angio DOPPLER -
CARDIOTHORACIC SURGERY SURGERIES

S7 CARDIAC AND S7.2 CARDIOTHORACIC AND VASCULAR S7.2.15.2 Femoro- Poplitial Bypass Without Graft IP 46178 angio DOPPLER -
CARDIOTHORACIC SURGERY SURGERIES

S7 CARDIAC AND S7.2 CARDIOTHORACIC AND VASCULAR S7.2.16.1 Femoro- Ileal Bypass With Graft IP 66703 angio DOPPLER -
CARDIOTHORACIC SURGERY SURGERIES

S7 CARDIAC AND S7.2 CARDIOTHORACIC AND VASCULAR S7.2.16.2 Femoro- Ileal Bypass Without Graft IP 46179 angio DOPPLER -
CARDIOTHORACIC SURGERY SURGERIES

S7 CARDIAC AND S7.2 CARDIOTHORACIC AND VASCULAR S7.2.17.1 Femoro-Femoral Bypass With Graft IP 66703 angio DOPPLER -
CARDIOTHORACIC SURGERY SURGERIES

S7 CARDIAC AND S7.2 CARDIOTHORACIC AND VASCULAR S7.2.17.2 Femoro-Femoral Bypass Without Graft IP 46179 angio DOPPLER -
CARDIOTHORACIC SURGERY SURGERIES

S7 CARDIAC AND S7.2 CARDIOTHORACIC AND VASCULAR S7.2.18.1 TGA - Arterial Switch IP 153929 angio,2D ECHO 2D ECHO -
CARDIOTHORACIC SURGERY SURGERIES

S7 CARDIAC AND S7.2 CARDIOTHORACIC AND VASCULAR S7.2.18.2 TGA - Sennings Procedure IP 153930 angio,2D ECHO 2D ECHO -
CARDIOTHORACIC SURGERY SURGERIES

S7 CARDIAC AND S7.2 CARDIOTHORACIC AND VASCULAR S7.2.19.1 TGA - Carotid Embolectomy IP 71834 ANGIOGRAM X-RAY,DOPPLER -
CARDIOTHORACIC SURGERY SURGERIES

S7 CARDIAC AND S7.2 CARDIOTHORACIC AND VASCULAR S7.2.2.1 Surgery For Intracardiac Tumors IP 102620 CAG,2D ECHO HPE,Clinical Photograph,ECHO -
CARDIOTHORACIC SURGERY SURGERIES

S7 CARDIAC AND S7.2 CARDIOTHORACIC AND VASCULAR S7.2.3.1 surgical management of Ruptured Sinus Of Valsalva IP 133405 CAG ECHO,Clinical Photograph -
CARDIOTHORACIC SURGERY SURGERIES

S7 CARDIAC AND S7.2 CARDIOTHORACIC AND VASCULAR S7.2.4.1 surgical management (Correction) of TAPVC IP 122980 2D ECHO ECHO,Clinical Photograph -
CARDIOTHORACIC SURGERY SURGERIES

S7 CARDIAC AND S7.2 CARDIOTHORACIC AND VASCULAR S7.2.5.1.1 Systemic Pulmonary Shunts With Graft TOF IP 65266 2D ECHO 2D ECHO -
CARDIOTHORACIC SURGERY SURGERIES

S7 CARDIAC AND S7.2 CARDIOTHORACIC AND VASCULAR S7.2.5.1.2 Systemic Pulmonary Shunts Without Graft TOF IP 56852 2D ECHO 2D ECHO -
CARDIOTHORACIC SURGERY SURGERIES

S7 CARDIAC AND S7.2 CARDIOTHORACIC AND VASCULAR S7.2.5.2 Total Correction of Tetralogy of Fallot IP 107001 2D ECHO ECHO,Clinical Photograph -
CARDIOTHORACIC SURGERY SURGERIES

S7 CARDIAC AND S7.2 CARDIOTHORACIC AND VASCULAR S7.2.6.1 Intra Cardiac Repair Of ASD IP 82095 2D ECHO 2D ECHO -
CARDIOTHORACIC SURGERY SURGERIES

S7 CARDIAC AND S7.2 CARDIOTHORACIC AND VASCULAR S7.2.6.2 Intracardiac Repair Of VSD IP 87227 2D ECHO 2D ECHO -
CARDIOTHORACIC SURGERY SURGERIES

S7 CARDIAC AND S7.2 CARDIOTHORACIC AND VASCULAR S7.2.7.1 Surgery for-PDA IP 41048 2D ECHO 2D ECHO -
CARDIOTHORACIC SURGERY SURGERIES

S7 CARDIAC AND S7.2 CARDIOTHORACIC AND VASCULAR S7.2.8.1 Ross procedure - Intracardiac repair of complex congenital IP 153930 2D ECHO 2D ECHO -
CARDIOTHORACIC SURGERY SURGERIES heart diseases with Special Conduits

S7 CARDIAC AND S7.2 CARDIOTHORACIC AND VASCULAR S7.2.8.2 Ross procedure - Intracardiac repair of complex IP 112379 2D ECHO 2D ECHO -
CARDIOTHORACIC SURGERY SURGERIES congenitalheart diseases without Special Conduits

S7 CARDIAC AND S7.2 CARDIOTHORACIC AND VASCULAR S7.2.9.1 Valve repair with Prosthetic Ring IP 143668 2D ECHO ECHO -
CARDIOTHORACIC SURGERY SURGERIES

S7 CARDIAC AND S7.2 CARDIOTHORACIC AND VASCULAR S7.2.9.2 Valve repair without Prosthetic Ring IP 112881 2D ECHO X-RAY,ECHO -
CARDIOTHORACIC SURGERY SURGERIES

S7 CARDIAC AND S7.2 CARDIOTHORACIC AND VASCULAR S7.2.9.3 Open Pulmonary Valvotomy IP 79017 2D ECHO 2D ECHO -
CARDIOTHORACIC SURGERY SURGERIES

S7 CARDIAC AND S7.2 CARDIOTHORACIC AND VASCULAR S7.2.9.4 Closed Mitral Valvotomy IP 41048 2D ECHO 2D ECHO -
CARDIOTHORACIC SURGERY SURGERIES

S7 CARDIAC AND S7.2 CARDIOTHORACIC AND VASCULAR S7.2.9.5 Mitral valvotomy (Open) IP 112881 2D ECHO 2D ECHO -
CARDIOTHORACIC SURGERY SURGERIES

S7 CARDIAC AND S7.2 CARDIOTHORACIC AND VASCULAR S7.2.9.6 Percutaneous Transluminal Tricuspid Commissurotormy IP 26681 2D ECHO Angio(Fluroscopy),2D ECHO -
CARDIOTHORACIC SURGERY SURGERIES (PTTC)

S7 CARDIAC AND S7.3 LUNGS S7.3.1 Pneumonectomy IP 61571 X-RAY,CT-Chest X-RAY,Clinical Photograph -
CARDIOTHORACIC SURGERY

S7 CARDIAC AND S7.3 LUNGS S7.3.2 Lobectomy IP 61571 X-RAY,CT-Chest X-RAY,Clinical Photograph -
CARDIOTHORACIC SURGERY

S7 CARDIAC AND S7.3 LUNGS S7.3.3 Decortication of lung IP 61572 X-RAY,CT-Chest X-RAY,Clinical Photograph -
CARDIOTHORACIC SURGERY

S7 CARDIAC AND S7.3 LUNGS S7.3.4 Surgical management of lung cyst IP 41048 X-RAY,CT-Chest X-RAY,Clinical Photograph -
CARDIOTHORACIC SURGERY

S7 CARDIAC AND S7.3 LUNGS S7.3.5 Surgical management of SolItary fibrous tumor- Mediastinum IP 61572 X-RAY,CT-Chest X-RAY,Clinical Photograph -
CARDIOTHORACIC SURGERY

S7 CARDIAC AND S7.3 LUNGS S7.3.6.1 Surgical management of Bronchopleural fistula -Thorocoplasty IP 69299 X-RAY,CT-Chest X-RAY,Clinical Photograph -
CARDIOTHORACIC SURGERY

S7 CARDIAC AND S7.3 LUNGS S7.3.6.2 Surgical management of Bronchopleural Fistula - Myoplasty IP 77118 X-RAY,CT-Chest X-RAY,Clinical Photograph -
CARDIOTHORACIC SURGERY

S7 CARDIAC AND S7.3 LUNGS S7.3.6.3 Transpleural Bronchopleural Fistula closure IP 66703 X-RAY,CT-Chest X-RAY,Clinical Photograph -
CARDIOTHORACIC SURGERY

S7 CARDIAC AND S7.3 LUNGS S7.3.7 Pulmonary Sequestration Resection IP 40000 Pre Op X-ray / CT Scan Post Op X-ray/CT Scan -
CARDIOTHORACIC SURGERY

17 of 47
CODE MAIN CATEGORY Sub SUB CATEGORY NAME CODE SURGERY / THERAPY DESCRIPTION PROCEDURE PACKAGE SPECIAL INVESTIGATION POST OPERATIVE PROCEDURE INVESTIGATION TREATMENT PROTOCOL
Category ID TYPE AMOUNT
S7 CARDIAC AND S7.3 LUNGS S7.3.8 BRONCHIAL ARTERY EMBOLIZATION IN HEMOPTYSIS USING IP 60000 HEMTO PLATLATE COUNT,CT SCAN INTRA OPETAIV,CT CHEST,WEBEX VIDEO -
CARDIOTHORACIC SURGERY PVA AND MICRO CATHETER

S7 CARDIAC AND S7.3 LUNGS S7.3.9 PLEURAL BIOPSY OPEN /VATS IP 20000 PLURAL PATHOLOGY ANALYSIS REPORT,CT CHEST,LUNG FUNCTION TEST INTRA-OPERATIVE PICTURE,HPE REPORT -
CARDIOTHORACIC SURGERY

S7 CARDIAC AND S7.4 CHEST SURGERY S7.4.1 Surgical management of Diaphragmatic Eventeration IP 51310 CT-Scan,BARIUM STUDIES USG -
CARDIOTHORACIC SURGERY

S7 CARDIAC AND S7.4 CHEST SURGERY S7.4.2 Surgical Management of Diaphragmatic Hernia IP 61571 USG,CT-Scan USG -
CARDIOTHORACIC SURGERY

S7 CARDIAC AND S7.4 CHEST SURGERY S7.4.3 Surgical Management of Oesophageal Diverticula /Achalasia IP 51310 CT-Scan,BARIUM STUDIES USG -
CARDIOTHORACIC SURGERY Cardia

S7 CARDIAC AND S7.4 CHEST SURGERY S7.4.4 Surgical management of Empyema Thoracis IP 53506 Pulmonary Function Test(Major),CT Scan Chest With Contrast,Chest X-Ray PA View(1 Film),PUS Culture & Chest X-Ray PA View(1 Film) -
CARDIOTHORACIC SURGERY Sensitivity,Aspirate For Culture

S7 CARDIAC AND S7.4 CHEST SURGERY S7.4.5 Rib Resection & Drainage IP 14000 CT CHEST,Clinical Photograph,X-RAY CHEST Biopsy CHEST,Clinical Photograph,POST OP X-RAY CHEST -
CARDIOTHORACIC SURGERY

S7 CARDIAC AND S7.4 CHEST SURGERY S7.4.6 Thoracoscopic Segmental Resection IP 25000 FNAC,Clinical Photograph,X-RAY CHEST,CT CHEST Post OP X-Ray Chest,Intra Op Photo,Biopsy,SCAR Photo -
CARDIOTHORACIC SURGERY

S7 CARDIAC AND S7.4 CHEST SURGERY S7.4.7 Thoracocentesis IP 11800 X-RAY CHEST,Clinical Photograph X-RAY CHEST,Clinical Photograph -
CARDIOTHORACIC SURGERY

S7 CARDIAC AND S7.4 CHEST SURGERY S7.4.8 Thorax (penetrating wounds) IP 12500 X-RAY CHEST,Clinical Photograph X-RAY CHEST,Clinical Photograph -
CARDIOTHORACIC SURGERY

S7 CARDIAC AND S7.5 DIAPHRAGMATIC INJURIES S7.5.1 Surgical management of Diaphragmatic injuries, Thoraco IP 56441 CT-Scan Clinical photograph with operative scars -
CARDIOTHORACIC SURGERY Abdominal approach

S7 CARDIAC AND S7.6 BRONCHIAL INJURIES/FB S7.6.1 Bronchoscopic Foreign body removal IP 20523 CT-Scan,Bronchoscopy Endoscopy picture -
CARDIOTHORACIC SURGERY

S7 CARDIAC AND S7.6 BRONCHIAL INJURIES/FB S7.6.2 Surgical management For Bronchial Injuries due to foreign IP 61572 CT-Scan,Bronchoscopy Endoscopy picture -
CARDIOTHORACIC SURGERY Body

S7 CARDIAC AND S7.8 OESOPHAGEAL INJURY/FB S7.8.1 Gastro Study Followed By Thoracotomy and Repairs For IP 66703 Gastroscopy Endoscopy picture -
CARDIOTHORACIC SURGERY Oesophageal Injury For Corrosive Injuries/Fb

S7 CARDIAC AND S7.9 VASCULAR INJURY S7.9.1 Surgery for Arterial Injuries, Venous Injuries Without Graft IP 25655 DOPPLER,ANGIOGRAM Clinical photograph with operative scars -
CARDIOTHORACIC SURGERY

S7 CARDIAC AND S7.9 VASCULAR INJURY S7.9.1.1 Surgical Management of Vascular Injury In Upper Limbs - IP 20523 - ANGIOGRAM,Color Doppler -
CARDIOTHORACIC SURGERY Axillary,Branchial,Radial And Ulnar -With Vein Graft

S7 CARDIAC AND S7.9 VASCULAR INJURY S7.9.1.2 Major Vascular Injury -In Lower Limbs-Repair IP 30786 - ANGIOGRAM,Color Doppler -
CARDIOTHORACIC SURGERY

S7 CARDIAC AND S7.9 VASCULAR INJURY S7.9.1.3 Surgical Management of Minor Vascular Injury - Tibial Vessels IP 20524 - ANGIOGRAM,Color Doppler -
CARDIOTHORACIC SURGERY In Leg

S7 CARDIAC AND S7.9 VASCULAR INJURY S7.9.1.4 Surgical Management of Minor Vascular Injury -Vessels In IP 20523 - ANGIOGRAM,Color Doppler -
CARDIOTHORACIC SURGERY Foot

S7 CARDIAC AND S7.9 VASCULAR INJURY S7.9.2 Surgical Management of Vascular injuries with vein graft IP 30785 DOPPLER,ANGIOGRAM Clinical photograph with operative scars -
CARDIOTHORACIC SURGERY

S7 CARDIAC AND S7.9 VASCULAR INJURY S7.9.3 Surgical Management of Vascular Injury With Prosthetic Graft IP 41048 DOPPLER,ANGIOGRAM Clinical photograph with operative scars -
CARDIOTHORACIC SURGERY

S7 CARDIAC AND S7.9 VASCULAR INJURY S7.9.4 Surgical Management of Neck Vascular Injury - Carotid IP 102619 ANGIOGRAM,Color Doppler - -
CARDIOTHORACIC SURGERY Vessels

S7 CARDIAC AND S7.9 VASCULAR INJURY S7.9.6 Surgical Management of Abdominal Vascular Injuries - Aorta, IP 102619 ANGIOGRAM,Color Doppler Color Doppler -
CARDIOTHORACIC SURGERY Illac Arteries, Ivc, Iliac Veins

S7 CARDIAC AND S7.9 VASCULAR INJURY S7.9.7 Surgical Management of Thoracic Vascular Injuries IP 153930 ANGIOGRAM,Color Doppler Color Doppler -
CARDIOTHORACIC SURGERY

S8 PEDIATRIC SURGERIES S8 PEDIATRIC SURGERY S8.11 Excision of External angular dermoid in Paediatric Patient DC 3000 Clinical Photograph,X-Ray of part Scar Photo,Routine Histopathological Examination -

S8 PEDIATRIC SURGERIES S8 PEDIATRIC SURGERY S8.12 High risk delivery: Major Fetal malformation requiring IP 11500 MRI,clinical notes,3D USG,Clinical Photograph Post OP Photos,clinical notes,Intra OP Photos -
intervention immediately after birth
S8 PEDIATRIC SURGERIES S8 PEDIATRIC SURGERY S8.13 Surgical treatment for Preauricular sinus in pediatric patient IP 10000 Sinogram,Clinical Photograph,USG Intra OP Photos,Routine Histopathological Examination,Scar Photo,Biopsy -

S8 PEDIATRIC SURGERIES S8.1 PAEDIATRIC CONGENITAL S8.1.1 Surgical management of Oesophageal Atresia In Paediatric IP 63512 - - -
MALFORMATIONS Patients
S8 PEDIATRIC SURGERIES S8.1 PAEDIATRIC CONGENITAL S8.1.2 Open repair of diaphragmatic hernia in paediatric patients IP 51310 - - -
MALFORMATIONS
S8 PEDIATRIC SURGERIES S8.1 PAEDIATRIC CONGENITAL S8.1.3 Surgical Management of Intestinal Atresias and Obstructions IP 66703 - - -
MALFORMATIONS In Paediatric Patients
S8 PEDIATRIC SURGERIES S8.1 PAEDIATRIC CONGENITAL S8.1.4 Surgical Management of Biliary Atresia and Choledochal Cyst IP 71270 - - -
MALFORMATIONS In Paediatric Patients
S8 PEDIATRIC SURGERIES S8.1 PAEDIATRIC CONGENITAL S8.1.5 Stage 1 procedure for Anorectal Malformations In Paediatric IP 49257 - - -
MALFORMATIONS Patients
S8 PEDIATRIC SURGERIES S8.1 PAEDIATRIC CONGENITAL S8.1.6 Stage 2 procedure for Anorectal Malformations In Paediatric IP 61572 - - -
MALFORMATIONS Patients
S8 PEDIATRIC SURGERIES S8.1 PAEDIATRIC CONGENITAL S8.1.7 Stage 1 procedure for Hirschprungs Disease In Paediatric IP 49257 - - -
MALFORMATIONS Patients
S8 PEDIATRIC SURGERIES S8.1 PAEDIATRIC CONGENITAL S8.1.8 Stage 2 procedure for Hirschprungs Disease In Paediatric IP 73887 - - -
MALFORMATIONS Patients
S8 PEDIATRIC SURGERIES S8.1 PAEDIATRIC CONGENITAL S8.1.9 VULVAL SYNECHIAE IP 4000 ULTRA SOUND ABDOMEN Clinical Photo -
MALFORMATIONS
S8 PEDIATRIC SURGERIES S8.1 PAEDIATRIC CONGENITAL S8.2.1 Surgical Management of Congenital Hydronephrosis in IP 56143 - - -
MALFORMATIONS Paediatric Patients
S8 PEDIATRIC SURGERIES S8.1 PAEDIATRIC CONGENITAL S8.2.2 Surgical Management of Ureteric Reimplantations IP 35681 - - -
MALFORMATIONS
S8 PEDIATRIC SURGERIES S8.1 PAEDIATRIC CONGENITAL S8.2.3.1 Stage 1 procedure for Exstrophy Bladder in Paediatric IP 75129 - - -
MALFORMATIONS Patients
S8 PEDIATRIC SURGERIES S8.1 PAEDIATRIC CONGENITAL S8.2.3.2 Stage 2 procedure for Exstrophy Bladder in Paediatric IP 72071 - - -
MALFORMATIONS Patients

18 of 47
CODE MAIN CATEGORY Sub SUB CATEGORY NAME CODE SURGERY / THERAPY DESCRIPTION PROCEDURE PACKAGE SPECIAL INVESTIGATION POST OPERATIVE PROCEDURE INVESTIGATION TREATMENT PROTOCOL
Category ID TYPE AMOUNT
S8 PEDIATRIC SURGERIES S8.1 PAEDIATRIC CONGENITAL S8.2.4 Surgical Management of Posterior Urethral Valves in IP 30786 - - -
MALFORMATIONS Paediatric Patients
S8 PEDIATRIC SURGERIES S8.1 PAEDIATRIC CONGENITAL S8.2.5 Single Stage procedure for Hypospadiasis IP 41048 - - -
MALFORMATIONS
S8 PEDIATRIC SURGERIES S8.1 PAEDIATRIC CONGENITAL S8.2.6.1 Stage 1 procedure for Hypospadiasis IP 30129 Clinical Photograph,Clinical Photograph Clinical Photograph,Clinical Photograph -
MALFORMATIONS
S8 PEDIATRIC SURGERIES S8.1 PAEDIATRIC CONGENITAL S8.2.6.2 Stage 2 procedure for Hypospadiasis IP 30642 - - -
MALFORMATIONS
S8 PEDIATRIC SURGERIES S8.1 PAEDIATRIC CONGENITAL S8.3.1 Surgical Management of Paediatric Tumors IP 51310 - - -
MALFORMATIONS
S8 PEDIATRIC SURGERIES S8.1 PAEDIATRIC CONGENITAL S8.4.1 Surgical correction of Cleft Lip IP 25655 - - -
MALFORMATIONS
S8 PEDIATRIC SURGERIES S8.1 PAEDIATRIC CONGENITAL S8.4.2 Surgical correction of Cleft Palate in pediatric patients IP 25656 - - -
MALFORMATIONS
S8 PEDIATRIC SURGERIES S8.1 PAEDIATRIC CONGENITAL S8.4.4 Surgical correction of Syndactyly of Hand For Each Hand in IP 25655 - - -
MALFORMATIONS Paediatric Patient
S8 PEDIATRIC SURGERIES S8.1 PAEDIATRIC CONGENITAL S8.4.5 Surgical correction of Microtia/Anotia In Paediatric Patient IP 33701 - - -
MALFORMATIONS
S8 PEDIATRIC SURGERIES S8.1 PAEDIATRIC CONGENITAL S8.4.6 Surgical Management of Tempero mandibular Joint Ankylosis IP 45707 - - -
MALFORMATIONS
S8 PEDIATRIC SURGERIES S8.10 CYST EXCISION S8.10.1 Excision of Retention Cyst Lip IP 5000 Clinical Photograph clinical / scar photo,Routine Histopathological Examination,Intra op photo -
S8 PEDIATRIC SURGERIES S8.10 CYST EXCISION S8.10.2 Duplication Cyst Excision IP 20000 CECT,clinical notes,USG,Clinical Photograph Biopsy report,Intra PhotoS,SCAR PhotoS -
S8 PEDIATRIC SURGERIES S8.10 CYST EXCISION S8.10.3 Excision of Sebacencyst / Lipoma in Paediatric Patient DC 4000 Clinical Photograph,X-Ray of part,clinical photo Scar Photo,Routine Histopathological Examination,Clinical Photograph -
S8 PEDIATRIC SURGERIES S8.2 CONGENITAL MALFORMATIONS S8.5.1 Surgical Management of Hamartoma Excision IP 20525 USG,IVP,Renogram IVP,Clinical Photograph -
S8 PEDIATRIC SURGERIES S8.2 CONGENITAL MALFORMATIONS S8.5.2 Surgical Management of Hemangioma Excision IP 19323 USG,Clinical Photograph IVP,Clinical Photograph -
S8 PEDIATRIC SURGERIES S8.2 CONGENITAL MALFORMATIONS S8.5.3 Surgical management of Lymphangioma In Paediatric Patients IP 49257 - - -

S8 PEDIATRIC SURGERIES S8.3 HEAD AND NECK S8.3.1 Neuroblastoma IP 51310 CT,Biopsy Clinical Photograph -
S8 PEDIATRIC SURGERIES S8.3 HEAD AND NECK S8.3.2 Surgical Management of Congenital Dermal Sinus IP 30786 - - -
S8 PEDIATRIC SURGERIES S8.3 HEAD AND NECK S8.3.2.1 Execision of cogental dermal sinus IP 29990 USG,Clinical Photograph Biopsy report,Scar Photo,Intra OP Photos -
S8 PEDIATRIC SURGERIES S8.3 HEAD AND NECK S8.3.3 Surgical Management of Cystic Lesions Of The Neck IP 24629 - - -
S8 PEDIATRIC SURGERIES S8.3 HEAD AND NECK S8.3.4 Surgical management of Encephalocele IP 43183 - - -
S8 PEDIATRIC SURGERIES S8.3 HEAD AND NECK S8.3.5 Surgical management of Sinuses and Fistula of the neck in IP 21417 - - -
Paediatric Patient
S8 PEDIATRIC SURGERIES S8.3 HEAD AND NECK S8.3.6 Meningo Myelocele Spinal Procedure IP 25655 Clinical Photograph ,X-Ray Dorso Lumbar Spine,Neurosonogram(NSG) Case Sheet with operation Notes -
S8 PEDIATRIC SURGERIES S8.3 HEAD AND NECK S8.3.7 Surgical Management of Torticollis in Paediatric Patient IP 20000 Clinical Photograph,X-Ray,USG Intra OP Photos,Scar Photo -

S8 PEDIATRIC SURGERIES S8.3 HEAD AND NECK S8.3.8.1 Ankyloglossia Major IP 15000 Clinical Photograph,clinical notes Clinical Photograph,clinical notes -
S8 PEDIATRIC SURGERIES S8.3 HEAD AND NECK S8.3.8.2 Ankyloglossia Minor IP 5000 Clinical Photograph,clinical notes Clinical Photograph,clinical notes -
S8 PEDIATRIC SURGERIES S8.3 HEAD AND NECK S8.3.8.3 Surgical treatment for release of tongue tie IP 7000 Clinical Photograph Intra OP Photos -
S8 PEDIATRIC SURGERIES S8.3 HEAD AND NECK S8.3.9 Management Of Tmj Dysfunction Syndrome (76.94) DC 1090 Orthopantomography (OPG) Orthopantomography(OPG) -
S8 PEDIATRIC SURGERIES S8.4 CHEST S8.4.4.1 Syndactoly correction-multiple correction in Paediatric Patient IP 28000 Clinical Photograph,X-Ray X-Ray,Scar Photo,Intra OP Photos -

S8 PEDIATRIC SURGERIES S8.4 CHEST S8.7.1 Bronchoscopy for Foreign Body Removal IP 20523 Clinical Photograph Clinical Photograph -
S8 PEDIATRIC SURGERIES S8.4 CHEST S8.7.2 Surgical Correction of Esophageal Obstructions In Paediatric IP 60032 Clinical Photograph Clinical Photograph -
Patients
S8 PEDIATRIC SURGERIES S8.4 CHEST S8.7.3 Surgical Correction of Esophageal Substitutions In Paediatric IP 75083 Endoscopy Clinical Photograph -
Patients
S8 PEDIATRIC SURGERIES S8.4 CHEST S8.7.4 Excision of Thoracoscopic Cysts IP 41049 Clinical Photograph Clinical Photograph -
S8 PEDIATRIC SURGERIES S8.4 CHEST S8.7.5 Thoracoscopic Decortication In Paediatric Patients IP 49258 Clinical Photograph Clinical Photograph -
S8 PEDIATRIC SURGERIES S8.4 CHEST S8.7.6 Surgical Correction of Thoracic Duplications In Paediatric IP 45708 X-RAY,Clinical Photograph Clinical Photograph -
Patients
S8 PEDIATRIC SURGERIES S8.4 CHEST S8.7.7 Surgical Correction of Thoracic Wall Defects IP 66710 - - -
S8 PEDIATRIC SURGERIES S8.4 CHEST S8.7.8 Empyema decortication In Paediatric Patients IP 31433 Chest X-Ray PA View(1 Film),CT Scan Chest With Contrast/CT Scan Chest Without Contrast Routine Histopathological Examination ,Chest X-Ray PA View(1 Film) -
S8 PEDIATRIC SURGERIES S8.5 ABDOMEN S8.8.1 Surgical management of - Gastric Outlet Obstructions In IP 30787 CT,Clinical Photograph Clinical Photograph -
Paediatric Patients
S8 PEDIATRIC SURGERIES S8.5 ABDOMEN S8.8.10 Laparoscopic Pull Through Surgeries For Hirschprungs Disease IP 73887 - - -
In Paediatric Patients
S8 PEDIATRIC SURGERIES S8.5 ABDOMEN S8.8.11 Paediatric Splenectomy (Non Traumatic) IP 43101 - - -
S8 PEDIATRIC SURGERIES S8.5 ABDOMEN S8.8.12 Adrenal Gland Surgeries In Paediatric patients(07.3and07.4) IP 48570 - - -

S8 PEDIATRIC SURGERIES S8.5 ABDOMEN S8.8.13 Meckels Diverticulectomy In Paediatric Patients IP 41048 Clinical Photograph ,USG Abdomen /Radio Scintography Scar Photo ,Routine Histopathological Examination -
S8 PEDIATRIC SURGERIES S8.5 ABDOMEN S8.8.14 Unilateral Inguinal Hernia repair In Paediatric Patients IP 15394 Clinical Photograph Scar Photo -
S8 PEDIATRIC SURGERIES S8.5 ABDOMEN S8.8.15 Bilateral Inguinal Hernia repair In Paediatric Patients IP 20524 Clinical Photograph Scar Photo -
S8 PEDIATRIC SURGERIES S8.5 ABDOMEN S8.8.16 Lumbar Hernia repair In Paediatric Patients IP 15393 Clinical Photograph Scar Photo -
S8 PEDIATRIC SURGERIES S8.5 ABDOMEN S8.8.17 Femoral Hernia repair In Paediatric Patients IP 15393 Clinical Photograph Scar Photo -
S8 PEDIATRIC SURGERIES S8.5 ABDOMEN S8.8.18 Umbilical Hernia repair In Paediatric Patients IP 20525 USG Abdomen Scar Photo -
S8 PEDIATRIC SURGERIES S8.5 ABDOMEN S8.8.19 Incisional Hernia repair In Paediatric Patients IP 30787 Clinical Photograph Scar Photo -
S8 PEDIATRIC SURGERIES S8.5 ABDOMEN S8.8.2 Surgical management of Gastro Esophageal Reflux In IP 37364 Neuro USG,CT Clinical Photograph -
Paediatric Patients
S8 PEDIATRIC SURGERIES S8.5 ABDOMEN S8.8.3 Surgical Correction of Hydatid Cysts In Paediatric Patient IP 41048 Neuro USG,CT Clinical Photograph -

S8 PEDIATRIC SURGERIES S8.5 ABDOMEN S8.8.4 Surgical management of Intestinal Polyposis In Paediatric IP 61572 - - -
Patients
S8 PEDIATRIC SURGERIES S8.5 ABDOMEN S8.8.5 Surgical Correction of Intususception IP 49258 - - -
S8 PEDIATRIC SURGERIES S8.5 ABDOMEN S8.8.6 Surgical mangement of Acute Intestinal Obstruction In IP 49258 - - -
Paediatric Patients
S8 PEDIATRIC SURGERIES S8.5 ABDOMEN S8.8.7 Laparoscopic Appendicectomy IP 21458 - - -
S8 PEDIATRIC SURGERIES S8.5 ABDOMEN S8.8.8 Laparoscopic Choleycystectomy IP 30786 - - -
S8 PEDIATRIC SURGERIES S8.5 ABDOMEN S8.8.9 Laparoscopic Pull Through For Ano Rectal Anomalies In IP 73887 - - -
Paediatric Patients
S8 PEDIATRIC SURGERIES S8.6 GENITOURINARY SYSTEM S8.6.4 Undescended testis IP 43183 Neuro USG,CT,Neuro USG,CT Clinical Photograph,Biopsy,Clinical Photograph,Biopsy -
S8 PEDIATRIC SURGERIES S8.6 GENITOURINARY SYSTEM S8.9.1 Simple Nephrectomy in pediatric patients IP 41048 USG,CT,FNAC,USG,CT,FNAC Clinical Photograph,Biopsy,Clinical Photograph,Biopsy -
S8 PEDIATRIC SURGERIES S8.6 GENITOURINARY SYSTEM S8.9.2 Surgical Correction of Epispadiasis IP 42963 Neuro USG,CT,Neuro USG,CT Clinical Photograph,Biopsy,Clinical Photograph,Biopsy -
S8 PEDIATRIC SURGERIES S8.6 GENITOURINARY SYSTEM S8.9.3 Surgical Correction of Scrotal Transposition In Paediatric IP 20524 USG,CT- Clinical Photograph,MRI,USG,CT- Clinical Photograph,MRI Clinical Photograph,Biopsy,Clinical Photograph,Biopsy -
Patients
S8 PEDIATRIC SURGERIES S8.6 GENITOURINARY SYSTEM S8.9.5 Surgical Management for Torsion of Testis IP 25850 CT,Clinical Photograph,CT,Clinical Photograph Clinical Photograph,Biopsy,Clinical Photograph,Biopsy -
S8 PEDIATRIC SURGERIES S8.6 GENITOURINARY SYSTEM S8.9.6 Laparoscopic Orchidopexy In Paediatric Patients IP 25655 - - -
S8 PEDIATRIC SURGERIES S8.6 GENITOURINARY SYSTEM S8.9.7 Laparoscopic Varicocele Ligation IP 41048 - - -
S8 PEDIATRIC SURGERIES S8.7 CHEST S8.7.10 Mediastinal Cyst Excision In Paediatric Patients IP 66000 CECT Post OP HPE,Chest X-ray -
S8 PEDIATRIC SURGERIES S8.7 CHEST S8.7.4.1 Open excision of Lung cyst In Paediatric Patient IP 40000 Chest X-Ray PA View(1 Film),CT Scan Chest With Contrast Scar Photo,Chest X-Ray PA View(1 Film),Routine Histopathological Examination,Intra OP -
Photos
S8 PEDIATRIC SURGERIES S8.7 CHEST S8.7.8.1 Empyema-ICD drainage In Paediatric Patients IP 10000 Chest X-Ray PA View(1 Film),CT Scan Chest With Contrast/CT Scan Chest Without Contrast Scar Photo,Chest X-Ray PA View(1 Film),Intra OP Photos -
S8 PEDIATRIC SURGERIES S8.7 CHEST S8.7.9 Surgery for Congenital Lobar Emphysema IP 25000 CECT,clinical notes,USG,Clinical Photograph Post OP X-Ray Chest,Intra PhotoS,SCAR PhotoS,Biopsy report -
S8 PEDIATRIC SURGERIES S8.8 ABDOMEN S8.8.1.1 Feeding Jejunostomy In Paediatric Patients IP 20000 Clinical Photograph Chest X-Ray ,Clinical Photograph,Intra OP Photos,Scar Photo -
S8 PEDIATRIC SURGERIES S8.8 ABDOMEN S8.8.13.1 Correction of Vitello intestinal duct anomalies in Paediatric IP 38760 Clinical Photograph,USG Abdomen Intra OP Photos,Scar Photo -
Patients
S8 PEDIATRIC SURGERIES S8.8 ABDOMEN S8.8.20 Colostomy closure exept in ARM IP 25000 Clinical Photograph Intra OP Photos,Scar Photo -
S8 PEDIATRIC SURGERIES S8.8 ABDOMEN S8.8.21 Exomphalo IP 25000 Scar photo,clinical notes,Clinical Photograph Post OP Clinical Photograph -
S8 PEDIATRIC SURGERIES S8.8 ABDOMEN S8.8.22 Correction of Duplications of alimentary tract in Paediatric IP 47160 CECT Scan/MRI,USG,CT Scan Scar Photo,Routine Histopathological Examination -
Patients
S8 PEDIATRIC SURGERIES S8.8 ABDOMEN S8.8.23 GI Tumor Excision IP 30000 CECT,clinical notes,USG,Clinical Photograph Scar PhotoS ,Intra OP PhotoS,USG,Post OP Biopsy reportS -
S8 PEDIATRIC SURGERIES S8.8 ABDOMEN S8.8.24 Ileostomy closure In Paediatric Patients IP 25010 Clinical Photograph Intra OP Photos,Scar Photo,Routine Histopathological Examination -
S8 PEDIATRIC SURGERIES S8.8 ABDOMEN S8.8.25 Surgical management of peritonitis in Paediatric Patients IP 40000 USG Abdomen,Abdomen Radiograph Supine Or Erect(1 Film),X-RAY Abdomen Intra OP Photos,Scar Photo -

19 of 47
CODE MAIN CATEGORY Sub SUB CATEGORY NAME CODE SURGERY / THERAPY DESCRIPTION PROCEDURE PACKAGE SPECIAL INVESTIGATION POST OPERATIVE PROCEDURE INVESTIGATION TREATMENT PROTOCOL
Category ID TYPE AMOUNT
S8 PEDIATRIC SURGERIES S8.8 ABDOMEN S8.8.26 Gastro schisis IP 37600 Clinical photo scar photo, post op USG,intra operative photos -
S8 PEDIATRIC SURGERIES S8.8 ABDOMEN S8.8.27 Mesenteric Caval Anastomosis IP 28500 COLOR DOPPLER SCAN,Clinical Photograph,UGI ENDOSCOPY scar Photo,Intra Op Photo,post op color doppler scan -
S8 PEDIATRIC SURGERIES S8.8 ABDOMEN S8.8.28 Coccygeal Teratoma Excision IP 35000 CECT report,Clinical Photograph SCAR Photo,Intra Op Photo,POST OP Biopsy -
S8 PEDIATRIC SURGERIES S8.8 ABDOMEN S8.8.29 OPEN CYSTECTOMY IP 45000 CECT Post OP HPE,Post OP Ultra Sound -
S8 PEDIATRIC SURGERIES S8.8 ABDOMEN S8.8.30 Pancreatic surgery in Paediatric Patients IP 75000 CECT Post OP Ultra Sound -
S8 PEDIATRIC SURGERIES S8.8 ABDOMEN S8.8.5.1 Intussusception - Non –Operative Reduction in infants IP 20000 Clinical Photograph,clinical notes,USG USG,Intra OP PhotoS -
S8 PEDIATRIC SURGERIES S8.8 ABDOMEN S8.8.9.1 Rectopexy Open without Mesh for Rectal Prolapse IP 30000 USG Abdomen,Colonoscopy/Sigmoidoscopy (REGID) / Defacogram,Clinical Photograph Scar Photo,USG Abdomen,Clinical Photograph -
S8 PEDIATRIC SURGERIES S8.8 ABDOMEN S8.8.9.2 Rectal polypectomy In Paediatric Patients DC 8000 Clinical Photograph,Proctoscopy Routine Histopathological Examination -
S8 PEDIATRIC SURGERIES S8.8 ABDOMEN S8.8.9.3 Surgical mangement of Anal Fissure and Fistula In Paediatric IP 22590 PROCTOSCOPY,Clinical Photograph Intra OP Photos,Scar Photo -
Patients
S8 PEDIATRIC SURGERIES S8.8 ABDOMEN S8.8.9.4 Anal Dilatation DC 1000 Clinical Photograph Clinical Photograph -
S8 PEDIATRIC SURGERIES S8.9 GENITOURINARY SYSTEM S8.9.1.1 Renal calculi-nephrolithotomy in Paediatric Patients IP 32210 IVP,USG Abdomen / Abdomen And Pelvis For Kidneys,And Bladder (KUB) / CT Scan Lower Abdomen With And Bladder(KUB),X-Ray Abdomen And Pelvis For Kidneys,Ureters,Scar Photo,Intra OP -
Contrast,Ureters Photos
S8 PEDIATRIC SURGERIES S8.9 GENITOURINARY SYSTEM S8.9.1.2 Ureterostomy in Paediatric Patients IP 32350 MCUG,USG Abdomen/Intra Veneous Pyelogram,Clinical Photograph Intra OP Photos,Scar Photo -
S8 PEDIATRIC SURGERIES S8.9 GENITOURINARY SYSTEM S8.9.1.3 Vesical calculi-vesicolithotomy in Paediatric Patients IP 25000 Clinical Photograph,USG Abdomen / X-Ray Kidneys,Bladder(KUB),Ureters,IVP And Bladder(KUB),X-ray Kidneys,Ureters,Scar Photo,Intra OP Photos -
S8 PEDIATRIC SURGERIES S8.9 GENITOURINARY SYSTEM S8.9.1.4 Supra pubic drainage- open in Paediatric Patients IP 10000 X-RAY KUB,USG Abdomen,Clinical Photograph Intra OP Photos,Scar Photo -
S8 PEDIATRIC SURGERIES S8.9 GENITOURINARY SYSTEM S8.9.1.5.1 Vesicotomy closure in Paediatric Patients IP 26910 X-RAY KUB,USG Abdomen,Clinical Photograph Intra OP Photos,Scar Photo -
S8 PEDIATRIC SURGERIES S8.9 GENITOURINARY SYSTEM S8.9.1.5.2 Vesicostomy IP 25760 USG Abdomen/ Micturating Cystourethrogram (MCUG) Vesicostomy Photos,Scar Photo -
S8 PEDIATRIC SURGERIES S8.9 GENITOURINARY SYSTEM S8.9.1.6 Repair of Urethral injuries in Paediatric Patients IP 28020 CECT,USG Abdomen,RGU,Clinical Photograph Micturation Photos,Clinical Photograph -
S8 PEDIATRIC SURGERIES S8.9 GENITOURINARY SYSTEM S8.9.1.7 Ureteric Implantation with tailoring IP 41880 Micturating Cystourethrogram (MCUG),CT Scan Lower Abdomen With Contrast,Intra Veneous Pyelogram,USG Intra OP Photos,USG Abdomen,KUB -
Abdomen
S8 PEDIATRIC SURGERIES S8.9 GENITOURINARY SYSTEM S8.9.1.8 Bladder augmentation IP 52640 Micturating Cystourethrogram(MCUG)/Urodynamic Study(Cystometry),USG Abdomen,Clinical Photograph Clinical Photograph -

S8 PEDIATRIC SURGERIES S8.9 GENITOURINARY SYSTEM S8.9.10 Open ureterolithotomy IP 28790 CECT,USG Abdomen/Intra Veneous Pyelogram,Clinical Photograph Intra OP Photos,USG Abdomen,Scar Photo,KUB -
S8 PEDIATRIC SURGERIES S8.9 GENITOURINARY SYSTEM S8.9.11 Open Nephro lithitomy IP 24180 Xray KUB & Blood investigations,USG,IVP U/S, Intra Op photos,Xray KUB -
S8 PEDIATRIC SURGERIES S8.9 GENITOURINARY SYSTEM S8.9.12 URSL IP 27900 Xray KUB & Blood investigations,USG,IVP U/S, Webex,Intra Op photos,Xray KUB -
S8 PEDIATRIC SURGERIES S8.9 GENITOURINARY SYSTEM S8.9.13 ESWL ST 21000 Xray KUB & Blood investigations,USG,IVP U/S, Intra Op photos,Xray KUB -
S8 PEDIATRIC SURGERIES S8.9 GENITOURINARY SYSTEM S8.9.14 Open pylo lithitomy IP 23500 Xray KUB & Blood investigations,USG,IVP U/S, Intra Op photos,Xray KUB -
S8 PEDIATRIC SURGERIES S8.9 GENITOURINARY SYSTEM S8.9.15 Endoscopic removal of Vessical calculus ST 14800 Xray KUB,U/S U/S, Intra Op photos,Webex ,Xray KUB -
S8 PEDIATRIC SURGERIES S8.9 GENITOURINARY SYSTEM S8.9.16 PCNL in pediatrics IP 37600 Xray KUB & Blood investigations,USG,IVP U/S, Webex,Intra Op photos,Scar photo,Xray KUB -
S8 PEDIATRIC SURGERIES S8.9 GENITOURINARY SYSTEM S8.9.17 CAPD -Tenchkoff catheter insertion ST 36000 USG abdomen,Renal profie scar photo, post op USG,intra operative photos -
S8 PEDIATRIC SURGERIES S8.9 GENITOURINARY SYSTEM S8.9.18 CAPD -Tenchkoff catheter removal ST 34000 Abdomen and pelvis U/S,Clinical photograph scar photo, post op USG,intra operative photos -
S8 PEDIATRIC SURGERIES S8.9 GENITOURINARY SYSTEM S8.9.7.1 Open Varicocele ligation IP 30000 CT Scan Of Lower Abdomen & Scrotum,Doppler And Scrotum & Testes,USG Abdomen Doppler Scan,Scar Photo,Intra OP Photos -
S8 PEDIATRIC SURGERIES S8.9 GENITOURINARY SYSTEM S8.9.7.2 Hydrocele high ligation In Paediatric Patients IP 15000 USG,Clinical Photograph Intra OP Photos,Scar Photo -
S8 PEDIATRIC SURGERIES S8.9 GENITOURINARY SYSTEM S8.9.8.1 Surgical Management of Phimosis and Paraphimosis IP 8000 Clinical Photograph Intra OP Photos,Scar Photo -
S8 PEDIATRIC SURGERIES S8.9 GENITOURINARY SYSTEM S8.9.8.2 Surgical Management of Penile Injuries IP 24920 USG Penis,MRI Scrotum/Doppler And Scrotum & Testes,Clinical Photograph Scar Photo,CT Scan Of Lower Abdomen & Scrotum,USG Penis -
S8 PEDIATRIC SURGERIES S8.9 GENITOURINARY SYSTEM S8.9.9 Intersex-Genitoplasty surgery(70.6) IP 50000 Karyo Typing - Cytogenetics,USG Abdomen/Genitogram Clinical Photograph -
S9 GENITO URINARY SURGERIES S9 GENITOURINARY SURGERY S9.12.1 Renal angio embolization IP 34310 Doppler Of Renal Arteries,USG of KUB,Renal Angiogram WEBEX,USG Abdomen -

S9 GENITO URINARY SURGERIES S9 GENITOURINARY SURGERY S9.12.2 Revascularization procedure for renovascular hypertension IP 28430 Blood Urea Nitrogen (BUN),Renal Profile,Complete Blood Count (CBC),24 Hrs Urine Analysis,Erythrocyte Renal Profile,Case Sheet with operation Notes,Renal Angiogram -
Sedimentation Rate (ESR),plasma renin activity,Renal Angiogram/ Digital Subtraction Angiogram,99 TC Dtpa
Renogram / Isotope Renogram/ Intra Veneous Pyelogram,ECG (Electro Cardiogram)/ ECHO Cardiogram,CT
Aortography,Urine Culture & Sensitivity,Serum Electrolytes

S9 GENITO URINARY SURGERIES S9 GENITOURINARY SURGERY S9.12.3 Difficult vascular access/graft IP 30000 Clinical Photograph,Colour Doppler Of Specific Limb Colour Doppler Of Specific Limb -

S9 GENITO URINARY SURGERIES S9 GENITOURINARY SURGERY S9.13 Retrograde Intrarenal Surgery(RIRS) IP 31580 NCCT(KUB),USG WEBEX USG KUB/X-ray KUB,USG Abdomen -

S9 GENITO URINARY SURGERIES S9 GENITOURINARY SURGERY S9.14.1 Emergency management of Hematuria ST 20000 RFT Platelet count,Cystoscopy,CT Abdomen,CUE,Urine Analysis,HB,RBS,BT,CT Operation Photo,Cystoscopy,Webex video -

S9 GENITO URINARY SURGERIES S9 GENITOURINARY SURGERY S9.14.2 Emergency management of Acute retention of Urine (TROCAR ST 6000 CUE,US Abdomen,Urine Analysis,RFT Clinical Photo -
SPC for Acute Retention Urine)
S9 GENITO URINARY SURGERIES S9 GENITOURINARY SURGERY S9.16 Urachal Cyst excision - Laparoscopic IP 34660 USG Abdomen,CT Scan Lower Abdomen With Contrast Routine Histopathological Examination,USG Abdomen,CT Scan Lower Abdomen With -
Contrast
S9 GENITO URINARY SURGERIES S9 GENITOURINARY SURGERY S9.17 Uni-lateral illioinguinal block dissection in non malignant IP 30000 Biopsy,Fine Needle Aspiration Cytology (FNAC),USG local area Routine Histopathological Examination -
conditions
S9 GENITO URINARY SURGERIES S9 GENITOURINARY SURGERY S9.18 Surgery for Retroperitoneal Fibrosis Open/Lap IP 39430 CT scan Lower Abdomen Without Contrast/CT Scan Abdomen Without Contrast,USG Abdomen USG Abdomen/CT scan Lower Abdomen Without Contrast/CT Scan Abdomen With -
Contrast/CT Scan Abdomen Without Contrast,Routine Histopathological Examination

S9 GENITO URINARY SURGERIES S9 GENITOURINARY SURGERY S9.19 Parapelvic Cyst Excision-Open/Lap IP 32000 USG Abdomen/CT scan Lower Abdomen Without Contrast/CT Scan Abdomen Without Contrast Routine Histopathological Examination,USG Abdomen -

S9 GENITO URINARY SURGERIES S9 GENITOURINARY SURGERY S9.20.1 Pelvic lymphadenectomy open, after prior cancer surgery IP 25000 FNAC,CT scan clinical notes -

S9 GENITO URINARY SURGERIES S9 GENITOURINARY SURGERY S9.20.2 Ilio-Inguinal lymphadenectomy IP 25000 clinical notes/ NCCT clinical notes -

S9 GENITO URINARY SURGERIES S9 GENITOURINARY SURGERY S9.20.3 RPLND for Testis Cancer in Children IP 57000 CT Abdomen,Serum Markers,CT Chest Followup Serum Markers -

S9 GENITO URINARY SURGERIES S9 GENITOURINARY SURGERY S9.20.4 RPLND as a part of Staging IP 27900 CT Contrast ,Clinical photo Biopsy Report -

S9 GENITO URINARY SURGERIES S9 GENITOURINARY SURGERY S9.20.5 BPLND ( Bilateral Pelvic lymphnode Dissection IP 57000 CT(CONTRAST) Biopsy Report,CT -

S9 GENITO URINARY SURGERIES S9.1 RENAL TRANSPLANTATION S9.1.1 A.V. Fistula surgery (creation) [Pre-Transplant Procedure Only] IP 10262 S.Electrolytes,RenalFunction Test,S.Electrolytes,RenalFunction Test Clinical Photograph,Clinical Photograph -

S9 GENITO URINARY SURGERIES S9.1 RENAL TRANSPLANTATION S9.1.2 Renal Transplantation Surgery IP 165321 USG,RFT Clinical Photograph -

S9 GENITO URINARY SURGERIES S9.1 RENAL TRANSPLANTATION S9.1.3 Post Renal Transplant Immunosuppressive Treatment From IP 94072 Renal Angiogram,RFT,USG Renal Angiogram, WEBEX ,Bills Copy -
1st To 6th Months
S9 GENITO URINARY SURGERIES S9.1 RENAL TRANSPLANTATION S9.1.4 Balloon dialatation of transplant Renal Artery stenosis IP 33464 - - -

S9 GENITO URINARY SURGERIES S9.1 RENAL TRANSPLANTATION S9.1.6 Laproscopic post transplant lymphocele IP 31390 USG Abdomen WEBEX,USG Abdomen -

S9 GENITO URINARY SURGERIES S9.1 RENAL TRANSPLANTATION S9.1.7 Post transplant graft Nephrectomy IP 35010 And Bladder(KUB),USG Abdomen,CT Scan Lower Abdomen,Abdomen And Pelvis For Kidneys,Ureters Routine Histopathological Examination,USG Abdomen -

S9 GENITO URINARY SURGERIES S9.1 RENAL TRANSPLANTATION S9.1.8 Post transplant revision Ureteroneo cystostomy/Pyelo IP 37260 USG Abdomen,CT Scan Lower Abdomen With Contrast USG Abdomen,CT Scan Lower Abdomen With Contrast -
Ureterostomy
S9 GENITO URINARY SURGERIES S9.1 RENAL TRANSPLANTATION S9.1.9 Open post transplant lymphocele IP 29330 USG Abdomen USG Abdomen -

S9 GENITO URINARY SURGERIES S9.10 TESTIS AND PENIS S9.10.1 Orchidopexy Bilateral IP 23465 USG Clinical Photograph -

S9 GENITO URINARY SURGERIES S9.10 TESTIS AND PENIS S9.10.1.1 Orchiopexy with laparoscopy IP 30000 USG Scrotum & Abdomen,Clinical Photo clinical notes-Photo + Scrotum USG -

S9 GENITO URINARY SURGERIES S9.10 TESTIS AND PENIS S9.10.1.2 Orchiectomy-simple DC 10000 clinical notes/USG clinical notes/USG -

S9 GENITO URINARY SURGERIES S9.10 TESTIS AND PENIS S9.10.1.3 Orchidectomy -Unilateral IP 22000 Clinical Photograph,USG-Doppler Abdomen,CT Scan Of Lower Abdomen & Scrotum,Ureters,Abdomen And Pelvis For Routine Histopathological Examination,USG Abdomen -
Kidneys,And Bladder(KUB)
S9 GENITO URINARY SURGERIES S9.10 TESTIS AND PENIS S9.10.1.4 Orchiopexy-without laparoscopy, unilateral IP 15000 Scrotum & Abdomen,Clinical Photo,USG clinical notes/USG Scrotum -

S9 GENITO URINARY SURGERIES S9.10 TESTIS AND PENIS S9.10.1.5 High Inguinal Orchiectomy (For Testis Cancer) IP 23500 CT,USG/BHCG/AFP,USG U/S scrotum,Post OP USG,Clinical Photo,Follow up harmonal study -

S9 GENITO URINARY SURGERIES S9.10 TESTIS AND PENIS S9.10.1.6 Laproscopic orchidopexy in Children Bilateral IP 32900 CT,USG U/S scrotum,Clinical Photo -

S9 GENITO URINARY SURGERIES S9.10 TESTIS AND PENIS S9.10.10 Infertility-Scrotal exploration bilateral DC 12000 clinical notes clinical notes -

S9 GENITO URINARY SURGERIES S9.10 TESTIS AND PENIS S9.10.11 Infertility-Scrotal exploration unilateral DC 10000 clinical notes clinical notes -

20 of 47
CODE MAIN CATEGORY Sub SUB CATEGORY NAME CODE SURGERY / THERAPY DESCRIPTION PROCEDURE PACKAGE SPECIAL INVESTIGATION POST OPERATIVE PROCEDURE INVESTIGATION TREATMENT PROTOCOL
Category ID TYPE AMOUNT
S9 GENITO URINARY SURGERIES S9.10 TESTIS AND PENIS S9.10.12 Vasectomy reversal IP 23010 Semen Analysis + Clinical examination Semen Analysis + Clinical examination -

S9 GENITO URINARY SURGERIES S9.10 TESTIS AND PENIS S9.10.13 Plaque Excision/Plasty for Penile curvature/Peyronies disease IP 40000 CT Scan Of Penis Clinical photo,CT Scan Of Lower Abdomen & Scrotum,USG Penis -

S9 GENITO URINARY SURGERIES S9.10 TESTIS AND PENIS S9.10.14 Surgery for Priapism IP 35000 Doppler of penis Clinical photo,USG Penis,CT Scan Of Lower Abdomen & Scrotum -

S9 GENITO URINARY SURGERIES S9.10 TESTIS AND PENIS S9.10.15 Surgical Management of Phimosis and Paraphimosis IP 10000 Clinical Photograph Scar Photo -

S9 GENITO URINARY SURGERIES S9.10 TESTIS AND PENIS S9.10.16 Scrotal/Perineal Injuries IP 27460 Clinical Photograph,USG Abdomen,CT Scan Lower Abdomen With Contrast Scar Photo,USG Abdomen,CT Scan Lower Abdomen With Contrast -

S9 GENITO URINARY SURGERIES S9.10 TESTIS AND PENIS S9.10.17 Open Varicocele ligation IP 25000 USG Abdomen,Doppler And Scrotum & Testes,CT Scan Of Lower Abdomen & Scrotum Scar Photo -

S9 GENITO URINARY SURGERIES S9.10 TESTIS AND PENIS S9.10.18 Penile prosthesis insertion IP 40000 Neurological Study report ,Penile Doppler,Vascular study clinical notes -

S9 GENITO URINARY SURGERIES S9.10 TESTIS AND PENIS S9.10.19 Surgical Management of Penile Injuries IP 24920 Clinical Photograph,CT Scan Of Lower Abdomen & Scrotum/Doppler And Scrotum & Testes,USG Penis USG Penis,CT Scan Of Lower Abdomen & Scrotum -

S9 GENITO URINARY SURGERIES S9.10 TESTIS AND PENIS S9.10.2 Surgical management of Torsion of Testis IP 25850 USG Clinical Photograph -

S9 GENITO URINARY SURGERIES S9.10 TESTIS AND PENIS S9.10.2.1 Torsion testis in children IP 23500 Colour Doppler U/S scrotum,Clinical Photo -

S9 GENITO URINARY SURGERIES S9.10 TESTIS AND PENIS S9.10.20 Testis Biopsy (Infertility) ST 11500 USG Scrotum,Semen Analysis,Clinical Photo Clinical Photo,Biopsy Report. -

S9 GENITO URINARY SURGERIES S9.10 TESTIS AND PENIS S9.10.21 Undescended Unilateral Testis in children IP 23500 CT Plain,Clinical Photo Scrotal U/S,Clinical Photo -

S9 GENITO URINARY SURGERIES S9.10 TESTIS AND PENIS S9.10.3 Surgical correction of Chordee IP 33721 USG Clinical Photograph -

S9 GENITO URINARY SURGERIES S9.10 TESTIS AND PENIS S9.10.4 Partial Amputation Of Penis(Non-Malignant) IP 37631 Clinical Photograph Clinical Photograph,Biopsy -

S9 GENITO URINARY SURGERIES S9.10 TESTIS AND PENIS S9.10.5 Total Penectomy IP 37631 Clinical Photograph Clinical Photograph,Biopsy -

S9 GENITO URINARY SURGERIES S9.10 TESTIS AND PENIS S9.10.6 Infertility-Vasoepididymostomy, microsurgical, bilateral DC 23000 Semenal analysis,clinical notes clinical notes -

S9 GENITO URINARY SURGERIES S9.10 TESTIS AND PENIS S9.10.7 Infertility-Vasoepididymostomy, microsurgical, unilateral DC 18000 Semenal analysis,clinical notes clinical notes -

S9 GENITO URINARY SURGERIES S9.10 TESTIS AND PENIS S9.10.8.1 Varicocele-unilateral-non microsurgical DC 17000 clinical notes/Scrotal Doppler clinical notes -

S9 GENITO URINARY SURGERIES S9.10 TESTIS AND PENIS S9.10.8.2 Varicocele-bilateral-non microsurgical DC 25000 clinical notes/Scrotal Doppler clinical notes -

S9 GENITO URINARY SURGERIES S9.10 TESTIS AND PENIS S9.10.9 Varicocele-unilateral-microsurgical DC 15000 clinical notes clinical notes -

S9 GENITO URINARY SURGERIES S9.11 CAPD S9.11.1 CAPD-Tenchkoff catheter insertion IP 37476 Renal Profile ,USG Abdomen,CT Scan Lower Abdomen With Contrast CT Scan Lower Abdomen With Contrast,USG Abdomen -

S9 GENITO URINARY SURGERIES S9.11 CAPD S9.11.2 CAPD-Tenchkoff catheter removal IP 34829 Clinical Photograph,Abdomen And Pelvis For Kidneys,Ureters,And Bladder (KUB),USG Abdomen Scar Photo ,Abdomen And Pelvis For Kidneys,Ureters,And Bladder (KUB),USG Abdomen -

S9 GENITO URINARY SURGERIES S9.11 CAPD S9.11.3 CAPD bags per month IP 8743 Clinical Photograph Clinical Photograph ,Case Sheet with treatment details -

S9 GENITO URINARY SURGERIES S9.15 BLADDER AND URETER S9.15.1 Vesicostomy IP 25760 USG Abdomen/Micturating Cystourethrogram(MCUG) Scar Photo -

S9 GENITO URINARY SURGERIES S9.15 BLADDER AND URETER S9.15.2 Intravesical BCG maintenance for one time IP 3000 Cystoscopy,Urine Cytology For Malignant Cells ,Urine Culture & Sensitivity,Case sheet Intra OP Photo,Case Sheet with operation Notes -

S9 GENITO URINARY SURGERIES S9.15 BLADDER AND URETER S9.15.3 Trans abdominal repair of Vesicovaginal Fistula with IP 52500 Cystoscopy,CT Scan Lower Abdomen With Contrast,USG Abdomen CT Scan Lower Abdomen With Contrast,USG Abdomen -
omentoplasty
S9 GENITO URINARY SURGERIES S9.15 BLADDER AND URETER S9.15.4 BLADDER INJURY REPAIR WITH COLOSTOMY (WITH OR IP 50000 CT abdomen,Cystogram clinical notes,Webex Video,Operative Photo -
WITHOUT URETHRAL INJURY)
S9 GENITO URINARY SURGERIES S9.15 BLADDER AND URETER S9.15.5 Bladder injury repair (with or without urethral injury) IP 40000 CT abdomen,Cystogram clinical notes,Webex Video,Operative Photo -

S9 GENITO URINARY SURGERIES S9.15 BLADDER AND URETER S9.15.6 Ureterolithotomy-Laparoscopic IP 30000 Like URSL clinical notes -

S9 GENITO URINARY SURGERIES S9.15 BLADDER AND URETER S9.15.7 Open ureterolithotomy IP 30000 USG Abdomen/Intra Veneous Pyelogram Scar Photo,USG Abdomen -

S9 GENITO URINARY SURGERIES S9.2 SURGERY FOR RENAL CALCULI S9.2.1 Open Pyelolithotomy IP 22336 USG,IVP,KUB X-RAY,Clinical Photograph,USG -

S9 GENITO URINARY SURGERIES S9.2 SURGERY FOR RENAL CALCULI S9.2.2 Open Nephrolithotomy IP 24731 USG,IVP,KUB X-RAY,Clinical Photograph,USG -

S9 GENITO URINARY SURGERIES S9.2 SURGERY FOR RENAL CALCULI S9.2.3 Open Cystolithotomy IP 19631 USG,IVP,KUB X-RAY,Clinical Photograph,USG -

S9 GENITO URINARY SURGERIES S9.2 SURGERY FOR RENAL CALCULI S9.2.4 Laparoscopic Pyelolithotomy IP 42901 USG X-RAY,Clinical Photograph -

S9 GENITO URINARY SURGERIES S9.2 SURGERY FOR RENAL CALCULI S9.2.6 Partial stag horn caluculi IP 33770 And Bladder(KUB),Intra Veneous Pyelogram,USG Abdomen/CT Scan Lower Abdomen With Ureters,CT Scan Lower Abdomen With Contrast,USG Abdomen,And -
Contrast,Ureters,Abdomen And Pelvis For Kidneys Bladder(KUB),Abdomen And Pelvis For Kidneys
S9 GENITO URINARY SURGERIES S9.2 SURGERY FOR RENAL CALCULI S9.2.7 Complete stag horn caluculi IP 37960 And Bladder(KUB),Intra Veneous Pyelogram,USG Abdomen/CT Scan Lower Abdomen With Ureters,CT Scan Lower Abdomen With Contrast,USG Abdomen,And -
Contrast,Ureters,Abdomen And Pelvis For Kidneys Bladder(KUB),Abdomen And Pelvis For Kidneys
S9 GENITO URINARY SURGERIES S9.3 LITHOTRIPSY PROCEDURES S9.3.1 Cystolithotripsy IP 13341 USG,IVP,KUB X-RAY,Clinical Photograph,USG -

S9 GENITO URINARY SURGERIES S9.3 LITHOTRIPSY PROCEDURES S9.3.2 PCNL IP 35178 USG,IVP,KUB X-RAY,Clinical Photograph -

S9 GENITO URINARY SURGERIES S9.3 LITHOTRIPSY PROCEDURES S9.3.3 Extracorporeal shockwave lithotripsy (ESWL) IP 20524 USG,IVP,KUB X-RAY,Clinical Photograph,IVP -

S9 GENITO URINARY SURGERIES S9.3 LITHOTRIPSY PROCEDURES S9.3.4 ursl IP 25655 USG,IVP,KUB X-RAY,Clinical Photograph -

S9 GENITO URINARY SURGERIES S9.3 LITHOTRIPSY PROCEDURES S9.3.5 Nephrostomy - Lithotropsy IP 13340 USG,IVP Clinical Photograph -

S9 GENITO URINARY SURGERIES S9.3 LITHOTRIPSY PROCEDURES S9.3.6 Dj Stent (One Side) IP 5131 USG,IVP X-RAY -

S9 GENITO URINARY SURGERIES S9.3 LITHOTRIPSY PROCEDURES S9.3.8 Laser URSL IP 32900 Evidence like URSL (S9.3.4) CT Scan -

S9 GENITO URINARY SURGERIES S9.4 Other Corrective S9.4.1.1 Single Stage Urethroplasty for stricture Urethra IP 51309 RUG Clinical Photograph -
Surgeries/Procedures
S9 GENITO URINARY SURGERIES S9.4 Other Corrective S9.4.1.2.1 Stage 1 Urethroplasty for stricture Double Stage IP 39683 RUG Clinical Photograph -
Surgeries/Procedures
S9 GENITO URINARY SURGERIES S9.4 Other Corrective S9.4.1.2.2 Stage 2 Urethroplasty for stricture Double Stage IP 38482 RUG Clinical Photograph -
Surgeries/Procedures
S9 GENITO URINARY SURGERIES S9.4 Other Corrective S9.4.2 Reconstruction procedure Urethroplasty for stricture IP 38482 Photo Photo -
Surgeries/Procedures
S9 GENITO URINARY SURGERIES S9.4 Other Corrective S9.4.3.1 Single Stage HYPOSPADIASIS (ADULT) IP 41048 Clinical Photograph Clinical Photograph -
Surgeries/Procedures
S9 GENITO URINARY SURGERIES S9.4 Other Corrective S9.4.3.2.1 Stage-1 HYPOSPADIASIS (ADULT) IP 30129 Clinical Photograph Clinical Photograph -
Surgeries/Procedures
S9 GENITO URINARY SURGERIES S9.4 Other Corrective S9.4.3.2.2 Stage-2 HYPOSPADIASIS (ADULT) IP 30642 Clinical Photograph Clinical Photograph -
Surgeries/Procedures
S9 GENITO URINARY SURGERIES S9.4 Other Corrective S9.4.4 Transurethral resection of bladder tumour (TURBT) IP 40022 CT Clinical Photograph -
Surgeries/Procedures
S9 GENITO URINARY SURGERIES S9.4 Other Corrective S9.4.5 Transurethral resection of bladder tumour (TURBT) with IP 35000 Cystoscopy,CT Scan Lower Abdomen With Contrast Routine Histopathological Examination,USG Abdomen,CT Scan Lower Abdomen With -
Surgeries/Procedures intravesical Mitomycin instillation Contrast

21 of 47
CODE MAIN CATEGORY Sub SUB CATEGORY NAME CODE SURGERY / THERAPY DESCRIPTION PROCEDURE PACKAGE SPECIAL INVESTIGATION POST OPERATIVE PROCEDURE INVESTIGATION TREATMENT PROTOCOL
Category ID TYPE AMOUNT
S9 GENITO URINARY SURGERIES S9.4 Other Corrective S9.4.6.1 Single Stage procedure for Hypospadias in Children IP 37600 Clinical Photo Clinical Photo -
Surgeries/Procedures
S9 GENITO URINARY SURGERIES S9.4 Other Corrective S9.4.6.2 Stage - I procedure for Hypospadias in Children IP 32900 Clinical Photo Clinical Photo -
Surgeries/Procedures
S9 GENITO URINARY SURGERIES S9.4 Other Corrective S9.4.6.3 Stage - II procedure for Hypospadias in Children IP 32900 Clinical Photo Clinical Photo -
Surgeries/Procedures
S9 GENITO URINARY SURGERIES S9.5 Renal Transplantation S9.5.1 Post Renal Transplant Immunosuppressive Treatment From IP 62814 USG,RFT Bills Copy -
7th To 12 Th Month.
S9 GENITO URINARY SURGERIES S9.6 RENAL S9.6.1 Nephrostomy - Renal IP 13340 USG,IVP USG -

S9 GENITO URINARY SURGERIES S9.6 RENAL S9.6.1.1 Nephropexy IP 35730 CT Scan Lower Abdomen With Contrast,USG Abdomen Scar Photo,USG Abdomen -

S9 GENITO URINARY SURGERIES S9.6 RENAL S9.6.10 Drainage of Perinephric Abscess IP 37970 And Bladder(KUB),USG Abdomen,CT Scan Lower Abdomen With Contrast,Abdomen And Pelvis For Kidneys,Renal CT Scan Lower Abdomen With Contrast,USG Abdomen -
Profile,Ureters
S9 GENITO URINARY SURGERIES S9.6 RENAL S9.6.11 Renal Cyst deroofing or marsupialization-Open IP 23000 CT scan,USG clinical notes -

S9 GENITO URINARY SURGERIES S9.6 RENAL S9.6.12 Laparoscopic deroofing of Renal Cyst IP 31790 USG Abdomen,CT Scan Lower Abdomen With Contrast WEBEX,USG Abdomen/CT Scan Lower Abdomen With Contrast,Routine -
Histopathological Examination
S9 GENITO URINARY SURGERIES S9.6 RENAL S9.6.13 Adrenelectomy in Children IP 57000 CT Contrast ,Serum Harmonal Study,DTPA Scan and USG,Isotop Scan in suspected pheochromo cytoma,IVP DTPS Scan,Nuclear scan, U/S Abdomen,Harmonal Study,USG -
Study,Clinical photo
S9 GENITO URINARY SURGERIES S9.6 RENAL S9.6.14 Nephrectomy in Children IP 37600 DTPS Scan,USG,CT Clinical Photo USG Abdomen -

S9 GENITO URINARY SURGERIES S9.6 RENAL S9.6.15 Paediatric Hydronephrosis IP 47000 ivp study,dtpa SCAN AND usg dtps SCAN,USG -

S9 GENITO URINARY SURGERIES S9.6 RENAL S9.6.2 Nephrectomy for Pyonephrosis/Xgp IP 41048 USG,IVP USG -

S9 GENITO URINARY SURGERIES S9.6 RENAL S9.6.3 Simple Nephrectomy IP 41048 USG,IVP USG -

S9 GENITO URINARY SURGERIES S9.6 RENAL S9.6.4 Laproscopic Simple Nephrectomy IP 51310 USG,IVP USG -

S9 GENITO URINARY SURGERIES S9.6 RENAL S9.6.5 Laproscopic Radical Nephrectomy IP 63501 USG,IVP USG -

S9 GENITO URINARY SURGERIES S9.6 RENAL S9.6.6 Lap. Partial Nephrectomy IP 61572 USG,IVP USG -

S9 GENITO URINARY SURGERIES S9.6 RENAL S9.6.6.1 Partial nephrectomy in children IP 52500 CT(CONTRAST) Ultra Sound,DTPS scan -

S9 GENITO URINARY SURGERIES S9.6 RENAL S9.6.7 Bilateral Nephroureterectomy IP 82096 USG,IVP USG -

S9 GENITO URINARY SURGERIES S9.6 RENAL S9.6.7.1 Hemi- Nephroureterectomy IP 45000 Renal biopsy,Intra Veneous Pyelogram,USG Abdomen/CT Scan Lower Abdomen With Contrast Ureters,USG Abdomen/CT Scan Lower Abdomen With Contrast,Routine -
Histopathological Examination,And Bladder(KUB),Abdomen And Pelvis For Kidneys

S9 GENITO URINARY SURGERIES S9.6 RENAL S9.6.7.2 Open unilateral Nephroureterectomy IP 45010 Renal biopsy,Intra Veneous Pyelogram/CT Scan Lower Abdomen With Contrast,USG Abdomen Routine Histopathological Examination,USG Abdomen,CT Scan Lower Abdomen With -
Contrast
S9 GENITO URINARY SURGERIES S9.6 RENAL S9.6.7.3 Laproscopic unilateral Nephroureterectomy IP 50000 Renal biopsy,CT Scan Lower Abdomen With Contrast,USG Abdomen WEBEX,USG Abdomen,CT Scan Lower Abdomen With Contrast,Routine Histopathological -
Examination
S9 GENITO URINARY SURGERIES S9.6 RENAL S9.6.7.4 Radical Nephro-Ureterectomy IP 50000 Renal biopsy,Intra Veneous Pyelogram,USG Abdomen/CT Scan Lower Abdomen With Contrast Routine Histopathological Examination,USG Abdomen,CT Scan Lower Abdomen With -
Contrast
S9 GENITO URINARY SURGERIES S9.6 RENAL S9.6.7.5 Nephro ureterectomy (Benign) Laparoscopic IP 30000 DTPA scan,USG,CT clinical notes -

S9 GENITO URINARY SURGERIES S9.6 RENAL S9.6.7.6 Nephro ureterectomy for TCC of renal pelvis in children IP 47000 DTPS Study,CT(CONTRAST) Clinical Photo with scar, Biopsy Report.,USG Abdomen -

S9 GENITO URINARY SURGERIES S9.6 RENAL S9.6.8 Renal Cyst Excision IP 23828 USG,IVP USG -

S9 GENITO URINARY SURGERIES S9.6 RENAL S9.6.9 Nephrolysis/surgery for Chyluria Open/Lap IP 40000 CT Scan Lower Abdomen With Contrast,USG Abdomen WEBEX,USG Abdomen,CT Scan Lower Abdomen With Contrast -

S9 GENITO URINARY SURGERIES S9.7 RENAL STONE S9.2.5 Anatrophic Peylolithotomy For Staghorn Caliculus IP 51310 IVP,USG,KUB USG,Clinical Photograph,X-Ray -
SURGERY/THERAPIES
S9 GENITO URINARY SURGERIES S9.7 RENAL STONE S9.3.7 DJ stenting including cystoscopy, ureteric catheterization, DC 10000 clinical notes clinical notes -
SURGERY/THERAPIES retrograde pyelogram
S9 GENITO URINARY SURGERIES S9.7 RENAL STONE S9.7.1 Endoscope Removal Of Stone In Bladder IP 14366 X-Ray KUB,IVP,Scopy,USG Endoscopy Picture -
SURGERY/THERAPIES
S9 GENITO URINARY SURGERIES S9.8 CORRECTIVE SURGERIES S9.8.1 Anderson Hynes Pyeloplasty IP 49258 X-RAY,IVP,USG Clinical Photograph -

S9 GENITO URINARY SURGERIES S9.8 CORRECTIVE SURGERIES S9.8.1.1 Endopyelotomy (retrograde with laser/bugbee) DC 35000 DTPA Pre-op,clinical notes clinical notes -

S9 GENITO URINARY SURGERIES S9.8 CORRECTIVE SURGERIES S9.8.1.2 Endopyelotomy (antegrade with laser/bugbee) IP 28000 USG,X-RAY,IVP,DTPA scan clinical notes -

S9 GENITO URINARY SURGERIES S9.8 CORRECTIVE SURGERIES S9.8.1.3 LAP PYELOPLASTY IP 50000 cect abd,ivp,dtpa renoreno gram usg -

S9 GENITO URINARY SURGERIES S9.8 CORRECTIVE SURGERIES S9.8.10 Excision of Ureterocele with Ureteric Implantation IP 43480 CT Scan Lower Abdomen With Contrast,USG Abdomen,Intra Veneous Pyelogram,Micturating Cystourethrogram Abdomen X-Ray (Lateral View),USG Abdomen,CT Scan Lower Abdomen With -
(MCUG) Contrast,Routine Histopathological Examination
S9 GENITO URINARY SURGERIES S9.8 CORRECTIVE SURGERIES S9.8.11 Balloon dilatation of Ureteric stricture IP 20627 Intra Veneous Pyelogram ,CT Scan Lower Abdomen With Contrast,USG Abdomen USG Abdomen,Fluoroscopy,CT Scan Lower Abdomen With Contrast -

S9 GENITO URINARY SURGERIES S9.8 CORRECTIVE SURGERIES S9.8.12.1 Ileal replacement for ureteric stricture IP 46000 DTPA scan,CT(Contrast) scan/IVU Operative Photos,Post op IVU -

S9 GENITO URINARY SURGERIES S9.8 CORRECTIVE SURGERIES S9.8.12.2 Boari flap for ureteric stricture, Laparoscopic IP 40000 Cystoscopy,IVU,USG clinical notes -

S9 GENITO URINARY SURGERIES S9.8 CORRECTIVE SURGERIES S9.8.13.1 Uretero-vaginal/uterine fistula repair open IP 27000 USG Abdomen,CT Scan Lower Abdomen With Contrast,Intra Veneous Pyelogram clinical notes -

S9 GENITO URINARY SURGERIES S9.8 CORRECTIVE SURGERIES S9.8.13.2 Uretero-vaginal/uterine fistula repair Laparoscopic IP 50000 USG Abdomen,CT Scan Lower Abdomen With Contrast,Intra Veneous Pyelogram clinical notes -

S9 GENITO URINARY SURGERIES S9.8 CORRECTIVE SURGERIES S9.8.14 Ureterostomy (Cutaneous) IP 20000 USG KUB/CT Scan/MRI Scan clinical notes -

S9 GENITO URINARY SURGERIES S9.8 CORRECTIVE SURGERIES S9.8.15 Ureterocalycostomy Laparoscopic IP 30000 RGP,CT/IVU clinical notes -

S9 GENITO URINARY SURGERIES S9.8 CORRECTIVE SURGERIES S9.8.16 Uretero-ureterostomy Open IP 30000 RGP,CT/IVU clinical notes -

S9 GENITO URINARY SURGERIES S9.8 CORRECTIVE SURGERIES S9.8.17 Uretero-ureterostomy Laparoscopic IP 35000 RGP,CT/IVU clinical notes -

S9 GENITO URINARY SURGERIES S9.8 CORRECTIVE SURGERIES S9.8.18 Internal Ureterotomy including cystoscopy as an independent DC 15000 clinical notes clinical notes -
procedure
S9 GENITO URINARY SURGERIES S9.8 CORRECTIVE SURGERIES S9.8.19 Ureteric sampling including cystoscopy, ureteric DC 11000 clinical notes clinical notes -
catheterization, retrograde pyelogram
S9 GENITO URINARY SURGERIES S9.8 CORRECTIVE SURGERIES S9.8.2 Surgical correction of Vesicovaginal Fistula IP 45153 Scopy,IVP,rgp Clinical Photograph -

S9 GENITO URINARY SURGERIES S9.8 CORRECTIVE SURGERIES S9.8.2.1 VVF/Uterovaginal Repair - Abdominal, Laparoscopic IP 35000 IVP,Scopy,rgp clinical notes -

S9 GENITO URINARY SURGERIES S9.8 CORRECTIVE SURGERIES S9.8.2.2 Urethrovaginal fistula repair IP 34000 IVP,Scopy,rgp clinical notes -

S9 GENITO URINARY SURGERIES S9.8 CORRECTIVE SURGERIES S9.8.20 Urinary diversion in children IP 66500 CT Contrast ,Clinical photo Clinical Photo,USG Abdomen, IBP Study -

S9 GENITO URINARY SURGERIES S9.8 CORRECTIVE SURGERIES S9.8.3 Epispadiasis - Correction IP 42963 Clinical Photograph Clinical Photograph -

S9 GENITO URINARY SURGERIES S9.8 CORRECTIVE SURGERIES S9.8.3.1 Epispadias Correction in Children IP 37600 Clinical Photo Clinical Photo -

22 of 47
CODE MAIN CATEGORY Sub SUB CATEGORY NAME CODE SURGERY / THERAPY DESCRIPTION PROCEDURE PACKAGE SPECIAL INVESTIGATION POST OPERATIVE PROCEDURE INVESTIGATION TREATMENT PROTOCOL
Category ID TYPE AMOUNT
S9 GENITO URINARY SURGERIES S9.8 CORRECTIVE SURGERIES S9.8.4 Closure Of Urethral Fistula IP 30786 RGU Clinical Photograph -

S9 GENITO URINARY SURGERIES S9.8 CORRECTIVE SURGERIES S9.8.5 Optical Urethrotomy IP 21478 X-RAY,RGU Endoscopy Picture -

S9 GENITO URINARY SURGERIES S9.8 CORRECTIVE SURGERIES S9.8.6 Perineal Urethrostomy IP 32479 X-RAY,RGU Endoscopy Picture -

S9 GENITO URINARY SURGERIES S9.8 CORRECTIVE SURGERIES S9.8.7 Ureteric Reimplantations IP 35681 X-RAY,IVP,USG USG -

S9 GENITO URINARY SURGERIES S9.8 CORRECTIVE SURGERIES S9.8.7.1 Ureteric replacement IP 44880 USG Abdomen,CT Scan Lower Abdomen With Contrast Ureters,CT Scan Lower Abdomen With Contrast,USG Abdomen,And -
Bladder(KUB),Abdomen And Pelvis For Kidneys
S9 GENITO URINARY SURGERIES S9.8 CORRECTIVE SURGERIES S9.8.7.2 Ureteric Implantation with tailoring IP 41880 Intra Veneous Pyelogram,CT Scan Lower Abdomen With Contrast,USG Abdomen USG Abdomen,CT Scan Lower Abdomen With Contrast -

S9 GENITO URINARY SURGERIES S9.8 CORRECTIVE SURGERIES S9.8.7.3 Paediatric Ureteric Re Implantation (Unilateral) IP 47000 DTPS Scan,MCU/IVU Post op MCU,USG abdomen -

S9 GENITO URINARY SURGERIES S9.8 CORRECTIVE SURGERIES S9.8.7.4 Paediatric Ureteric Re Implantation (Bilateral) IP 66500 DTPS Scan,MCU/IVU Post op MCU,USG abdomen -

S9 GENITO URINARY SURGERIES S9.8 CORRECTIVE SURGERIES S9.8.8 Surgical Procedure for Ileal Conduit Formation IP 41735 X-RAY,IVP,USG Clinical Photograph -

S9 GENITO URINARY SURGERIES S9.8 CORRECTIVE SURGERIES S9.8.9 Surgical corrrection of Ureterocele IP 24279 X-RAY,RGU Clinical Photograph -

S9 GENITO URINARY SURGERIES S9.9 BLADDER and PROSTATE S9.16.2 Urachal Cyst excision - Open IP 18500 Clinical Photograph,Abdomen And Pelvis For Kidneys,USG Abdomen,And Bladder (KUB),Ureters USG Abdomen,Abdomen And Pelvis For Kidneys,Ureters,Clinical Photograph,And -
Bladder(KUB)
S9 GENITO URINARY SURGERIES S9.9 BLADDER and PROSTATE S9.9.1 Transurethral Resection of Prostate (TURP) IP 30786 USG,U.scopy USG -

S9 GENITO URINARY SURGERIES S9.9 BLADDER and PROSTATE S9.9.1.1 Bipolar TURP IP 40000 Cystouretroscopy,Uroflowmetry,CT Scan Lower Abdomen With Contrast,USG Abdomen,Cystoscopy Routine Histopathological Examination,USG Abdomen,CT Scan Lower Abdomen With -
Contrast
S9 GENITO URINARY SURGERIES S9.9 BLADDER and PROSTATE S9.9.10 Mid urethral sling procedure for stress urinary incontinence IP 30786 Case sheet with clinical History ,USG Abdomen,CT Scan Lower Abdomen With Contrast CT Scan Lower Abdomen With Contrast,USG Abdomen -

S9 GENITO URINARY SURGERIES S9.9 BLADDER and PROSTATE S9.9.11 MMK/birch colpo suspension for stress urinary Incontinence IP 40000 Cystouretroscopy,USG Abdomen,CT Scan Lower Abdomen With Contrast,Cystoscopy CT Scan Lower Abdomen With Contrast,USG Abdomen -

S9 GENITO URINARY SURGERIES S9.9 BLADDER and PROSTATE S9.9.12.1 Bladder neck incision IP 24140 Cystoscopy,CT Scan Lower Abdomen With Contrast,Cystourethroscopy,USG Abdomen CT Scan Lower Abdomen With Contrast,USG Abdomen -

S9 GENITO URINARY SURGERIES S9.9 BLADDER and PROSTATE S9.9.12.2 Excision of Urethral Caruncle IP 15970 clinical notes clinical notes -

S9 GENITO URINARY SURGERIES S9.9 BLADDER and PROSTATE S9.9.13 Meatoplasty DC 12280 Clinical Photograph,USG Abdomen,CT Scan Lower Abdomen With Contrast CT Scan Lower Abdomen With Contrast,USG Abdomen -

S9 GENITO URINARY SURGERIES S9.9 BLADDER and PROSTATE S9.9.14.1 Dilatation for Urethra stenosis DC 1500 CT Scan Lower Abdomen With Contrast,USG Abdomen CT Scan Lower Abdomen With Contrast,USG Abdomen -

S9 GENITO URINARY SURGERIES S9.9 BLADDER and PROSTATE S9.9.14.2 Urethral Dilatation-endocopic as an independent procedure DC 3000 clinical notes clinical notes -

S9 GENITO URINARY SURGERIES S9.9 BLADDER and PROSTATE S9.9.14.3 Surgical management of Posterior Urethral Valves IP 27900 USG abdomen,MCU Post OP USG & MCUG -

S9 GENITO URINARY SURGERIES S9.9 BLADDER and PROSTATE S9.9.15 Stress incontinence surgery, laparoscopic IP 35000 U.scopy,USG clinical notes -

S9 GENITO URINARY SURGERIES S9.9 BLADDER and PROSTATE S9.9.16 Meatotomy DC 4000 Clinical photo,clinical notes clinical notes -

S9 GENITO URINARY SURGERIES S9.9 BLADDER and PROSTATE S9.9.17 Mitrafanoff procedure IP 46250 USG Abdomen,CT Scan Lower Abdomen With Contrast USG Abdomen,CT Scan Lower Abdomen With Contrast -

S9 GENITO URINARY SURGERIES S9.9 BLADDER and PROSTATE S9.9.19 Intravesical BCG Induction therapy DC 9750 Triple Markers/Immunohistochemistry(IHC) Three Markers,Urine Cytology For Malignant Cells ,LFT(liver function Case Sheet with operation Notes,Cystoscopy -
tests),Renal Profile,Urine Culture & Sensitivity,Alkaline Phosphatase Levels,Cystoscopy

S9 GENITO URINARY SURGERIES S9.9 BLADDER and PROSTATE S9.9.2 Transurethral Resection of Prostate (TURP) Cyst Lithotripsy IP 30785 X-RAY,USG USG -

S9 GENITO URINARY SURGERIES S9.9 BLADDER and PROSTATE S9.9.2.1 TURP/Laser + Hydrocele surgery IP 40000 USG Abdomen sprotum,Like TURP clinical notes -

S9 GENITO URINARY SURGERIES S9.9 BLADDER and PROSTATE S9.9.2.2 TURBT - Restage IP 22000 clinical notes like TURBT clinical notes -

S9 GENITO URINARY SURGERIES S9.9 BLADDER and PROSTATE S9.9.2.3 TURP/Laser + Circumcision IP 32000 clinical notes like TURP & Clinical photo clinical notes -

S9 GENITO URINARY SURGERIES S9.9 BLADDER and PROSTATE S9.9.2.4 TURP/Laser + Orchidectomy IP 32000 USG Sprotum,clinical notes like TURP clinical notes -

S9 GENITO URINARY SURGERIES S9.9 BLADDER and PROSTATE S9.9.2.5 TURP/Laser + URS with stone removal IP 40000 clinical notes like TURP & NCCT KUB clinical notes -

S9 GENITO URINARY SURGERIES S9.9 BLADDER and PROSTATE S9.9.2.6 TURP/Laser + VIU (visual internal Ureterotomy) IP 40000 Urethroscopy,clinical notes,RGU,USG clinical notes -

S9 GENITO URINARY SURGERIES S9.9 BLADDER and PROSTATE S9.9.2.7 TURP/Laser + Hernioplasty IP 40000 USG,clinical notes clinical notes -

S9 GENITO URINARY SURGERIES S9.9 BLADDER and PROSTATE S9.9.2.8 TURP/Laser + Urethral dilatation-non endoscopic IP 40000 RGU,clinical notes clinical notes -

S9 GENITO URINARY SURGERIES S9.9 BLADDER and PROSTATE S9.9.2.9 TURP/Laser + Urethral dilatation-endoscopic IP 40000 RGU,clinical notes clinical notes -

S9 GENITO URINARY SURGERIES S9.9 BLADDER and PROSTATE S9.9.20 Total Extenteration in Children or Adults IP 66500 CT(CONTRAST) Clinical Photo,IVP Study, Biopsy Report. -

S9 GENITO URINARY SURGERIES S9.9 BLADDER and PROSTATE S9.9.21 Anterior Extenteration for Ca. Bladder in Children or Adult IP 66500 CT(CONTRAST) Clinical Photo,IVP Study, Biopsy Report. -

S9 GENITO URINARY SURGERIES S9.9 BLADDER and PROSTATE S9.9.22 Clot Evacuation (Bladder) for Clot retention ST 23500 CT CUB Plain Webex vedio of post treatment systeroscopy -

S9 GENITO URINARY SURGERIES S9.9 BLADDER and PROSTATE S9.9.3 Open Prostatectomy IP 33864 X-RAY,USG Clinical Photograph -

S9 GENITO URINARY SURGERIES S9.9 BLADDER and PROSTATE S9.9.3.1 Open radical Prostratectomy IP 51310 Cystouretroscopy ,USG Abdomen,CT Scan Lower Abdomen With Contrast,Prostate-Specific Antigen (PSA) Routine Histopathological Examination,USG Abdomen,CT Scan Lower Abdomen With -
Contrast
S9 GENITO URINARY SURGERIES S9.9 BLADDER and PROSTATE S9.9.3.2 Laser Prostatectomy IP 40000 Cystouretroscopy,Uroflowmetry,Cystoscopy,CT Scan Lower Abdomen With Contrast,USG Abdomen,Prostate- CT Scan Lower Abdomen With Contrast,USG Abdomen -
Specific Antigen (PSA)
S9 GENITO URINARY SURGERIES S9.9 BLADDER and PROSTATE S9.9.3.3 Transrectal Ultrasound guided prostate biopsy (minimum 12 DC 10000 clinical notes clinical notes -
core)
S9 GENITO URINARY SURGERIES S9.9 BLADDER and PROSTATE S9.9.3.4 Laproscopic radical Prostratectomy IP 55000 Cystouretroscopy,USG Abdomen,Prostate-Specific Antigen(PSA),Routine Histopathological Examination,CT Scan Routine Histopathological Examination,USG Abdomen,CT Scan Lower Abdomen With -
Lower Abdomen With Contrast Contrast
S9 GENITO URINARY SURGERIES S9.9 BLADDER and PROSTATE S9.9.3.5 LAP TOTAL PROSTATECTOMY IP 50000 TRUS,Cystoscopy,PSA,CECT Abdomen usg -

S9 GENITO URINARY SURGERIES S9.9 BLADDER and PROSTATE S9.9.4 Caecocystoplasty IP 42936 USG,U.scopy USG -

S9 GENITO URINARY SURGERIES S9.9 BLADDER and PROSTATE S9.9.5 Total Cystectomy IP 46199 USG,U.scopy USG -

S9 GENITO URINARY SURGERIES S9.9 BLADDER and PROSTATE S9.9.5.1 Partial Cystectomy IP 34737 Renal biopsy ,CT Scan Lower Abdomen With Contrast,USG Abdomen,Cystoscopy Routine Histopathological Examination,USG Abdomen,CT Scan Lower Abdomen With -
Contrast
S9 GENITO URINARY SURGERIES S9.9 BLADDER and PROSTATE S9.9.5.2 Open radical cystectomy with Ureterosigmoidostomy (57.88) IP 45000 USG Abdomen,CT Scan Lower Abdomen With Contrast,Biopsy,Cystoscopy Routine Histopathological Examination,USG Abdomen,CT Scan Lower Abdomen With -
Contrast
S9 GENITO URINARY SURGERIES S9.9 BLADDER and PROSTATE S9.9.5.3 Open radical cystectomy with Continent Urinary diversion IP 50000 USG Abdomen,CT Scan Lower Abdomen With Contrast,Biopsy,Cystoscopy Routine Histopathological Examination,USG Abdomen,CT Scan Lower Abdomen With -
Contrast
S9 GENITO URINARY SURGERIES S9.9 BLADDER and PROSTATE S9.9.5.4 Radical Cystectomy with ureterostomy-open IP 40000 Biopsy,clinical notes,CT Scan Lower Abdomen With Contrast,USG Abdomen,Cystoscopy USG pelvis -

S9 GENITO URINARY SURGERIES S9.9 BLADDER and PROSTATE S9.9.5.5 Radical Cystectomy with ureterosigmoidostomy-open IP 40000 Biopsy,clinical notes,CT Scan Lower Abdomen With Contrast,USG Abdomen,Cystoscopy USG pelvis -

S9 GENITO URINARY SURGERIES S9.9 BLADDER and PROSTATE S9.9.5.6 Partial Cystectomy-Laparoscopic IP 30000 clinical notes clinical notes -

23 of 47
CODE MAIN CATEGORY Sub SUB CATEGORY NAME CODE SURGERY / THERAPY DESCRIPTION PROCEDURE PACKAGE SPECIAL INVESTIGATION POST OPERATIVE PROCEDURE INVESTIGATION TREATMENT PROTOCOL
Category ID TYPE AMOUNT
S9 GENITO URINARY SURGERIES S9.9 BLADDER and PROSTATE S9.9.5.7 Augmentation cystoplasty-Laparoscopic IP 40000 U.scopy,USG USG pelvis -

S9 GENITO URINARY SURGERIES S9.9 BLADDER and PROSTATE S9.9.5.8 Diagnostic Cystoscopy DC 2500 clinical notes Urography,X-ray KUB/USG KUB/CT -

S9 GENITO URINARY SURGERIES S9.9 BLADDER and PROSTATE S9.9.5.9 Suprapubic Drainage - Closed/Trocar DC 7000 USG KUB,clinical notes clinical Photo,clinical notes -

S9 GENITO URINARY SURGERIES S9.9 BLADDER and PROSTATE S9.9.6 Bladder Diverticulectomy IP 33043 USG,U.scopy USG -

S9 GENITO URINARY SURGERIES S9.9 BLADDER and PROSTATE S9.9.7 Surgical Management of Incontinence Urine (Female) IP 22576 USG,U.scopy USG -

S9 GENITO URINARY SURGERIES S9.9 BLADDER and PROSTATE S9.9.8 Surgical Management of Incontinence Urine (Male) IP 26270 USG,U.scopy USG -

S9 GENITO URINARY SURGERIES S9.9 BLADDER and PROSTATE S9.9.9 Bladder neck reconstruction for Incontinence IP 61572 Case sheet with clinical History,USG Abdomen,CT Scan Lower Abdomen With Contrast CT Scan Lower Abdomen With Contrast,USG Abdomen -

S10 NEUROSURGERY S10 NEUROSURGERY S10.1.18.1 VP SHUNT FOR NPH IP 13800 MRI Brain,CBP.,LFT,Serum Electrolytes Serum Electrolytes -
S10 NEUROSURGERY S10 NEUROSURGERY S10.11 Muscle Biopsy with report DC 7000 MRI/NCS Post Op HPE -
S10 NEUROSURGERY S10.1 BRAIN S10.1.1 Craniotomy And Evacuation of Subdural Haematoma IP 67729 CT Clinical Photograph -
S10 NEUROSURGERY S10.1 BRAIN S10.1.11 Excision of Subtentorial Brain Tumours IP 49513 CT Clinical Photograph,Biopsy -
S10 NEUROSURGERY S10.1 BRAIN S10.1.12 Ventriculoperitoneal Shunt IP 30785 CT Clinical Photograph -
S10 NEUROSURGERY S10.1 BRAIN S10.1.13 Twist Drill Craniostomy IP 15393 CT Clinical Photograph -
S10 NEUROSURGERY S10.1 BRAIN S10.1.14 Subdural Tapping IP 20011 CT Clinical Photograph -
S10 NEUROSURGERY S10.1 BRAIN S10.1.15 Ventricular Tapping IP 15393 CT Clinical Photograph -
S10 NEUROSURGERY S10.1 BRAIN S10.1.16 Tapping of Brain Abscess IP 41048 CT Clinical Photograph -
S10 NEUROSURGERY S10.1 BRAIN S10.1.17 Surgical Management of Vascular Malformations IP 61571 MRI Angio Clinical Photograph -
S10 NEUROSURGERY S10.1 BRAIN S10.1.18 Ventriculo Peritoneal Shunt IP 30785 CT Clinical Photograph -
S10 NEUROSURGERY S10.1 BRAIN S10.1.18.2 LUMBAR PERITONEAL/SYRINGO SUBARACHANOID /CYSTO IP 40000 MRI USG ,Clinical photo,Intra Op photos,X-Ray -
PERITONEAL SHUNT
S10 NEUROSURGERY S10.1 BRAIN S10.1.19 Atrial Shunt IP 20524 CT Clinical Photograph -
S10 NEUROSURGERY S10.1 BRAIN S10.1.2 Craniotomy And Evacuation of Extradural Haematoma IP 61572 CT Clinical Photograph -
S10 NEUROSURGERY S10.1 BRAIN S10.1.20 Surgical Management of Meningo Encephalocele IP 41048 MRI Clinical Photograph -
S10 NEUROSURGERY S10.1 BRAIN S10.1.21 Surgical Management of Meningomyelocele IP 41047 MRI Clinical Photograph -
S10 NEUROSURGERY S10.1 BRAIN S10.1.22 Surgical Management of C.S.F. Rhinorrhoea IP 41048 CT Clinical Photograph -
S10 NEUROSURGERY S10.1 BRAIN S10.1.23 Cranioplasty IP 30786 CT,Clinical Photograph Clinical Photograph -
S10 NEUROSURGERY S10.1 BRAIN S10.1.23.1 Cranioplasty With Impants IP 30787 CT Angio Of Brain(Head) ,CT Scan Head Without Contrast X-Ray Skull -
S10 NEUROSURGERY S10.1 BRAIN S10.1.23.2 Depressed / Elevated Fracture IP 30000 CT Angio Of Brain(Head) /MRI Brain Without Contrast,CT Scan Head Without Contrast CT Angio Of Brain(Head),X-Ray Skull/CT Scan Head Without Contrast -
S10 NEUROSURGERY S10.1 BRAIN S10.1.23.3 Depressed Fracture IP 40000 CT/X-Ray skull Post Op X-ray/CT Scan -
S10 NEUROSURGERY S10.1 BRAIN S10.1.23.4 arnold chiari malformation-surgery IP 65000 MRI USG ,Clinical photo,Intra Op photos,X-Ray -
S10 NEUROSURGERY S10.1 BRAIN S10.1.24 Meningocele Excision IP 41048 MRI Clinical Photograph -
S10 NEUROSURGERY S10.1 BRAIN S10.1.25 Ventriculo Atrial Shunt IP 20523 CT Clinical Photograph -
S10 NEUROSURGERY S10.1 BRAIN S10.1.26 Excision Of Brain Abcess IP 71833 CT Clinical Photograph -
S10 NEUROSURGERY S10.1 BRAIN S10.1.27 Aneurysm Clipping IP 112882 MRI Angio X-RAY,Clinical Photograph -
S10 NEUROSURGERY S10.1 BRAIN S10.1.28 External Ventricular Drainage (EVD) IP 41048 CT Clinical Photograph -
S10 NEUROSURGERY S10.1 BRAIN S10.1.29 Craniostenosis IP 42000 CT Post Op X-ray/CT Scan -
S10 NEUROSURGERY S10.1 BRAIN S10.1.3 Burr Hole procedure for evacuation of Brain Abscess IP 33535 CT Clinical Photograph -
S10 NEUROSURGERY S10.1 BRAIN S10.1.4 Excision Of Lobe (Frontal,Temporal,Cerebe llum Etc.) IP 41048 CT Clinical Photograph,Biopsy -
S10 NEUROSURGERY S10.1 BRAIN S10.1.4.1 Brain Biopsy IP 15000 CT/MRI HPE report -
S10 NEUROSURGERY S10.1 BRAIN S10.1.4.2 INTRACRANIAL FOREIGN BODY REMOVAL IP 62000 CT,MRI USG ,Clinical photo,Intra Op photos,X-Ray -
S10 NEUROSURGERY S10.1 BRAIN S10.1.5.1 Excision of Parasagital Brain tumour IP 70695 CT Clinical Photograph,Biopsy -
S10 NEUROSURGERY S10.1 BRAIN S10.1.5.2 Excision of Basal Brain tumour IP 71833 CT Clinical Photograph,Biopsy -
S10 NEUROSURGERY S10.1 BRAIN S10.1.5.3 Excision of Brain Stem Brain tumour IP 71833 CT Clinical Photograph,Biopsy -
S10 NEUROSURGERY S10.1 BRAIN S10.1.5.4 Excision of C P Angle Brain tumour IP 82096 CT Clinical Photograph,Biopsy -
S10 NEUROSURGERY S10.1 BRAIN S10.1.5.5 Excision of Other Brain tumours IP 49514 CT Clinical Photograph,Biopsy -
S10 NEUROSURGERY S10.1 BRAIN S10.1.5.5.1 Pre-operative tumour embolization IP 40000 Histopathological report/CT/MRI Histopathological report/post op xray and clinicla photos -
S10 NEUROSURGERY S10.1 BRAIN S10.1.5.5.2 Brain Tumour Embolisation IP 28000 MRI Brain With Contrast CT Angio Of Brain(Head) -
S10 NEUROSURGERY S10.10 SCALP S10.10.1 Scalp Arterio venous malformation (AVM) IP 25000 Histopathological report Histopathological report -
S10 NEUROSURGERY S10.10 SCALP S10.10.2 Excision Of Scalp Lesions IP 10000 Clinical Photograph Routine Histopathological Examination -
S10 NEUROSURGERY S10.12 DUROPLASTY S10.12.1 Duroplasty - Endogenous IP 12500 CT/MRI scar Photo,Intra OP Photos -
S10 NEUROSURGERY S10.12 DUROPLASTY S10.12.2 Duroplasty - Exogenous IP 12500 CT/MRI scar Photo,Intra OP Photos -
S10 NEUROSURGERY S10.2 SPINAL SURGERIES S10.2.1 Surgery for Cord Tumours IP 38995 MRI Clinical Photograph,Biopsy -
S10 NEUROSURGERY S10.2 SPINAL SURGERIES S10.2.10 Surgical Management of Intra Medullary Spinal Tumours IP 51310 MRI X-RAY,Biopsy,Clinical Photograph -

S10 NEUROSURGERY S10.2 SPINAL SURGERIES S10.2.11 Surgical Management of Spina Bifida Major IP 35917 MRI X-RAY,Clinical Photograph -
S10 NEUROSURGERY S10.2 SPINAL SURGERIES S10.2.12 Surgical Management of Spina Bifida Minor IP 30786 MRI X-RAY,Clinical Photograph -
S10 NEUROSURGERY S10.2 SPINAL SURGERIES S10.2.13.1 Spine - Extradural Haematoma IP 30000 CT/MRI scar Photo,Post OP X Ray -
S10 NEUROSURGERY S10.2 SPINAL SURGERIES S10.2.13.2 Spine - Extradural Haematoma with fixation IP 55000 CT/MRI scar Photo,CT/MRI -
S10 NEUROSURGERY S10.2 SPINAL SURGERIES S10.2.13.3 Spine - Intradural Tumour IP 45000 CT/MRI Histopathological report -
S10 NEUROSURGERY S10.2 SPINAL SURGERIES S10.2.13.4 Spine - Intradural Haematoma IP 40000 CT/MRI scar Photo,Post OP X Ray -
S10 NEUROSURGERY S10.2 SPINAL SURGERIES S10.2.13.5 Spine - Extradural Tumour IP 40000 CT/MRI Biopsy & Scar Photo -
S10 NEUROSURGERY S10.2 SPINAL SURGERIES S10.2.14 Selective Posterior Rhizotomy IP 30000 Case sheet with clinical History Case Sheet with operation Notes -
S10 NEUROSURGERY S10.2 SPINAL SURGERIES S10.2.15 Spine - Canal Stenosis IP 40000 CT/MRI Clinical Photograph -
S10 NEUROSURGERY S10.2 SPINAL SURGERIES S10.2.2 Excision Of Cervical Inter-Vertebral Discs IP 30785 MRI Clinical Photograph -
S10 NEUROSURGERY S10.2 SPINAL SURGERIES S10.2.2.1 Cervical Ribs – Unilateral IP 20000 CT Post Op X-ray/CT Scan -
S10 NEUROSURGERY S10.2 SPINAL SURGERIES S10.2.3 Posterior Cervical Discectomy IP 27348 MRI Clinical Photograph -
S10 NEUROSURGERY S10.2 SPINAL SURGERIES S10.2.4 Anterior Cervical Discectomy IP 27348 MRI Clinical Photograph -
S10 NEUROSURGERY S10.2 SPINAL SURGERIES S10.2.5 Anterior Cervical Spine Surgery With Fusion IP 46178 X-Ray Cerical Spine,MRI X-RAY -
S10 NEUROSURGERY S10.2 SPINAL SURGERIES S10.2.6 Anterior Lateral Decompression IP 30786 MRI X-RAY,Clinical Photograph -
S10 NEUROSURGERY S10.2 SPINAL SURGERIES S10.2.7 Laminectomy IP 27348 MRI X-RAY,Clinical Photograph -
S10 NEUROSURGERY S10.2 SPINAL SURGERIES S10.2.7.1 Laminoplasty With Implants IP 30971 X-Ray Dorso Lumbar Spine,CT Spine (Cervical Dorsal Lumbar Sacral) Without Contrast /MRI Local Area X-Ray Dorso Lumbar Spine -
S10 NEUROSURGERY S10.2 SPINAL SURGERIES S10.2.8 Discectomy IP 27348 MRI X-RAY,Clinical Photograph -
S10 NEUROSURGERY S10.2 SPINAL SURGERIES S10.2.9 Spinal Fusion Procedure IP 51309 MRI X-RAY,Clinical Photograph -
S10 NEUROSURGERY S10.2 SPINAL SURGERIES S10.2.9.1 Spine - Decompression and Fusion IP 35000 CT/MRI Clinical Photograph -
S10 NEUROSURGERY S10.2 SPINAL SURGERIES S10.2.9.2 SPINAL FRACTURE - CONSERVATIVE MANAGEMENT IP 15000 CT,XRay Clinical Photo,BRACE Photo -
S10 NEUROSURGERY S10.2 SPINAL SURGERIES S10.2.9.3 KYPHOPLASTY IP 40000 CT,MRI USG ,Clinical photo,Intra Op photos,X-Ray -
S10 NEUROSURGERY S10.3 OTHER SURGERIES/PROCEDURES S10.3.1 Stereotactic Procedures IP 20524 - Clinical Photograph -

S10 NEUROSURGERY S10.3 OTHER SURGERIES/PROCEDURES S10.3.2 Trans Sphenoidal Surgery IP 41048 CT Clinical Photograph,Biopsy -

S10 NEUROSURGERY S10.3 OTHER SURGERIES/PROCEDURES S10.3.3 Trans Oral Surgery IP 41047 CT Clinical Photograph,Biopsy -

S10 NEUROSURGERY S10.3 OTHER SURGERIES/PROCEDURES S10.3.4 Combined Trans-Oral Surgery and Cv Junction Fusion IP 52530 X-Ray Cerical Spine,MRI Clinical Photograph -

S10 NEUROSURGERY S10.3 OTHER SURGERIES/PROCEDURES S10.3.5 C.V. Junction Fusion IP 41047 X-Ray Cerical Spine,MRI Clinical Photograph -

S10 NEUROSURGERY S10.3 OTHER SURGERIES/PROCEDURES S10.3.6 Excision of Orbital Tumour IP 50000 CT CT -

S10 NEUROSURGERY S10.4 BRAIN S10.4.1 Endoscopy Procedures -Brain IP 80043 MRI Clinical Photograph -
S10 NEUROSURGERY S10.4 BRAIN S10.4.1.1 De-Compressive Craniectomy (Non Traumatic) IP 82096 - Clinical Photograph -
S10 NEUROSURGERY S10.4 BRAIN S10.4.2 Evacuation of Intra-Cerebral Hematoma IP 73886 MRI Clinical Photograph -
S10 NEUROSURGERY S10.4 BRAIN S10.4.3 Endoscopic Third Ventriculostomy IP 30786 - Clinical Photograph -
S10 NEUROSURGERY S10.5 SPINE S10.5.1 Anterior Discectomy and Bone Grafting IP 41048 MRI X-RAY -
S10 NEUROSURGERY S10.5 SPINE S10.5.2 Discectomy With Implants IP 66703 MRI X-RAY -
S10 NEUROSURGERY S10.5 SPINE S10.5.3 Corpectomy For Spinal Fixation IP 76964 MRI X-RAY -
S10 NEUROSURGERY S10.5 SPINE S10.5.4 Spinal Fixation Rods And Plates, Artificial Discs IP 87226 MRI X-RAY -
S10 NEUROSURGERY S10.5 SPINE S10.5.5 Surgical Management of Syringomyelia IP 61571 MRI Clinical Photograph -
S10 NEUROSURGERY S10.5 SPINE S10.5.6 Endoscopy - Spinal IP 29000 Endoscopic Photograph Case Sheet with operation Notes -
24 of 47
CODE MAIN CATEGORY Sub SUB CATEGORY NAME CODE SURGERY / THERAPY DESCRIPTION PROCEDURE PACKAGE SPECIAL INVESTIGATION POST OPERATIVE PROCEDURE INVESTIGATION TREATMENT PROTOCOL
Category ID TYPE AMOUNT
S10 NEUROSURGERY S10.5 SPINE S10.5.7 Surgery for Lumbar Disc including pre and post Op. MRI IP 30000 MRI/NCS Post OP HPE -
S10 NEUROSURGERY S10.5 SPINE S10.5.8 Vertebroplasty IP 40000 Hematological and radiological investigations Hematological and radiological investigations -
S10 NEUROSURGERY S10.5 SPINE S10.5.9 DERMAL SINUS WITH INTRADURAL EXTENSION/TETHERED IP 42000 MRI USG ,Clinical photo,Intra Op photos,X-Ray -
CORD /RELEASE OF TIGHT FILUM
S10 NEUROSURGERY S10.6 SOFT TISSUE and VASCULAR S10.6.1 Surgical treatment for brachial plexus injuries IP 73886 MRI Clinical Photograph -
SURGERIES
S10 NEUROSURGERY S10.6 SOFT TISSUE and VASCULAR S10.6.10.1 Additonal balloon for Parent Vessel Occlusion IP 11000 Hematological and radiological investigations Hematological and radiological investigations -
SURGERIES
S10 NEUROSURGERY S10.6 SOFT TISSUE and VASCULAR S10.6.10.2 Additonal coil for Parent Vessel Occlusion IP 24000 Hematological and radiological investigations Hematological and radiological investigations -
SURGERIES
S10 NEUROSURGERY S10.6 SOFT TISSUE and VASCULAR S10.6.10.3 Parent vessel occlusion - Basic IP 30000 Hematological and radiological investigations Hematological and radiological investigations -
SURGERIES
S10 NEUROSURGERY S10.6 SOFT TISSUE and VASCULAR S10.6.11 Peripheral Nerve Surgery Minor IP 15000 Clinical Photograph showing scar Clinical Photograph showing scar -
SURGERIES
S10 NEUROSURGERY S10.6 SOFT TISSUE and VASCULAR S10.6.12 Nerve Biopsy excluding Hensens IP 8000 NCS Post OP HPE -
SURGERIES
S10 NEUROSURGERY S10.6 SOFT TISSUE and VASCULAR S10.6.13 Surgical management Carpal tunnel syndrome IP 10000 ENMG (Elektroneuromyography) ,CT Scan Limbs Without Contrast /MRI Of Both Hands,Nerve conduction study Case Sheet with operation Notes,Scar Photo -
SURGERIES
S10 NEUROSURGERY S10.6 SOFT TISSUE and VASCULAR S10.6.2 Cervical Sympathectomy IP 30786 Nerve conduction study,EMG,MRI Clinical Photograph -
SURGERIES
S10 NEUROSURGERY S10.6 SOFT TISSUE and VASCULAR S10.6.3 Lumbar Sympathectomy IP 30786 Nerve conduction study,EMG,MRI Clinical Photograph -
SURGERIES
S10 NEUROSURGERY S10.6 SOFT TISSUE and VASCULAR S10.6.4 Decompression/Excision Of Optic Nerve Lesions IP 80043 MRI Clinical Photograph -
SURGERIES
S10 NEUROSURGERY S10.6 SOFT TISSUE and VASCULAR S10.6.5 Peripheral Nerve Injury Repair IP 41048 Nerve conduction study,EMG Clinical Photograph -
SURGERIES
S10 NEUROSURGERY S10.6 SOFT TISSUE and VASCULAR S10.6.6 Proptosis IP 61572 MRI Clinical Photograph -
SURGERIES
S10 NEUROSURGERY S10.6 SOFT TISSUE and VASCULAR S10.6.7.1 Local Neurectomy IP 16000 NCS/MRI Post OP HPE -
SURGERIES
S10 NEUROSURGERY S10.6 SOFT TISSUE and VASCULAR S10.6.7.2 Facet, Nerve Root Blocks IP 10000 CT Spine(Cervical,Dorsal,Lumbar,Sacral) Without Contrast/MRI Local Area Case Sheet with operation Notes -
SURGERIES
S10 NEUROSURGERY S10.6 SOFT TISSUE and VASCULAR S10.6.8 Carotid Endarterectomy IP 40000 Angiogram report Stills showing the procedure with graft -
SURGERIES
S10 NEUROSURGERY S10.6 SOFT TISSUE and VASCULAR S10.6.9 Cranial Nerve Anastomosis IP 32000 NCS Post OP HPE -
SURGERIES
S10 NEUROSURGERY S10.7 EPILEPSY Surgery S10.7.1 Temporal Lobectomy IP 76965 MRI-Video EEG Psychologic assesment Clinical Photograph -
S10 NEUROSURGERY S10.7 EPILEPSY Surgery S10.7.2 Lesionectomy Type 1 IP 58348 MRI-Video EEG Psychologic assesment Clinical Photograph -
S10 NEUROSURGERY S10.7 EPILEPSY Surgery S10.7.3 Lesionectomy Type 2 IP 58534 MRI-Video EEG Psychologic assesment Clinical Photograph -
S10 NEUROSURGERY S10.7 EPILEPSY Surgery S10.7.4 Temporal Lobectomy Plus Depth Electrodes IP 143668 MRI-Video EEG Psychologic assesment X-RAY,Clinical Photograph -
S10 NEUROSURGERY S10.8 MANAGEMENT OF TRIGEMINAL S10.8.1 Radiofrequency Ablation For Trigeminal Neuralgia IP 30785 Nerve Conduction,EMG Clinical Photograph -
NEURALGIA
S10 NEUROSURGERY S10.8 MANAGEMENT OF TRIGEMINAL S10.8.2 Microvascular Decompression For Trigeminal Neuralgia IP 61571 Nerve Conduction,EMG Clinical Photograph -
NEURALGIA
S10 NEUROSURGERY S10.9 MANAGEMENT OF ANEYRISMS S10.9.1 Embolization of Aneurysm IP 76964 ANGIOGRAM,MRI Angio Clinical Photograph -
S10 NEUROSURGERY S10.9 MANAGEMENT OF ANEYRISMS S10.9.2 Coil Embolization of Aneurysm (each coil cost) IP 30786 ANGIOGRAM,MRI Angio Clinical Photograph -
S10 NEUROSURGERY S10.9 MANAGEMENT OF ANEYRISMS S10.9.3 Intra Cranial Vascular Bypass IP 100000 CT ANGIOGRAM VIDEOS,INTRA OP PHOTOS -
S11 SURGICAL ONCOLOGY S11 SURGICAL ONCOLOGY S11.37 Diagnostic Laparoscopy in malignant conditions IP 22140 USG Abdomen/CT scan Lower Abdomen Without Contrast/CT Scan Abdomen With Contrast/CT Scan Abdomen Routine Histopathological Examination -
Without Contrast
S11 SURGICAL ONCOLOGY S11 SURGICAL ONCOLOGY S11.38 Vascular isolation and perfusion in malignant conditions IP 53350 CT Scan Abdomen With Contrast/MRI Abdomen With Contrast USG-Doppler Abdomen ,Routine Histopathological Examination -

S11 SURGICAL ONCOLOGY S11 SURGICAL ONCOLOGY S11.39 IVC thrombectomy in malignant conditions IP 53660 Digital Subtraction Angiography(DSA Peripheral Artery\Arteries),CT Scan Chest With Contrast Routine Histopathological Examination -
S11 SURGICAL ONCOLOGY S11 SURGICAL ONCOLOGY S11.40 Inoperable Laparotomy in malignant conditions IP 20000 USG Abdomen/CT scan Lower Abdomen Without Contrast/CT Scan Abdomen With Contrast/CT Scan Abdomen Routine Histopathological Examination,USG Abdomen -
Without Contrast
S11 SURGICAL ONCOLOGY S11 SURGICAL ONCOLOGY S11.41 Voice prosthesis IP 30000 Clinical Photos,Biopsy Clinical Photos,Invoice of prosthesis -
S11 SURGICAL ONCOLOGY S11 SURGICAL ONCOLOGY S11.42 Popliteal lymphadenectomy in malignant conditions IP 30000 USG Abdomen,Fine Needle Aspiration Cytology (FNAC) Routine Histopathological Examination -
S11 SURGICAL ONCOLOGY S11.1 HEAD and NECK S11.1.1 Composite Resection and Reconstruction - Head and Neck in IP 68313 X-RAY,Biopsy,Clinical Photograph,USG Clinical Photograph,Biopsy -
malignant conditions
S11 SURGICAL ONCOLOGY S11.1 HEAD and NECK S11.1.10 Head and Neck - Wide Excision IP 41548.5 X-RAY,Biopsy,Clinical Photograph,USG Clinical Photograph,Biopsy -
S11 SURGICAL ONCOLOGY S11.1 HEAD and NECK S11.1.11 External carotid artery ligation IP 25000 - - -
S11 SURGICAL ONCOLOGY S11.1 HEAD and NECK S11.1.2 Neck Dissection Any Type in malignant conditions IP 34125 X-RAY,Biopsy,Clinical Photograph,USG Clinical Photograph,Biopsy -
S11 SURGICAL ONCOLOGY S11.1 HEAD and NECK S11.1.2.1 Bilateral neck dissection any type in malignant conditions IP 45000 Fine Needle Aspiration Cytology(FNAC),USG Abdomen,CT Scan Abdomen With Contrast/MRI Abdomen With Routine Histopathological Examination -
Contrast
S11 SURGICAL ONCOLOGY S11.1 HEAD and NECK S11.1.3 Hemiglossectomy in malignant conditions IP 43323 X-RAY,Biopsy,Clinical Photograph,USG Clinical Photograph,Biopsy -
S11 SURGICAL ONCOLOGY S11.1 HEAD and NECK S11.1.4 Maxillectomy Any Type in malignant conditions IP 32308.5 X-RAY,Biopsy,Clinical Photograph,USG Clinical Photograph,Biopsy -
S11 SURGICAL ONCOLOGY S11.1 HEAD and NECK S11.1.5 Thyroidectomy any type in malignant conditions IP 31500 X-RAY,Biopsy,Clinical Photograph,USG Clinical Photograph,Biopsy -
S11 SURGICAL ONCOLOGY S11.1 HEAD and NECK S11.1.6 Parotidectomy any type in malignant conditions IP 26250 X-RAY,Biopsy,Clinical Photograph,USG Clinical Photograph,Biopsy -
S11 SURGICAL ONCOLOGY S11.1 HEAD and NECK S11.1.7 Laryngectomy Any Type in malignant conditions IP 71589 X-RAY,Biopsy,Clinical Photograph,USG Clinical Photograph,Biopsy -
S11 SURGICAL ONCOLOGY S11.1 HEAD and NECK S11.1.8 Laryngopharyngo Oesophagectomy in malignant conditions IP 101850 X-RAY,Biopsy,Clinical Photograph,USG Clinical Photograph,Biopsy -

S11 SURGICAL ONCOLOGY S11.1 HEAD and NECK S11.1.9 Hemimandibulectomy in malignant conditions IP 39648 X-RAY,Biopsy,Clinical Photograph,USG Clinical Photograph,Biopsy -
S11 SURGICAL ONCOLOGY S11.10 Ca.Eye/ Maxilla /Para Nasal Sinus S11.10.1 Orbital Exenteration in malignant conditions IP 44194.5 CT Clinical Photograph -

S11 SURGICAL ONCOLOGY S11.10 Ca.Eye/ Maxilla /Para Nasal Sinus S11.10.2 Maxillectomy + Orbital Exenteration in malignant conditions IP 56553 CT Clinical Photograph -

S11 SURGICAL ONCOLOGY S11.10 Ca.Eye/ Maxilla /Para Nasal Sinus S11.10.3 Maxillectomy + Infratemporal Fossa Clearance in malignant IP 68964 CT Clinical Photograph -
conditions
S11 SURGICAL ONCOLOGY S11.10 Ca.Eye/ Maxilla /Para Nasal Sinus S11.10.4 Cranio Facial Resection in malignant conditions IP 95550 MRI,CT Clinical Photograph -

S11 SURGICAL ONCOLOGY S11.11 Ca. Nasopharynx S11.11.1 Resection of Nasopharyngeal Tumor in malignant conditions IP 80430 MRI,CT Clinical Photograph,Biopsy -

S11 SURGICAL ONCOLOGY S11.11 Ca. Nasopharynx S11.11.2 Excision of Parapharyngeal tumours in malignant conditions IP 47430 CT of Nose \ Nasopharynx Routine Histopathological Examination -

S11 SURGICAL ONCOLOGY S11.12 Ca.Soft Palate S11.12.1 Palatectomy any type in malignant conditions IP 41775.3 CT Clinical Photograph -
S11 SURGICAL ONCOLOGY S11.13 Ca. Ear S11.13.1 Sleeve Resection of Ear in malignant conditions IP 46525.5 CT Clinical Photograph -
S11 SURGICAL ONCOLOGY S11.13 Ca. Ear S11.13.2 Resection of Lateral Temporal Bone in malignant conditions IP 71526 MRI,CT Clinical Photograph -

S11 SURGICAL ONCOLOGY S11.13 Ca. Ear S11.13.3 Subtotal Resection of Temporal Bone in malignant conditions IP 75568.5 MRI,CT Clinical Photograph -

S11 SURGICAL ONCOLOGY S11.13 Ca. Ear S11.13.4 Total Resection of Temporal Bone in malignant conditions IP 81900 MRI,CT Clinical Photograph -

S11 SURGICAL ONCOLOGY S11.14 Ca. Salivary Gland S11.14.1 Excision of Submandibular gland in malignant conditions IP 27300 Clinical Photograph Clinical Photograph,Biopsy -

S11 SURGICAL ONCOLOGY S11.15 Ca. Thyroid S11.15.1 Tracheal Resection in malignant conditions(CA. THYROID) IP 68250 CT,Bronchoscopy Clinical Photograph,Biopsy -

S11 SURGICAL ONCOLOGY S11.16 Ca. Trachea S11.16.1 Superior Mediastinal Dissection+Sternotomy in malignant IP 63787.5 CT Clinical Photograph -
conditions(77.31)
S11 SURGICAL ONCOLOGY S11.16 Ca. Trachea S11.16.2 Tracheal Resection in malignant conditions IP 68250 CT,Bronchoscopy Clinical Photograph,Biopsy -
S11 SURGICAL ONCOLOGY S11.16 Ca. Trachea S11.16.3 Tracheal Stenting IP 70000 CT,BIOPSY - -
S11 SURGICAL ONCOLOGY S11.17 Ca. Parathyroid S11.17.1 Parathyroidectomy in malignant conditions IP 36750 S.PTH,CT,Nuclear scan Clinical Photograph,Biopsy -
S11 SURGICAL ONCOLOGY S11.18 Ca. Gastro Intestinal Tract S11.18.1 Small Bowel Resection in malignant conditions IP 50400 CT,Barium Meal Follow Through Clinical Photograph,Biopsy -
S11 SURGICAL ONCOLOGY S11.18 Ca. Gastro Intestinal Tract S11.18.1.1 Stapplers in Bowel Resection and anastomosis IP 35000 BIOPSY,CXR CT/MRI -
S11 SURGICAL ONCOLOGY S11.18 Ca. Gastro Intestinal Tract S11.18.2 Ileostomy Closure in malignant conditions IP 26250 Colonoscopy Clinical Photograph -
S11 SURGICAL ONCOLOGY S11.18 Ca. Gastro Intestinal Tract S11.18.3 Colostomy Closure in malignant conditions IP 26250 Colonoscopy Clinical Photograph -

25 of 47
CODE MAIN CATEGORY Sub SUB CATEGORY NAME CODE SURGERY / THERAPY DESCRIPTION PROCEDURE PACKAGE SPECIAL INVESTIGATION POST OPERATIVE PROCEDURE INVESTIGATION TREATMENT PROTOCOL
Category ID TYPE AMOUNT
S11 SURGICAL ONCOLOGY S11.19 Ca.Rectum S11.19.1 Abdomino Perineal Resection (Apr) + Sacrectomy in malignant IP 63000 CT,BMFT Clinical Photograph,Biopsy -
conditions(77.99)
S11 SURGICAL ONCOLOGY S11.19 Ca.Rectum S11.19.2 Posterior Exenteration for Carcinoma Rectum IP 63000 CT,BMFT Clinical Photograph,Biopsy -
S11 SURGICAL ONCOLOGY S11.19 Ca.Rectum S11.19.3 Total Exenteration for Carcinoma Rectum IP 102900 CT,BMFT Clinical Photograph,Biopsy -
S11 SURGICAL ONCOLOGY S11.2 GASTROINTESTINAL TRACT S11.2.1 Oesophagectomy Any Type in malignant conditions IP 81900 USG,Biopsy,CT,Endoscopy USG,Biopsy,Clinical Photograph -
S11 SURGICAL ONCOLOGY S11.2 GASTROINTESTINAL TRACT S11.2.10 Thoracoscopic Mobilization of Oesophagus + Laparoscopic IP 120000 BIOPSY,CT SCAN/MRI CXR -
Mobilization of stomach + Gastric Pull-up in malignant
conditions
S11 SURGICAL ONCOLOGY S11.2 GASTROINTESTINAL TRACT S11.2.11 Laparoscopic mobilization of stomach with distal gastrectomy IP 60000 BIOPSY,CT/MRI CXR -
with billroth i/ii anastomosis in malignant conditions

S11 SURGICAL ONCOLOGY S11.2 GASTROINTESTINAL TRACT S11.2.12 HCC Chemo embolization IP 200000 MRI,Histopathological report,CT post op xray and clinicla photos,Histopathological report -
S11 SURGICAL ONCOLOGY S11.2 GASTROINTESTINAL TRACT S11.2.2 Gastrectomy Any Type in malignant conditions IP 52500 USG,Biopsy,CT,Endoscopy USG,Biopsy,Clinical Photograph -
S11 SURGICAL ONCOLOGY S11.2 GASTROINTESTINAL TRACT S11.2.3 Colectomy Any Type in malignant conditions IP 54600 USG,Biopsy,CT,Endoscopy USG,Biopsy,Clinical Photograph -
S11 SURGICAL ONCOLOGY S11.2 GASTROINTESTINAL TRACT S11.2.3.1 Laproscopic Right Hemicolectomy in malignant conditions IP 45000 Biopsy,CEA(Carcino Embryonic Antigen)125,Ca 19-9(Cancer Antigen 19-9 Or Carbohydrate Antigen 19-9),CT Scan WEBEX,Routine Histopathological Examination ,USG Abdomen -
Lower Abdomen With Contrast,Colono Scopy
S11 SURGICAL ONCOLOGY S11.2 GASTROINTESTINAL TRACT S11.2.3.2 Laparoscopic Left Hemicolectomy in malignant conditions IP 45000 Biopsy,USG Abdomen/CT Scan Lower Abdomen With Contrast,Colono Scopy WEBEX,Routine Histopathological Examination ,USG Abdomen -

S11 SURGICAL ONCOLOGY S11.2 GASTROINTESTINAL TRACT S11.2.4 Anterior Resection of rectum in malignant conditions IP 52500 USG,Biopsy,CT,Endoscopy USG,Biopsy,Clinical Photograph -
S11 SURGICAL ONCOLOGY S11.2 GASTROINTESTINAL TRACT S11.2.5 Abdominoperinial Resection in malignant conditions IP 53224.5 USG,Biopsy,CT,Endoscopy USG,Biopsy,Clinical Photograph -
S11 SURGICAL ONCOLOGY S11.2 GASTROINTESTINAL TRACT S11.2.6 Whipples Any Type In malignant conditions IP 105000 USG,Biopsy,CT,Endoscopy USG,Biopsy,Clinical Photograph -
S11 SURGICAL ONCOLOGY S11.2 GASTROINTESTINAL TRACT S11.2.7 Triple Bypass -Pancreas in malignant conditions IP 63000 USG,Biopsy,CT,Endoscopy USG,Biopsy,Clinical Photograph -
S11 SURGICAL ONCOLOGY S11.2 GASTROINTESTINAL TRACT S11.2.8 Other Bypasses-Pancreas in malignant conditions IP 53041.8 USG,Biopsy,CT,Endoscopy USG,Biopsy,Clinical Photograph -
S11 SURGICAL ONCOLOGY S11.2 GASTROINTESTINAL TRACT S11.2.9 Hartman procedure in malignant conditions IP 49790 CT Scan Lower Abdomen With Contrast,CEA(Carcino Embryonic Antigen) 125 ,Ca 19-9(Cancer Antigen 19-9 Or USG Abdomen,Routine Histopathological Examination -
Carbohydrate Antigen 19-9)
S11 SURGICAL ONCOLOGY S11.20 Ca. Gall Bladder S11.20.1 Radical Cholecystectomy in malignant conditions IP 81900 CT Clinical Photograph,Biopsy -
S11 SURGICAL ONCOLOGY S11.21 Spleen S11.21.1 Splenectomy in malignant conditions IP 44940 CT Clinical Photograph,Biopsy -
S11 SURGICAL ONCOLOGY S11.22 Retroperitoneal Tumor S11.22.1 Resection Of Retroperitoneal Tumors in malignant conditions IP 63000 CT Clinical Photograph,Biopsy -

S11 SURGICAL ONCOLOGY S11.23 Abdominal wall tumor S11.23.1 Abdominal Wall Tumor Resection in malignant conditions IP 55104 CT Clinical Photograph,Biopsy -

S11 SURGICAL ONCOLOGY S11.23 Abdominal wall tumor S11.23.2 Resection With Reconstruction of Abdominal wall Tumors in IP 61950 CT Clinical Photograph,Biopsy -
malignant conditions
S11 SURGICAL ONCOLOGY S11.24 Gynaec Cancers S11.24.1 Bilateral Pelvic Lymph Node Dissection(BPLND)- Gynaec IP 54285 CT Clinical Photograph,Biopsy -
cancers
S11 SURGICAL ONCOLOGY S11.24 Gynaec Cancers S11.24.2 Radical Trachelectomy in malignant conditions IP 53098.5 CT Clinical Photograph,Biopsy -
S11 SURGICAL ONCOLOGY S11.24 Gynaec Cancers S11.24.3 Radical Vaginectomy in malignant conditions IP 55776 CT Clinical Photograph,Biopsy -
S11 SURGICAL ONCOLOGY S11.24 Gynaec Cancers S11.24.4 Radical Vaginectomy + Reconstruction(70.62) IP 63577.5 CT Clinical Photograph,Biopsy -
S11 SURGICAL ONCOLOGY S11.24 Gynaec Cancers S11.24.5 Laparoscopic ExtraFACIAL Hysterectomy with Bilateral pelvic IP 50000 Biopsy,CT scan Lower Abdomen Without Contrast,CT Scan Abdomen With Contrast,USG Abdomen USG Abdomen,Routine Histopathological Examination -
node dissection in malignant conditions
S11 SURGICAL ONCOLOGY S11.24 Gynaec Cancers S11.24.6 Laparoscopic extraFACIAL hysterectomy + multiple biopsies + IP 49047 Biopsy,CT scan Lower Abdomen Without Contrast,CT Scan Abdomen With Contrast,USG Abdomen USG Abdomen,Routine Histopathological Examination -
omentectomy in malignant conditions
S11 SURGICAL ONCOLOGY S11.25 Ca. Cervix S11.25.1 Radical Hysterectomy +Bilateral Pelvic Lymph Node Dissection IP 52510.5 CT Clinical Photograph,Biopsy -
(Bplnd) + Bilateral Salpingo Ophorectomy (Bso) / Ovarian
Transposition in malignant conditions
S11 SURGICAL ONCOLOGY S11.25 Ca. Cervix S11.25.2 Anterior Exenteration - Carcinoma Cervix IP 88987.5 CT Clinical Photograph,Biopsy -
S11 SURGICAL ONCOLOGY S11.25 Ca. Cervix S11.25.3 Posterior Exenteration - Carcinoma Cervix IP 68250 CT Clinical Photograph,Biopsy -
S11 SURGICAL ONCOLOGY S11.25 Ca. Cervix S11.25.4 Total Pelvic Exenteration - Carcinoma Cervix IP 102900 CT Clinical Photograph,Biopsy -
S11 SURGICAL ONCOLOGY S11.25 Ca. Cervix S11.25.5 Supra Levator Exenteration - Carcinoma Cervix IP 94500 CT Clinical Photograph,Biopsy -
S11 SURGICAL ONCOLOGY S11.26 Ca. Endometrium S11.26.1 Total Abdominal Hysterectomy(Tah) + Bilateral Salpingo IP 65247 CT Clinical Photograph,Biopsy -
Ophorectomy (Bso) + Bilateral Pelvic Lymph Node Dissection
(Bplnd) + Omentectomy in malignant conditions

S11 SURGICAL ONCOLOGY S11.27 Soft tissue /Bone tumors . Chest S11.27.1 Surgical Resection of Soft tissue /Bone tumors of Chest wall IP 31500 CT-Chest,Bone Scan Clinical Photograph -
wall
S11 SURGICAL ONCOLOGY S11.27 Soft tissue /Bone tumors . Chest S11.27.2 Surgical Resection and Reconstruction of Soft tissue /Bone IP 73500 CT-Chest,Bone Scan Clinical Photograph -
wall tumors of Chest wall in malignant conditions
S11 SURGICAL ONCOLOGY S11.27 Soft tissue /Bone tumors . Chest S11.27.3 Bronchoscopic Tumor Resection IP 85000 BRONCHOSCOPY,,CECT CHEST,BIOPSY USG ABDOMEN -
wall
S11 SURGICAL ONCOLOGY S11.28 Bone / Soft tissue tumors S11.28.1.1 Surgery (removal) for Bone/Soft tissue tumors-Without IP 51628.5 MRI,Bone Scan,CT-Chest,CT-Local Part Clinical Photograph -
Prosthesis in malignant conditions(83.49)
S11 SURGICAL ONCOLOGY S11.28 Bone / Soft tissue tumors S11.28.1.2 Surgery (removal) for Bone / Soft tissue tumors-With Custom IP 89785.5 MRI,Bone Scan,CT-Chest,CT-Local Part Clinical Photograph -
Made Prosthesis in malignant conditions(83.49+84.40)

S11 SURGICAL ONCOLOGY S11.28 Bone / Soft tissue tumors S11.28.1.3 Surgery (removal) for Bone / Soft tissue tumors-With Modular IP 102900 MRI,Bone Scan,CT-Chest,CT-Local Part Clinical Photograph -
Prosthesis in malignant conditions(83.49+84.40)

S11 SURGICAL ONCOLOGY S11.28 Bone / Soft tissue tumors S11.28.2 Forequarter Amputation in malignant conditions IP 82141.5 CT-Chest X-RAY,Clinical Photograph -
S11 SURGICAL ONCOLOGY S11.28 Bone / Soft tissue tumors S11.28.3 Hemipelvectomy in malignant conditions IP 82830.3 MRI-Pelvis,CT,CT-Chest X-RAY,Clinical Photograph -
S11 SURGICAL ONCOLOGY S11.28 Bone / Soft tissue tumors S11.28.4 Internal Hemipelvectomy in malignant conditions IP 83622 MRI-Pelvis,CT,CT-Chest X-RAY,Clinical Photograph -
S11 SURGICAL ONCOLOGY S11.28 Bone / Soft tissue tumors S11.28.5 Curettage and Bone Cement in malignant conditions IP 53686.5 MRI,CT X-RAY,Clinical Photograph -
S11 SURGICAL ONCOLOGY S11.28 Bone / Soft tissue tumors S11.28.6 Bone Resection in malignant conditions IP 45118.5 MRI,CT X-RAY,Clinical Photograph -
S11 SURGICAL ONCOLOGY S11.28 Bone / Soft tissue tumors S11.28.7 Shoulder Girdle Resection in malignant conditions IP 57844.5 MRI,Bone Scan,CT X-RAY,Clinical Photograph -
S11 SURGICAL ONCOLOGY S11.28 Bone / Soft tissue tumors S11.28.8 Sacral Resection in malignant conditions IP 63000 MRI,CT X-RAY,Clinical Photograph -
S11 SURGICAL ONCOLOGY S11.29 Genito urinary Cancer S11.29.1 Open Partial Nephrectomy IP 42000 Isotope renogram,CT,Isotope renogram,CT Clinical Photograph,Biopsy,Clinical Photograph,Biopsy -
S11 SURGICAL ONCOLOGY S11.29 Genito urinary Cancer S11.29.2 Nephroureterectomy For Transitional Cell Carcinoma Of Renal IP 68250 CT,CT Clinical Photograph,Biopsy,Clinical Photograph,Biopsy -
Pelvis in malignant conditions
S11 SURGICAL ONCOLOGY S11.29 Genito urinary Cancer S11.29.3 Channel TURP IP 39280 Prostate-Specific Antigen (PSA),USG Abdomen,CT Scan Lower Abdomen With Contrast USG Abdomen,Routine Histopathological Examination -
S11 SURGICAL ONCOLOGY S11.3 GENITO URINARY SYSTEM S11.3.1 Radical Nephrectomy IP 52500 USG,Biopsy,CT,IVP,KUB,USG,Biopsy,CT,IVP,KUB USG,Biopsy,Clinical Photograph,USG,Biopsy,Clinical Photograph -
S11 SURGICAL ONCOLOGY S11.3 GENITO URINARY SYSTEM S11.3.1.1 Laproscopic radical nephrectomy in malignant conditions IP 70000 CECT,CT/MRI CXR -

S11 SURGICAL ONCOLOGY S11.3 GENITO URINARY SYSTEM S11.3.10 Emasculation in malignant conditions IP 42588 USG,Biopsy,USG,Biopsy USG,Biopsy,Clinical Photograph,USG,Biopsy,Clinical Photograph -
S11 SURGICAL ONCOLOGY S11.3 GENITO URINARY SYSTEM S11.3.2 Open radical cystectomy with Ilealconduit diversion IP 105000 USG,Biopsy,CT,IVP,KUB,USG,Biopsy,CT,IVP,KUB USG,Biopsy,Clinical Photograph,USG,Biopsy,Clinical Photograph -
S11 SURGICAL ONCOLOGY S11.3 GENITO URINARY SYSTEM S11.3.2.1 Laproscopic radical cystectomy with Ilealconduit diversion IP 90000 2D ECHO,BIOPSY,CT/MRI,CXR PAC -

S11 SURGICAL ONCOLOGY S11.3 GENITO URINARY SYSTEM S11.3.3 Other Cystectomies in malignant conditions IP 92022 USG,Biopsy,CT,IVP,KUB,USG,Biopsy,CT,IVP,KUB USG,Biopsy,Clinical Photograph,USG,Biopsy,Clinical Photograph -
S11 SURGICAL ONCOLOGY S11.3 GENITO URINARY SYSTEM S11.3.4 Total Penectomy IP 38503.5 Clinical Photograph,Clinical Photograph USG,Biopsy,Clinical Photograph,USG,Biopsy,Clinical Photograph -
S11 SURGICAL ONCOLOGY S11.3 GENITO URINARY SYSTEM S11.3.5 Partial Penectomy IP 38503.5 Clinical Photograph,Clinical Photograph USG,Biopsy,Clinical Photograph,USG,Biopsy,Clinical Photograph -
S11 SURGICAL ONCOLOGY S11.3 GENITO URINARY SYSTEM S11.3.6 Inguinal Block Dissection One Side in malignant conditions IP 31269 Clinical Photograph,Biopsy,Clinical Photograph,Biopsy USG,Biopsy,Clinical Photograph,USG,Biopsy,Clinical Photograph -

S11 SURGICAL ONCOLOGY S11.3 GENITO URINARY SYSTEM S11.3.6.1 Bilateral inguinal block dissection in malignant conditions IP 44000 Clinical Photograph,Fine Needle Aspiration Cytology (FNAC),USG local area Routine Histopathological Examination -

S11 SURGICAL ONCOLOGY S11.3 GENITO URINARY SYSTEM S11.3.6.2 Bi-lateral Ilioinguinal block disection in malignant conditions IP 63850 BIOPSY,USG ABDOMEN,USG GROIN CXR -

S11 SURGICAL ONCOLOGY S11.3 GENITO URINARY SYSTEM S11.3.7 Radical Prostatectomy in malignant conditions IP 90978.3 USG,CT,KUB,USG,CT,KUB USG,Biopsy,Clinical Photograph,USG,Biopsy,Clinical Photograph -
S11 SURGICAL ONCOLOGY S11.3 GENITO URINARY SYSTEM S11.3.8 High Orchidectomy IP 23100 USG,Biopsy,USG,Biopsy USG,Biopsy,Clinical Photograph,USG,Biopsy,Clinical Photograph -
S11 SURGICAL ONCOLOGY S11.3 GENITO URINARY SYSTEM S11.3.9 Bilateral Orchidectomy IP 24507 USG,Biopsy,USG,Biopsy USG,Biopsy,Clinical Photograph,USG,Biopsy,Clinical Photograph -
S11 SURGICAL ONCOLOGY S11.30 Testes cancer S11.30.1 Retro Peritoneal Lymph Node Dissection(Rplnd) (For Residual IP 81900 Tumor Markers,CT-Abdomen + Pelvis,CT-Chest,Tumor Markers,CT-Abdomen + Pelvis,CT-Chest Clinical Photograph,Biopsy,Clinical Photograph,Biopsy -
Disease) in malignant conditions
S11 SURGICAL ONCOLOGY S11.30 Testes cancer S11.30.2 Unilateral Adrenalectomy in malignant conditions IP 68917.8 UrinaryHormones,CT,MRI,UrinaryHormones,CT,MRI Clinical Photograph,Biopsy,Clinical Photograph,Biopsy -
S11 SURGICAL ONCOLOGY S11.30 Testes cancer S11.30.2.1 Laparoscopic Biilateral adrenalectomy in malignant conditions IP 50000 24 hour free cortisol,Adrenal function test,Urinary VMA,Urinary Metanephrine/Nor metanephrine,Urinary USG Abdomen,Routine Histopathological Examination -
Catecholamines,USG Abdomen/CT Scan Abdomen With Contrast/MRI Abdomen With Contrast,Aldosterone - Urine

S11 SURGICAL ONCOLOGY S11.30 Testes cancer S11.30.3 Urinary Diversion in malignant conditions(56.6/56.7) IP 66412.5 - Clinical Photograph,Biopsy,Clinical Photograph,Biopsy -

26 of 47
CODE MAIN CATEGORY Sub SUB CATEGORY NAME CODE SURGERY / THERAPY DESCRIPTION PROCEDURE PACKAGE SPECIAL INVESTIGATION POST OPERATIVE PROCEDURE INVESTIGATION TREATMENT PROTOCOL
Category ID TYPE AMOUNT
S11 SURGICAL ONCOLOGY S11.30 Testes cancer S11.30.4 Retro Peritoneal Lymph Node Dissection Rplnd As Part Of IP 42000 CT,CT Clinical Photograph,Biopsy,Clinical Photograph,Biopsy -
Staging in malignant conditions
S11 SURGICAL ONCOLOGY S11.30 Testes cancer S11.30.5 Scrotectomy in malignant conditions IP 38440 Biopsy,USG Abdomen,CT Scan Lower Abdomen With Contrast USG Abdomen,Routine Histopathological Examination -
S11 SURGICAL ONCOLOGY S11.31 Ca. Urinary Bladder S11.31.1 Anterior Exenteration (CA. URINARY BLADDER) IP 63000 CT,CT Clinical Photograph,Biopsy,Clinical Photograph,Biopsy -
S11 SURGICAL ONCOLOGY S11.31 Ca. Urinary Bladder S11.31.2 Total Exenteration (CA. URINARY BLADDER) IP 78750 CT,CT Clinical Photograph,Biopsy,Clinical Photograph,Biopsy -
S11 SURGICAL ONCOLOGY S11.31 Ca. Urinary Bladder S11.31.3 Bilateral Pelvic Lymph Node Dissection(Bplnd) (CA. URINARY IP 42000 CT,CT Clinical Photograph,Biopsy,Clinical Photograph,Biopsy -
BLADDER)
S11 SURGICAL ONCOLOGY S11.32 Thoracic and Mediastinum S11.32.1 Resection of mediastinal tumors in malignant conditions IP 66948 CT Clinical Photograph,Biopsy -

S11 SURGICAL ONCOLOGY S11.33 Lung S11.33.1 Solitary Lung Metastatectomy in malignant conditions IP 72513 CT X-RAY,Biopsy -
S11 SURGICAL ONCOLOGY S11.33 Lung S11.33.2 Lung Metastatectomy multiple in malignant conditions IP 81900 CT X-RAY,Biopsy -
S11 SURGICAL ONCOLOGY S11.33 Lung S11.33.3 Sleeve Resection of Lung Cancer IP 113400 CT,Bronchoscopy Biopsy,X-RAY -
S11 SURGICAL ONCOLOGY S11.34 Esophagus S11.34.1 Oesophagectomy With Two Field Lymphadenectomy in IP 122850 CT Clinical Photograph,Biopsy -
malignant conditions(40.59)
S11 SURGICAL ONCOLOGY S11.34 Esophagus S11.34.2 Oesophagectomy With Three Field Lymphadenectomy in IP 126000 - Clinical Photograph,Biopsy -
malignant conditions(40.59)
S11 SURGICAL ONCOLOGY S11.35 Palliative Surgeries S11.35.1 Tracheostomy in malignant conditions IP 6541.5 Clinical Photograph Clinical Photograph -
S11 SURGICAL ONCOLOGY S11.35 Palliative Surgeries S11.35.10 Substernal Gastric Bypass in malignant conditions IP 52258.5 Clinical Photograph Clinical Photograph,Biopsy -
S11 SURGICAL ONCOLOGY S11.35 Palliative Surgeries S11.35.2 Gastrostomy in malignant conditions IP 21000 Clinical Photograph Clinical Photograph -
S11 SURGICAL ONCOLOGY S11.35 Palliative Surgeries S11.35.3 Jejunostomy in malignant conditions IP 33442.5 Clinical Photograph Clinical Photograph -
S11 SURGICAL ONCOLOGY S11.35 Palliative Surgeries S11.35.4 Ileostomy in malignant conditions IP 34230 Clinical Photograph Clinical Photograph -
S11 SURGICAL ONCOLOGY S11.35 Palliative Surgeries S11.35.4.1 Laparoscopic anterior/low resection with stapplers with IP 90000 BIOPSY,CXR,CT/MRI - -
diversion covering ileostomy in malignant conditions

S11 SURGICAL ONCOLOGY S11.35 Palliative Surgeries S11.35.5 Colostomy in malignant conditions IP 21000 Clinical Photograph Clinical Photograph -
S11 SURGICAL ONCOLOGY S11.35 Palliative Surgeries S11.35.6 Suprapubic cystostomy IP 17839.5 Clinical Photograph Clinical Photograph -
S11 SURGICAL ONCOLOGY S11.35 Palliative Surgeries S11.35.7 Intercostal Drainage(Icd) in malignant conditions IP 3150 Clinical Photograph Clinical Photograph -
S11 SURGICAL ONCOLOGY S11.35 Palliative Surgeries S11.35.8 Gastro Jejunostomy in malignant conditions IP 52500 Clinical Photograph Clinical Photograph,Biopsy -
S11 SURGICAL ONCOLOGY S11.35 Palliative Surgeries S11.35.9 Ileotransverse Colostomy in malignant conditions IP 63000 Clinical Photograph Clinical Photograph,Biopsy -
S11 SURGICAL ONCOLOGY S11.36 Reconstruction S11.36.1 Reconstructon with Myocutaneous / Cutaneous Flap in IP 37453.5 Clinical Photograph Clinical Photograph -
malignant conditions
S11 SURGICAL ONCOLOGY S11.36 Reconstruction S11.36.2 Micro Vascular Reconstruction in malignant conditions IP 47754 Clinical Photograph Clinical Photograph -
S11 SURGICAL ONCOLOGY S11.36 Reconstruction S11.36.3 Vascular reconstruction with synthetic graft in malignant IP 71250 BIOPSY,CT SCAN/MRI CXR -
conditions
S11 SURGICAL ONCOLOGY S11.36 Reconstruction S11.36.4 Reconstruction with Ossco MyoCutaneous flap IP 70000 BIOPSY,,CLINICAL IMAGES - -
S11 SURGICAL ONCOLOGY S11.36 Reconstruction S11.36.5 Revision Surgeires for Flap necrosis IP 35000 CLINICAL PHOTOS - -
S11 SURGICAL ONCOLOGY S11.37 OTHERS S11.37.1 Chemo port (Below 13 years age group) + EWS + Breast cancer IP 40000 BIOPSY,CT SCAN,BLEEDING PHOTOS USG ABDOMEN -
patients + folfox patients.
S11 SURGICAL ONCOLOGY S11.37 OTHERS S11.37.2 Surgical Management of Post Operative Anastamotic leak IP 40000 CLINICAL PHOTOS USG/CT -

S11 SURGICAL ONCOLOGY S11.4 GYNAECOLOGICAL ONCOLOGY S11.4.1 Hysterectomy in malignant conditions IP 34125 USG,Biopsy,CT USG,Biopsy,Clinical Photograph -
S11 SURGICAL ONCOLOGY S11.4 GYNAECOLOGICAL ONCOLOGY S11.4.2 Radical Hysterectomy in malignant conditions IP 58443 USG,Biopsy,CT USG,Biopsy,Clinical Photograph -
S11 SURGICAL ONCOLOGY S11.4 GYNAECOLOGICAL ONCOLOGY S11.4.3 Surgery For Carcinoma Ovary Early Stage IP 33348 USG,Biopsy,CT USG,Biopsy,Clinical Photograph -
S11 SURGICAL ONCOLOGY S11.4 GYNAECOLOGICAL ONCOLOGY S11.4.4 Surgery For Carcinoma Ovary Advance Stage IP 54600 USG,Biopsy,CT USG,Biopsy,Clinical Photograph -
S11 SURGICAL ONCOLOGY S11.4 GYNAECOLOGICAL ONCOLOGY S11.4.5 Vulvectomy in malignant conditions IP 48153 Clinical Photograph,Biopsy USG,Biopsy,Clinical Photograph -
S11 SURGICAL ONCOLOGY S11.4 GYNAECOLOGICAL ONCOLOGY S11.4.6 Unilateral /BilateralSalpingo Oophorectomy in malignant IP 31500 USG,Biopsy,CT USG,Biopsy,Clinical Photograph -
conditions(65.6.1)
S11 SURGICAL ONCOLOGY S11.4 GYNAECOLOGICAL ONCOLOGY S11.4.7 Ovarian cystectomy in malignant conditions IP 50020 Ca 125(Cancer Antigen 125 Or Carbohydrate Antigen 125),USG Abdomen,CT scan Lower Abdomen Without Contrast USG Abdomen,Routine Histopathological Examination -

S11 SURGICAL ONCOLOGY S11.4 GYNAECOLOGICAL ONCOLOGY S11.4.8 Excision of Complex ovarian mass in malignant conditions IP 50080 Ca 125(Cancer Antigen 125 Or Carbohydrate Antigen 125),USG Abdomen,CT scan Lower Abdomen Without Contrast USG Abdomen,Routine Histopathological Examination -

S11 SURGICAL ONCOLOGY S11.4 GYNAECOLOGICAL ONCOLOGY S11.4.9 Laparoscopic wertheim hysterectomy in malignant conditions IP 44220 CT Scan Abdomen With Contrast,Routine Histopathological Examination,Pap Smear,CT scan Lower Abdomen USG Abdomen,Routine Histopathological Examination -
Without Contrast
S11 SURGICAL ONCOLOGY S11.5 TUMORS OF THE FEMALE BREAST S11.5.1 Mastectomy Any Type in malignant conditions IP 31500 Mammography,Biopsy,Clinical Photograph Clinical Photograph,Biopsy -

S11 SURGICAL ONCOLOGY S11.5 TUMORS OF THE FEMALE BREAST S11.5.2 Axillary Dissection in malignant conditions IP 41187.3 Clinical Photograph,Biopsy Clinical Photograph,Biopsy -

S11 SURGICAL ONCOLOGY S11.5 TUMORS OF THE FEMALE BREAST S11.5.3 Wide Excision - Breast in malignant conditions IP 5407.5 Clinical Photograph,Biopsy Clinical Photograph,Biopsy -

S11 SURGICAL ONCOLOGY S11.5 TUMORS OF THE FEMALE BREAST S11.5.4 Lumpectomy IP 3244.5 Clinical Photograph,Biopsy Clinical Photograph,Biopsy -

S11 SURGICAL ONCOLOGY S11.5 TUMORS OF THE FEMALE BREAST S11.5.5 Breast Reconstruction Surgery IP 43921.5 Clinical Photograph,Biopsy Clinical Photograph,Biopsy -

S11 SURGICAL ONCOLOGY S11.5 TUMORS OF THE FEMALE BREAST S11.5.6 Surgical Resection of Soft tissue /Bone tumors of Chest wall IP 31500 Clinical Photograph,Biopsy Clinical Photograph,Biopsy -

S11 SURGICAL ONCOLOGY S11.6 SKIN TUMORS S11.6.1 Skin Tumors Wide Excision in malignant conditions IP 36172.5 Clinical Photograph,Biopsy Clinical Photograph,Biopsy -
S11 SURGICAL ONCOLOGY S11.6 SKIN TUMORS S11.6.2 Skin Tumors wide Excision + Reconstruction in malignant IP 42000 Clinical Photograph,Biopsy Clinical Photograph,Biopsy -
conditions(86.6/86.7)
S11 SURGICAL ONCOLOGY S11.6 SKIN TUMORS S11.6.3 Skin Tumors amputation in malignant conditions IP 25599 Clinical Photograph,Biopsy Clinical Photograph,Biopsy -
S11 SURGICAL ONCOLOGY S11.7 SOFT TISSUE AND BONE TUMORS S11.7.1 Soft Tissue And Bone Tumors Wide Excision IP 15750 Clinical Photograph,Biopsy Clinical Photograph,Biopsy -

S11 SURGICAL ONCOLOGY S11.7 SOFT TISSUE AND BONE TUMORS S11.7.2 Soft Tissue And Bone Tumors Wide Excision + Reconstruction IP 26250 Clinical Photograph,Biopsy Clinical Photograph,Biopsy -

S11 SURGICAL ONCOLOGY S11.7 SOFT TISSUE AND BONE TUMORS S11.7.3 Bone and Soft TissueTumors Amputation in malignant IP 25641 Clinical Photograph,Biopsy Clinical Photograph,Biopsy -
conditions(83.49)
S11 SURGICAL ONCOLOGY S11.8 LUNG CANCER S11.8.1 Pneumonectomy for Carcinoma Lung IP 84300.3 X-RAY,Biopsy,CT X-RAY,Biopsy,Clinical Photograph -
S11 SURGICAL ONCOLOGY S11.8 LUNG CANCER S11.8.2 Lobectomy for Carcinoma Lung IP 80850 X-RAY,Biopsy,CT X-RAY,Biopsy,Clinical Photograph -
S11 SURGICAL ONCOLOGY S11.8 LUNG CANCER S11.8.3 Decortication IP 63000 X-RAY,Biopsy,CT X-RAY,Biopsy,Clinical Photograph -
S11 SURGICAL ONCOLOGY S11.8 LUNG CANCER S11.8.4.1 Surgical Correction Of Bronchopleural Fistula. Thoracoplasty IP 70906.5 X-RAY,Biopsy,CT X-RAY,Biopsy,Clinical Photograph -

S11 SURGICAL ONCOLOGY S11.8 LUNG CANCER S11.8.4.2 Surgical Correction Of Bronchopleural Fistula. Myoplasty IP 78907.5 X-RAY,Biopsy,CT X-RAY,Biopsy,Clinical Photograph -

S11 SURGICAL ONCOLOGY S11.8 LUNG CANCER S11.8.4.3 Surgical Correction of Bronchopleural Fistula - Transpleural IP 78792 X-RAY,Biopsy,CT X-RAY,Biopsy,Clinical Photograph -
BPF Closure in malignant conditions
S11 SURGICAL ONCOLOGY S11.8 LUNG CANCER S11.8.4.4 Icd + pleurodesis IP 19380 Chest X-Ray PA View( 2 Films(1. at different dates film. 2. Plural Fluid Cytology)),Chest X-Ray PA View(1 Film),CT Scan Case Sheet with operation Notes,Clinical Photograph,Pulmonary Function Test(Major) -
Chest With Contrast,Ultra Sound Chest showing recurrent pleural effusion
S11 SURGICAL ONCOLOGY S11.8 LUNG CANCER S11.8.5 Extrapleural Pneumonectomies IP 90000 BIOPSY, - -
S11 SURGICAL ONCOLOGY S11.9 Ca.Oral cavity S11.9.1 Marginal Mandibulectomy in malignant conditions IP 46326 Orthopantomogram Clinical Photograph -
S11 SURGICAL ONCOLOGY S11.9 Ca.Oral cavity S11.9.2 Segmental Mandibulectomy IP 36472.8 Orthopantomogram,CT Clinical Photograph -
S11 SURGICAL ONCOLOGY S11.9 Ca.Oral cavity S11.9.3 Total Glossectomy + Reconstruction in malignant IP 60742.5 CT Clinical Photograph -
conditions(25.59)
S11 SURGICAL ONCOLOGY S11.9 Ca.Oral cavity S11.9.4 Full Thickness Buccal Mucosal Resection and Reconstruction in IP 66475.5 Biopsy Clinical Photograph -
malignant conditions(27.59)
S11 SURGICAL ONCOLOGY S11.9 Ca.Oral cavity S11.9.5 Cyst and tumour of Maxilla/mandible by IP 2500 Clinical assessment and investigations Clinical assessment and investigations -
enucleation/excision/marsupialization under LA
S11 SURGICAL ONCOLOGY S11.9 Ca.Oral cavity S11.9.6 Mandible Tumour Resection and reconstruction/Cancer IP 55000 Clinical assessment and investigations Clinical assessment and investigations -
surgery
S12 MEDICAL ONCOLOGY S12.1 BREAST CANCER S12.1.1 Chemotherapy for Breast Cancer with Adriamycin / IP 3960 Mammography,Biopsy,Clinical Photograph Clinical Photograph -
Cyclophosphamide (Ac)
S12 MEDICAL ONCOLOGY S12.1 BREAST CANCER S12.1.10 Chemotherapy for Breast Cancer with Trastuzumab - IP 30000 BIOPSY,2D ECHO,ULTRA SOUND ABDOMEN,CHEST X-RAY,Her 2/NEU status (FISH) CBP -
Remaining 15 Cycles

27 of 47
CODE MAIN CATEGORY Sub SUB CATEGORY NAME CODE SURGERY / THERAPY DESCRIPTION PROCEDURE PACKAGE SPECIAL INVESTIGATION POST OPERATIVE PROCEDURE INVESTIGATION TREATMENT PROTOCOL
Category ID TYPE AMOUNT
S12 MEDICAL ONCOLOGY S12.1 BREAST CANCER S12.1.11 BREAST CANCER - OTHER REGIMEN (MAY BE CHOSEN FOR DC 10000 Clinical photograph,Mammography,Biopsy Clinical Photograph -
ANY OTHER INTERNATIONALLY APPROVED CURATIVE
REGIMEN WITH SUBMISSION OF SUBSTANTIATING
DOCUMENTS) ; (MAY BE CHOSEN FOR ANY OTHER
INTERNATIONALLY APPROVED CURATIVE REGIMEN WITH
SUBMISSION OF SUBSTANTIATING DOCUMENTS)

S12 MEDICAL ONCOLOGY S12.1 BREAST CANCER S12.1.12 BREAST CANCER - TAC (DOCETAXEL/ADRIAMYCIN/CYCLOPHO DC 5601 Clinical photograph,Mammography,Biopsy Clinical Photograph -
SPHAMIDE) ; DAY 1: DOXORUBICIN 60MG/M2 IV ; DAY 1:
CYCLOPHOSPHAMIDE 600MG/M2 IV. ; DAY 1: DOCETAXEL
100MG/M2 IV. ; REPEAT CYCLE EVERY 21 DAYS FOR 4 CYCLES,

S12 MEDICAL ONCOLOGY S12.1 BREAST CANCER S12.1.13 BREAST CANCER - FEC/CEF FOLLOWED BY T DC 5100 Clinical photograph,Mammography,Biopsy Clinical Photograph -
(FLUOROURACIL/EPIRUBICIN/CYCLOPH OSPHAMIDE) -
FOLLOWED BY DOCETAXEL OR FOLLOWED BY WEEKLY
PACLITAXEL) ; DAY 1: 5- FLUOROURACIL 500MG/M2 IV ; DAY
1: EPIRUBICIN 100MG/M2 IV ; DAY 1: CYCLOPHOSPHAMIDE
500MG/M2 IV. ; REPEAT CYCLE EVERY 21 DAYS FOR 3 CYCLES

S12 MEDICAL ONCOLOGY S12.1 BREAST CANCER S12.1.14 BREAST CANCER - EC (EPIRUBICIN/CYCLOPHOSPHAMIDE) ; DC 5100 Clinical photograph,Mammography,Biopsy Clinical Photograph -
DAY 1: EPIRUBICIN 100MG/M2 IV ; DAY 1:
CYCLOPHOSPHAMIDE 830MG/M2 IV. ; REPEAT CYCLE - EVERY
21 DAYS FOR 8 CYCLES

S12 MEDICAL ONCOLOGY S12.1 BREAST CANCER S12.1.2 Chemotherapy for Breast Cancer with 5- Fluorouracil A-C (Fac) IP 3960 Mammography,Biopsy,Clinical Photograph Clinical Photograph -

S12 MEDICAL ONCOLOGY S12.1 BREAST CANCER S12.1.3 Chemotherapy for Breast Cancer with Ac (Ac Then T) IP 3695 Mammography,Biopsy,Clinical Photograph Clinical Photograph -
S12 MEDICAL ONCOLOGY S12.1 BREAST CANCER S12.1.4 Chemotherapy for Breast Cancer with Paclitaxel IP 7700 Mammography,Biopsy,Clinical Photograph Clinical Photograph -
S12 MEDICAL ONCOLOGY S12.1 BREAST CANCER S12.1.5 Chemotherapy for Breast Cancer with Cyclophosphamide/ IP 2200 Mammography,Biopsy,Clinical Photograph Clinical Photograph -
Methotrexate / 5fluorouracil (Cmf)

S12 MEDICAL ONCOLOGY S12.1 BREAST CANCER S12.1.6 Chemotherapy for Breast Cancer with Tamoxifen Tabs IP 550 Mammography,Biopsy,Clinical Photograph Clinical Photograph -
S12 MEDICAL ONCOLOGY S12.1 BREAST CANCER S12.1.7 Chemotherapy for Breast Cancer with Aromatase Inhibitors IP 1320 Mammography,Biopsy,Clinical Photograph Clinical Photograph -

S12 MEDICAL ONCOLOGY S12.1 BREAST CANCER S12.1.8 Chemotherapy for Breast Cancer with Docetaxel IP 11011 Bone Scan,Routine Histopathological Examination,Prostate-Specific Antigen (PSA),Estrogen Receptor/Progesterone Clinical Photograph -
Receptor,Chest X-Ray PA View(1 Film),Chest X-Ray Lateral View(1 Film),USG local area

S12 MEDICAL ONCOLOGY S12.1 BREAST CANCER S12.1.9 Chemotherapy for Breast Cancer with Trastuzumab - 1st Cycle IP 45000 BIOPSY,2D ECHO,ULTRA SOUND ABDOMEN,CHEST X-RAY,Her 2/NEU status (FISH) CBP -

S12 MEDICAL ONCOLOGY S12.10 BLADDER CANCER S12.10.1 Chemotherapy for Bladder Cancer with Weekly Cisplatin. IP 2200 USG,Biopsy Clinical Photograph -

S12 MEDICAL ONCOLOGY S12.10 BLADDER CANCER S12.10.2 Chemotherapy for Bladder Cancer with Methotrexate IP 6600 USG,Biopsy,CT Clinical Photograph -
Vinblastine Adriamycin Cyclophosphamide (Mvac)
S12 MEDICAL ONCOLOGY S12.10 BLADDER CANCER S12.10.3 BLADDER CANCER -RADIOSENSITIZING - 5-FU + MITOMYCIN32 DC 15100 Clinical assessment,HPE,Clinical Photograph,Haematology Chemotherapy drug batch number with bar code -
; DAY 1 OF RADIOTHERAPY: MITOMYCIN 12MG/M2 IV BOLUS,
PLUS ; WEEK 1 (FRACTIONS 1-5) AND WEEK 4 (FRACTIONS 16-
20) OF RADIOTHERAPY: 5-FU 500MG/M2 CONTINUOUS IV
INFUSION (10 DAYS TOTAL)

S12 MEDICAL ONCOLOGY S12.10 BLADDER CANCER S12.10.4 BLADDER CANCER - DDMVAC ; DAY 1: METHOTREXATE DC 3800 Clinical assessment,HPE,Clinical Photograph,Haematology Case Sheet with treatment details,Clinical Photograph -
30MG/M2 IV; DAY 2: VINBLASTINE 3MG/M2 IV,
DOXORUBICIN 30MG/M2 IV, CISPLATIN 70MG/M2 IV; ;
REPEAT EVERY 2 WEEKS FOR 3-4 CYCLES
S12 MEDICAL ONCOLOGY S12.11 LUNG CANCER S12.11.1 Chemotherapy for Non SMAL cell Lung Cancer with IP 7700 X-RAY,Biopsy,CT-Scan Clinical Photograph -
Cisplatin/Etoposide (Iiib)
S12 MEDICAL ONCOLOGY S12.11 LUNG CANCER S12.11.10 LUNG CANCER - NSCLC- CISPLATIN & VINORELBINE - (I) ; DAYS DC 33601 CT-Scan,X-RAY,Biopsy Case Sheet with treatment details,Clinical Photograph -
1 AND 8: CISPLATIN 50MG/M2 IV AND DAYS 1, 8, 15 AND 22:
VINORELBINE 25MG/M2 IV ; (OR) ; DAY 1: CISPLATIN
100MG/M2 IV AND DAYS 1, 8, 15 AND 22: VINORELBINE
30MG/M2 IV. ; REPEAT CYCLE EVERY 4 WEEKS FOR 4 CYCLES.

S12 MEDICAL ONCOLOGY S12.11 LUNG CANCER S12.11.2 Chemotherapy for Non SMAL cell Lung Cancer with Erlotinib IP 16511 Clinical Photograph,Chest X-Ray PA View(1 Film),USG local area,CT local area without contrast,Routine Clinical Photograph ,Case Sheet with treatment details -
histopathological examination
S12 MEDICAL ONCOLOGY S12.11 LUNG CANCER S12.11.3 Chemotherapy for Non SMAL cell Lung Cancer with PEM + IP 22011 Clinical Photograph,Routine Histopathological Examination,USG local area,SAlkaline Phosphatase Levels,Bone Case Sheet with treatment details -
Cisplatin Scan,CT local area with contrast
S12 MEDICAL ONCOLOGY S12.11 LUNG CANCER S12.11.4 Chemotherapy for Non SMAL cell Lung Cancer with GEFITINIB IP 7788 Case sheet with clinical History ,Routine Histopathological Examination, CT scan chest with contrast, USG local area, Clinical Photograph ,Case Sheet with treatment details -
Alkaline Phosphatase Levels
S12 MEDICAL ONCOLOGY S12.11 LUNG CANCER S12.11.5 Chemotherapy for Non SMAL cell Lung Cancer with Paclitaxel IP 11011 Alkaline Phosphatase Levels,Routine Histopathological Examination, CT chest with contrast/CT upper abdomen Clinical Photograph ,Case Sheet with treatment details -
/Carboplatin with contrast, Fine Needle Aspiration Cytology (FNAC)/Routine histopathological examination

S12 MEDICAL ONCOLOGY S12.11 LUNG CANCER S12.11.6 LUNG CANCER - SCLC - CARBOPLATIN & IRINOTECAN ; DAY 1: DC 7700 CT-Scan,X-RAY,Biopsy Case Sheet with treatment details,Clinical Photograph -
CARBOPLATIN AUC 5MG PER MIN/ML IV ; DAYS 1, 8, AND 15:
IRINOTECAN 50MG/M2 IV. ; REPEAT CYCLE EVERY 4 WEEKS
FOR 4 CYCLES
S12 MEDICAL ONCOLOGY S12.11 LUNG CANCER S12.11.7 LUNG CANCER - SCLC - CISPLATIN + IRINOTECAN ; DAY 1 AND DC 5700 CT-Scan,X-RAY,Biopsy Case Sheet with treatment details,Clinical Photograph -
8: CISPLATIN 30MG/M2 IV, IRINOTECAN 65MG/M2 IV. ;
REPEAT CYCLE EVERY 3 WEEKS FOR 4-6 CYCLES.
S12 MEDICAL ONCOLOGY S12.11 LUNG CANCER S12.11.8 LUNG CANCER - SCLC - CISPLATIN + IRINOTECAN ; DAY 1: DC 5801 CT-Scan,X-RAY,Biopsy Case Sheet with treatment details,Clinical Photograph -
CISPLATIN 60MG/M2 IV. ; DAYS 1, 8, AND 15: IRINOTECAN
60MG/M2 IV. ; REPEAT CYCLE EVERY 4 WEEKS FOR 4 CYCLES.

S12 MEDICAL ONCOLOGY S12.11 LUNG CANCER S12.11.9 LUNG CANCER - NSCLC- CISPLATIN & DOCETAXEL ; DAY 1: DC 6300 CT-Scan,X-RAY,Biopsy Case Sheet with treatment details,Clinical Photograph -
DOCETAXEL 75MG/M2 IV, CISPLATIN 75MG/M2 IV. ; REPEAT
EVERY 3 WEEKS FOR 4 CYCLES.
S12 MEDICAL ONCOLOGY S12.12 OESOPHAGEAL CANCER S12.12.1 Chemotherapy for Oesophageal Cancer with Cisplatin/5fu IP 6000 Endoscopy,Biopsy,CT-Scan Clinical Photograph -
Cross protocol (Paclitaxel and Carboplatin Weekly) for
concurrent chemo radio therapy for Oesophageal along with
radiation protocol - 6 cycles allowed

S12 MEDICAL ONCOLOGY S12.12 OESOPHAGEAL CANCER S12.12.2 ESOPHAGEAL CANCER - DEFINITIVE - IRINOTECAN & DC 9701 Clinical assessment,HPE,Clinical Photograph,Haematology Case Sheet with treatment details,Clinical Photograph -
CISPLATIN ; DAYS 1, 8, 22, AND 29: IRINOTECAN 65MG/M2 IV
; DAYS 1, 8, 22, AND 29: CISPLATIN 30MG/M2 IV.

S12 MEDICAL ONCOLOGY S12.12 OESOPHAGEAL CANCER S12.12.3 ESOPHAGEAL CANCER- DEFINITIVE - CISPLATIN + DC 2000 Clinical assessment,HPE,Clinical Photograph,Haematology Case Sheet with treatment details,Clinical Photograph -
CAPECITABINE ; DAY 1: CISPLATIN 30MG/M2 IV ; DAYS 1-5:
CAPECITABINE 800MG/M2 ORALLY TWICE DAILY ; REPEAT
CYCLE WEEKLY FOR 5 WEEKS
S12 MEDICAL ONCOLOGY S12.12 OESOPHAGEAL CANCER S12.12.4 ESOPHAGEAL CANCER - PERI-OPERATIVE - ECF DC 16700 Clinical assessment,HPE,Clinical Photograph,Haematology Case Sheet with treatment details,Clinical Photograph -
(EPIRUBICIN/CISPLATIN/FLUOROURAC IL) ; DAY 1: EPIRUBICIN
50MG/M2 IV; CISPLATIN 60MG/M2 IV ; DAYS 1-21: 5-FU
200MG/M2 IV CONTINUOUS INFUSION ONCE DAILY; ; REPEAT
EVERY 21 DAYS FOR 3 CYCLES PREOPERATIVELY AND 3 CYCLES
POSTOPERATIVELY

28 of 47
CODE MAIN CATEGORY Sub SUB CATEGORY NAME CODE SURGERY / THERAPY DESCRIPTION PROCEDURE PACKAGE SPECIAL INVESTIGATION POST OPERATIVE PROCEDURE INVESTIGATION TREATMENT PROTOCOL
Category ID TYPE AMOUNT
S12 MEDICAL ONCOLOGY S12.12 OESOPHAGEAL CANCER S12.12.5 ESOPHAGEAL CANCER - NEO ADJUVANT - IRINOTECAN & DC 9701 Clinical assessment,HPE,Clinical Photograph,Haematology Case Sheet with treatment details,Clinical Photograph -
CISPLATIN ; DAYS 1, 8, 22, AND 29: IRINOTECAN 65MG/M2 IV,
CISPLATIN 30MG/M2 IV.
S12 MEDICAL ONCOLOGY S12.12 OESOPHAGEAL CANCER S12.12.6 ESOPHAGEAL CANCER - NEO ADJUVANT - CISPLATIN + DC 2501 Clinical assessment,HPE,Clinical Photograph,Haematology Case Sheet with treatment details,Clinical Photograph -
CAPECITABINE ; DAY 1: CISPLATIN 30MG/M2 IV ; DAYS 1-5:
CAPECITABINE 800MG/M2 ORALLY TWICE DAILY ; REPEAT
CYCLE WEEKLY FOR 5 WEEKS
S12 MEDICAL ONCOLOGY S12.13 GASTRIC CANCER S12.13.1 Chemotherapy for Gastric Cancer with 5-Fu Leucovorin IP 5500 Endoscopy,Biopsy,CT-Scan Clinical Photograph -
(Mcdonald Regimen)
S12 MEDICAL ONCOLOGY S12.13 GASTRIC CANCER S12.13.2 Chemotherapy for Gastric Cancer with EOX IP 16511 Case sheet with clinical History,Routine Histopathological Examination,CT Scan Abdomen With Contrast,Upper GI Clinical Photograph,Case Sheet with treatment details,Clinical Photograph,Case Sheet -
endoscopy,Chest X-Ray PA View(1 Film),Case sheet with clinical History,Routine Histopathological Examination,CT with treatment details
Scan Abdomen With Contrast,Upper GI endoscopy,Chest X-Ray PA View(1 Film)

S12 MEDICAL ONCOLOGY S12.13 GASTRIC CANCER S12.13.3 Chemotherapy for Gastric Cancer with IP 17611 Chest X-Ray PA View(1 Film),Routine Histopathological Examination, CT scan Lower Abdomen Without Contrast Clinical Photograph ,Case Sheet with treatment details -
Gemcitabine+Oxaliplatin
S12 MEDICAL ONCOLOGY S12.13 GASTRIC CANCER S12.13.4 Chemotherapy for Gastric Cancer with Gemcitabine / Cisplatin IP 13211 Chest X-Ray PA View(1 Film),Routine Histopathological Examination, CT scan Lower Abdomen Without Contrast Clinical Photograph ,Case Sheet with treatment details -

S12 MEDICAL ONCOLOGY S12.13 GASTRIC CANCER S12.13.5 Chemotherapy for Gastric Cancer with Imatinib(CML) IP 6204 Upper GI endoscopy,Routine Histopathological Examination, Upper GI endoscopy, Chest X-Ray PA View(1 Film), BCR- Clinical Photograph ,Case Sheet with treatment details -
ABL1 Transcripts By Quantitative PCR
S12 MEDICAL ONCOLOGY S12.13 GASTRIC CANCER S12.13.6 Chemotherapy for Gastric Cancer with Dcf IP 19811 Case sheet with clinical History,Routine Histopathological Examination, CT scan Abdomen With Contrast, Chest X- Clinical Photograph ,Case Sheet with treatment details -
Ray PA View(1 Film), Upper GI endoscopy
S12 MEDICAL ONCOLOGY S12.13 GASTRIC CANCER S12.13.7 GASTRIC CANCER - PERIOPERATIVE CHEMOTHERAPY DC 16700 Clinical assessment,HPE,Clinical Photograph,Haematology Case Sheet with treatment details,Clinical Photograph -
(INCLUDING ESOPHAGOGASTRIC JUNCTION) - ECF
(EPIRUBICIN/CISPLATIN/FLUOROURAC IL) ; DAY 1: EPIRUBICIN
50MG/M2 IV, CISPLATIN 60MG/M2 IV ; DAYS 1-21: 5-FU
200MG/M2/DAY IV ; REPEAT CYCLE EVERY 21 DAYS FOR 3
CYCLES PREOPERATIVELY AND 3 CYCLES POSTOPERATIVELY

S12 MEDICAL ONCOLOGY S12.13 GASTRIC CANCER S12.13.8 GASTRIC CANCER - PREOPERATIVE CHEMORADIATION DC 3101 Clinical assessment,HPE,Clinical Photograph,Haematology Case Sheet with treatment details,Clinical Photograph -
(ESOPHAGOGASTRIC JUNCTION AND GASTRIC CARDIA) -
PACLITAXEL + CAPECITABINE ; DAY 1: PACLITAXEL 45-
50MG/M2 IV ; DAYS 1-5: CAPECITABINE 625-825MG/M2
ORALLY TWICE DAILY. ; REPEAT CYCLE WEEKLY FOR 5 WEEKS.

S12 MEDICAL ONCOLOGY S12.13 GASTRIC CANCER S12.13.9 GASTRIC CANCER - PREOPERATIVE CHEMORADIATION DC 25801 Clinical assessment,HPE,Clinical Photograph,Haematology Case Sheet with treatment details,Clinical Photograph -
(ESOPHAGOGASTRIC JUNCTION AND GASTRIC CARDIA) -
FLUOROURACIL & OXALIPLATIN (I)DAYS 1, 15, AND 29:
OXALIPLATIN 85MG/M2 IV ; DAYS 1- 33: 5-FU
180MG/M2/DAY IV.
S12 MEDICAL ONCOLOGY S12.14 COLORECTAL CANCER S12.14.1 Chemotherapy for Colorectal Cancer with Monthly 5-Fu IP 5720 Endoscopy,Biopsy,CT-Scan Clinical Photograph -

S12 MEDICAL ONCOLOGY S12.14 COLORECTAL CANCER S12.14.2 Chemotherapy for Colorectal Cancer with 5-Fluorouracil- IP 12650 Endoscopy,Biopsy,CT-Scan Clinical Photograph -
Oxaliplatin Leucovorin (Folfox) (Stage III) Only

S12 MEDICAL ONCOLOGY S12.14 COLORECTAL CANCER S12.14.3 Chemotherapy for Colorectal Cancer with Capecitabine + IP 7922 CT Scan Abdomen With Contrast Abdomen(Whole),Chest X-Ray PA View(1 Film), Colono Scopy, CEA(Carcino Clinical Photograph ,Case Sheet with treatment details -
bevacizumab (metastatic) Embryonic Antigen) 125
S12 MEDICAL ONCOLOGY S12.14 COLORECTAL CANCER S12.14.4 Chemotherapy for Colorectal Cancer with Capecitabine + IP 13211 CT Scan Abdomen With ContrastAbdomen(Whole),Chest X-Ray PA View(1 Film), Colono Scopy, CEA(Carcino Clinical Photograph ,Case Sheet with treatment details -
Oxalipantia (adjuvant) and metastatic Embryonic Antigen) 125-
S12 MEDICAL ONCOLOGY S12.14 COLORECTAL CANCER S12.14.5 Chemotherapy for Colorectal Cancer with Capacitabine IP 7711 CEA(Carcino Embryonic Antigen),Routine Histopathological Examination, CT Scan Abdomen With Contrast, Chest X- Clinical Photograph ,Case Sheet with treatment details -
Ray PA View(1 Film), Colono Scopy
S12 MEDICAL ONCOLOGY S12.14 COLORECTAL CANCER S12.14.6 ANAL CANAL CANCER - 5-FU + MITOMYCIN ; DAYS 1-4 AND 29- DC 11400 Clinical assessment,HPE,Clinical Photograph,Haematology Case Sheet with treatment details,Clinical Photograph -
32: 5-FU 1,000MG/M2/DAY IV ; DAYS 1 AND 29: MITOMYCIN
10MG/M2 IV BOLUS (MAXIMUM 20MG PER COURSE), WITH
CONCURRENT RADIOTHERAPY
S12 MEDICAL ONCOLOGY S12.15 OSTEOSARCOMA/ BONE TUMORS S12.15.1 Chemotherapy for Bone Tumors with Cisplatin/Adriamycin IP 7700 X-RAY,Biopsy,CT-Scan Clinical Photograph -

S12 MEDICAL ONCOLOGY S12.15 OSTEOSARCOMA/ BONE TUMORS S12.15.2 OTHER BONE TUMORS- MESENCHYMAL CHORDOSARCOMA DC 7601 Clinical assessment,HPE,Clinical Photograph,Haematology Case Sheet with treatment details,Clinical Photograph -
VAIA ; DAY 1: VINCRISTINE 1.5MG/M2 IV ; DAYS 1-3:
IFOSFAMIDE 2,000 MG/M2 IV + MESNA ; DAYS 1, 3, AND 5:
DACTINOMYCIN 0.5MG/M2 IV ; DAYS 2 AND 4: DOXORUBICIN
30MG/M2 IV. ; REPEAT CYCLE EVERY 3 WEEKS.

S12 MEDICAL ONCOLOGY S12.15 OSTEOSARCOMA/ BONE TUMORS S12.15.3 OTHER BONE TUMORS - GIANT CELL TUMOR OF BONE - DC 3501 Clinical assessment,HPE,Clinical Photograph,Haematology Case Sheet with treatment details,Clinical Photograph -
PEGINTERFERON ; PEGINTERFERON ALFA-2A 1.0MCG/KG SQ
INJECTION WEEKLY.
S12 MEDICAL ONCOLOGY S12.15 OSTEOSARCOMA/ BONE TUMORS S12.15.4 OTHER BONE TUMORS - GIANT CELL TUMOR OF BONE - DC 4601 Clinical assessment,HPE,Clinical Photograph,Haematology Case Sheet with treatment details,Clinical Photograph -
INTERFERON ALFA ; INTERFERON ALFA- 2A THRICE WEEKLY

S12 MEDICAL ONCOLOGY S12.15 OSTEOSARCOMA/ BONE TUMORS S12.15.5 OTHER BONE TUMORS - GIANT CELL TUMOR OF BONE - DC 56000 Clinical assessment,HPE,Clinical Photograph,Haematology Case Sheet with treatment details,Clinical Photograph -
DENOSUMAB ; DENOSUMAB 120MG SUBCUTANEOUS ON
WEEK 1,2 AND 3 OF A 4 WEEK CYCLE
S12 MEDICAL ONCOLOGY S12.15 OSTEOSARCOMA/ BONE TUMORS S12.15.6 OTHER BONE TUMORS - CHORDROMA - SUNITINIB ; DC 28501 Clinical assessment,HPE,Clinical Photograph,Haematology Case Sheet with treatment details,Clinical Photograph -
SUNITINIB 37.5MG OD
S12 MEDICAL ONCOLOGY S12.15 OSTEOSARCOMA/ BONE TUMORS S12.15.7 OSTEOSARCOMA/ BONE TUMORS / DEDIFFERENTIATED DC 8300 Clinical assessment,HPE,Clinical Photograph,Haematology Case Sheet with treatment details,Clinical Photograph -
CHONDROSARCOMA - IFOSFAMIDE + CISPLATIN + EPIRUBICIN
; DAY 1: EPIRUBICIN 90MG/M2 IV, CISPLATIN 100MG/M2 IV ;
DAYS 2-4: IFOSFAMIDE 2.0G/M2 WITH MESNA ; REPEAT
CYCLE EVERY 21 DAYS. (3 CYCLES PREOPERATIVELY AND 3
CYCLES POSTOPERATIVELY).

S12 MEDICAL ONCOLOGY S12.16.1 Lymphoma i) Hodgkin Disease S12.16.1.1 Chemotherapy for Bone Tumors - Hodgkin Lymphoma disease IP 5500 Biopsy Clinical Photograph -
with Adriamycin Bleomycin Vinblastine Dacarbazine (Abvd)

S12 MEDICAL ONCOLOGY S12.16.1 Lymphoma i) Hodgkin Disease S12.16.1.2 Relapse Hodgekin Lymphoma Protocol - ICE/DHAP - 3 cycles IP 135000 BIOPSY,LFT,CBP,2D ECHO,PETCT/CECT and BM,LYMPOMA PANEL,IHC RFT -
are allowed
S12 MEDICAL ONCOLOGY S12.16.2 Lymphoma ii) NHL S12.16.2.1 Chemotherapy for Non Hodgkin Lymphoma with IP 4950 Biopsy Clinical Photograph -
Cyclophosphamide Adriamycin Vincristine Prednisone (Chop)

S12 MEDICAL ONCOLOGY S12.16.2 Lymphoma ii) NHL S12.16.2.2 Chemotherapy for Non Hodgkin Lymphoma with R - chop IP 49511 IHC,CT Scan Lower Abdomen With Contrast, CT local Area , CT Scan Neck (Thyroid,Parathyroid,Softtissues)With Clinical Photograph ,Case Sheet with treatment details -
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
S12 MEDICAL ONCOLOGY S12.16.2 Lymphoma ii) NHL S12.16.2.3 Relapse Non- Hodgekin LymphomaProtocol - RICE/RDHAP - 3 IP 150000 BIOPSY,LFT,CBP,2D ECHO,PETCT/CECT and BM,LYMPOMA PANEL,IHC RFT -
cycles are allowed
S12 MEDICAL ONCOLOGY S12.16.2 Lymphoma ii) NHL S12.16.2.4 Burkitts Lymphoma - 6 cycles allowed IP 150000 BIOPSY,RFT,LFT,CBP,2D ECHO,PETCT,LYMPOMA PANEL,IHC - -
S12 MEDICAL ONCOLOGY S12.16.2 Lymphoma ii) NHL S12.16.2.5 Paeditric burkitts/ DLBCL lymphoma: LMB Protocol / IP 125000 BONE MARROW ASPIRATION,BONE MARROW BIOSPY,CT-CHEST AND ABDOMEN WITH CONTRAST,FLOW PETCT -
MCGRATH protocol - 4 cycles allowed CYTOMETRY,HISTOPATHOLOGY
S12 MEDICAL ONCOLOGY S12.16.2 Lymphoma ii) NHL S12.16.2.6 Paediatric ALCL : BFM NHL Protocol - 6 cycles allowed IP 80000 FLOW CYTOMETRY,LFT,RFT,CBP,BIOPSY,BMA KARYOTYPING -
S12 MEDICAL ONCOLOGY S12.17 MULTIPLE MYELOMA S12.17.1 Chemotherapy for Multiple Myeloma with Vincristine, IP 30000 Heamatology Clinical Photograph -
Adriamycin,Dexamethasone(Vad)
S12 MEDICAL ONCOLOGY S12.17 MULTIPLE MYELOMA S12.17.2 Chemotherapy for Bortezomib + lenalidomid + IP 25000 Heamatology Clinical Photograph -
dexamethasone for every 3 weeks up to one year.
S12 MEDICAL ONCOLOGY S12.17 MULTIPLE MYELOMA S12.17.3 Chemotherapy for Multiple Myeloma with Melphalan IP 4950 Heamatology Clinical Photograph -
Prednisone (Oral)

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CODE MAIN CATEGORY Sub SUB CATEGORY NAME CODE SURGERY / THERAPY DESCRIPTION PROCEDURE PACKAGE SPECIAL INVESTIGATION POST OPERATIVE PROCEDURE INVESTIGATION TREATMENT PROTOCOL
Category ID TYPE AMOUNT
S12 MEDICAL ONCOLOGY S12.17 MULTIPLE MYELOMA S12.17.4 Multiple Myeloma Bortezomib+ cyclophosphamide+ IP 10000 Clinical assessment Chemotherapy drug batch number with bar code -
dexamethasone, per cycle x 6
S12 MEDICAL ONCOLOGY S12.17 MULTIPLE MYELOMA S12.17.5 Multiple Myeloma Bortezomib + dexamethasone, per cycle x 9 IP 6000 Clinical assessment Chemotherapy drug batch number with bar code -

S12 MEDICAL ONCOLOGY S12.18 WILM¿S TUMOR S12.18.1 Chemotherapy for Wilms Tumor with Siopwts Regimen(Stages IP 7700 USG,Biopsy,CT Clinical Photograph -
I-III)
S12 MEDICAL ONCOLOGY S12.19 HEPATOBLASTOMA- OPERABLE S12.19.1 Chemotherapy for Hepatoblastoma operable with Cisplatin - IP 5500 USG,Biopsy,CT Clinical Photograph -
Adriamycin
S12 MEDICAL ONCOLOGY S12.19 HEPATOBLASTOMA- OPERABLE S12.19.2 Chemotherapy Chemotherapy for Hepatoblastoma operable IP 11011 USG local area,Alpha Feto Protiens Levels, Routine Histopathological Examination, LFT(liver function tests) Case Sheet with operation Notes -
with Sorafenib
S12 MEDICAL ONCOLOGY S12.19 HEPATOBLASTOMA- OPERABLE S12.19.3 Chemotherapy for Hepatoblastoma with super plado - for IP 5000 RFT,LFT,CBP,CXR,CECT ABDOMEN,IHC,BIOPSY,VIRAL MARKERS - -
every 15 days upto 6 cycles
S12 MEDICAL ONCOLOGY S12.2 CERVICAL CANCER S12.2.1 Chemotherapy for Cervical Cancer with Weekly Cisplatin IP 2200 USG,Biopsy Clinical Photograph -

S12 MEDICAL ONCOLOGY S12.2 CERVICAL CANCER S12.2.2 CervixCisplatin/Carboplatin (AUC2) along with RT- max 6 IP 5000 Biopsy/CT Chemotherapy drug batch number with bar code -
cycles (Per cycle)
S12 MEDICAL ONCOLOGY S12.20 CHILDHOOD B CELL LYMPHOMAS S12.20.1 Chemotherapy for Childhood B cell Lymphoma with variable IP 20524 Heamatology Clinical Photograph -
regimen
S12 MEDICAL ONCOLOGY S12.21 NEUROBLASTOMA ( STAGES I-III ) S12.21.1 Chemotherapy for Neuroblastoma (Stages I-III ) with Variable IP 11000 CT,Biopsy Clinical Photograph -
Regimen
S12 MEDICAL ONCOLOGY S12.21 NEUROBLASTOMA ( STAGES I-III ) S12.21.2 Chemotherapy for Neuroblastoma (Stages I-III ) PCV IP 5511 Case sheet with clinical History,Routine Histopathological Examination, CT Scan Head With Contrast, Chest X-Ray PA Case Sheet with operation Notes -
(medulloblastoma) View(1 Film)
S12 MEDICAL ONCOLOGY S12.22 RETINOBLASTOMA S12.22.1 Chemotherapy for Retinoblastoma with IP 5500 Biopsy Clinical Photograph -
Carbo/Etoposide/Vincristine
S12 MEDICAL ONCOLOGY S12.23 HISTIOCYTOSIS S12.23.1 Chemotherapy for Histiocytosis with Variable Regimen IP 5500 Heamatology,Biopsy Clinical Photograph -
S12 MEDICAL ONCOLOGY S12.23 HISTIOCYTOSIS S12.23.2 HISTIOCYTOSIS - OTHER REGIMEN (MAY BE CHOSEN FOR ANY DC 10000 Clinical assessment,HPE,Clinical Photograph,Haematology Case Sheet with treatment details,Clinical Photograph -
OTHER INTERNATIONALLY APPROVED CURATIVE REGIMEN
WITH SUBMISSION OF SUBSTANTIATING DOCUMENTS)

S12 MEDICAL ONCOLOGY S12.23 HISTIOCYTOSIS S12.23.3 HISTIOCYTOSIS - PREDNISOLONE AND VINBLASTINE - DC 1800 Clinical assessment,HPE,Clinical Photograph,Haematology Case Sheet with treatment details,Clinical Photograph -
CONTINUATION; PREDNISOLONE AND VINBLASTINE -
CONTINUATION AFTER EITHER COURSE 1 OR BOTH 1 & 2 ;
PREDNISOLONE - 5 DAYS A WEEK ORAL ; VINBLASTINE -IV ;
REPEAT EVERY 3 WEEKS TILL 1 YEAR
S12 MEDICAL ONCOLOGY S12.23 HISTIOCYTOSIS S12.23.4 HISTIOCYTOSIS - PREDNISOLONE AND VINBLASTINE - 2; DC 6801 Clinical assessment,HPE,Clinical Photograph,Haematology Case Sheet with treatment details,Clinical Photograph -
PREDNISOLONE AND VINBLASTINE - 1; PREDNISOLONE - 6
WEEKS ORAL ; VINBLASTINE 1,2,3,4,5,6
S12 MEDICAL ONCOLOGY S12.23 HISTIOCYTOSIS S12.23.5 HISTIOCYTOSIS - PREDNISOLONE AND VINBLASTINE - 1; DC 6100 Clinical assessment,HPE,Clinical Photograph,Haematology Case Sheet with treatment details,Clinical Photograph -
PREDNISOLONE AND VINBLASTINE - 1; PREDNISOLONE - 6
WEEKS ORAL ; VINBLASTINE 1,2,3,4,5,6
S12 MEDICAL ONCOLOGY S12.24 RHABDOMYOSARCOMA S12.24.1 Chemotherapy for Rhabdomyosarcoma with Vincristine- IP 9900 Biopsy Clinical Photograph -
Actinomycin-Cyclophosphamide(Vactc) Based Chemo

S12 MEDICAL ONCOLOGY S12.25 EWINGS SARCOMA S12.25.1 Chemotherapy for Ewings Sarcoma with Variable Regimen IP 5500 X-RAY,Biopsy,CT-Scan Clinical Photograph -

S12 MEDICAL ONCOLOGY S12.26 ACUTE MYELOID LEUKEMIA S12.26.1 Chemotherapy for Acute Myeloid Leukaemia with Induction IP 330000 Heamatology,Heamatology Clinical Photograph,Clinical Photograph -
Phase for one time only
S12 MEDICAL ONCOLOGY S12.26 ACUTE MYELOID LEUKEMIA S12.26.2 Chemotherapy for Acute Myeloid Leukemia with IP 150000 - Clinical Photograph,Clinical Photograph -
Consolidation Phase
S12 MEDICAL ONCOLOGY S12.26 ACUTE MYELOID LEUKEMIA S12.26.3 Chemotherapy for Acute Myeloid Leukemia with Maintenance IP 3079 - Clinical Photograph,Clinical Photograph -
phase
S12 MEDICAL ONCOLOGY S12.26 ACUTE MYELOID LEUKEMIA S12.26.4 AML ealderly (more than 60 yrs) / not fit for intensive IP 80000 FLOW CYTOMETRY,LFT,RFT,CBP,BIOPSY,BMA,FLOW CYTOMETRY,LFT,RFT,CBP,BIOPSY,BMA KARYOTYPING,KARYOTYPING -
theraphy; Decitabine / azacytidine
S12 MEDICAL ONCOLOGY S12.26 ACUTE MYELOID LEUKEMIA S12.26.5 APML- Induction IP 370000 FLOWCYTOMETRY,KARYOTYPING,LFT,RFT,CBP,BMA+ BIOPSY - -
S12 MEDICAL ONCOLOGY S12.26 ACUTE MYELOID LEUKEMIA S12.26.5.1 APML - Consolidation - 4 cycles allowed IP 60000 - - -
S12 MEDICAL ONCOLOGY S12.27 ACUTE LYMPHOBLASTIC LEUKEMIA S12.27.1.1 Chemotherapy for Acute Lymphoblastic Leukaemia with IP 150000 Heamatology,Heamatology Clinical Photograph,Clinical Photograph -
Induction 1st And 2nd Months for (<15 years) one time only

S12 MEDICAL ONCOLOGY S12.27 ACUTE LYMPHOBLASTIC LEUKEMIA S12.27.1.1.1 Chemotherapy for Acute Lymphoblastic Leukaemia with IP 250000 Haematology Flowcytometry Cytogenetic test Bone Marrow test. Clinical Photograph -
Induction 1st And 2nd Months for (15 to 25 years) one time
only
S12 MEDICAL ONCOLOGY S12.27 ACUTE LYMPHOBLASTIC LEUKEMIA S12.27.1.1.2 Chemotherapy for Acute Lymphoblastic Leukaemia with IP 270000 Haematology Flowcytometry Cytogenetic test Bone Marrow test. Clinical Photograph -
Induction 1st And 2nd Months for (> 25 years) one time only

S12 MEDICAL ONCOLOGY S12.27 ACUTE LYMPHOBLASTIC LEUKEMIA S12.27.1.2 Chemotherapy for Acute Lymphoblastic Leukemia with IP 21000 Heamatology,Heamatology Clinical Photograph,Clinical Photograph -
Induction 3rd, 4th, 5th
S12 MEDICAL ONCOLOGY S12.27 ACUTE LYMPHOBLASTIC LEUKEMIA S12.27.1.2.1 Chemotherapy for Acute Lymphoblastic Leukaemia with IP 25000 Haematology Clinical Photograph -
Induction 3rd 4th 5thfor (15 to 25 years) one time only

S12 MEDICAL ONCOLOGY S12.27 ACUTE LYMPHOBLASTIC LEUKEMIA S12.27.1.2.2 Chemotherapy for Acute Lymphoblastic Leukaemia with IP 30000 Haematology Clinical Photograph -
Induction 3rd 4th 5th for (> 25 years) one time only

S12 MEDICAL ONCOLOGY S12.27 ACUTE LYMPHOBLASTIC LEUKEMIA S12.27.1.3 Chemotherapy for Acute Lymphoblastic Leukemia with IP 13200 Heamatology,Heamatology Clinical Photograph,Clinical Photograph -
Induction Maintenance
S12 MEDICAL ONCOLOGY S12.27 ACUTE LYMPHOBLASTIC LEUKEMIA S12.27.1.4 Acute Lymphatic LeukemiaMaintenance Phase - Per month (x DC 5000 Hematology/Clinical assessment,Hematology/Clinical assessment Chemotherapy drug batch number with bar code,Chemotherapy drug batch number -
24) with bar code
S12 MEDICAL ONCOLOGY S12.27 ACUTE LYMPHOBLASTIC LEUKEMIA S12.27.1.4.1 Chemotherapy for Acute Lymphoblastic Leukaemia with Re- IP 60000 Haematology Flowcytometry Cytogenetic test Bone Marrow test. Clinical Photograph -
Induction for (< 15 years) one time only
S12 MEDICAL ONCOLOGY S12.27 ACUTE LYMPHOBLASTIC LEUKEMIA S12.27.1.4.2 Chemotherapy for Acute Lymphoblastic Leukaemia with Re- IP 80000 Haematology Flowcytometry Cytogenetic test Bone Marrow test. Clinical Photograph -
Induction for (15 to 25 years) one time only
S12 MEDICAL ONCOLOGY S12.27 ACUTE LYMPHOBLASTIC LEUKEMIA S12.27.1.4.3 Chemotherapy for Acute Lymphoblastic Leukaemia with Re- IP 80000 Haematology Flowcytometry Cytogenetic test Bone Marrow test. Clinical Photograph -
Induction for (> 25 years) one time only
S12 MEDICAL ONCOLOGY S12.28 FOR UNLISTED REGIMEN S12.28.1 Palliative Chemotherapy for unlisted Regimen IP 5500 USG,Biopsy,CT Clinical Photograph -
S12 MEDICAL ONCOLOGY S12.29 Acute Lymphoblastic Leukemia - S12.29.1 Palliative And Supportive Therapy for terminally ill cancer IP 3300 USG,Biopsy,CT Clinical Photograph -
For Terminally ill Cancer Patient patient

S12 MEDICAL ONCOLOGY S12.3 VULVAL CANCER S12.3.1 Chemotherapy for Vulval Cancer with Cisplatin/5-Fu IP 5500 Clinical Photograph,Biopsy Clinical Photograph -
S12 MEDICAL ONCOLOGY S12.30 Colo Rectal Cancer Stage 2 and 3 S12.30.1 Chemotherapy for Acute Myeloid Leukemia with Xelox Along IP 12314 Tissue Biospy,CT-Abdomen + Pelvis,Photograph USG,Biochemical Investigations,Biopsy,CT -
With Adjuvant Chemotherapy Of As-I
S12 MEDICAL ONCOLOGY S12.31 MULTIPLE MYELOMA S12.31.1 Chemotherapy for Multiple myeloma with Zoledronic Acid IP 3300 Urine for Bence Jones protein,2D ECHO,Biopsy,Bone marrow aspiration,S.Electrolytes,SIEP,Skeltal survey USG,Biochemical Investigations,Biopsy,CT -
Along With Adjuvant Chemotherapy Of As-I
S12 MEDICAL ONCOLOGY S12.31 MULTIPLE MYELOMA S12.31.2 Chemotherapy for Multiple myeloma with Lenalidomide dexa IP 11011 Complete Blood Picture [CBP] ,Bone Marrow Profile/Routine Histopathological Examination, Bence Jones Protein In Case Sheet with operation Notes -
Urine, Protein Electrophoresis, Renal Profile
S12 MEDICAL ONCOLOGY S12.31 MULTIPLE MYELOMA S12.31.3 Chemotherapy for Multiple myeloma with MPT(myeloma) IP 5907 Skeletal Survey Protein Electrophoresis,Bence Jones Protein In Urine Case Sheet with operation Notes -

S12 MEDICAL ONCOLOGY S12.31 MULTIPLE MYELOMA S12.31.4 Chemotherapy for Multiple myeloma with Imatinib (GSIT) IP 7193 USG local area Case Sheet with operation Notes -

S12 MEDICAL ONCOLOGY S12.31 MULTIPLE MYELOMA S12.31.5 Myloma autologous HSCT IP 650000 FLOW CYTOMETRY,RFT,PFT,Echo,b2 MIC,MRI-SPINE (OR) PET,CT-SCAN WITH CYTOGENIC TEST,FREE LIGHT Triple cultures -
CHAINS,SERUM AND URINE IMMUNOFIXATION ELECTROPHOROSIS,SERUM PROTEIN ELECTROPHORESIS

S12 MEDICAL ONCOLOGY S12.32 FEBRILE NEUTROPENIA S12.32.1 Chemotherapy for Febrile Neutropenia with 1st Line Iv IP 6000 X-Ray Chest,Blood CandS,Tissue Biospy USG,Biochemical Investigations,Biopsy,CT -
Antibiotics And Other Supportive Therapy ( Third Generation
Cephalosporin, Aminoglycoside Etc.,)

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CODE MAIN CATEGORY Sub SUB CATEGORY NAME CODE SURGERY / THERAPY DESCRIPTION PROCEDURE PACKAGE SPECIAL INVESTIGATION POST OPERATIVE PROCEDURE INVESTIGATION TREATMENT PROTOCOL
Category ID TYPE AMOUNT
S12 MEDICAL ONCOLOGY S12.32 FEBRILE NEUTROPENIA S12.32.2 Chemotherapy for Febrile Neutropenia with 2nd Line Iv IP 48000 X-Ray Chest,Blood CandS,Tissue Biospy USG,Biochemical Investigations,Biopsy,CT -
Antibiotics And Other Supportive Therapy(Carbapenems,
Fourth Generation Cephalosporins, Piperacillin, Anti-Fungal .
Azoles Etc.,)
S12 MEDICAL ONCOLOGY S12.33 CHRONIC LYMPHOID LEUKAMIA S12.33.1 Chemotherapy for Chronic lymphoid leukemia with IP 17611 Immuno pheno typing,Bone Marrow Aspiration,Renal Profile,Complete Blood Picture [CBP],LFT(liver function Case Sheet with operation Notes ,Clinical Photograph -
Benadamustine tests),Abdomen X-Ray (Lateral View),USG Abdomen
S12 MEDICAL ONCOLOGY S12.33 CHRONIC LYMPHOID LEUKAMIA S12.33.2 Chemotherapy for Chronic lymphoid leukemia with IP 3311 Immuno pheno typing,Bone Marrow Aspiration,Renal Profile,Complete Blood Picture [CBP],LFT(liver function tests) Case Sheet with operation Notes ,Clinical Photograph -
Chilorambucil
S12 MEDICAL ONCOLOGY S12.33 CHRONIC LYMPHOID LEUKAMIA S12.33.3 Chemotherapy for Chronic lymphoid leukemia with IA IP 10272 Chest X-Ray Lateral View(1 Film),LFT(liver function tests),Routine Histopathological Examination, CT local area Case Sheet with operation Notes ,Clinical Photograph -
without contrast,Chest X-Ray PA View(1 Film)
S12 MEDICAL ONCOLOGY S12.33 CHRONIC LYMPHOID LEUKAMIA S12.33.4 Chemotherapy for Chronic lymphoid leukemia with IP 7711 Bone Marrow Aspiration/ Routine HistopathologicalExamination Case Sheet with operation Notes,Routine Histopathological Examination,CT local area -
Imatinib(CML) without contrast,USG local area
S12 MEDICAL ONCOLOGY S12.33 CHRONIC LYMPHOID LEUKAMIA S12.33.5 Chemotherapy for Chronic lymphoid leukemia with Sunitinib IP 15403 Chest X-Ray Lateral View(1 Film),LFT(liver function tests),USG local area,Chest X-Ray PA View(1 Film) Clinical Photograph -

S12 MEDICAL ONCOLOGY S12.34 BRAIN TUMORS S12.34.1 Chemotherapy With Temozolamide (brain tumours) IP 11011 MRI Brain with contrast,Routine Histopathological Examination,CT Brain Plain and Contrast Case Sheet with operation Notes ,Clinical Photograph -
S12 MEDICAL ONCOLOGY S12.34 BRAIN TUMORS S12.34.10 BRAIN CARCINOMA - PRIMARY CNS LYMPHOMA - HIGH DOSE DC 32401 Clinical Photograph,Haematology,Clinical assessment,HPE Case Sheet with treatment details,Clinical Photograph -
METHOTREXATE MAINTANANCE (CYCLES 1-4) ; DAY 1: MTX
8G/M2 IV, RITUXIMAB 375MG/M2 IV. ; REPEAT EVERY 4
WEEKS FOR 4 CYCLES
S12 MEDICAL ONCOLOGY S12.34 BRAIN TUMORS S12.34.11 BRAIN CARCINOMA - PRIMARY CNS LYMPHOMA - HIGH DOSE DC 7900 Clinical assessment,HPE,Clinical Photograph,Haematology Case Sheet with treatment details,Clinical Photograph -
METHOTREXATE CONSOLIDATION ; MTX 8G/M2 IV
ADMINISTERED ; REPEAT EVERY 2 WEEKS FOR 2 CYCLES.
S12 MEDICAL ONCOLOGY S12.34 BRAIN TUMORS S12.34.12 BRAIN CARCINOMA - PRIMARY CNS LYMPHOMA - HIGH DOSE DC 7900 Clinical assessment,HPE,Clinical Photograph,Haematology Case Sheet with treatment details,Clinical Photograph -
METHOTREXATE INDUCTION ; MTX 8G/M2 IV ; REPEAT EVERY
2 WEEKS UNTIL COMPLETE RESPONSE ACHIEVED OR MAX OF
8 CYCLES REACHED. ;
S12 MEDICAL ONCOLOGY S12.34 BRAIN TUMORS S12.34.13 BRAIN CARCINOMA - PRIMARY CNS LYMPHOMA - RITUXIMAB DC 41900 Clinical assessment,HPE,Clinical Photograph,Haematology Case Sheet with treatment details,Clinical Photograph -
+ MTX + VINCRISTINE +PROCARBAZINE ; DAY 1: RITUXIMAB
500MG/M2 IV ; DAY 2: MTX 3.5MG/M2 IV PLUS VINCRISTINE
1.4MG/M2 ; PROCARBAZINE 100MG/M2/DAY ADMINISTERED
FOR 7 DAYS WITH ODD-NUMBERED CYCLES

S12 MEDICAL ONCOLOGY S12.34 BRAIN TUMORS S12.34.14 BRAIN CARCINOMA - PRIMARY CNS LYMPHOMA - HIGH DOSE DC 9501 Clinical assessment,HPE,Clinical Photograph,Haematology Case Sheet with treatment details,Clinical Photograph -
METHOTREXATE + LEUCOVORIN + IFOSFAMIDE + MESNA ;
DAY 1: MTX 4GM/M2 IV, ; DAYS 2-5: LEUCOVORIN 20-25MG
IV (UPTO 40MG) ; DAYS 3-5: IFOSFAMIDE 1.5GM/M2 IV +
MESNA 400MG IV
S12 MEDICAL ONCOLOGY S12.34 BRAIN TUMORS S12.34.15 BRAIN CARCINOMA - PRIMARY CNS LYMPHOMA - HIGH DOSE DC 6601 Clinical assessment,HPE,Clinical Photograph,Haematology Case Sheet with treatment details,Clinical Photograph -
METHOTREXATE + CYTARABINE ; DAY 1: MTX 3.5G/M2 ; DAYS
2-3: CYTARABINE 2G/M2 IV TWICE A DAY.

S12 MEDICAL ONCOLOGY S12.34 BRAIN TUMORS S12.34.16 BRAIN CARCINOMA - SYSTEMIC THERAPY FOR ANAPLASTIC DC 3800 Clinical assessment,HPE,Clinical Photograph,Haematology Case Sheet with treatment details,Clinical Photograph -
GLIOMAS - PCV FOR 1P19Q CO-DELETED (WITH
RADIOTHERAPY) ; DAY 1: LOMUSTINE 110MG/M2 ORALLY ;
DAYS 8-21: PROCARBAZINE 60MG/M2 ORALLY ONCE DAILY ;
DAYS 8 AND 29: VINCRISTINE 1.4MG/M2 (MAXIMUM 2MG)
IV. ; REPEAT EVERY 6 WEEKS. FOR 6 CYCLES

S12 MEDICAL ONCOLOGY S12.34 BRAIN TUMORS S12.34.17 BRAIN CARCINOMA - SYSTEMIC THERAPY FOR ANAPLASTIC DC 3800 Clinical assessment,HPE,Clinical Photograph,Haematology Case Sheet with treatment details,Clinical Photograph -
GLIOMAS - PCV WITH DEFERRED RT (LOMUSTINE +
PROCARBAZINE + VINCRISTINE) ; DAY 1: LOMUSTINE
110MG/M2 ORALLY ; DAYS 8-21: PROCARBAZINE 60MG/M2
ORALLY ONCE DAILY ; DAYS 8 AND 29: VINCRISTINE
1.4MG/M2 (MAXIMUM 2MG) IV. ; REPEAT EVERY 6 WEEKS

S12 MEDICAL ONCOLOGY S12.34 BRAIN TUMORS S12.34.2 PRIMITIVE NEURO ECTODERMAL TUMOR - OTHER REGIMEN DC 10000 Clinical assessment,HPE,Clinical Photograph,Haematology Case Sheet with treatment details,Clinical Photograph -
(MAY BE CHOSEN FOR ANY OTHER INTERNATIONALLY
APPROVED CURATIVE REGIMEN WITH SUBMISSION OF
SUBSTANTIATING DOCUMENTS)
S12 MEDICAL ONCOLOGY S12.34 BRAIN TUMORS S12.34.3 PRIMITIVE NEURO ECTODERMAL TUMOR - VINCRISTINE + DC 4401 Clinical assessment,HPE,Clinical Photograph,Haematology Case Sheet with treatment details,Clinical Photograph -
CISPLATIN + LOMUSTINE ; DURING CRANIOSPINAL
RADIOTHERAPY (RT) ; DAY 1: LOMUSTINE 75MG/M2 ORALLY ;
DAY 2: CISPLATIN 75MG/M2 IV ; DAYS 2, 8 AND 15:
VINCRISTINE 1.5MG/M2 IV BOLUS, MAX 2MG BOLUS; UP TO
MAX 8 DOSES
S12 MEDICAL ONCOLOGY S12.34 BRAIN TUMORS S12.34.4 PRIMITIVE NEURO ECTODERMAL TUMOR - WEEKLY DC 1701 Clinical assessment,HPE,Clinical Photograph,Haematology Case Sheet with treatment details,Clinical Photograph -
VINCRISTINE ; VINCRISTINE 1.5MG/M2 IV, MAX 2MG ; FOR 5
TO 6 WEEKS
S12 MEDICAL ONCOLOGY S12.34 BRAIN TUMORS S12.34.5 BRAIN CARCINOMA - MENINGIOMA - SUNITINIB ; DAYS 1-28: DC 2901 Clinical assessment,HPE,Clinical Photograph,Haematology Case Sheet with treatment details,Clinical Photograph -
SUNITINIB 50MG ORALLY DAILY. ; REPEAT CYCLE EVERY 42
DAYS.
S12 MEDICAL ONCOLOGY S12.34 BRAIN TUMORS S12.34.6 BRAIN CARCINOMA - MENINGIOMA -SOMATOSTATIN DC 5401 Clinical assessment,HPE,Clinical Photograph,Haematology Case Sheet with treatment details,Clinical Photograph -
ANALOG ; SANDOSTATIN LAR DEPOT 10-30MG IM ; REPEAT
EVERY 4 WEEKS. ;
S12 MEDICAL ONCOLOGY S12.34 BRAIN TUMORS S12.34.7 BRAIN CARCINOMA - PRIMARY CNS LYMPHOMA - RITUXIMAB DC 1600 Clinical assessment,HPE,Clinical Photograph,Haematology Case Sheet with treatment details,Clinical Photograph -
+ TEMOZOLOMIDE REGIMEN - MAINTANANCEDAYS 1-5:
TEMOZOLOMIDE 150-200MG/M2 ORALLY DAILY. ; REPEAT
CYCLE EVERY 4 WEEKS FOR 8 CYCLES.

S12 MEDICAL ONCOLOGY S12.34 BRAIN TUMORS S12.34.8 CM0128-V-D-1 : BRAIN CARCINOMA - PRIMARY CNS DC 26601 Clinical assessment,HPE,Clinical Photograph,Haematology Case Sheet with treatment details,Clinical Photograph -
LYMPHOMA - RITUXIMAB + TEMOZOLOMIDE REGIMEN -
INDUCTION ; DAY 1: RITUXIMAB 375MG/M2 IV, FOLLOWED
BY ; DAYS 1-5: TEMOZOLOMIDE 150-200MG/M2 ORALLY
DAILY, AFTER RITUXIMAB INFUSION. ; REPEAT CYCLE EVERY 4
WEEKS FOR 4 CYCLES.

S12 MEDICAL ONCOLOGY S12.34 BRAIN TUMORS S12.34.9 BRAIN CARCINOMA - PRIMARY CNS LYMPHOMA - HIGH DOSE DC 7900 Clinical assessment,HPE,Clinical Photograph,Haematology Case Sheet with treatment details,Clinical Photograph -
METHOTREXATE MAINTANANCE (CYCLES 5-11) ; MTX 8G/M2
IV ADMINISTERED EVERY 4 WEEKS FOR 11 CYCLES. ; REPEAT
CYCLE EVERY 4 WEEKS FOR 4 CYCLES
S12 MEDICAL ONCOLOGY S12.35 OTHERS S12.35.1 Chemotherapy With Benadamustin -RITUXIMAB IP 66011 Complete Blood Picture [CBP],CT Scan with Abdomen with contrast,LFT(liver function tests),Routine Case Sheet with operation Notes ,Clinical Photograph -
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,Renal Profile

S12 MEDICAL ONCOLOGY S12.35 OTHERS S12.35.10 Gemcitabine + Cisplatin - 6 cycles allowed IP 12000 BIOPSY,RFT,CBP,usg abdomen,cxr,cect,IHC LFT -
S12 MEDICAL ONCOLOGY S12.35 OTHERS S12.35.11 Pemetrexed + carboplatin - for every 3 weeks upto 6 cycles IP 20010 BIOPSY,usg abdomen,RFT,CBP,cxr,cect,IHC LFT -

S12 MEDICAL ONCOLOGY S12.35 OTHERS S12.35.12 Dose Dense AC (includes growth factor + apprepitant; Once in IP 10000 BIOPSY,LFT,RFT,2D ECHO,ULTRA SOUND ABDOMEN,CHEST X-RAY,IHC CBP -
two weeks) - upto 4 cycles
S12 MEDICAL ONCOLOGY S12.35 OTHERS S12.35.13 Dose Dense Paclitaxel (includes growth factor ; Once in two IP 13000 BIOPSY,LFT,RFT,2D ECHO,ULTRA SOUND ABDOMEN,CHEST X-RAY,IHC CBP -
weeks) - upto 4 cycles
S12 MEDICAL ONCOLOGY S12.35 OTHERS S12.35.14 Chemotherapy for NET Pancreas with octreotide depot - for IP 30000 Biopsy,RFT,CBP,PETCT,somatostatin receptor,IHC - -
every 4 weeks for a period of one year
S12 MEDICAL ONCOLOGY S12.35 OTHERS S12.35.15 auto transplant for lymphomas IP 935000 BIOPSY,CMV,TRIPLE CULTURES,,VIRAL MARKERS,RFT,LFT,CBP,2D ECHO,PETCT,LYMPOMA PANEL,IHC HSV -
S12 MEDICAL ONCOLOGY S12.35 OTHERS S12.35.16 Lymphoma workup IP 20000 CLINICAL NOTES CLINICAL PHOTOS -
31 of 47
CODE MAIN CATEGORY Sub SUB CATEGORY NAME CODE SURGERY / THERAPY DESCRIPTION PROCEDURE PACKAGE SPECIAL INVESTIGATION POST OPERATIVE PROCEDURE INVESTIGATION TREATMENT PROTOCOL
Category ID TYPE AMOUNT
S12 MEDICAL ONCOLOGY S12.35 OTHERS S12.35.17 Transplant for paediatric solid cancers (EWS, Neuro blastoma, IP 650000 RFT,HSV,PET,CT-CHEST AND ABDOMEN WITH CONTRAST,CMV,HEPATITIS -B CORE ANTIGEN,CBP,TRIPLE PFT,2D ECHO -
Wilms tumour, RMS, Germcell tumour; CULTURES(BLOOD,URINE),VIRAL MARKERS,LFT
S12 MEDICAL ONCOLOGY S12.35 OTHERS S12.35.18 Myelo Displastic Syndrome - 6 cycles allowed IP 40000 FLOWCYTOMETRY,KARYOTYPING,LFT,RFT,CBP,BMA+ BIOPSY - -
S12 MEDICAL ONCOLOGY S12.35 OTHERS S12.35.19 Pet scan only for hodgkin and non hodgkin lymphoma (Only IP 15000 BIOPSY,CBP,IHC RFT -
two pet scans) in entire course. - Maximum 2 pet scans are
allowed
S12 MEDICAL ONCOLOGY S12.35 OTHERS S12.35.2 Chemotherapy With TIP (GCT 2nd line) IP 22011 CT Scan with Abdomen with contrast,Beta HCG(Human Chorionic Gonadotropin) Levels,Alpha Feto Protiens Case Sheet with operation Notes ,Clinical Photograph -
Levels,Lactate Dehydrogenase (LDH),CT Scan Chest With Contrast
S12 MEDICAL ONCOLOGY S12.35 OTHERS S12.35.20 UNKNOWN PRIMARY - ADENOCARCINOMA - IRINOTECAN + DC 7700 Clinical assessment,HPE,Clinical Photograph,Haematology Chemotherapy drug batch number with bar code -
CARBOPLATIN ; DAY 1: CARBOPLATIN AUC 5MG PER MIN/ML
IV ; DAYS 1, 8, AND 15: IRINOTECAN 60MG/M2 IV. ; REPEAT
CYCLE EVERY 4 WEEKS FOR UP TO 6 CYCLES

S12 MEDICAL ONCOLOGY S12.35 OTHERS S12.35.21 RENAL CELL CARCINOMARENAL CELL CARCINOMA - SYSTEMIC DC 66250 Clinical assessment,HPE,Clinical Photograph,Haematology Chemotherapy drug batch number with bar code -
THERAPY FOR PATIENTS WITH NON-CLEAR CELL HISTOLOGY -
BEVACIZUMAB ; BEVACIZUMAB 10MG/KG IV EVERY 2 WEEKS.

S12 MEDICAL ONCOLOGY S12.35 OTHERS S12.35.22 RENAL CELL CARCINOMARENAL CELL CARCINOMA - DC 37250 Clinical assessment,HPE,Clinical Photograph,Haematology Chemotherapy drug batch number with bar code -
SUBSEQUENT THERAPY FOR PATIENTS WITH
PREDOMINANTLY CLEAR CELL CARCINOMA - EVEROLIMUS ;
EVEROLIMUS 10MG ORALLY ONCE DAILY
S12 MEDICAL ONCOLOGY S12.35 OTHERS S12.35.23 MELPHALAN / PREDNISOLONE/THALIDOMIDE(MPT) DC 2258 Clinical assessment,HPE,Clinical Photograph,Haematology Chemotherapy drug batch number with bar code -
S12 MEDICAL ONCOLOGY S12.35 OTHERS S12.35.24 MELPHALAN + PREDNISOLONE DC 1138 Clinical assessment,HPE,Clinical Photograph,Haematology Chemotherapy drug batch number with bar code -
S12 MEDICAL ONCOLOGY S12.35 OTHERS S12.35.25 MELPHALAN DC 3901 Clinical assessment,HPE,Clinical Photograph,Haematology Chemotherapy drug batch number with bar code -
S12 MEDICAL ONCOLOGY S12.35 OTHERS S12.35.26 DEXAMETHASONE + THALIDOMIDE + CISPLATIN + DC 7725 Clinical assessment,HPE,Clinical Photograph,Haematology Chemotherapy drug batch number with bar code -
DOXORUBICIN + CYCLOPHOSPHAMIDE + ETOPOSIDE (DT-
PACE)
S12 MEDICAL ONCOLOGY S12.35 OTHERS S12.35.27 DEXAMETHASONE + CYCLOPHOSPHAMIDE + ETOPOSIDE + DC 5764 Clinical assessment,HPE,Clinical Photograph,Haematology Chemotherapy drug batch number with bar code -
CISPLATIN (DCEP)
S12 MEDICAL ONCOLOGY S12.35 OTHERS S12.35.28 CYCLOPHOSPHAMIDE + LENALIDOMIDE + DEXAMETHASONE DC 5137 Clinical assessment,HPE,Clinical Photograph,Haematology Chemotherapy drug batch number with bar code -

S12 MEDICAL ONCOLOGY S12.35 OTHERS S12.35.29 BENDAMUSTINE DC 22000 Renal Profile,Complete Blood Picture[CBP],CT Scan with Abdomen with contrast,LFT(liver function tests),Routine Clinical Photograph,Case Sheet with operation Notes -
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

S12 MEDICAL ONCOLOGY S12.35 OTHERS S12.35.3 Chemotherapy with Capeiri (metastatic) IP 8481 Routine Histopathological Examination,CT Scan Abdomen Without Contrast Case Sheet with operation Notes -
S12 MEDICAL ONCOLOGY S12.35 OTHERS S12.35.30 BENDAMUSTINE + LENALIDOMIDE + DEXAMETHASONE DC 13639 Clinical assessment,HPE,Clinical Photograph,Haematology Chemotherapy drug batch number with bar code -
S12 MEDICAL ONCOLOGY S12.35 OTHERS S12.35.31 LENALIDOMIDE DC 2575 Clinical assessment,HPE,Clinical Photograph,Haematology Chemotherapy drug batch number with bar code -
S12 MEDICAL ONCOLOGY S12.35 OTHERS S12.35.32 VIPID DC 6619 Clinical assessment,HPE,Clinical Photograph,Haematology Chemotherapy drug batch number with bar code -
S12 MEDICAL ONCOLOGY S12.35 OTHERS S12.35.33 DEVIC +RT DC 9164 Clinical assessment,HPE,Clinical Photograph,Haematology Chemotherapy drug batch number with bar code -
S12 MEDICAL ONCOLOGY S12.35 OTHERS S12.35.34 SMILE DC 27484 Clinical assessment,HPE,Clinical Photograph,Haematology Chemotherapy drug batch number with bar code -
S12 MEDICAL ONCOLOGY S12.35 OTHERS S12.35.35 LENALIDOMIDE + RITUXIMAB DC 4941 Clinical assessment,HPE,Clinical Photograph,Haematology Chemotherapy drug batch number with bar code -
S12 MEDICAL ONCOLOGY S12.35 OTHERS S12.35.36 CYCLOPHOSPHAMIDE + VINCRISTINE + PREDNISONE + DC 25768 Clinical assessment,HPE,Clinical Photograph,Haematology Chemotherapy drug batch number with bar code -
RITUXIMAB (RCVP)
S12 MEDICAL ONCOLOGY S12.35 OTHERS S12.35.37 CDE (CYCLOPHOSPHAMIDE + DOXORUBICIN + ETOPOSIDE) + DC 2501 Clinical assessment,HPE,Clinical Photograph,Haematology Chemotherapy drug batch number with bar code -
RITUXIMAB I
S12 MEDICAL ONCOLOGY S12.35 OTHERS S12.35.38 CODOX-M ALTERNATED WITH IVAC (IVAC) CODOX-M/IVAC DC 42848 Clinical assessment,HPE,Clinical Photograph,Haematology Chemotherapy drug batch number with bar code -
(MODIFIED) (CYCLOPHOSPHAMIDE + VINCRISTINE +
DOXORUBICIN + HIGH-DOSE METHOTREXATE ALTERNATING
WITH IFOSFAMIDE + ETOPOSIDE + HIGH-DOSE CYTARABINE)

S12 MEDICAL ONCOLOGY S12.35 OTHERS S12.35.39 CDE (CYCLOPHOSPHAMIDE + DOXORUBICIN + ETOPOSIDE) + DC 2501 Clinical assessment,HPE,Clinical Photograph,Haematology Chemotherapy drug batch number with bar code -
RITUXIMAB
S12 MEDICAL ONCOLOGY S12.35 OTHERS S12.35.4 Chemotherapy with Capeox (adjuvant) and metastatic IP 7909 Routine Histopathological Examination,CT Scan Abdomen Without Contrast Case Sheet with operation Notes -
S12 MEDICAL ONCOLOGY S12.35 OTHERS S12.35.40 RIVAC (RITUXIMAB + IFOSFAMIDE + CYTARABINE + DC 43895 Clinical assessment,HPE,Clinical Photograph,Haematology Chemotherapy drug batch number with bar code -
ETOPOSIDE)
S12 MEDICAL ONCOLOGY S12.35 OTHERS S12.35.41 CLADRIBINE - RITUXIMAB DC 8250 Clinical assessment,HPE,Clinical Photograph,Haematology Chemotherapy drug batch number with bar code -
S12 MEDICAL ONCOLOGY S12.35 OTHERS S12.35.42 CLADRIBINE WITH OR WITHOUT RITUXIMAB DC 32251 Clinical assessment,HPE,Clinical Photograph,Haematology Chemotherapy drug batch number with bar code -
S12 MEDICAL ONCOLOGY S12.35 OTHERS S12.35.43 THALIDOMIDE WITH OR WITHOUT RITUXIMAB (WEEKS 50-52) DC 6001 Clinical assessment,HPE,Clinical Photograph,Haematology Chemotherapy drug batch number with bar code -

S12 MEDICAL ONCOLOGY S12.35 OTHERS S12.35.44 THALIDOMIDE WITH OR WITHOUT RITUXIMAB (WEEKS 3-50) DC 6001 Clinical assessment,HPE,Clinical Photograph,Haematology Case Sheet with treatment details,Clinical Photograph -

S12 MEDICAL ONCOLOGY S12.35 OTHERS S12.35.45 THALIDOMIDE WITH OR WITHOUT RITUXIMAB (WEEKS 1 AND DC 2540 Clinical assessment,HPE,Clinical Photograph,Haematology Case Sheet with treatment details,Clinical Photograph -
2)
S12 MEDICAL ONCOLOGY S12.35 OTHERS S12.35.46 RITUXIMAB + CYCLOPHOSPHAMIDE + DEXAMETHASONE DC 25521 Clinical assessment,HPE,Clinical Photograph,Haematology Case Sheet with treatment details,Clinical Photograph -
S12 MEDICAL ONCOLOGY S12.35 OTHERS S12.35.47 RITUXIMAB + CYCLOPHOSPHAMIDE + PREDNISONE DC 25738 Clinical assessment,HPE,Clinical Photograph,Haematology Case Sheet with treatment details,Clinical Photograph -
S12 MEDICAL ONCOLOGY S12.35 OTHERS S12.35.48 ABVD + RITUXIMAB (1 CYCLE - WEEKLY RITUXIMAB 4 DOSES) DC 102480 Clinical assessment,HPE,Clinical Photograph,Haematology Case Sheet with treatment details,Clinical Photograph -
FOLLOWED BY ABVD
S12 MEDICAL ONCOLOGY S12.35 OTHERS S12.35.49 ABVD + RITUXIMAB (CYLED EVERY 4 WEEKS) DC 28480 Clinical assessment,HPE,Clinical Photograph,Haematology Case Sheet with treatment details,Clinical Photograph -
S12 MEDICAL ONCOLOGY S12.35 OTHERS S12.35.5 Palliative Chemotherapy with paclitaxel/Carboplatin - for IP 11000 ECG,RFT,CBP,usg abdomen,cxr,cect,IHC,Biopsy LFT -
every 3 weeks upto 6 cycles
S12 MEDICAL ONCOLOGY S12.35 OTHERS S12.35.50 ESCALATED BEACOPP DC 7120 Clinical assessment,HPE,Clinical Photograph,Haematology Case Sheet with treatment details,Clinical Photograph -
S12 MEDICAL ONCOLOGY S12.35 OTHERS S12.35.51 NILOTINIB III DC 17801 Clinical assessment,HPE,Clinical Photograph,Haematology Case Sheet with treatment details,Clinical Photograph -
S12 MEDICAL ONCOLOGY S12.35 OTHERS S12.35.52 MITOXANTRONE + CYTARABINE DC 10821 Clinical assessment,HPE,Clinical Photograph,Haematology Case Sheet with treatment details,Clinical Photograph -
S12 MEDICAL ONCOLOGY S12.35 OTHERS S12.35.53 IDARUBICIN + CYTARABINE DC 23240 Clinical assessment,HPE,Clinical Photograph,Haematology Case Sheet with treatment details,Clinical Photograph -
S12 MEDICAL ONCOLOGY S12.35 OTHERS S12.35.54 IDARUBICIN + CYTARABINE (HIGH DOSE) DC 29600 Clinical assessment,HPE,Clinical Photograph,Haematology Case Sheet with treatment details,Clinical Photograph -
S12 MEDICAL ONCOLOGY S12.35 OTHERS S12.35.55 DAUNORUBICIN + CYTARABINE + CLADRIBINE DC 10365 Clinical assessment,HPE,Clinical Photograph,Haematology Case Sheet with treatment details,Clinical Photograph -
S12 MEDICAL ONCOLOGY S12.35 OTHERS S12.35.56 NILOTINIB DC 17801 Clinical assessment,HPE,Clinical Photograph,Haematology Case Sheet with treatment details,Clinical Photograph -
S12 MEDICAL ONCOLOGY S12.35 OTHERS S12.35.57 NILOTINIB II DC 17801 Clinical assessment,HPE,Clinical Photograph,Haematology Case Sheet with treatment details,Clinical Photograph -
S12 MEDICAL ONCOLOGY S12.35 OTHERS S12.35.58 UNKNOWN PRIMARY - ADENOCARCINOMA - GEMCITABINE + DC 5601 Clinical assessment,HPE,Clinical Photograph,Haematology Case Sheet with treatment details,Clinical Photograph -
IRINOTECAN ; DAYS 1 AND 8: IRINOTECAN 100MG/M2 IV,
GEMCITABINE 1000MG/M2 IV. ; REPEAT CYCLE EVERY 3
WEEKS FOR 6 CYCLES.RESTAGE EVERY 2-3 CYCLES

S12 MEDICAL ONCOLOGY S12.35 OTHERS S12.35.59 UNKNOWN PRIMARY - ADENOCARCINOMA - GEMCITABINE + DC 5801 Clinical assessment,HPE,Clinical Photograph,Haematology Case Sheet with treatment details,Clinical Photograph -
DOCETAXEL ; DAY 1 AND 8: GEMCITABINE 1000MG/M2 IV
OVER 30 MINUTES ; DAY 8: DOCETAXEL 75MG/M2 IV ;
REPEAT CYCLE EVERY 3 WEEKS FOR A MAXIMUM OF 6 CYCLES

S12 MEDICAL ONCOLOGY S12.35 OTHERS S12.35.6 Palliative Chemotherapy with TPF regimen - for every 3 weeks IP 18000 ECG,RFT,CBP,usg abdomen,cxr,cect,IHC,Biopsy LFT -
upto 6 cycles
S12 MEDICAL ONCOLOGY S12.35 OTHERS S12.35.60 THYROID CANCER - DOXORUBICIN ; DOXORUBICIN 60 MG/M2 DC 4401 Clinical assessment,HPE,Clinical Photograph,Haematology Case Sheet with treatment details,Clinical Photograph -
AS MONOTHERAPY OR IN COMBINATION WITH CISPLATIN 40
MG/M2
S12 MEDICAL ONCOLOGY S12.35 OTHERS S12.35.61 THYROID CANCER - PAZOPANIB DC 9501 Clinical assessment,HPE,Clinical Photograph,Haematology Case Sheet with treatment details,Clinical Photograph -
S12 MEDICAL ONCOLOGY S12.35 OTHERS S12.35.62 THYROID CANCER - SUNITINIB ; SUNITINIB 50 MG DC 28501 Clinical assessment,HPE,Clinical Photograph,Haematology Case Sheet with treatment details,Clinical Photograph -
S12 MEDICAL ONCOLOGY S12.35 OTHERS S12.35.63 SARCOMA - SOFT TISSUE SARCOMA - LIPOSOMAL DC 7900 Clinical assessment,HPE,Clinical Photograph,Haematology Case Sheet with treatment details,Clinical Photograph -
DOXORUBICIN ; LIPOSOMAL DOXORUBICIN 30-50MG/M2 IV ;
REPEAT EVERY 4 WEEKS.
S12 MEDICAL ONCOLOGY S12.35 OTHERS S12.35.64 SARCOMA - SOFT TISSUE SARCOMA - DACARBAZINE (II) ; DC 2400 Clinical assessment,HPE,Clinical Photograph,Haematology Case Sheet with treatment details,Clinical Photograph -
DACARBAZINE 800-1,000MG/M2 IV ; REPEAT EVERY 3 WEEKS.

S12 MEDICAL ONCOLOGY S12.35 OTHERS S12.35.65 SARCOMA - SOFT TISSUE SARCOMA - DACARBAZINE (I) ; DC 6201 Clinical assessment,HPE,Clinical Photograph,Haematology Case Sheet with treatment details,Clinical Photograph -
DACARBAZINE 250MG/M2/DAY IV FOR 5 DAYS ; REPEAT
EVERY 3 WEEKS.
32 of 47
CODE MAIN CATEGORY Sub SUB CATEGORY NAME CODE SURGERY / THERAPY DESCRIPTION PROCEDURE PACKAGE SPECIAL INVESTIGATION POST OPERATIVE PROCEDURE INVESTIGATION TREATMENT PROTOCOL
Category ID TYPE AMOUNT
S12 MEDICAL ONCOLOGY S12.35 OTHERS S12.35.66 SARCOMA - SOFT TISSUE SARCOMA - GEMCITABINE ; DAYS 1 DC 3600 Clinical assessment,HPE,Clinical Photograph,Haematology Case Sheet with treatment details,Clinical Photograph -
AND 8: GEMCITABINE 1,200MG/M2 IV ; REPEAT CYCLE EVERY
3 WEEKS.
S12 MEDICAL ONCOLOGY S12.35 OTHERS S12.35.67 SARCOMA - SOFT TISSUE SARCOMA - EPIRUBICIN ; DC 5900 Clinical assessment,HPE,Clinical Photograph,Haematology Case Sheet with treatment details,Clinical Photograph -
EPIRUBICIN 160MG/M2 IV ; REPEAT EVERY 3 WEEKS
S12 MEDICAL ONCOLOGY S12.35 OTHERS S12.35.68 SARCOMA - SOFT TISSUE SARCOMA - DOXORUBICIN ; DC 2901 Clinical assessment,HPE,Clinical Photograph,Haematology Case Sheet with treatment details,Clinical Photograph -
DOXORUBICIN 60-75MG/M2 IV ; ONCE EVERY 3 WEEKS
S12 MEDICAL ONCOLOGY S12.35 OTHERS S12.35.69 SARCOMA - SOFT TISSUE SARCOMA - GEMCITABINE + DC 3301 Clinical assessment,HPE,Clinical Photograph,Haematology Case Sheet with treatment details,Clinical Photograph -
DACARBAZINE ; DAY 1: GEMCITABINE 1,800MG/M2 IV +
DACARBAZINE 500MG/M2 IV. ; REPEAT CYCLE EVER 2 WEEKS
FOR A TOTAL OF 12 CYCLES;
S12 MEDICAL ONCOLOGY S12.35 OTHERS S12.35.7 Palliative Chemotherapy with Gemcitabina/Cisplatin - for IP 15000 ECG,RFT,CBP,usg abdomen,cxr,cect,IHC,Biopsy LFT -
every 3 weeks upto 6 cycles
S12 MEDICAL ONCOLOGY S12.35 OTHERS S12.35.70 SARCOMA - SOFT TISSUE SARCOMA - GEMCITABINE + DC 14700 Clinical assessment,HPE,Clinical Photograph,Haematology Case Sheet with treatment details,Clinical Photograph -
VINORELBINE ; DAYS 1 AND 8: VINORELBINE 25MG/M2 IV,
GEMCITABINE 800MG/M2 IV ; REPEAT CYCLE EVERY 3 WEEKS

S12 MEDICAL ONCOLOGY S12.35 OTHERS S12.35.71 SARCOMA - SOFT TISSUE SARCOMA - GEMCITABINE + DC 5100 Clinical assessment,HPE,Clinical Photograph,Haematology Case Sheet with treatment details,Clinical Photograph -
DOCETAXEL ; DAYS 1 AND 8: GEMCITABINE 900MG/M2 IV ;
DAY 8: DOCETAXEL 100MG/M2 IV. ; REPEAT CYCLE EVERY 3
WEEKS
S12 MEDICAL ONCOLOGY S12.35 OTHERS S12.35.72 PANCREAS CARCINOMA-ADJUVANT CHEMOTHERAPY & DC 6700 Clinical assessment,HPE,Clinical Photograph,Haematology Case Sheet with treatment details,Clinical Photograph -
CHEMORADIATION-GEMCITABINE&5FU;PRIOR TO
CHEMORADIATION;DAYS 1,8&15 GEMCITABINE1,000MG/M2
IV;INITIATE 1-2 WEEKS PRIOR TO CHEMORADIATION;AFTER
CHEMORADIATION;DAYS 1,8 AND 15 GEMCITABINE
IV;INITIATE 3-5WEEKS FOLLOWING;REPEAT CYCLE EVERY 4
WEEKS FOR 3 MONTHS

S12 MEDICAL ONCOLOGY S12.35 OTHERS S12.35.73 NASOPHARYNX CANCER - CISPLATIN - WEEKLY - PRECEDED BY DC 2800 Clinical assessment,HPE,Clinical Photograph,Haematology Case Sheet with treatment details,Clinical Photograph -
3 CYCLES OF DOCETAXEL + 5-FU ; DAY 1: CISPLATIN
100MG/M2; ; REPEAT EVERY 3 WEEKS, TILL RADIATION

S12 MEDICAL ONCOLOGY S12.35 OTHERS S12.35.74 NASOPHARYNX CANCER - DOCETAXEL + CISPLATIN + 5-FU - DC 6201 Clinical assessment,HPE,Clinical Photograph,Haematology Case Sheet with treatment details,Clinical Photograph -
FOLLOWED BY CISPLATIN AFTER 3 CYCLES ; DAY 1:
DOCETAXEL 70MG/M2 IV, CISPLATIN 75MG/M2 IV ; DAYS 1-4:
5-FU 1,000MG/M2/DAY IV ; REPEAT EVERY WEEK FOR 3
CYCLES
S12 MEDICAL ONCOLOGY S12.35 OTHERS S12.35.75 HEAD AND NECK CANCER - CARBOPLATIN + INFUSIONAL 5-FU DC 4700 Clinical assessment,HPE,Clinical Photograph,Haematology Case Sheet with treatment details,Clinical Photograph -
; DAYS 1-4: 5-FU 600MG/M2/DAY AS CONTINUOUS IV I,
CARBOPLATIN 70MG/M2/DAY IV ; REPEAT EVERY 3 WEEKS
FOR 3 CYCLES (GIVEN CONCURRENTLY WITH RADIOTHERAPY).

S12 MEDICAL ONCOLOGY S12.35 OTHERS S12.35.76 DOXORUBICIN + CISPLATIN + IFOSFAMIDE + HIGH- DOSE DC 111505 Clinical assessment,HPE,Clinical Photograph,Haematology Case Sheet with treatment details,Clinical Photograph -
METHOTREXATE (SURGERY TO BE DONE ALSO)
S12 MEDICAL ONCOLOGY S12.35 OTHERS S12.35.77 Allogenic (peripheral / Bone marrow) stem cell IP 1000000 - - -
Transplantation (<14 Yrs)
S12 MEDICAL ONCOLOGY S12.35 OTHERS S12.35.78 Allogenic (peripheral / Bone marrow) stem cell IP 1100000 - - -
Transplantation (>14 Yrs)
S12 MEDICAL ONCOLOGY S12.35 OTHERS S12.35.8 Weekly paclitaxel - Per week IP 4000 BIOPSY,LFT,RFT,2D ECHO,ULTRA SOUND ABDOMEN,CHEST X-RAY,IHC CBP -
S12 MEDICAL ONCOLOGY S12.35 OTHERS S12.35.9 Docetaxel + Cyclophosphamide (includes groth factor) - for IP 12000 BIOPSY,LFT,RFT,2D ECHO,ULTRA SOUND ABDOMEN,CHEST X-RAY,IHC CBP -
every 3 weeks upto 4 cycles
S12 MEDICAL ONCOLOGY S12.4 VAGINAL CANCER S12.4.1 Chemotherapy for Vaginal Cancer with Cisplatin/5-Fu IP 6600 Clinical Photograph,Biopsy Clinical Photograph -
S12 MEDICAL ONCOLOGY S12.5 OVARIAN CANCER S12.5.1 Chemotherapy for Ovarian cancer with Carboplatin / Paclitaxel IP 12100 USG,Biopsy,CT Clinical Photograph -

S12 MEDICAL ONCOLOGY S12.6 OVARY- GERM CELL TUMOR S12.6.1 Chemotherapy for Ovarian cancer with Germ Cell Tumor IP 8800 USG,Biopsy,CT Clinical Photograph -
Bleomycin-Etoposide-Cisplatin (Bep)
S12 MEDICAL ONCOLOGY S12.7.1 Gestational Trophoblast Ds. S12.7.1.1 Chemotherapy for low risk Gestational trophoblast DS with IP 2200 USG,Biopsy,CT Clinical Photograph -
Weekly Methotrexate
S12 MEDICAL ONCOLOGY S12.7.1 Gestational Trophoblast Ds. S12.7.1.2 Chemotherapy for low risk Gestational trophoblast DS with IP 5500 USG,Biopsy,CT Clinical Photograph -
Actinomycin
S12 MEDICAL ONCOLOGY S12.7.1 Gestational Trophoblast Ds. S12.7.1.3 GESTATIONAL TROPHOBLAST DISEASES - OTHER REGIMEN DC 10000 Clinical assessment,HPE,Clinical Photograph,Haematology Case Sheet with treatment details,Clinical Photograph -
(MAY BE CHOSEN FOR ANY OTHER INTERNATIONALLY
APPROVED CURATIVE REGIMEN WITH SUBMISSION OF
SUBSTANTIATING DOCUMENTS)
S12 MEDICAL ONCOLOGY S12.7.1 Gestational Trophoblast Ds. S12.7.1.4 GESTATIONAL TROPHOBLAST DISEASES - METHOTREXATE + DC 2000 Clinical assessment,HPE,Clinical Photograph,Haematology Case Sheet with treatment details,Clinical Photograph -
FOLINIC ACID ; DAY 1 : MTX 100 MG/M 2 IVP, THEN 200
MG/M 2 INFUSION ; DAY 2 : FOLINIC ACID 15 MG IM/PO
Q12H FOR 4 DOSES ; REPEAT CYCLE EVERY 18 DAYS

S12 MEDICAL ONCOLOGY S12.7.2 High risk S12.7.2.1 Chemotherapy for high risk Gestational trophoblast DS with IP 7700 USG,Biopsy,CT Clinical Photograph -
Etoposide-Methotrexate -Actinomycin / Cyclophosphamide
Vincristine (Ema-Co)
S12 MEDICAL ONCOLOGY S12.8 TESTICULAR CANCER S12.8.1 Chemotherapy for Testicular Cancer with Bleomycin with IP 8800 USG,Biopsy Clinical Photograph -
Etoposide-Cisplatin (Bep)
S12 MEDICAL ONCOLOGY S12.9 PROSTATE CANCER S12.9.1 Prostate Cancer with Hormonal Therapy IP 4081 USG,Biopsy Clinical Photograph -
S13 RADIATION ONCOLOGY S13.1 COBALT 60 EXTERNAL BEAM S13.1.1 Radical Treatment with Cobalt 60 External Beam Radiotherapy IP 28600 X-RAY,Biopsy,CT,USG RT Treatment Charts,Clinical Photograph -
RADIOTHERAPY
S13 RADIATION ONCOLOGY S13.1 COBALT 60 EXTERNAL BEAM S13.1.2 Palliative Treatment with Cobalt 60 External Beam IP 14300 X-RAY,Biopsy,CT,USG RT Treatment Charts,Clinical Photograph -
RADIOTHERAPY Radiotherapy
S13 RADIATION ONCOLOGY S13.1 COBALT 60 EXTERNAL BEAM S13.1.3 Adjuvant Treatment with Cobalt 60 External Beam IP 16500 X-RAY,Biopsy,CT,USG RT Treatment Charts,Clinical Photograph -
RADIOTHERAPY Radiotherapy
S13 RADIATION ONCOLOGY S13.2 EXTERNAL BEAM RADIOTHERAPY S13.2.1 Radical Treatment With Photons External Beam Radiotherapy IP 71500 X-RAY,Biopsy,CT,USG RT Treatment Charts,Clinical Photograph -
(ON LINEAR ACCELERATOR) (on Linear Accelerator)

S13 RADIATION ONCOLOGY S13.2 EXTERNAL BEAM RADIOTHERAPY S13.2.2 Palliative Treatment With Photons External Beam IP 28600 X-RAY,Biopsy,CT,USG,X-RAY,Biopsy,CT,USG RT Treatment Charts,Clinical Photograph, RT Treatment Charts,Clinical Photograph -
(ON LINEAR ACCELERATOR) Radiotherapy (on Linear Accelerator)

S13 RADIATION ONCOLOGY S13.2 EXTERNAL BEAM RADIOTHERAPY S13.2.3 Adjuvant Treatment With Photons/Electrons / (92.25)External IP 49500 X-RAY,Biopsy,CT,USG RT Treatment Charts,Clinical Photograph -
(ON LINEAR ACCELERATOR) Beam Radiotherapy (on Linear Accelerator)

S13 RADIATION ONCOLOGY S13.3.1 Brachytherapy A) Intracavitary S13.3.1.1 Brachytherapy Intracavitary I. Ldr Per Application for one time IP 10000 X-RAY,Biopsy,CT,USG Clinical Photograph, RT Treatment Charts -
only
S13 RADIATION ONCOLOGY S13.3.1 Brachytherapy A) Intracavitary S13.3.1.2 Brachytherapy Intracavitary II. Hdr Per Application IP 16519.8 X-RAY,Biopsy,CT,USG,X-RAY,Biopsy,CT,USG RT Treatment Charts,Clinical Photograph, RT Treatment Charts,Clinical Photograph -

S13 RADIATION ONCOLOGY S13.3.1 Brachytherapy A) Intracavitary S13.3.1.3 Brachytherapy High Dose Radiation (Intraluminal) - per IP 4500 Blood test Data of RT treatment plan & dose -
fraction, maximum 4 sessions
S13 RADIATION ONCOLOGY S13.3.2 Brachytherapy B) Interstitial S13.3.2.1 Brachytherapy Interstitial I. Ldr Per Application IP 16758 X-RAY,Biopsy,CT,USG RT Treatment Charts,Clinical Photograph -
S13 RADIATION ONCOLOGY S13.3.2 Brachytherapy B) Interstitial S13.3.2.2 Brachytherapy Interstitial II. Hdr One Application And Multiple IP 78330 X-RAY,Biopsy,CT,USG,X-RAY,Biopsy,CT,USG RT Treatment Charts,Clinical Photograph, RT Treatment Charts,Clinical Photograph -
Dose Fractions on a whole
S13 RADIATION ONCOLOGY S13.4.1 SPECIALIZED RADIATION THERAPY - S13.4.1.1 Specialized Radiation therapy- IMRT (Intensity modulated IP 127270 CT-Scan with Contrast,Biopsy RT Treatment Charts,CT,Tumor Markers,USG -
IMRT (Intensity modulated radiotherapy) Upto 40 Fractions IMRT In 8 Weeks
radiotherapy)

33 of 47
CODE MAIN CATEGORY Sub SUB CATEGORY NAME CODE SURGERY / THERAPY DESCRIPTION PROCEDURE PACKAGE SPECIAL INVESTIGATION POST OPERATIVE PROCEDURE INVESTIGATION TREATMENT PROTOCOL
Category ID TYPE AMOUNT
S13 RADIATION ONCOLOGY S13.4.1 SPECIALIZED RADIATION THERAPY - S13.4.1.2 SPECIALIZED RADIATION THERAPY - RAPID ARC THERAPY IP 150000 CT-Scan with Contrast,Biopsy USG,RT Treatment Charts,CT,Tumor Markers -
IMRT (Intensity modulated
radiotherapy)
S13 RADIATION ONCOLOGY S13.5 PAEDIATRIC CANCER S13.5.1 Hodgkin Lymphoma (Favorable group): radiation IP 10000 Clinical assessment and investigations Data of RT treatment plan & dose -
S13 RADIATION ONCOLOGY S13.5 PAEDIATRIC CANCER S13.5.2 Retinoblastoma (Intraocular): radiation IP 10000 Clinical assessment and investigations Data of RT treatment plan & dose -
S13 RADIATION ONCOLOGY S13.5 PAEDIATRIC CANCER S13.5.3 Retinoblastoma (extraocular): radiation IP 10000 Clinical assessment and investigations Clinical assessment and investigations -
S13 RADIATION ONCOLOGY S13.5 PAEDIATRIC CANCER S13.5.4 Bone tumors/soft tissue sarcomas : radiation IP 25000 X-ray,Biopsy ,CT-Scan Data of RT treatment plan & dose -
S13 RADIATION ONCOLOGY S13.5 PAEDIATRIC CANCER S13.5.5 Brain tumors: radiation IP 30000 Clinical assessment and investigations Data of RT treatment plan & dose -
S13 RADIATION ONCOLOGY S13.5 PAEDIATRIC CANCER S13.5.6 Hodgkin Lymphoma (unfavorable group): radiation IP 15000 Clinical assessment and investigations Data of RT treatment plan & dose -
S13 RADIATION ONCOLOGY S13.6 IGRT S13.6.1 IGRT:List of Diseases - 1. CA Prostate non metastatic2. CA Lung IP 275001 BIOPSY,RFT,CBP,ULTR SOUND ABDOMEN,CECT-CHEST IHC,LFT -
non metastatic (minimum of 6600cGy in 33 fractions or its
equivalent)
S13 RADIATION ONCOLOGY S13.7 RIA S13.7.1 I-131 Radio iodine ablation therapy for Thyroid Malignancies IP 30000 BIOPSY,TSH+ TG+ ANTI THYRO GLOBULIN ANTI BODIES,RADIO IODINE SCAN,IHC POST OP HPE -
(For every 50 milli curie given dose in each application)

S13 RADIATION ONCOLOGY S14.4.2 SPECIALIZED RADIATION THERAPY - S13.4.2.1 Radical - Specialized Radiation therapy - 3DCRT(3-D IP 95000 CT-Scan with Contrast,Biopsy USG,CT -
3DCRT(3-D conformational conformational radiotherapy)Upto 30 Fractions 3DCRT In 6
radiotherapy) Weeks
S13 RADIATION ONCOLOGY S14.4.3 SPECIALIZED RADIATION THERAPY - S13.4.2.1.1 Palliative - Specialized Radiation therapy - 3DCRT(3-D IP 60000 CT-Scan with Contrast Biopsy USG/CT -
SRS/SRT conformational radiotherapy)Upto 30 Fractions 3DCRT In 6
Weeks
S13 RADIATION ONCOLOGY S14.4.3 SPECIALIZED RADIATION THERAPY - S13.4.2.1.2 Adjuvant - Specialized Radiation therapy - 3DCRT(3-D IP 74999 CT-Scan with Contrast Biopsy USG/CT -
SRS/SRT conformational radiotherapy)Upto 30 Fractions 3DCRT In 6
Weeks
S13 RADIATION ONCOLOGY S14.4.3 SPECIALIZED RADIATION THERAPY - S13.4.3.1 Specialized Radiation therapy - SRS/SRT Upto 30 Fractions In IP 114000 CT-Scan with Contrast,Biopsy RT Treatment Charts,Tumor Markers -
SRS/SRT SRS/SRT 6 Weeks
S14 PLASTIC SURGERY S14.1 PLASTIC REPAIR S14.1.1 Surgical Management Of Cleft Lip IP 20524 Clinical Photograph Clinical Photograph -
S14 PLASTIC SURGERY S14.1 PLASTIC REPAIR S14.1.10 Reimplantation at wrist IP 75000 XRAY,CLINICAL PHOTO POST OF PHOTOS,INTRA PROCEDURE PHOTOS -
S14 PLASTIC SURGERY S14.1 PLASTIC REPAIR S14.1.11 Toe transfer IP 75000 XRAY,CLINICAL PHOTO POST OF PHOTOS,INTRA PROCEDURE PHOTOS -
S14 PLASTIC SURGERY S14.1 PLASTIC REPAIR S14.1.12 ULNAR /RADIAL CLUB HAND IP 50000 CLINICAL PHOTO WITH XRAY INTRA OPERATIVE PHOTO,CLINICAL PHOTO WITH XRAY -
S14 PLASTIC SURGERY S14.1 PLASTIC REPAIR S14.1.13 Reconstructive surgery for facial palsy -conventional/ IP 70000 NERVE CONDUCTION,CLINICAL PHOTO WITH VIDEO SCAR PHOTOS,INTRA PROCEDURE PHOTOS -
Microvascular
S14 PLASTIC SURGERY S14.1 PLASTIC REPAIR S14.1.2 Surgical correction of Cleft Palate IP 25656 Clinical Photograph Clinical Photograph -
S14 PLASTIC SURGERY S14.1 PLASTIC REPAIR S14.1.2.1 Palatal fistula Repair IP 39790 Clinical Photograph Case Sheet with operation Notes,Clinical Photograph -
S14 PLASTIC SURGERY S14.1 PLASTIC REPAIR S14.1.3 Surgical corection of Velo-Pharyngeal Incompetence IP 36256 Endoscopy Clinical Photograph -
S14 PLASTIC SURGERY S14.1 PLASTIC REPAIR S14.1.4 Surgical Management of Syndactyly of Hand For Each Hand IP 33604 Clinical Photograph Clinical Photograph -

S14 PLASTIC SURGERY S14.1 PLASTIC REPAIR S14.1.4.1 Polydactyly Repair each digit IP 29230 Clinical Photograph,X-Ray Intra & Post OP Photos,X-Ray -
S14 PLASTIC SURGERY S14.1 PLASTIC REPAIR S14.1.5 Reconstruction or prosthetic appliance for absent ear IP 30786 Clinical Photograph Clinical Photograph -
S14 PLASTIC SURGERY S14.1 PLASTIC REPAIR S14.1.5.1 Ear reconstruction per stage(2/3 stages) IP 41880 Clinical Photograph Case Sheet with operation Notes,Clinical Photograph -
S14 PLASTIC SURGERY S14.1 PLASTIC REPAIR S14.1.6 Surgery for Tm Joint Ankylosis IP 45707 X-RAY,Clinical Photograph Clinical Photograph -
S14 PLASTIC SURGERY S14.1 PLASTIC REPAIR S14.1.7 Management Of Tmj Dysfunction Syndrome (76.94) DC 1090 Clinical Photograph,Orthopantomography (OPG) Orthopantomography(OPG),Intra & Post OP Photos -
S14 PLASTIC SURGERY S14.1 PLASTIC REPAIR S14.1.8 Surgical Management of Penile Injuries IP 24920 USG Penis,Clinical Photograph,MRI Scrotum/Doppler And Scrotum & Testes Scar Photo,CT Scan Of Lower Abdomen & Scrotum,USG Penis -
S14 PLASTIC SURGERY S14.1 PLASTIC REPAIR S14.1.8.1 Penis reconstruction traumatic/ oncology IP 115000 HPE REPORT,CLINICAL PHOTO SCAR PHOTOS,INTRA PHOTOS -
S14 PLASTIC SURGERY S14.1 PLASTIC REPAIR S14.1.9 Micrognathia - pierre robbinsequalae- 3 Stages (Per Stage) IP 60000 CLINICAL PHOTO,CT SKULL,X RAY INTRA OPRATIVE PHOTOS,X RAY -

S14 PLASTIC SURGERY S14.2 BURNS S14.2.1.1 Conservative management of 40% burns IP 61572 Clinical Photograph Clinical Photograph -
S14 PLASTIC SURGERY S14.2 BURNS S14.2.1.2 Surgical Management of 40% mixed burns IP 66703 Clinical Photograph Clinical Photograph -
S14 PLASTIC SURGERY S14.2 BURNS S14.2.1.3 Conservative management of 50% burns IP 123144 Clinical Photograph Clinical Photograph -
S14 PLASTIC SURGERY S14.2 BURNS S14.2.1.4 Surgical Management of 50% mixed burns IP 118280 Clinical Photograph Clinical Photograph -
S14 PLASTIC SURGERY S14.2 BURNS S14.2.2.1 Conservative management of 60% burns IP 92897 Clinical Photograph Clinical Photograph -
S14 PLASTIC SURGERY S14.2 BURNS S14.2.2.2 Surgical Management of 60% mixed burns IP 137039 Clinical Photograph Clinical Photograph -
S14 PLASTIC SURGERY S14.2 BURNS S14.2.2.3 Surgical Management of above 60% mixed burns IP 135027 Clinical Photograph Clinical Photograph -
S14 PLASTIC SURGERY S14.2 BURNS S14.2.3.1 Electrical contact burns: Low voltage- without part of IP 30000 Clinical Photograph and diagram with Rule of 9/ L & B Chart for extent of burns Clinical Photograph -
limb/limb loss; Includes % TBSA skin grafted, flap cover, follow-
up dressings etc. as deemed necessary; Surgical procedures
are required for deep burns that are not amenable to heal
with dressings alone.
S14 PLASTIC SURGERY S14.2 BURNS S14.2.3.2 electrical burn cases require multiple procedures serial IP 40000 Clinical Photograph and diagram with Rule of 9/ L & B Chart for extent of burns Clinical Photograph -
debridements,amputations and flap covers
S14 PLASTIC SURGERY S14.2 BURNS S14.2.4 Chemical burns: Without significant facial scarring and/or loss IP 40000 Clinical Photograph and diagram with Rule of 9/ L & B Chart for extent of burns Clinical Photograph -
of function; Includes % TBSA skin grafted, flap cover, follow-up
dressings etc. as deemed necessary; Surgical procedures are
required for deep burns that are not amenable to heal with
dressings alone.

S14 PLASTIC SURGERY S14.2 BURNS S14.2.5 Thermal/Flame/ Scald Burns:% Total Body Surface Area Burns DC 7000 CASE SHEET,CLINICAL PHOTO CASE SHEET,CLINICAL PHOTO -
(TBSA) - any % (not requiring admission).Needs at least 5-6
dressing
S14 PLASTIC SURGERY S14.3 POST BURN CONTRACTURE S14.3.1 Post Burn Contracture Surgeries - Mild IP 39581 Clinical Photograph Clinical Photograph -
SURGERIES FOR FUNCTIONAL
IMPROVEMENT(PACKAGE
INCLUDING SPLINTS, PRESSURE
GARMENTS AND PHYSIOTHERAPY)

S14 PLASTIC SURGERY S14.3 POST BURN CONTRACTURE S14.3.2 Post Burn Contracture Surgeries - Moderate IP 41660 Clinical Photograph Clinical Photograph -
SURGERIES FOR FUNCTIONAL
IMPROVEMENT(PACKAGE
INCLUDING SPLINTS, PRESSURE
GARMENTS AND PHYSIOTHERAPY)

S14 PLASTIC SURGERY S14.3 POST BURN CONTRACTURE S14.3.3 Post Burn Contracture Surgeries - Severe IP 49257 Clinical Photograph Clinical Photograph -
SURGERIES FOR FUNCTIONAL
IMPROVEMENT(PACKAGE
INCLUDING SPLINTS, PRESSURE
GARMENTS AND PHYSIOTHERAPY)

S14 PLASTIC SURGERY S14.4 PLASTIC SURGERY S14.10 Surgical Correction of hemifacial microsomia IP 83133 3D CT,MRI Clinical Photograph -
S14 PLASTIC SURGERY S14.4 PLASTIC SURGERY S14.11 Surgical Correction of Leprosy Reconstructive Surgery IP 21961 Nerve conduction study Clinical Photograph -
S14 PLASTIC SURGERY S14.4 PLASTIC SURGERY S14.12 Surgical Correction of Nerve and Tendon Repair + Vascular IP 48016 Nerve conduction study,CT-Scan Clinical Photograph -
Repair (82.4+39.3)
S14 PLASTIC SURGERY S14.4 PLASTIC SURGERY S14.13 Correction of lid retraction IP 25655 ICE pack test with Chin Elevation,Clinical Photograph Clinical Photograph -
S14 PLASTIC SURGERY S14.4 PLASTIC SURGERY S14.14 Surgical Correction of lid retraction with Tumour of Mandible IP 60392 MRI,Biopsy,CT,HPE Clinical Photograph -
And Maxilla
S14 PLASTIC SURGERY S14.4 PLASTIC SURGERY S14.15 Reconstructive procedures for vaginal atresia IP 38431 Ultra sound of abdomin Clinical Photograph -
S14 PLASTIC SURGERY S14.4 PLASTIC SURGERY S14.16 Surgical correction for Vascular malformations IP 33814 ANGIOGRAM Clinical Photograph -
S14 PLASTIC SURGERY S14.4 PLASTIC SURGERY S14.17 Tarsorrhaphy surgery to prevent exposure keratitis to prevent IP 10272 Clinical Photograph Case Sheet with operation Notes ,Clinical Photograph -
loss or impairment of vision especially in facial burns

S14 PLASTIC SURGERY S14.4 PLASTIC SURGERY S14.18 Panfacial fractures combination with polytrauma IP 105196 Clinical Photograph,3D CT Facial Bones,X-Ray Facial Bones X-Ray Facial Bones -
S14 PLASTIC SURGERY S14.4 PLASTIC SURGERY S14.19 Aplasia / hypoplasia / post traumatic loss of thumb for IP 65205 Clinical Photograph,X-Ray CT Local Area Without Contrast -
reconstruction - conventional surgery
S14 PLASTIC SURGERY S14.4 PLASTIC SURGERY S14.20 Reimplantation / revascularization - single digit IP 86119 Clinical Photograph,X-Ray Clinical Photograph,X-Ray -
S14 PLASTIC SURGERY S14.4 PLASTIC SURGERY S14.21 Reimplantation / revascularization - multiple digits per finger IP 86129 Clinical Photograph,X-Ray Clinical Photograph,X-Ray -

34 of 47
CODE MAIN CATEGORY Sub SUB CATEGORY NAME CODE SURGERY / THERAPY DESCRIPTION PROCEDURE PACKAGE SPECIAL INVESTIGATION POST OPERATIVE PROCEDURE INVESTIGATION TREATMENT PROTOCOL
Category ID TYPE AMOUNT
S14 PLASTIC SURGERY S14.4 PLASTIC SURGERY S14.22 Flap cover for trauma of the hand / forearm / arm / foot / leg IP 61582 Clinical Photograph Clinical Photograph -
/ thigh etc., with exposure of the underlying vital structures
like tendons, nerves, vessels, bone, with or without any
fracture- flap insert
S14 PLASTIC SURGERY S14.4 PLASTIC SURGERY S14.23.1 Surgical management for keloid and hypertrophic scar IP 25300 Clinical Photograph Clinical Photograph -
requiring flap cover/SSG
S14 PLASTIC SURGERY S14.4 PLASTIC SURGERY S14.23.2 Nose injuries / avulsions -flap cover IP 33750 Clinical Photograph Clinical Photograph -
S14 PLASTIC SURGERY S14.4 PLASTIC SURGERY S14.23.3 Ear injuries / avulsions - flap cover IP 35370 Clinical Photograph Clinical Photograph -
S14 PLASTIC SURGERY S14.4 PLASTIC SURGERY S14.23.4 Lip injuries / avulsions - flap cover IP 33290 Clinical Photograph Clinical Photograph -
S14 PLASTIC SURGERY S14.4 PLASTIC SURGERY S14.23.5 Sub mucosal fibrosis - surgical management with flap IP 48420 Clinical Photograph Clinical Photograph -
S14 PLASTIC SURGERY S14.4 PLASTIC SURGERY S14.23.6 Crush injury hand involving loss of skin and vital parts IP 48940 Clinical Photograph Clinical Photograph -
requiring flap cover
S14 PLASTIC SURGERY S14.4 PLASTIC SURGERY S14.24.1 Any raw area which needs skin grafting - mild<5% IP 32610 Clinical Photograph Clinical Photograph -
S14 PLASTIC SURGERY S14.4 PLASTIC SURGERY S14.24.2 Any raw area which needs skin grafting - moderate 5-10% IP 36660 Clinical Photograph Clinical Photograph -

S14 PLASTIC SURGERY S14.4 PLASTIC SURGERY S14.24.3 Any raw area which needs skin grafting - major - >10 % IP 49890 Clinical Photograph Clinical Photograph -
S14 PLASTIC SURGERY S14.4 PLASTIC SURGERY S14.25.1 Nose injuries / avulsions- primary closure/ skin graft(86.6) IP 20000 Clinical Photograph Clinical Photograph -

S14 PLASTIC SURGERY S14.4 PLASTIC SURGERY S14.25.2 Ear injuries / avulsions - primary closure/ skin graft(86.6) IP 20000 Clinical Photograph Clinical Photograph -

S14 PLASTIC SURGERY S14.4 PLASTIC SURGERY S14.25.3 Lip injuries / avulsions - primary closure/ skin graft(86.6) IP 20000 Clinical Photograph Clinical Photograph -

S14 PLASTIC SURGERY S14.4 PLASTIC SURGERY S14.25.4 Debridement and primary closure for avulsion injuries(86.59) IP 20000 Clinical Photograph Clinical Photograph -

S14 PLASTIC SURGERY S14.4 PLASTIC SURGERY S14.26.1 Breast reduction for gynacomastia-male(each side) unilateral IP 25000 Case sheet with clinical History,USG Breast,Clinical Photograph Scar Photo -

S14 PLASTIC SURGERY S14.4 PLASTIC SURGERY S14.26.2 Breast reduction for gigantomastia female (each IP 25000 Clinical Photograph With Scale 12 Cm From Areola Margin To Mammillary Fold,USG Breast Scar Photo -
side)(procedure name)unilateral
S14 PLASTIC SURGERY S14.4 PLASTIC SURGERY S14.26.3 Nipple areola reconstruction IP 25000 Clinical Photograph,Fine Needle Aspiration Cytology (FNAC) ,USG Breast Clinical Photograph -
S14 PLASTIC SURGERY S14.4 PLASTIC SURGERY S14.27.1 Surgical treatment for release of tongue tie IP 9990 Clinical Photograph Clinical Photograph -
S14 PLASTIC SURGERY S14.4 PLASTIC SURGERY S14.27.2 Macroglossia Correction IP 45000 Clinical Photograph Case Sheet with operation Notes,Clinical Photograph -
S14 PLASTIC SURGERY S14.4 PLASTIC SURGERY S14.28.1 Sequalae of brachial plexus injuries IP 40580 Clinical Photograph,Nerve conduction study Clinical Photograph -
S14 PLASTIC SURGERY S14.4 PLASTIC SURGERY S14.28.2 Conservative treatment for brachial plexus injuries IP 10000 Clinical Photograph,MRI Local Area,Nerve conduction study Clinical Photograph -
S14 PLASTIC SURGERY S14.4 PLASTIC SURGERY S14.28.3 Compressive neuropathies IP 30690 Clinical Photograph,Nerve conduction study Intra OP Photos,Nerve conduction study,Clinical Photograph -
S14 PLASTIC SURGERY S14.4 PLASTIC SURGERY S14.29.1 Treatment for trisser fingerenosynovitis(82.2) IP 28730 Clinical Photograph,X-Ray Clinical Photograph,X-Ray -
S14 PLASTIC SURGERY S14.4 PLASTIC SURGERY S14.29.2 Mallet finger Surgery IP 26680 Clinical Photograph,X-Ray Clinical Photograph,X-Ray -
S14 PLASTIC SURGERY S14.4 PLASTIC SURGERY S14.29.3 Boutonnieries deformity Repair IP 35000 Clinical Photograph,X-Ray Clinical Photograph,X-Ray -
S14 PLASTIC SURGERY S14.4 PLASTIC SURGERY S14.29.4 Treatment for supparativechondritis(EAR) IP 15000 Clinical Photograph,X-Ray Intra & Post OP Photos,X-Ray -
S14 PLASTIC SURGERY S14.4 PLASTIC SURGERY S14.29.5 Dupuytrens contracture release IP 20000 Clinical Photograph,Contrast Enhanced USG CT Local Area Without Contrast,Intra & Post OP Photos -
S14 PLASTIC SURGERY S14.4 PLASTIC SURGERY S14.29.6 Tendon transfer procedure for wrist drop IP 32000 Clinical Photograph,Nerve conduction study CT Local Area Without Contrast,Clinical Photograph -
S14 PLASTIC SURGERY S14.4 PLASTIC SURGERY S14.30.1 Disarticulation through shoulder IP 36510 Clinical Photograph,X-Ray Clinical Photograph,X-Ray -
S14 PLASTIC SURGERY S14.4 PLASTIC SURGERY S14.30.2 Disarticulation through thigh IP 40000 Clinical Photograph,X-Ray Clinical Photograph,X-Ray -
S14 PLASTIC SURGERY S14.4 PLASTIC SURGERY S14.31.1 Amputation of hand / fore arm / arm / foot / leg / thigh with IP 35000 Clinical Photograph,X-Ray Clinical Photograph,X-Ray -
skin cover (84.1)
S14 PLASTIC SURGERY S14.4 PLASTIC SURGERY S14.31.2 Amputation of digit with skin cover(84.11) IP 10000 Clinical Photograph,X-Ray Clinical Photograph,X-Ray -
S14 PLASTIC SURGERY S14.4 PLASTIC SURGERY S14.32 Post cabg(sternal dehiscence/osdo Repair IP 40750 Clinical Photograph,Sinography ,Chest X-Ray PA View(1 Film) Scar Photo,Sinography ,Chest X-Ray PA View(1 Film) -
S14 PLASTIC SURGERY S14.4 PLASTIC SURGERY S14.33 Tuboplasty/Open Tubal Recanalisation IP 26590 HSG(Hysterosalpingography),USG Abdomen,CT scan Lower Abdomen Without Contrast HSG(Hysterosalpingography),CT scan Lower Abdomen Without Contrast,USG -
Abdomen,Intra & Post OP Photos
S14 PLASTIC SURGERY S14.4 PLASTIC SURGERY S14.34.1 Scar revision procedures involving natural orifices IP 27980 Clinical Photograph Clinical Photograph -
S14 PLASTIC SURGERY S14.4 PLASTIC SURGERY S14.34.2 Post traumatic squeal like contractures, severe hypertrophy, IP 38770 Clinical Photograph Clinical Photograph -
unstable scars, non-healing ulcers etc.,
S14 PLASTIC SURGERY S14.4 PLASTIC SURGERY S14.35 Injection treatment - each sitting for keloid,haemangioma, IP 1000 Clinical Photograph Scar Photo -
lymphangioma and vascular malformations

S14 PLASTIC SURGERY S14.4 PLASTIC SURGERY S14.36.1 Corrective surgery for congenital deformities of foot (per foot) IP 50000 Clinical Photograph,X- Ray Foot X- Ray Foot,Clinical Photograph -

S14 PLASTIC SURGERY S14.4 PLASTIC SURGERY S14.36.2 Corrective surgery for Hyperchalonism elecanthes IP 52740 Clinical Photograph,CT Orbits With Contrast X-Ray Orbit,Clinical Photograph -
S14 PLASTIC SURGERY S14.4 PLASTIC SURGERY S14.37.1 Tissue expansion -for functional purpose IP 30000 Clinical Photograph Clinical Photograph -
S14 PLASTIC SURGERY S14.4 PLASTIC SURGERY S14.37.2 Cleft hand / foot Correction IP 60000 Clinical Photograph,X-Ray X-Ray,Clinical Photograph -
S14 PLASTIC SURGERY S14.4 PLASTIC SURGERY S14.37.3 Tessiers cleft IP 51500 Clinical Photograph Clinical Photograph,Case Sheet with operation Notes -
S14 PLASTIC SURGERY S14.4 PLASTIC SURGERY S14.38.1 Pressure Sore – Surgery IP 30000 clinical and/or relevant imaging Photographs clinical and/or relevant imaging Photographs -
S14 PLASTIC SURGERY S14.4 PLASTIC SURGERY S14.38.2 Diabetic Foot – Surgery IP 30000 clinical and/or relevant imaging Photographs clinical and/or relevant imaging Photographs -
S14 PLASTIC SURGERY S14.4 PLASTIC SURGERY S14.39 Hypospadias cripples IP 39680 Clinical Photograph Clinical Photograph,Case Sheet with operation Notes -
S14 PLASTIC SURGERY S14.4 PLASTIC SURGERY S14.4 Surgical correction for Congenital Deformity of Hand (Per IP 24126 X-RAY,CT-Scan Clinical Photograph -
Hand)
S14 PLASTIC SURGERY S14.4 PLASTIC SURGERY S14.40.1 Nose fractures with implants IP 45000 X-Ray Facial Bones,CT of Nose \ Nasopharynx X-Ray Facial Bones,Intra & Post OP Photos -
S14 PLASTIC SURGERY S14.4 PLASTIC SURGERY S14.40.2 Closed reduction (1 jaw) using wires - under LA IP 5000 Clinical Photograph,Clinical assessment and investigations Clinical assessment and investigations,Intra & Post OP Photos -
S14 PLASTIC SURGERY S14.4 PLASTIC SURGERY S14.40.3 Alveolar bone grafting with bone graft IP 30320 Clinical Photograph,Orthopantomography (OPG) X-Ray Facial Bones,Intra & Post OP Photos -
S14 PLASTIC SURGERY S14.4 PLASTIC SURGERY S14.40.4 Surgical Correction Of Fracture Lefort III IP 51080 3D CT Facial Bones,Orthopantomography (OPG) X-Ray PNS,Intra & Post OP Photos -
S14 PLASTIC SURGERY S14.4 PLASTIC SURGERY S14.41.1 Exicision of benign lision (With graft / without graft) IP 14000 Clinical Photograph Post op Photo,USG/FNAC -
S14 PLASTIC SURGERY S14.4 PLASTIC SURGERY S14.41.2 Estlander Operation (lip) DC 9300 Doppler report Scar Photo,Doppler report,Operative Photos -
S14 PLASTIC SURGERY S14.4 PLASTIC SURGERY S14.41.3 Lip reconstruction with flap (more than 1/3rd) IP 40000 Clinical picture,Clinical Photograph,Biopsy report POST OP SCAR Photo,Intra Op Photo,Biopsy report -
S14 PLASTIC SURGERY S14.4 PLASTIC SURGERY S14.41.4 Hemangioma Scleotherapy IP 9150 sclergent used,USG local area,Clinical Photograph Clinical Photograph,Routine Histopathological Examination -
S14 PLASTIC SURGERY S14.4 PLASTIC SURGERY S14.41.5 Plexiform neurofibroma IP 5000 Clinical photograph showing more than 3 leisions,Clinical Photograph,FNAC,Café-au-lat spots Biopsy report,Intra Op Photo,SCAR Photo -
S14 PLASTIC SURGERY S14.4 PLASTIC SURGERY S14.5 Surgical correction for Craniosynostosis IP 90173 3D CT,MRI Clinical Photograph -
S14 PLASTIC SURGERY S14.4 PLASTIC SURGERY S14.6 Surgical Correction of anamolies of Ear (cup and bat ears) IP 25655 Clinical Photograph Clinical Photograph -

S14 PLASTIC SURGERY S14.4 PLASTIC SURGERY S14.7 Management of electrical burns with vitals exposed with flap IP 51310 Clinical Photograph Clinical Photograph -
cover
S14 PLASTIC SURGERY S14.4 PLASTIC SURGERY S14.8 Reduction Surgery For Filarial Lymphoedema IP 40648 Clinical Photograph Clinical Photograph -
S14 PLASTIC SURGERY S14.4 PLASTIC SURGERY S14.9 Surgical Correction of Hemifacial Atrophy IP 90644 3D CT,MRI Clinical Photograph -
S15 POLY TRAUMA S15 POLYTRAUMA S15.10 Visceral injury requiring surgical intervention IP 30000 Pre-op. X-ray Post-op. X-ray,Doppler -
S15 POLY TRAUMA S15.1 ORTHOPEDIC TRAUMA S15.1.1 Surgical Correction Of Longbone Fracture IP 30786 X-RAY X-RAY -
S15 POLY TRAUMA S15.1 ORTHOPEDIC TRAUMA S15.1.2 Amputation Surgery IP 10262 X-RAY Clinical Photograph -
S15 POLY TRAUMA S15.1 ORTHOPEDIC TRAUMA S15.1.2.1 Toes Amputation IP 10000 Clinical Photograph,X-Ray X-Ray,Clinical Photograph -
S15 POLY TRAUMA S15.1 ORTHOPEDIC TRAUMA S15.1.3 Management of Soft Tissue Injury IP 6671 Clinical Photograph Clinical Photograph -
S15 POLY TRAUMA S15.10 OTHERS S15.10.1 Blood Transfusion for trauma patients ST 2000 PR and reason for tranfusion,HB,BP Repeated HB and Transfusion clinical photograph -
S15 POLY TRAUMA S15.2 NEURO-SURGICAL TRAUMA S15.2.1.1 Medical Management in General Ward @ Rs.900/-Neuro IP 11084 X-RAY,CT Clinical Photograph -
surgical trauma
S15 POLY TRAUMA S15.2 NEURO-SURGICAL TRAUMA S15.2.1.2 Intesive care managementof Neuro Surgical Trauma in Neuro IP 49258 X-RAY,CT Clinical Photograph -
Icu @Rs.4000/Day
S15 POLY TRAUMA S15.2 NEURO-SURGICAL TRAUMA S15.2.2 Surgical Treatment (Up To) for Neuro Surgical Trauma IP 153931 X-RAY,CT Clinical Photograph -
S15 POLY TRAUMA S15.3 CHEST INJURIES S15.3.1.1 Conservative management for Chest Injuries In General IP 5541 X-RAY,CT Clinical Photograph -
Ward@Rs.900/Day
S15 POLY TRAUMA S15.3 CHEST INJURIES S15.3.1.2 Intesive care management for Chest injuries in RICU Rs. 4000/- IP 35918 X-RAY,CT Clinical Photograph -
per day
S15 POLY TRAUMA S15.3 CHEST INJURIES S15.3.2 Surgical Treatment for Chest injuries IP 29566 X-RAY,CT X-RAY -
S15 POLY TRAUMA S15.4 ABDOMINAL INJURIES S15.4.1.1 Conservative management for Abdominal Injuries In General IP 5541 X-RAY,CT,USG USG -
Ward@Rs.900/Day
S15 POLY TRAUMA S15.4 ABDOMINAL INJURIES S15.4.1.2 Intensive care management for abdominal injuries in surgical IP 28734 X-RAY,CT,USG USG -
ICU @ Rs.4000/-
S15 POLY TRAUMA S15.4 ABDOMINAL INJURIES S15.4.2 Surgical Management for Abdominal Injuries IP 76965 X-RAY,CT,USG USG,Clinical Photograph -
S15 POLY TRAUMA S15.5 EMERGENCY ROOM PROCEDURES S15.5.1 Tracheostomy IP 6393 Clinical Photograph Clinical Photograph -

35 of 47
CODE MAIN CATEGORY Sub SUB CATEGORY NAME CODE SURGERY / THERAPY DESCRIPTION PROCEDURE PACKAGE SPECIAL INVESTIGATION POST OPERATIVE PROCEDURE INVESTIGATION TREATMENT PROTOCOL
Category ID TYPE AMOUNT
S15 POLY TRAUMA S15.5 EMERGENCY ROOM PROCEDURES S15.5.2 Thoracostomy IP 10796 Clinical Photograph Clinical Photograph -

S15 POLY TRAUMA S15.6 WOUND MANAGEMENT FOR S15.6.1 Surgical Management of Grade IandII Compound Fractures IP 15393 X-Ray,Clinical Photograph Clinical Photograph -
COMPOUND FRACTURES
S15 POLY TRAUMA S15.6 WOUND MANAGEMENT FOR S15.6.2 Surgical Management of Grade III Compound Fractures IP 26681 X-Ray,Clinical Photograph Clinical Photograph -
COMPOUND FRACTURES
S15 POLY TRAUMA S15.6 WOUND MANAGEMENT FOR S15.6.3 Surgical Management of wound In Compound Fracture with IP 26682 X-Ray,Clinical Photograph Clinical Photograph -
COMPOUND FRACTURES Flap cover(86.7)
S15 POLY TRAUMA S15.7 OTHER SMALL BONE FRACTURES-K- S15.7.1 Surgical Management of Patella Fracture (To Be Covered IP 5132 X-Ray X-Ray -
WIRING (TO BE COVERED ALONG Along With Other Injuries Only And Not As Exclusive
WITH OTHER INJURIES ONLY AND Procedure)
NOT AS EXCLUSIVE PROCEDURE)

S15 POLY TRAUMA S15.7 OTHER SMALL BONE FRACTURES-K- S15.7.2 Surgical management with K-Wiring for Small bone fractures IP 5132 X-Ray X-Ray -
WIRING (TO BE COVERED ALONG (To Be Covered Along With Other Injuries Only And Not As
WITH OTHER INJURIES ONLY AND Exclusive Procedure)
NOT AS EXCLUSIVE PROCEDURE)

S15 POLY TRAUMA S15.8 FACIAL INJURIES S15.8.1 Surgical Management with Facial Bone Fractures (Facio- IP 15393 Clinical Photograph,X-Ray Clinical Photograph,X-Ray -
Maxillary Injuries)
S15 POLY TRAUMA S15.9 PELVIC BONE FRACTURE S15.9.1 Surgical Correction Of Pelvic Bone Fractures. IP 35814 X-Ray X-Ray -
S15 POLY TRAUMA S15.9 PELVIC BONE FRACTURE S15.9.2 Internal fixation of Pelviacetabular fracture IP 40000 X-RAY/CT Clinical Photograph showing scar -
S16 COCHLEAR IMPLANT SURGERY S16.1 COCHLEAR IMPLANT SURGERY FOR S16.1 Cochlear Implant Surgery IP 533624 - - -
CHILDREN BELOW 5 YEARS
S16 COCHLEAR IMPLANT SURGERY S16.1 COCHLEAR IMPLANT SURGERY FOR S16.1.2 Already unilateral surgery done in other Scheme and IP 533624 - - -
CHILDREN BELOW 5 YEARS proposed opposite side (Second Implant) ear cochlear
implantation under Dr,YSR Aarogyasri Scheme
S16 COCHLEAR IMPLANT SURGERY S16.1 COCHLEAR IMPLANT SURGERY FOR S16.1.3 Already unilateral surgery done in Dr,YSR Aarogyasri Scheme IP 533624 - - -
CHILDREN BELOW 5 YEARS previously and proposed opposite side (second Implant) ear
cochlear implantation in same Dr.YSR Aarogyasri scheme

S16 COCHLEAR IMPLANT SURGERY S16.1 COCHLEAR IMPLANT SURGERY FOR S16.1.4 Bilateral Cochlear Implantation IP 1067248 - - -
CHILDREN BELOW 5 YEARS
S16 COCHLEAR IMPLANT SURGERY S16.2 AUDITORY-VERBAL THERAPY S16.2.1 Initial Mapping/Switch On for Auditory - Verbal Therapy IP 51310 Progress Reports,Mapping Charts Progress Reports,Mapping Charts -

S16 COCHLEAR IMPLANT SURGERY S16.2 AUDITORY-VERBAL THERAPY S16.2.2 Post Switch On Mapping/Initiation Of AVT And Training Of IP 20524 Progress Reports,Mapping Charts Progress Reports,Mapping Charts -
Child And Mother - First Installment
S16 COCHLEAR IMPLANT SURGERY S16.2 AUDITORY-VERBAL THERAPY S16.2.3 Post Switch On Mapping/Initiation Of AVT And Training Of IP 20524 Progress Reports,Mapping Charts Progress Reports,Mapping Charts -
Child And Mother - Second Installment
S16 COCHLEAR IMPLANT SURGERY S16.2 AUDITORY-VERBAL THERAPY S16.2.4 Post Switch On Mapping/Initiation Of AVT And Training Of IP 20524 Progress Reports,Mapping Charts Progress Reports,Mapping Charts -
Child And Mother - Third Installment
S16 COCHLEAR IMPLANT SURGERY S16.2 AUDITORY-VERBAL THERAPY S16.2.5 Post Switch On Mapping/Initiation Of AVT And Training Of IP 20524 Progress Reports,Mapping Charts Progress Reports,Mapping Charts -
Child And Mother - Fourth Installment
S16 COCHLEAR IMPLANT SURGERY S16.3 HEARING IMPAIRED S16.3.1 Behind Ear Analogue Hearing Aid for Hearing impaired IP 10262 Audiometry,Audiometry Clinical Photograph,Clinical Photograph -

S17 PROSTHESES S17.1.1 Symes Prostheses S17.1.1.1 SYMES Prostheses - High Density Ppolyethylene (HDP) / IP 1027 Clinical Photograph Clinical Photograph -
Polypropylene (PP)
S17 PROSTHESES S17.1.1 Symes Prostheses S17.1.1.2 SYMES Prostheses - Fibre IP 1232 Clinical Photograph Clinical Photograph -
S17 PROSTHESES S17.1.1 Symes Prostheses S17.1.1.3 SYMES Prostheses - Modular IP 1540 Clinical Photograph Clinical Photograph -
S17 PROSTHESES S17.1.2 Below Knee(BK/PTB) Prostheses S17.1.2.1 Below Knee/ Petellar Tendon Bearing - High Density IP 1232 Clinical Photograph Clinical Photograph -
Ppolyethylene (HDP) / Polypropylene (PP)
S17 PROSTHESES S17.1.2 Below Knee(BK/PTB) Prostheses S17.1.2.2 Below Knee/Petellar Tendon Bearing - Fibre IP 1540 Clinical Photograph Clinical Photograph -

S17 PROSTHESES S17.1.2 Below Knee(BK/PTB) Prostheses S17.1.2.3 Below Knee/Petellar Tendon Bearing - Modular IP 3079 Clinical Photograph Clinical Photograph -

S17 PROSTHESES S17.1.3 Through Knee Prostheses S17.1.3.1 Through Knee - High Density Ppolyethylene (HDP) / IP 1540 Clinical Photograph Clinical Photograph -
Polypropylene (PP)
S17 PROSTHESES S17.1.3 Through Knee Prostheses S17.1.3.2 Through Knee - Fibre IP 1847 Clinical Photograph Clinical Photograph -
S17 PROSTHESES S17.1.3 Through Knee Prostheses S17.1.3.3 Through Knee - Modular IP 3592 Clinical Photograph Clinical Photograph -
S17 PROSTHESES S17.1.4 Above Knee(AK) Prostheses S17.1.4.1 Above Knee - High Density Ppolyethylene (HDP) / IP 1540 Clinical Photograph Clinical Photograph -
Polypropylene (PP)
S17 PROSTHESES S17.1.4 Above Knee(AK) Prostheses S17.1.4.2 Above Knee - Fibre IP 1847 Clinical Photograph Clinical Photograph -
S17 PROSTHESES S17.1.4 Above Knee(AK) Prostheses S17.1.4.3 Above Knee - Modular IP 3592 Clinical Photograph Clinical Photograph -
S17 PROSTHESES S17.1.4 Above Knee(AK) Prostheses S17.1.5.1 Hip disarticulation prostheses - Hdp/Pp IP 2566 Clinical Photograph Clinical Photograph -
S17 PROSTHESES S17.1.4 Above Knee(AK) Prostheses S17.1.5.2 Hip disarticulation prostheses - Fibre IP 3079 Clinical Photograph Clinical Photograph -
S17 PROSTHESES S17.1.4 Above Knee(AK) Prostheses S17.1.5.3 Hip disarticulation prostheses - Modular IP 6157 Clinical Photograph Clinical Photograph -
S17 PROSTHESES S17.1.4 Above Knee(AK) Prostheses S17.1.5.4 Hip disarticulation prostheses - Partial Foot Prostheses IP 513 Clinical Photograph Clinical Photograph -
S17 PROSTHESES S17.2 UPPERLIMB S17.2.1.1 Upper Limb - High Density Ppolyethylene (HDP) / IP 1540 Clinical Photograph Clinical Photograph -
Polypropylene (PP)
S17 PROSTHESES S17.2 UPPERLIMB S17.2.1.2 Upper Limb - Fibre IP 1847 Clinical Photograph Clinical Photograph -
S17 PROSTHESES S17.2 UPPERLIMB S17.2.1.3 Upper Limb - Modular IP 3592 Clinical Photograph Clinical Photograph -
S17 PROSTHESES S17.2 UPPERLIMB S17.2.2.1 Above Elbow - High Density Ppolyethylene (HDP) / IP 1540 Clinical Photograph Clinical Photograph -
Polypropylene (PP)
S17 PROSTHESES S17.2 UPPERLIMB S17.2.2.2 Above Elbow - Fibre IP 2053 Clinical Photograph Clinical Photograph -
S17 PROSTHESES S17.2 UPPERLIMB S17.2.2.3 Above Elbow - Modular IP 4104 Clinical Photograph Clinical Photograph -
S17 PROSTHESES S17.2 UPPERLIMB S17.2.3.1 Whole Upper Limb - High Density Ppolyethylene (HDP) / IP 1027 Clinical Photograph Clinical Photograph -
Polypropylene (PP)
S17 PROSTHESES S17.2 UPPERLIMB S17.2.3.2 Whole Upper Limb - Fibre IP 1232 Clinical Photograph Clinical Photograph -
S17 PROSTHESES S17.2 UPPERLIMB S17.2.3.3 Whole Upper Limb - Modular IP 1539 Clinical Photograph Clinical Photograph -
M1 CRITICAL CARE M1 CRITICAL CARE M1.1 Medical Management of Acute Severe Asthma With Acute IP 51310 clinical photo intubated with ventilator,Spirometry,Serum IgE,ABG,clinical photo intubated with other lab investigation,ABG,other lab investigation,ABG Ventilatory Care,Asthma Guide lines - GINA
Respiratory Failure ventilator,Spirometry,Serum IgE,ABG /India,Ventilatory Care,Asthma Guide lines - GINA
/India
M1 CRITICAL CARE M1 CRITICAL CARE M1.2 Medical Management of COPD with Respiratory Failure IP 82095 ventilator when necessary,HRCT Chest,Blood gases,ventilator when necessary,HRCT Chest,Blood gases other lab investigation,ABG,other lab investigation,ABG According to International Guide lines,Ventilatory
(Infective Exacerbation) Care,According to International Guide lines,Ventilatory
Care
M1 CRITICAL CARE M1 CRITICAL CARE M1.3 Medical Management of Acute Bronchitis with Pneumonia IP 61572 Ventilator,Clinical photoHRCT Scan,FOB,SputumC/S,Ventilator,Clinical photoHRCT Scan,FOB,SputumC/S other lab investigation,ABG,other lab investigation,ABG LABA,Ventilatory Care,IP 10
and Respiratory Failure days,Inhalers,LABA,Ventilatory Care,IP 10 days,Inhalers

M1 CRITICAL CARE M1 CRITICAL CARE M1.4 Medical Management of ARDS IP 102619 Ventilator,Clinical photoHRCT Scan,FOB,SputumC/S,Ventilator,Clinical photoHRCT Scan,FOB,SputumC/S other lab investigation,ABG,other lab investigation,ABG Antimicrobials,Ventilatory
Care,MICU,O2,Antimicrobials,Ventilatory
Care,MICU,O2
M1 CRITICAL CARE M1 CRITICAL CARE M1.5 Medical Management of ARDS with Multi Organ failure IP 118013 ABGS,Clinical photoHRCT Scan,FOB,SputumC/S,,Ventilator,ABGS,Clinical photoHRCT other lab investigation,ABG,other lab investigation,ABG Antimicrobials,Ventilatory
(R65.1) Scan,FOB,SputumC/S,,Ventilator Care,MICU,O2,Antimicrobials,Ventilatory
Care,MICU,O2
M1 CRITICAL CARE M1 CRITICAL CARE M1.6 Medical Management of ARDS with DIC (Blood and Blood IP 143668 ABGS,Clinical photoHRCT Scan,FOB,SputumC/S,Ventilator,ABGS,Clinical photoHRCT Scan,FOB,SputumC/S,Ventilator other lab investigation,ABG,other lab investigation,ABG Cryo precipitate,Ventilatory Care,FFP,Cryo
Products) (D65) precipitate,Ventilatory Care,FFP
M1 CRITICAL CARE M1 CRITICAL CARE M1.7 Medical Management of Poisioning Requiring Ventilatory IP 51310 Ventilatory assistance,Clinical photo Renal chemistry Drug/Poison level in blood,Blood gases,Intubation other lab investigation,ABG atropine,Ventilatory Care,MICU,O2
Assistance
M1 CRITICAL CARE M1 CRITICAL CARE M1.8 Intensive care management of Septic Shock IP 61572 Ventilatory assistance,Clinical phot Renal Chemistry,Blood gases,Blood Culture,Urine Culture,USG,Intubation ABG and other Lab Investigations Ventilatory Care and other supportive
measures,MICU,O2,Antimicrobials
M1 CRITICAL CARE M1 CRITICAL CARE M1.9 Poisonings with unstable vitals ST 5400 ECG,Gastric Content Anaysis,LFT,RFT clinical notes -
M2 GENERAL MEDICINE M2 GENERAL MEDICINE M2.1 Medical Management of Thrombocytopenia With Bleeding IP 30786 Report and video clip online,Aspiration / BiopsyReport,Platelet count,PT APTT,Leptospira,Parasite F / V,Bone Lab Investigations Factor -VIII,PRP,SDPIV - IgIV antimicrobials,IV fluids
Diathesis Marrow

36 of 47
CODE MAIN CATEGORY Sub SUB CATEGORY NAME CODE SURGERY / THERAPY DESCRIPTION PROCEDURE PACKAGE SPECIAL INVESTIGATION POST OPERATIVE PROCEDURE INVESTIGATION TREATMENT PROTOCOL
Category ID TYPE AMOUNT
M2 GENERAL MEDICINE M2 GENERAL MEDICINE M2.10 Medical Management of Anaemias (Less Than 7 Gms) with IP 15000 ECG,Complete Blood Picture [CBP] ,Erythrocyte Sedimentation Rate (ESR),ICU Photo on Ventilator,2D Echo Bone Marrow Aspiration,Complete Haemogram,USG Abdomen,Chest X-Ray PA View(1 -
Heart Failure Film),Serum Ferritin Levels,serum iron,UIBCIBC(Unsaturated Iron Binding Capacity
Test/Total),Stool For Occult Blood,Perpheral Smear For Malarial Parasites(MP),Vitamin
B12,Folic Acid Levels,Upper GI endoscopy ,Colono Scopy

M2 GENERAL MEDICINE M2 GENERAL MEDICINE M2.11 Medical Management of Pancytopenia IP 20000 Erythrocyte Sedimentation Rate (ESR),Complete Blood Picture [CBP] Coombs Test Direct,Bone Marrow Aspiration ,CUE(pH,Specific Gravity,Sugar,Protein And -
Microscopy),Complete Haemogram,Lactate Dehydrogenase(LDH)

M2 GENERAL MEDICINE M2 GENERAL MEDICINE M2.12 Medical Management of Periodic Paralysis IP 15000 CPK,Serum Electrolytes,ECG (Electro Cardiogram),RBS ECG(Electro Cardiogram),Serum Electrolytes -
M2 GENERAL MEDICINE M2 GENERAL MEDICINE M2.16 Acute bronchitis ST 7000 CBC,Chest Xray,PFT(if necessary),Sputum Exam clinical notes -
M2 GENERAL MEDICINE M2 GENERAL MEDICINE M2.17 Severe Asthma ST 5000 CBC,Chest Xray,PFT(if necessary),Sputum Exam clinical notes -
M2 GENERAL MEDICINE M2 GENERAL MEDICINE M2.18 Acute COPD ST 5000 Chest X-Ray,ABG-Respiratory Failure clinical notes,PFT -
M2 GENERAL MEDICINE M2 GENERAL MEDICINE M2.19 Medical Management of Acute Rheumatic Fever IP 15000 ECG (Electro Cardiogram),Complete Blood Picture [CBP],Erythrocyte Sedimentation Rate (ESR) C- Reactive Protein,Anti-Streptolysin O(ASO) Titres ,ECG(Electro Cardiogram) ,ECHO -
Cardiogram,Throat Swab For KLB ,Complete Blood Picture[CBP],Erythrocyte
Sedimentation Rate(ESR)
M2 GENERAL MEDICINE M2 GENERAL MEDICINE M2.19.1 INTERVENTIONS LIMITED TO ACUTE RHEUMATIC FEVER AND IP 30000 2D ECHO,BLOOD CULTURE 2D ECHO,BLOOD CULTURE -
RELATED CONDITIONS
M2 GENERAL MEDICINE M2 GENERAL MEDICINE M2.2.1 Medical Management of Hemophilia (D67/D68.0) IP 61573 Factor VIII / IX,PT APTT,Report and video clip online Lab Investigations IV-FPP,Factor -VIII
M2 GENERAL MEDICINE M2 GENERAL MEDICINE M2.2.2 Medical Management of Other Coagulation Disorders IP 45153 Von willi brands factor Lab Investigations Factor - VIII - Cryoprecipitate,IV FFP
M2 GENERAL MEDICINE M2 GENERAL MEDICINE M2.20 Medical Management of Typhoid And Paratyphoid Fevers IP 10000 Widal test,Complete Blood Picture [CBP],Blood Culture & Sensitivity - Automated /Clinical Photograph Case Sheet with treatment details -

M2 GENERAL MEDICINE M2 GENERAL MEDICINE M2.21 Medical Management of Deep Vein Thrombosis IP 25000 CT-PTA,Venous Doppler,D-Dimer Test,Complete Blood Picture [CBP],Clinical Photograph,A PTT Blood Coagulation Analyzer(BCA) Or Coagulation Profile,Color Doppler Sonography -
Single Study,Case sheet with clinical improvement
M2 GENERAL MEDICINE M2 GENERAL MEDICINE M2.22 Medical Management of Hypertensive Emergencies IP 7500 Chest X-Ray,Clinical Photograph,Case sheet with clinical History,ECG,RFT Renal Profile,ECG(Electro Cardiogram),Cerebrospinal Fluid (CSF) Analysis Cell -
Count,ECHO Cardiogram,CUE(pH,Specific Gravity,Sugar,Protein And Microscopy),Case
Sheet with treatment details
M2 GENERAL MEDICINE M2 GENERAL MEDICINE M2.23 Medical Management of Metabolic Encephalopathy IP 35000 CXR,Serum Electrolytes,Renal Profile,LFT(liver function tests),Random Blood Sugar(RBS)Test,ICU Photo on Random Blood Sugar(RBS) Test,Serum Electrolytes,LFT(liver function tests),Renal -
Ventilator,USG Profile,CT-Scan Brain Plain And Contrast/MRI Brain Without Contrast,Cerebrospinal Fluid
(CSF) Analysis Cell Count,Case Sheet with treatment details,Clinical Photograph

M2 GENERAL MEDICINE M2 GENERAL MEDICINE M2.24 Raised intracranial pressure - ventilator / decompressive ST 7000 Fundal Examination,CT Brain clinical notes -
craniotomy / ICP monitoring / Shunt procedure / Other
emergency neuro surgical procedures

M2 GENERAL MEDICINE M2 GENERAL MEDICINE M2.25 Hyper Pyrexia ST 4500 CUE,Complete hemogram,CXR clinical notes -
M2 GENERAL MEDICINE M2 GENERAL MEDICINE M2.26 Recurrent vomiting with dehydration DC 2500 LFT,Serum electrolytes,RBS,Serum Creatinine clinical notes -
M2 GENERAL MEDICINE M2 GENERAL MEDICINE M2.27 Dysentery DC 1500 Serum Creatinine,Stool Test,Blood Sugar clinical notes -
M2 GENERAL MEDICINE M2 GENERAL MEDICINE M2.28 Medical Management of Acute Gastroenteritis IP 15000 Clinical Photograph,Stool For Microscopy,Blood Culture & Sensitivity - Automated,LFT(liver function tests),Complete Case Sheet with treatment details,Clinical Photograph -
Blood Picture[CBP]
M2 GENERAL MEDICINE M2 GENERAL MEDICINE M2.29 Unexplained jaundice ST 6500 HIV,LFT,HBS AG,HCV,US Abdomen clinical notes -
M2 GENERAL MEDICINE M2 GENERAL MEDICINE M2.3 Medical Management of Chelation Therapy For Thalassemia IP 15393 Agargel Electrophosis for Hemoglobin,Heamogram,Serum,Ferritin,S.Iron,Heamatocrit,Peripheral Smear,Complete Lab Investigations,Lab Investigations Chelation Theraphy,Chelation Theraphy
Major Blood Picture,Liver Function Test,Renal Function Test,Agargel Electrophosis for
Hemoglobin,Heamogram,Serum,Ferritin,S.Iron,Heamatocrit,Peripheral Smear,Complete Blood Picture,Liver
Function Test,Renal Function Test
M2 GENERAL MEDICINE M2 GENERAL MEDICINE M2.30 HIV with minor complications ST 7000 Viral Markers,CXR,Western blot Test,Intra & Post OP Photos CD4 count,clinical notes -
M2 GENERAL MEDICINE M2 GENERAL MEDICINE M2.31 Blood transfusion -Children, Pregnant women, Anemic DC 2000 Hb%,Blood Grouping,RH Typhe,Anemia repeated admission HPLC scan copy clinical notes -
M2 GENERAL MEDICINE M2 GENERAL MEDICINE M2.32 Medical Management of Myelodysplastic Syndromes IP 30000 Erythrocyte Sedimentation Rate (ESR),Complete Blood Picture [CBP] Coombs Test Direct,Bone Marrow Aspiration ,CUE(pH,Specific Gravity,Sugar,Protein And -
Microscopy),Complete Haemogram,Lactate Dehydrogenase(LDH)

M2 GENERAL MEDICINE M2 GENERAL MEDICINE M2.33 Non Obstructive Hydrocephalus / NPH /BIH ST 9000 CFS Analysis SOS,CT Brain clinical notes -
M2 GENERAL MEDICINE M2 GENERAL MEDICINE M2.34 Emergency management of Hematuria ST 5000 BT CT Platelet count,US Abdomen,Urine Analysis,CUE clinical notes -
M2 GENERAL MEDICINE M2 GENERAL MEDICINE M2.35 Heat stroke ST 6000 CPK,Electrolytes,CBP,Blood sugar,RFT,ABG clinical notes -
M2 GENERAL MEDICINE M2 GENERAL MEDICINE M2.36 Acute abdomen ST 6000 X ray,US Abdomen,CXR,serum Amylase,CBP,CRP,Erect Abdomen clinical notes -
M2 GENERAL MEDICINE M2 GENERAL MEDICINE M2.37 Renal colic ST 6000 CT KUB,USG Abdomen,KUB,Xray,Urine Analysis,Urine Culture (if required),Sr.Calcium clinical notes -
M2 GENERAL MEDICINE M2 GENERAL MEDICINE M2.38 Unexplained hepatosplenomegaly ST 7000 HIV,LFT,Sr ammonium,PT,APTT,BM Aspiration if required,Peripheral smear,CBP,HBS AG,HCV,US Abdomen clinical notes -

M2 GENERAL MEDICINE M2 GENERAL MEDICINE M2.39 Chikungunya fever ST 6500 ELISA,CBP clinical notes -
M2 GENERAL MEDICINE M2 GENERAL MEDICINE M2.4 Medical Management of Cerebral Malaria IP 25655 Parasite F Test and QBC,CSF Analysis Clinical and Lab Investigations Ventilatiory Support,IV fluids,IV antibiotics,Oral
Chloroquine or IV quinine or IV
artesunate,Paracetamol,Mefloquine,Blood and Platelet
Transfusion
M2 GENERAL MEDICINE M2 GENERAL MEDICINE M2.40 Scorpion Bite DC 1700 Clinical Photograph Casesheet,Treatment photo -
M2 GENERAL MEDICINE M2 GENERAL MEDICINE M2.41 Addison’s disease IP 20000 cortisol assay after dexa methasone ,ACTH assay,lab investigations clinical and lab investigation,ACTH assay -
M2 GENERAL MEDICINE M2 GENERAL MEDICINE M2.42 Heat stroke with ICU IP 6000 ABG,Electrolytes,CBP,Blood sugar ,RFT,LFT,CPK total clinical notes -
M2 GENERAL MEDICINE M2 GENERAL MEDICINE M2.43 HYPERKALEMIA MANAGEMENT ST 4180 2D Echo,Serum electrolites,ECG ECG,Serum electrolites -
M2 GENERAL MEDICINE M2 GENERAL MEDICINE M2.44 HYPOGLYCEMIA MANAGEMENT ST 6800 CT Brain,RBS. S.Electrolytes RBS -
M2 GENERAL MEDICINE M2 GENERAL MEDICINE M2.45 HYPOGLYCEMIA POST PTCA MANAGEMENT ST 7500 ECHO,CBP,SERUM CRE, RBS K,ECHO,NA -
M2 GENERAL MEDICINE M2 GENERAL MEDICINE M2.46 Anaphylaxis ST 12880 clinical picture,CBP,S.Electrolytes,RFT S.Electrolytes, Clinical picture,CBP -
M2 GENERAL MEDICINE M2 GENERAL MEDICINE M2.47 MEDICAL MANAGEMENT OF DIABETIC FOOT IP 27900 Clinical photo,RBS,HV A1c,Colour Dopler leg, Xray Clinical photo,RBS -
M2 GENERAL MEDICINE M2 GENERAL MEDICINE M2.48 PTB DEFAULTER ST 7000 LFT,HB ,TC,PLATELETS CBP,RBS,CHEST X-RAY,VIRALS -
M2 GENERAL MEDICINE M2 GENERAL MEDICINE M2.49 OLD CVA WITH RIGHT HEMIPARESIS,T2DM ST 7000 RFT,CT BRAIN,GRBS, S. CREATINE,ELOTROYES,URINE ANALYSIS,VIRAL MARKS, HB, CBP RFT,GRBS -
M2 GENERAL MEDICINE M2 GENERAL MEDICINE M2.5 Medical Management of TB Meningitis IP 30787 CT Scan Brain CSF ADA Analysis,ABG Lab Investigations Mechanical Ventilatory support,IV fluids,Naso gastric
feeds,IV antibiotics,Antitubercular
theraphy,Paracetamol,IV Mannitol,Anticonvulsants
(Midazolam or Lorazepam, Phenobarbitone or
Phenytoin),IV dexamethasone and oral steroids

M2 GENERAL MEDICINE M2 GENERAL MEDICINE M2.50 HYPONETRENIA ST 15861 S. Electrolytes,CT Brain S. Electrolytes -
M2 GENERAL MEDICINE M2 GENERAL MEDICINE M2.51 MEDICAL MANAGEMENT OF PNEUMONIA WITH SEPTIC IP 5000 CX-R,CBP,S. Electrolytes,ECG,CT Brain,ECHO ECHO,ECG,S. Electrolytes -
SHOCK
M2 GENERAL MEDICINE M2 GENERAL MEDICINE M2.52 IJV CATHETER INSERTION WITHOUT DIALYSIS IP 5000 RFT,LFT RFT,LFT -
M2 GENERAL MEDICINE M2 GENERAL MEDICINE M2.53 PLASMAPHERESIS - PER SESSION IP 2000 ROUTINE ROUTINE -
M2 GENERAL MEDICINE M2 GENERAL MEDICINE M2.54 ACUTE CEREBELLAR SYNDROME IP 15000 MRI BRAIN MRI BRAIN -
M2 GENERAL MEDICINE M2 GENERAL MEDICINE M2.55 ALCOHOL WITHDRAWL SEIZURES IP 15000 CT BRAIN,RBS CT BRAIN,RBS -
M2 GENERAL MEDICINE M2 GENERAL MEDICINE M2.56 ALCOHOL WITHDRAWL SYNDROME IP 15000 CT BRAIN,RBS CT BRAIN,RBS -
M2 GENERAL MEDICINE M2 GENERAL MEDICINE M2.57 alcoholic cardiomyopathy IP 15000 ECG,2D ECHO ECG,2D ECHO -
M2 GENERAL MEDICINE M2 GENERAL MEDICINE M2.58 LEPTOSPIROSIS WITH HEPATITIS WITH VIRAL FEVER IP 15000 IGM,LEPTO IGG IGM,LEPTO IGG -
M2 GENERAL MEDICINE M2 GENERAL MEDICINE M2.59 NEUROTIC, STRESS-RELATED AND SOMATOFORM DISORDERS IP 15000 EEG,CT BRAIN EEG,CT BRAIN -
(ROUTINE WARD)
M2 GENERAL MEDICINE M2 GENERAL MEDICINE M2.6 Medical Management of Snake Bite Requiring Ventilator IP 61572 CT Scan Brain,ABG 8 hrly (3-day X 7-days),Blood Sugar 4 hrly,EEG Lab Investigations Antisnake Venom,Oxygen,IV
Support fluids,Inj.Meropenem,Inj.Vancomycin,Anticonvulsants
(Inj.Lorazepam, Inj.Phenobarbitone,
Inj.Phenytoin),Inotropes(Dobutamine, Dopamine,
Adrenaline, Noradrenaline),Mechanical
Ventilation,Inj.Midazolam infusion

M2 GENERAL MEDICINE M2 GENERAL MEDICINE M2.6.1 Medical Management of Snake Bite IP 25000 Renal function test and Serum Creatinine,Photo at the site of wound,PT INR,CBP,Blood Urea,Bleeding time Clotting CT Brain,Serum,Electrolytes -
time
M2 GENERAL MEDICINE M2 GENERAL MEDICINE M2.60 RICKETTSIAL Fever IP 13000 BLOOD CULTURE,CBC,CRP,ESR BLOOD CULTURE,CBC,CRP,ESR -
M2 GENERAL MEDICINE M2 GENERAL MEDICINE M2.61 TYPHUS Fever IP 13000 IGM,IGG IGM,IGG -
M2 GENERAL MEDICINE M2 GENERAL MEDICINE M2.62 VIRAL FEVER+POLYSEROSITIS IP 9000 RA FACTOR,LFT,ESR,CRP RA FACTOR,LFT,ESR,CRP -

37 of 47
CODE MAIN CATEGORY Sub SUB CATEGORY NAME CODE SURGERY / THERAPY DESCRIPTION PROCEDURE PACKAGE SPECIAL INVESTIGATION POST OPERATIVE PROCEDURE INVESTIGATION TREATMENT PROTOCOL
Category ID TYPE AMOUNT
M2 GENERAL MEDICINE M2 GENERAL MEDICINE M2.7 Medical Management of Scorpion Sting Requiring Ventilator IP 25656 Arterial Blood Pressure,ABG 8 hrly (3-day X 7-days),Blood Sugar 8 hrly,Echo,ECG,CVP monitoring Lab Investigations Antiscorption Venom,Oxygen,IV
Support fluids,Inj.Meropenem,Inj.Vancomycin,Inotropes(Dobut
amine, Dopamine, Adrenaline,
Noradrenaline),Mechanical Ventilation,Inj.Midazolam
infusion
M2 GENERAL MEDICINE M2 GENERAL MEDICINE M2.8 Medical Management of Metabolic Coma Requiring IP 35917 Arterial Blood Pressure,ABG,Blood Sugar,Blood Urea,S.Creatininine,Thyroid Profile,Echo,ECG,CVP monitoring Lab Investigations Antiscorption Venom,Oxygen,IV fluids,IV
Ventilatory Support antibiotics,Dobutamine,Dopamine,Adrenaline,Noradre
naline,Sodium Nitroprusside,Mechanical
Ventilation,Inj.Midazolam infusion

M2 GENERAL MEDICINE M2 GENERAL MEDICINE M2.9 Medical Management of Dengue Haemorrhagic Fever IP 35917 ICU Photo on Ventilator ,Complete Blood Picture [CBP],Platelet Count,CUE (Ph, Specific Gravity,Sugar,Protein And Case Sheet with treatment details ,Platelet Count ,PCV,Dengue Serology,Stool For Platelet transfusion,Antibiotics,IV fluids
Microscopy),Renal profile,LFT(liver function tests) Microscopy
M2 GENERAL MEDICINE M2.13 SEIZURES M2.13.1 Seizures ST 15688 Eeg,Serum Electrolytes,Rbs,Serum Creatine,Cbp,Dengue Serology,Malaria Antibodies,Malaria Peripheral Clinical Notes -
Smear,Serum Prolactin,Ct Brain
M2 GENERAL MEDICINE M2.13 SEIZURES M2.13.2 Seizures without Ventilator (ICU) ST 18098 Serum Prolactin,Serum Electrolytes,Rbs,Serum Creatine,Eeg,Ct Brain(Sos) If Needed,Cbp,Dengue Serology,Malaria Clinical Notes -
Antibodies,Malaria Peripheral Smear
M2 GENERAL MEDICINE M2.13 SEIZURES M2.13.3 Seizures with ventilator (ICU) ST 30000 ABG,Serum electrolytes,RBS,Serum Creatine,EEG,CT Brain(SOS) if needed clinical notes -
M2 GENERAL MEDICINE M2.14 DIABETIC KETOACIDOSIS M2.14.1 Diabetic ketoacidosis ST 15000 RBS,CBP,Serum creatine,Serum Electrolytes,Urine Ketones clinical notes -
M2 GENERAL MEDICINE M2.14 DIABETIC KETOACIDOSIS M2.14.3 Diabetic ketoacidosis without Ventilator (ICU) ST 15000 ABG,CBP,Serum creatine,Serum Electrolytes,Chest Xray,ECG,Blood culture,Urine Ketones,RBS clinical notes -
M2 GENERAL MEDICINE M2.14 DIABETIC KETOACIDOSIS M2.14.4 Diabetic ketoacidosis with ventilator ST 30000 ABG,CBP,Serum creatine,Serum Electrolytes,Chest Xray,ECG,Blood culture,Serum Bicorbonate ,Urine clinical notes -
Culture,CUE,USG Abdomen,Urine Ketones,RBS
M2 GENERAL MEDICINE M2.15 GASTRO INTESTINAL BLEED M2.15.1 Upper GI bleeding (conservative) ST 7000 Viral Markers CBP,Gastroscopy clinical notes -
M2 GENERAL MEDICINE M2.15 GASTRO INTESTINAL BLEED M2.15.2 Lower GI hemorrhage ST 5000 CT,PT,APTT,Platelet count,US abdomen,BT clinical notes,Colonoscopy -
M2 GENERAL MEDICINE M2.4 MALARIA M2.4.1 Medical Management of Falciparum Malaria IP 10000 ABG,Perpheral Smear For Malarial Parasites (MP),Complete Blood Picture [CBP],LFT(liver function tests) ,Renal Clinical Photograph,Perpheral Smear For Malarial Parasites(MP) Or Parasite F Test and -
Profile,Parasite F Test and Quantitative Buffy Coat (QBC),LDH Quantitative Buffy Coat(QBC)
M2 GENERAL MEDICINE M2.4 MALARIA M2.4.2 Medical Management of Vivax Malaria IP 10000 ICU Photo on Ventilator,Perpheral Smear For Malarial Parasites (MP) Or Parasite F Test and Quantitative Buffy Case sheet with clinical improvement -
Coat(QBC)
M2 GENERAL MEDICINE M2.9 DENGUE M2.9.1 Medical Management of Dengue Fever IP 10000 ICU Photo on Ventilator,Chest X-Ray PA View(1 Film),Complete Blood Picture [CBP],Platelet Count,Dengue Case Sheet with treatment details,Platelet Count,Dengue Serology,PCV -
Check,USG Abdomen
M3 INFECTIOUS DISEASES M3 INFECTIOUS DISEASES M3.1 Medical Management of Severe Tetanus IP 28703 ABG Ventilator,Swab for c/s,Clinical Photo intubation Clinical Photograph ventilator,MEDICAL,Tracheostomy
M3 INFECTIOUS DISEASES M3 INFECTIOUS DISEASES M3.2 Medical Management of Complicated Diphtheria IP 27502 ECG-5 times,Throat swab for c/s-3 times,Urine for ketone bodies Lab Investigations ventilator,MEDICAL,Tracheostomy
M3 INFECTIOUS DISEASES M3 INFECTIOUS DISEASES M3.3 Medical Management of Cryptococcal Meningitis IP 30581 Cryptococcal antigen,Lumbar Puncture CSF analysis Lab Investigations Amphoterecin B,Fluconazole
M4 PEDIATRICS M4.1 NEONATAL INTENSIVE CARE M4.1.1 Medical management of term Baby With Septicemia Culture IP 35917 Neurosonogram,Lumbar Puncture CSF analysis Evidence for Clinical Improvement with lab investigations Phototherapy,Fluconazole,Tobramycin -80mg,IV
Positive,Hyperbili rubinemia Not requiring Ventilatory antibiotics -Meropenem - 500mg,Maintenance IV
support. Fluids - Isolyte P,25 % dextrose,Calcium
gluconate,Nasogastric tube feeds
M4 PEDIATRICS M4.1 NEONATAL INTENSIVE CARE M4.1.10 Medical management of pre-term Baby of 30 To 32 Weeks IP 61572 2D ECHO -TWICE,Neurosonogram on day 2 and 5 Evidence for Clinical Improvement with lab investigations Frusemide,FFP,PRP,Maintenance IV Fluids - Isolyte P,25
Septi cemia Ductus Arteriosus -requiring Mechanical % dextrose,Calcium gluconate,Nasogastric tube
Ventilation. feeds,Supplemental Oxygen,PRBC,Phototherapy-
Umbilical venous and arterial
lines,Midazolam,Heparin,Aminoven,IV antibiotics
(Meropenem - 500mg , Tobramycin -
80mgFluconazole),Mechanical ventilation,Surfactant
therapy - Neosurf,Dopamine,Dobutamine,Vecuronium

M4 PEDIATRICS M4.1 NEONATAL INTENSIVE CARE M4.1.11 Medical management of pre-term Baby of <30 Weeks Severe IP 92358 Neurosonogram on day 2 and 5, 2D ECHO -TWICE Evidence for Clinical Improvement with lab investigations Frusemide,FFP,PRP,Maintenance IV Fluids - Isolyte P,25
Hyaline Membrane Disease Septi cemia Culture % dextrose,Calcium gluconate,Nasogastric tube
Positive,Hyperbili rubinemia Patent Ductus Arteriosus - feeds,Supplemental Oxygen,PRBC,Phototherapy-
requiring Mechanical Ventilation. Umbilical venous and arterial
lines,Midazolam,Heparin,Aminoven,IV antibiotics
(Meropenem - 500mg , Tobramycin -
80mgFluconazole),Mechanical ventilation,Surfactant
therapy -
Neosurf,Dopamine,Dobutamine,Vecuronium,Normal
saline

M4 PEDIATRICS M4.1 NEONATAL INTENSIVE CARE M4.1.12 Medical Management of Term Baby With Persistent IP 51310 Neurosonogram 2, 2D ECHO - 4 Evidence for Clinical Improvement with lab investigations Sodium bicarbonate,FFP,PRP,Maintenance IV Fluids -
Pulmonary Hypertension Ventilation-Hfo Hyperbilirubinem ia Isolyte P,25 % dextrose,Calcium gluconate,Nasogastric
Clinically evident septicemia. tube feeds,Supplemental Oxygen,PRBC,Phototherapy-
Umbilical venous and arterial
lines,Midazolam,Heparin,Aminoven,IV antibiotics
(Meropenem - 500mg , Tobramycin -
80mgFluconazole),Mechanical ventilation,Surfactant
therapy -
Neosurf,Dopamine,Dobutamine,Vecuronium,Normal
saline,Frusemide

M4 PEDIATRICS M4.1 NEONATAL INTENSIVE CARE M4.1.13 Medical Management of Term Baby With Severe Perinatal IP 35917 BERA CSF analysis(LP),CT-Scan,Neurosonogram 2 Evidence for Clinical Improvement with lab investigations IV Phenytoin,Maintenance IV Fluids - Isolyte P,25 %
Asphyxia Clinically evident septicemia, Hyperbilirubinem ia - dextrose,Calcium gluconate,Nasogastric tube
Not requiring Ventilatory support. feeds,Supplemental
Oxygen,Midazolam,Phisiotherapy,Normal saline,IV
antibiotics (Piperacillin Tazobactum, Tobramycin - 80
mg ),IV Phenobarbitone
M4 PEDIATRICS M4.1 NEONATAL INTENSIVE CARE M4.1.14 Medical Management of Term Baby With Severe Perinatal IP 51310 BERA CSF analysis(LP),CT-Scan,Neurosonogram 3 Evidence for Clinical Improvement with lab investigations IV Phenytoin,FFP,PRP,Maintenance IV Fluids - Isolyte
Asphyxia Clinically evident septicemia, Hyperbilirubinemia - P,25 % dextrose,Calcium gluconate,Nasogastric tube
requiring Ventilatory support. feeds,Supplemental Oxygen,PRBC,Phototherapy-
Umbilical venous and arterial
lines,Midazolam,Heparin,Aminoven,Phisiotherapy,IV
antibiotics (Meropenem - 500mg , Tobramycin -
80mgFluconazole),Dopamine,Dobutamine,Vecuronium,
Normal saline,IV Phenobarbitone

M4 PEDIATRICS M4.1 NEONATAL INTENSIVE CARE M4.1.15 Medical Management of Term Baby Severe IP 35917 Neurosonogram Evidence for Clinical Improvement with lab investigations Whole blood,Maintenance IV Fluids - Isolyte P,25 %
Hyperbilirubinemia Clinically evident Septicemia. dextrose,Calcium gluconate,Nasogastric tube
feeds,Double surface Phototherapy,IV antibiotics
(Piperacillin Tazobactum, Tobramycin - 80 mg ),Double
volume exchange transfusion
M4 PEDIATRICS M4.1 NEONATAL INTENSIVE CARE M4.1.16 Medical management of Seizures in term baby requiring IP 51310 Metabolilc screening-blood and urine ABG,CT-Scan,Ultra sound of abdomin,Lumbar Puncture CSF Evidence for Clinical Improvement with lab investigations IV Phenytoin,FFP,PRP,Maintenance IV Fluids - Isolyte
ventilatory support. analysis,Neurosonogram, Blood ammonia,lactate P,25 % dextrose,Calcium gluconate,Nasogastric tube
feeds,Supplemental Oxygen,PRBC,Phototherapy-
Umbilical venous and arterial
lines,Midazolam,Heparin,Aminoven,Phisiotherapy,IV
antibiotics (Meropenem - 500mg , Tobramycin -
80mgFluconazole),Mechanical
ventilation,Dopamine,Dobutamine,IV Phenobarbitone

38 of 47
CODE MAIN CATEGORY Sub SUB CATEGORY NAME CODE SURGERY / THERAPY DESCRIPTION PROCEDURE PACKAGE SPECIAL INVESTIGATION POST OPERATIVE PROCEDURE INVESTIGATION TREATMENT PROTOCOL
Category ID TYPE AMOUNT
M4 PEDIATRICS M4.1 NEONATAL INTENSIVE CARE M4.1.17 Medical Management of Necrotising Enterocolitis, Clinically IP 35917 LFT,Ultra sound of abdomin,Neurosonogram,Abdomen radiograph,,Stool for occult blood Evidence for Clinical Improvement with lab investigations Central line,Maintenance IV Fluids - Isolyte P,25 %
evident Septicemia, Hyperbilirubinem ia not requiring dextrose,Calcium gluconate,Nasogastric tube
ventilatory support. feeds,Phototherapy,Heparin,Aminoven,IV antibiotics
(Meropenem - 500mg , Tobramycin -
80mgFluconazole),Normal saline,
Metronidazole,Albumin,Total parenteral nutrition

M4 PEDIATRICS M4.1 NEONATAL INTENSIVE CARE M4.1.18 Medical Management of Term Baby, Fulminant septicemia IP 51310 LFT,2D ECHO,Ultra sound of abdomin,Neurosonogram,BERA CSF analysis(LP),Abdomen radiograph,,Stool for occult Evidence for Clinical Improvement with lab investigations Nonadrenaline,FFP,PRP,Maintenance IV Fluids - Isolyte
Culture Positive with Septic Shock, Hyperbilirubinem ia Renal blood P,25 % dextrose,Calcium gluconate,Nasogastric tube
Failure requiring ventilatory support. feeds,Supplemental Oxygen,PRBC,Phototherapy-
Umbilical venous and arterial
lines,Midazolam,Heparin,Aminoven,IV antibiotics
(Meropenem - 500mg , Tobramycin -
80mgFluconazole),Dopamine,Dobutamine,Vecuronium,
Normal saline,Frusemide,Sodium
bicarbonate,Albumin,Total parenteral
nutrition,Peritoneal dialysis,Adrenaline

M4 PEDIATRICS M4.1 NEONATAL INTENSIVE CARE M4.1.19 Advanced Neonatal Care (Rs. 2500 per day): Babies of 1200- IP 75000 Blood Gas,Blood sugar,Blood group Bilirubin,Complete Blood Counts,Coombs Test,CRP,Micro ESR,Blood Culture,CSF Serial ABG and Ultra sound,CBP,CRP,Repeat X - rays,RFT,LFT -
1499 g / with at least one of the conditions: on ventilation/HIE studies,Other Body Fluid Cultures,Electrolytes,Renal function tests,Liver Function tests,Serum Calcium,Serum
requiring hypothermia/Cardiac rhythm disorders needing Magnesium,USG abdomen,USG Cranium,Echocardiogram,EEG,ECG,MRI Brain,Coagulation profile,Metabolic
intervention/Sepsis with complications/Renal failure requiring Screen,Others as required Screening,Screening,Chest X ray,Other X-rays
dialysis/Inborn errors of metabolism and KMC is mandatory

M4 PEDIATRICS M4.1 NEONATAL INTENSIVE CARE M4.1.2 Medical Management of Preterm Baby 33 To 34 Weeks with IP 61572 Neurosonogram,2D ECHO Evidence for Clinical Improvement with lab investigations Aminoven,25 % dextrose,Calcium
Severe Hyaline Membrane Disease Clinically evident gluconate,Nasogastric tube feeds,Supplemental
septicemia Hyperbilirubinemia requiring Bubble Cpap. Oxygen,IV antibiotics (Piperacillin Tazobactum-1,
Tobramycin - 80 mg),Phototherapy-Umbilical venous
and arterial lines,Midazolam,Heparin
M4 PEDIATRICS M4.1 NEONATAL INTENSIVE CARE M4.1.20 Basic neonatal care package (Rs. 500 per day, maximum ST 1500 TSB,Blood sugar ,Complete blood count,Blood group,Coombs test,others as required TSB,clinical notes -
1500):• Any newborn needing feeding support • Babies
requiring closer monitoring for conditions like: o Moderate
jaundice requiring Phototherapy o Large for dates (>97
percentile) Babies o Small for gestational age (less than 3rd
centile)
M4 PEDIATRICS M4.1 NEONATAL INTENSIVE CARE M4.1.21 Newborn (suspected to be) affected by maternal renal and IP 16060 ultra sound Abdomen,Renal Profile,CUE (pH,Specific Gravity,Sugar,Protein And Microscopy),CRP,Blood culture,CBP CRP,Case sheet with clinical improvement,RFT,ultra sound Abdomen -
urinary tract diseasesNewborn (suspected to be) affected by
maternal conditions classifiable to N00-N39

M4 PEDIATRICS M4.1 NEONATAL INTENSIVE CARE M4.1.22 PRETERM/IUGR IP 9660 Serium eloctrolytes.,CBP,CRP,TSB CRP and clinical Notes,TSB,CBP -
M4 PEDIATRICS M4.1 NEONATAL INTENSIVE CARE M4.1.23 MECONIUM STAINED AMNIOTIC FLUID ST 6965 ABG,chest x ray,CBP,CRP chest x ray -
M4 PEDIATRICS M4.1 NEONATAL INTENSIVE CARE M4.1.25 MANAGEMENT OF NEONATAL HYPER BILRUBINEMIA ST 4500 INDIRECT BILRUBIN,SERUM BILRUBIN,DIRECT PLATELETS,BILRUBIN,HB -
M4 PEDIATRICS M4.1 NEONATAL INTENSIVE CARE M4.1.26 TERM/LARGE FOR DATES/SYNDROMIC ST 5000 PLATELETS,HB ,TC RBS,CBP -
M4 PEDIATRICS M4.1 NEONATAL INTENSIVE CARE M4.1.27 TERM/SEVERE IUGR IP 32900 RBS,CBP,CRP,SERUM SODIUM,TSB, NSG ,Blood Culture,serum electrolytes RBS,CBP -
M4 PEDIATRICS M4.1 NEONATAL INTENSIVE CARE M4.1.28 LATE ONSET SEPSIS(AGE UPTO 28 DAYS) IP 40000 CUE,CBP,CRP,QBC,UREA,CREATININE ELECTROLYTES,NSCT BLOOD CULTURE CSF -
M4 PEDIATRICS M4.1 NEONATAL INTENSIVE CARE M4.1.29 PRE TERM WITH SEVERE INTRAVENTRICULAR HEMORRHAGE IP 60000 NSG,CBP,CRP,S.ELECTROLYTES APTT,PT -

M4 PEDIATRICS M4.1 NEONATAL INTENSIVE CARE M4.1.3 Medical Management of pre term baby of 33 To 34 Weeks IP 61572 Neurosonogram,2D ECHO Evidence for Clinical Improvement with lab investigations Mechanical ventilation,FFP,PRP,Maintenance IV Fluids -
with Severe Hyaline Membrane Disease Clinically evident Isolyte P,25 % dextrose,Calcium gluconate,Nasogastric
septicemia Hyperbilirubinemia requiring ventilatory support. tube feeds,Supplemental Oxygen,IV antibiotics
(Piperacillin Tazobactum-1, Tobramycin - 80
mg),PRBC,Phototherapy-Umbilical venous and arterial
lines,Midazolam,Heparin,Aminoven

M4 PEDIATRICS M4.1 NEONATAL INTENSIVE CARE M4.1.4 Medicalmanagement of Preterm baby of 35 To 36 Weeks with IP 35917 Neurosonogram 3,2D ECHO,Lumbar Puncture CSF analysis Evidence for Clinical Improvement with lab investigations Supplemental Oxygen,Fluconazole,Tobramycin -
Mild Hyaline Membrane Disease septicemia Culture Positive 80mg,IV antibiotics -Meropenem - 500mg,Maintenance
Hyperbilirubinem ia not requiring ventilatory support. IV Fluids - Isolyte P,25 % dextrose,Calcium
gluconate,Nasogastric tube feeds,Phototherapy

M4 PEDIATRICS M4.1 NEONATAL INTENSIVE CARE M4.1.5 Medicalmanagement of Preterm baby of 33 To 34 Weeks with IP 35917 Neurosonogram 3,2D ECHO,Lumbar Puncture CSF analysis Evidence for Clinical Improvement with lab investigations PRBC,FFP,PRP,Fluconazole,Tobramycin -80mg,IV
Mild Hyaline Membrane Disease septicemia Culture Positive antibiotics -Meropenem - 500mg,Maintenance IV
Hyperbilirubinem ia not requiring ventilatory support. Fluids - Isolyte P,25 % dextrose,Calcium
gluconate,Nasogastric tube
feeds,Phototherapy,Supplemental Oxygen
M4 PEDIATRICS M4.1 NEONATAL INTENSIVE CARE M4.1.6 Medical management of Preterm baby of 33 To 34 Weeks with IP 61572 Neurosonogram 4,2D ECHO,Lumbar Puncture CSF analysis Evidence for Clinical Improvement with lab investigations Normal saline,FFP,PRP,Fluconazole,Tobramycin -
severe Hyaline Membrane Disease septicemia Culture Positive 80mg,IV antibiotics -Meropenem - 500mg,Maintenance
Hyperbilirubinem requiring ventilatory support/ bubble Cpap. IV Fluids - Isolyte P,25 % dextrose,Calcium
gluconate,Nasogastric tube
feeds,Phototherapy,Supplemental
Oxygen,PRBC,Heparin,Aminoven,Mechanical
ventilation,Surfactant therapy -
Neosurf,Dopamine,Dobutamine,Vecuronium
M4 PEDIATRICS M4.1 NEONATAL INTENSIVE CARE M4.1.7 Medical management of Preterm baby of 30 To 32 Weeks with IP 61572 Neurosonogram 3,2D ECHO,Lumbar Puncture CSF analysis Evidence for Clinical Improvement with lab investigations Vecuronium,FFP,PRP,Maintenance IV Fluids - Isolyte
severe Hyaline Membrane Disease septicemia Culture Positive P,25 % dextrose,Calcium gluconate,Nasogastric tube
Hyperbilirubinem ia requiring Mechanical ventilatory support. feeds,Supplemental Oxygen,PRBC,Phototherapy-
Umbilical venous and arterial
lines,Midazolam,Heparin,Aminoven,IV antibiotics
(Meropenem - 500mg , Tobramycin -
80mgFluconazole),Mechanical ventilation,Surfactant
therapy - Neosurf,Dopamine,Dobutamine

M4 PEDIATRICS M4.1 NEONATAL INTENSIVE CARE M4.1.8 Medical management of Preterm baby of<30 Weeks with IP 92358 Neurosonogram 4,2D ECHO,Lumbar Puncture CSF analysis Evidence for Clinical Improvement with lab investigations Normal saline,FFP,PRP,Maintenance IV Fluids - Isolyte
severe Hyaline Membrane Disease septicemia Culture P,25 % dextrose,Calcium gluconate,Nasogastric tube
PositiveHyperbilirubinem ia requiring Mechanical ventilatory feeds,Supplemental Oxygen,PRBC,Phototherapy-
support. Umbilical venous and arterial
lines,Midazolam,Heparin,Aminoven,IV antibiotics
(Meropenem - 500mg , Tobramycin -
80mgFluconazole),Mechanical ventilation,Surfactant
therapy - Neosurf,Dopamine,Dobutamine,Vecuronium

M4 PEDIATRICS M4.1 NEONATAL INTENSIVE CARE M4.1.9 Medical management of Preterm baby of 33 To 34 Weeks with IP 61572 2D ECHO -TWICE,Neurosonogram 4 Evidence for Clinical Improvement with lab investigations Frusemide,FFP,PRP,Maintenance IV Fluids - Isolyte P,25
severe Hyaline Membrane Disease septicemia Culture Positive % dextrose,Calcium gluconate,Nasogastric tube
Hyperbilirubinem ia Patent Ductus Arteriosus- requiring feeds,Supplemental Oxygen,PRBC,Phototherapy-
Mechanical ventilatory support. Umbilical venous and arterial
lines,Midazolam,Heparin,Aminoven,IV antibiotics
(Meropenem - 500mg , Tobramycin -
80mgFluconazole),Mechanical ventilation,Surfactant
therapy -
Neosurf,Dopamine,Dobutamine,Vecuronium,Normal
saline

M4 PEDIATRICS M4.2 PEDIATRIC INTENSIVE CARE M4.2.1.1 Medical management of Severe Bronchiolitis(Non Ventilated) IP 15393 CP,ABG OD (ABG -5) pulse oxymetry,X-RAY,ABG Budesonide,IV fluids,Oxygen,Inj. Ceftriaxone,Inj.
Hydrocortisone,Salbutamol
39 of 47
CODE MAIN CATEGORY Sub SUB CATEGORY NAME CODE SURGERY / THERAPY DESCRIPTION PROCEDURE PACKAGE SPECIAL INVESTIGATION POST OPERATIVE PROCEDURE INVESTIGATION TREATMENT PROTOCOL
Category ID TYPE AMOUNT
M4 PEDIATRICS M4.2 PEDIATRIC INTENSIVE CARE M4.2.1.10 Medical Management of Severe respiratory distress in IP 15000 Clinical Photograph,Arterial Blood Gas Analysis (ABG),Chest X- Ray PA View(1 Film) Chest X- Ray PA View(1 Film),Arterial Blood Gas Analysis(ABG) -
paediatric patient not requiring ventilatory support
M4 PEDIATRICS M4.2 PEDIATRIC INTENSIVE CARE M4.2.1.11 Medical Management of Severe respiratory distress in IP 40000 Clinical Photograph,Arterial Blood Gas Analysis (ABG),Chest X- Ray PA View(1 Film) Chest X- Ray PA View(1 Film),Arterial Blood Gas Analysis(ABG) -
paediatric patient requiring ventilatory support.
M4 PEDIATRICS M4.2 PEDIATRIC INTENSIVE CARE M4.2.1.2 Medical Management of Severe Bronchiolitis(Ventilated) IP 20524 ABG 8th hrly (3/day X 7 days),CP pulse oxymetry,X-RAY,ABG Inj. Midazolam Infusion .,IV
fluids,Oxygen,Salbutamol,Budesonide,nebulisations,Inj.
Pipracillin Tazobactum,Inj. Amikacin,Inj. Methyl
prednisolone
M4 PEDIATRICS M4.2 PEDIATRIC INTENSIVE CARE M4.2.1.3 Medical Management of Severe Bronchopneumon ia(Non IP 15393 CP,ABG OD (ABG -5) pulse oxymetry,X-RAY,ABG Oxygen
Ventilated)
M4 PEDIATRICS M4.2 PEDIATRIC INTENSIVE CARE M4.2.1.4 Medical Management of Severe Bronchopneumon IP 20524 ABG 8th hrly (3/day X 7 days) pulse oxymetry,X-RAY,ABG Inj. Midazolam Infusion .,IV fluids,Oxygen,Mechanical
ia(Ventilated) ventilation,Salbutamol,Budesonide,nebulisations,Inj.
Pipracillin Tazobactum,Inj. Amikacin

M4 PEDIATRICS M4.2 PEDIATRIC INTENSIVE CARE M4.2.1.5 Medical Management of Acute Severe Asthma (Ventilated) IP 20524 ABG 8th hrly (3/day X 7 days) pulse oxymetry,X-RAY,ABG Inj. Midazolam Infusion .,IV fluids,Oxygen,Mechanical
ventilation,Salbutamol,Budesonide,nebulisations,Inj.
Pipracillin Tazobactum,Inj. Amikacin

M4 PEDIATRICS M4.2 PEDIATRIC INTENSIVE CARE M4.2.1.6 Medical Management of Severe Aspiration Pneumonia (Non IP 15393 ABG OD (ABG -3) pulse oxymetry,X-RAY,ABG Inj. Amikacin,IV
Ventilated) fluids,Oxygen,Salbutamol,nebulisations,Inj. Pipracillin
Tazobactum
M4 PEDIATRICS M4.2 PEDIATRIC INTENSIVE CARE M4.2.1.7 Medical Management of Severe Aspiration Pneumonia ( IP 20524 ABG 8th hrly (3/day X 7 days) pulse oxymetry,X-RAY,ABG Inj. Midazolam Infusion .,IV fluids,Oxygen,Mechanical
Ventilated) ventilation,Salbutamol,nebulisations,Inj. Pipracillin
Tazobactum,Inj. Amikacin

M4 PEDIATRICS M4.2 PEDIATRIC INTENSIVE CARE M4.2.1.8 Medical Management of ARDS With Multi- Organ Failure IP 118013 Ventilator,Clinical Photo,HRCT Scan,FOB,Sputum C-S,ABGS,Ventilator,Clinical Photo,HRCT Scan,FOB,Sputum C- ABG and other Lab Investigations,ABG and other Lab Investigations Ventilatiory Care,MICU,O2,Antimicrobials,Ventilatiory
S,ABGS Care,MICU,O2,Antimicrobials

M4 PEDIATRICS M4.2 PEDIATRIC INTENSIVE CARE M4.2.1.9 Medical Management of ARDS Plus DIC (Blood and Blood IP 143668 Ventilator,Clinical Photo,HRCT Scan,FOB,Sputum C-S,ABGS,Ventilator,Clinical Photo,HRCT Scan,FOB,Sputum C- ABG and other Lab Investigations,ABG and other Lab Investigations Ventilatiory Care,FFP,Cryp Precipitate,Ventilatiory
Products) S,ABGS Care,FFP,Cryp Precipitate

M4 PEDIATRICS M4.2 PEDIATRIC INTENSIVE CARE M4.2.10 Haemolytic uremic syndrome ST 3000 CUE,RFT,Complete Hemogram,Platelet count,KUB clinical notes -
M4 PEDIATRICS M4.2 PEDIATRIC INTENSIVE CARE M4.2.2.1 Medical Management of Severe Myocarditis in Paediatric IP 41048 ABG 12 hrly,ECG,ECHO, arterial blood pressure pulse oxymetry,X-RAY,ABG T.lasilactone,IV fluids,Oxygen,Mechanical
patient ventilation,Inj. Pipracillin Tazobactum,Inj. Amikacin,Inj.
Midazolam Infusion
.,inj.Dobutamine,inj.Dopamine,inotropes,Inj.
Adrenaline,inj. Milrinone,Syp. Digoxin,T. Captopril,Inj.
Lasix
M4 PEDIATRICS M4.2 PEDIATRIC INTENSIVE CARE M4.2.2.2 Medical Management of Congenital Heart Disease With IP 25655 pulse oxymetry,ECHO pulse oxymetry,X-RAY,ABG inj.Dopamine,IV fluids,Oxygen,Inj.
Infection (Non Ventilated) in Paediatric patient Ceftriaxone,inj.Tobramycin,inj.Dobutamine
M4 PEDIATRICS M4.2 PEDIATRIC INTENSIVE CARE M4.2.2.3 Medical Management of Congenital Heart Disease With IP 51310 ABG 8th hrly (3/day X 7 days) pulse oxymetry,X-RAY,ABG milirinone,IV
Infection And Cardiogenic Shock (Ventilated) in Paediatric fluids,Oxygen,Dopamine,Dobutamine,Adrenaline,Nona
patients drenaline,inotropes,inj. Meropenem,Inj.
Vancomycin,Mechanical ventilation X,Inj. Midazolam

M4 PEDIATRICS M4.2 PEDIATRIC INTENSIVE CARE M4.2.2.4 Medical Management of Cardiogenic Shock in Paediatric IP 51310 ABG 8th hrly (3/day X 7 days) pulse oxymetry,X-RAY,ABG milirinone,IV
patients fluids,Oxygen,Dopamine,Dobutamine,Adrenaline,Nona
drenaline,inotropes,inj. Meropenem
M4 PEDIATRICS M4.2 PEDIATRIC INTENSIVE CARE M4.2.2.5 Medical Management of Infective Endocarditis IP 25654 ABG 8th hrly (3/day X 7 days) pulse oxymetry,X-RAY,ABG Low molecular weight Heparin,IV
fluids,Oxygen,Mechanical
ventilation,Dopamine,Dobutamine,Adrenaline,Nonadr
enaline,inotropes,inj. Meropenem,Inj.
Midazolam,milirinone,inj.Heparin
M4 PEDIATRICS M4.2 PEDIATRIC INTENSIVE CARE M4.2.2.6 Medical Management of Rheumatic heart disease in Paediatric IP 15393 Anti Nuclear Anti Body (ANA) Indirect Immunofluorescence (IIF) /Anti Nuclear Anti Body (ANA) Case Sheet with treatment details ,Chest X-Ray PA View(1 Film) Lasix/Dijoxil if CCF,Inj Procain
patient pencillin,Antipuretics,Steroid
Titres,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
M4 PEDIATRICS M4.2 PEDIATRIC INTENSIVE CARE M4.2.2.7 Medical Management of Cyanotic heart disease in Paediatric IP 10000 Arterial Blood Gas Analysis(ABG),CXR,ECG(Electro Cardiogram),ECHO Cardiogram CXR,ECG (Electro Cardiogram),Arterial Blood Gas Analysis(ABG),Case Sheet with -
patient treatment details
M4 PEDIATRICS M4.2 PEDIATRIC INTENSIVE CARE M4.2.2.8 CHF-Acute Decompensation-Medical Management Without DC 10000 Chest X-ray PA view,ECHO Cardiogram,ECG (Electro Cardiogram) ECHO,Case Sheet with treatment details -
Ventilator
M4 PEDIATRICS M4.2 PEDIATRIC INTENSIVE CARE M4.2.3.1 Medical Management of Meningo- Encephalitis (Non IP 41048 CSF analysis,CT-Scan,EEG Evidence for Clinical Improvement with lab investigations Anticonvulsants,IV fluids,Oxygen,Inj. Midazolam
Ventilated) Infusion .,Inj.
Vancomycin,inj.Acyclovir,inj.Phenibarbitone,inj.cefepi
me,inj.Lorazapem,inj.Phenytoin
M4 PEDIATRICS M4.2 PEDIATRIC INTENSIVE CARE M4.2.3.2 Medical Management of Meningo- Encephalitis in Paediatric IP 61572 arterial monitoring,CT-Scan,EEG,CSF analysis,ABG 8th hrly (3/day X 7 days) Evidence for Clinical Improvement with lab investigations IV fluids,Oxygen,Inj. Midazolam Infusion .,Inj.
patients (Ventilated) Vancomycin,inj.Acyclovir,inj.Phenibarbitone,inj.cefepi
me,inj.Lorazapem,inj.Phenytoin,Anticonvulsants

M4 PEDIATRICS M4.2 PEDIATRIC INTENSIVE CARE M4.2.3.3 Medical Management of Status Epilepticus IP 22074 ABG 8th hrly (3/day X 7 days),EEG,CSF analysis Evidence for Clinical Improvement with lab investigations Anticonvulsants,IV fluids,Oxygen,Mechanical
ventilation,Inj. Midazolam Infusion .,Inj.
Vancomycin,inj.Acyclovir,inj.Phenibarbitone,inj.cefepi
me,inj.Lorazapem,inj.Phenytoin
M4 PEDIATRICS M4.2 PEDIATRIC INTENSIVE CARE M4.2.3.4 Medical Management of Febrile Seizures (Atypical- IP 25655 ABG 8th hrly (3/day X 7 days),EEG,CSF analysis Evidence for Clinical Improvement with lab investigations Anticonvulsants,IV fluids,Oxygen,Mechanical
Mechanical Ventilated) in Paediatric patients ventilation,Inj. Amikacin,Inj. Midazolam Infusion
.,inj.Phenibarbitone,inj.cefepime,inj.Lorazapem,inj.Phe
nytoin

M4 PEDIATRICS M4.2 PEDIATRIC INTENSIVE CARE M4.2.3.5 Medical Management of Intra Cranial Bleed in Paediatric IP 51310 carotied doppler,CT Brain,Blood sugar 4 hrly,ABG 8th hrly (3/day X 7 days) Evidence for Clinical Improvement with lab investigations inj.Calcium,IV fluids,Oxygen,Mechanical
patient ventilation,Adrenaline,Nonadrenaline,Inj. Midazolam
Infusion
.,inj.Tobramycin,inj.Dobutamine,inj.Dopamine,inotrop
es,inj.
Meropenem,milirinone,inj.Phenibarbitone,inj.Lorazape
m,inj.Phenytoin,Anticonvulsants
M4 PEDIATRICS M4.2 PEDIATRIC INTENSIVE CARE M4.2.3.6 Medical Management of Hypertensive Emergencies IP 20000 Case sheet with clinical History,Clinical Photograph Cerebrospinal Fluid(CSF) Analysis Cell Count,ECG (Electro Cardiogram),ECHO -
Cardiogram,Renal Profile,CUE(pH,Specific Gravity,Sugar,Protein And Microscopy),Case
Sheet with treatment details,USG Abdomen
M4 PEDIATRICS M4.2 PEDIATRIC INTENSIVE CARE M4.2.4.1 Medical Management of Acute Gastro Intestinal Bleed in IP 25655 ABG OD/Upper GI Endoscopy,USG abdomen Evidence for Clinical Improvement with lab investigations inotropes,IV fluids,Oxygen,Mechanical
Paediatric patients ventilation,Dopamine,Dobutamine,Inj. Midazolam
Infusion .,Antibiotics (Inj. Ceftriaxone , Inj. Ofloxacin,
Inj. Amikacin),endoscopic sclerotherapy

M4 PEDIATRICS M4.2 PEDIATRIC INTENSIVE CARE M4.2.4.1.1 Lower GI hemorrhage ST 5000 CT,PT,Platelet count,APTT,US abdomen,BT clinical notes -
M4 PEDIATRICS M4.2 PEDIATRIC INTENSIVE CARE M4.2.4.2 Medical management of Acute Pancreatitis (Mild) in pediatric IP 51310 USG abdomen,CT-Scan Evidence for Clinical Improvement with lab investigations TPN,IV fluids,Oxygen,Mechanical
patients ventilation,Dopamine,Dobutamine,Adrenaline,Nonadr
enaline,Inj. Midazolam Infusion
.,inotropes,milirinone,inj.Calcium,Antibiotics ( Inj.
Meropenem , Inj. Vancomycin),Insulin

40 of 47
CODE MAIN CATEGORY Sub SUB CATEGORY NAME CODE SURGERY / THERAPY DESCRIPTION PROCEDURE PACKAGE SPECIAL INVESTIGATION POST OPERATIVE PROCEDURE INVESTIGATION TREATMENT PROTOCOL
Category ID TYPE AMOUNT
M4 PEDIATRICS M4.2 PEDIATRIC INTENSIVE CARE M4.2.4.3 Medical Management of Acute Hepatitis With Hepatic IP 51310 Hepatic viral studies ( Hepatitis B, Hepatitis C, Hepatitis A),CT-Scan,USG abdomen,Blood sugar 4 hrly,ABG 8th hrly Evidence for Clinical Improvement with lab investigations L- Carnitine,IV fluids,Oxygen,Mechanical
Encephalopathy in Paediatric patient (3/day X 7 days) ventilation,Adrenaline,Nonadrenaline,Inj. Midazolam
Infusion
.,inj.Dobutamine,inj.Dopamine,inotropes,milirinone,inj
.Phenibarbitone,inj.Lorazapem,inj.Phenytoin,Anticonvu
lsants,inj.Calcium,Antibiotic(inj.Meropenem), Inj. N-
Acetyl Cystein,Inj. L-ornathine

M4 PEDIATRICS M4.2 PEDIATRIC INTENSIVE CARE M4.2.4.4 Acute hepatitis ST 3000 HCV,LFT,Bilirubin,Urine bile salts&Bile pigments,APTT,HBS Ag,HAV,US abdomen,PT,Sr Electrolytes Bilirubin,clinical notes -
M4 PEDIATRICS M4.2 PEDIATRIC INTENSIVE CARE M4.2.4.5 Medical Management of Viral hepatitis in Paediatric patient IP 10000 Serum Creatinine Levels ,Random Blood Sugar (RBS) Test,Anti HCV (Hepatitis C) Antibodies,Anti-HAV IgM (IgM Case Sheet with treatment details,LFT(liver function tests) -
Antibody To Hepatitis A Antigen),Acquired Immune Deficiency Syndrome Serology (HIV 1&2 Anti Body) - Elisa,Serum
Electrolytes,LFT(liver function tests),HBs Ag,Serum Ammonia Levels,Prothrombin Time,USG Abdomen

M4 PEDIATRICS M4.2 PEDIATRIC INTENSIVE CARE M4.2.5.1 Medical Management of Acute Renal Failure IP 20524 Blood Urea cum Serum Creatinine 4 hrly,USG abdomen,ABG 8th hrly (3/day X 7 days) Evidence for Clinical Improvement with lab investigations Antibiotics(inj.Meropenem,inj.ofloxacin),IV
fluids,Oxygen,Mechanical
ventilation,Dopamine,Dobutamine,Peritoneal
dialysis,Inj. Midazolam Infusion .,inotropes,inj.Calcium

M4 PEDIATRICS M4.2 PEDIATRIC INTENSIVE CARE M4.2.5.2 CRRT IP 8000 clinical notes clinical notes -
M4 PEDIATRICS M4.2 PEDIATRIC INTENSIVE CARE M4.2.5.3 ACUTE RENAL FAILURE (CONSERVATIVE MANAGEMENT NOT IP 20000 ELECTROLLYTES x12HOURSx3D,CBC,CRP,ELECTROLYTES RFT Serum ELECTROLYTES,RFT -
REQUIRING DIALYSIS)
M4 PEDIATRICS M4.2 PEDIATRIC INTENSIVE CARE M4.2.6.1 Medical Management of Diabetic Ketoacidosis in Paediatric IP 30786 Serum Electrolytes CVP monitoring,Blood sugar 4 hrly,ABG 8 hrly (3/day X 5 days), Evidence for Clinical Improvement with biochemical parameters insulin infusion,IV
patient fluids,Oxygen,Dopamine,Dobutamine,IV antibiotics
(Piperacillin Tazobactum, Tobramycin - 80 mg
),inotropes,Calcium
M4 PEDIATRICS M4.2 PEDIATRIC INTENSIVE CARE M4.2.7.1 Medical management of Septic shock IP 61572 USG abdomen,ECHO,EEG Evidence for Clinical Improvement with lab investigations TPN,IV fluids,Oxygen,Mechanical
ventilation,Dopamine,Dobutamine,Adrenaline,Nonadr
enaline,Inj. Midazolam Infusion .,inotropes,inj.
Meropenem,Inj.
Vancomycin,milirinone,inj.Phenibarbitone,inj.Lorazape
m,inj.Phenytoin,Anticonvulsants
M4 PEDIATRICS M4.2 PEDIATRIC INTENSIVE CARE M4.2.7.2 CELLULITIS/MUSCLE ABSCESS IP 10000 CREATININE SGPT,CLINCAL PICTURE CBP,CRP PUS CULTURE SENSITIVITY -
M4 PEDIATRICS M4.2 PEDIATRIC INTENSIVE CARE M4.2.8.1 Medical Management of Snake Bite Requiring Ventilatory IP 61572 ABG 4 hrly (3/day X 4 days),ECHO,EEG,CT Brain,ABG 8 hrly (3/day X 4 days) Evidence for Clinical Improvement with biochemical parameters antisnake Venom,IV fluids,Oxygen,Mechanical
Assistance ventilation,Dopamine,Dobutamine,Adrenaline,Nonadr
enaline,Inj. Midazolam Infusion .,inotropes,inj.
Meropenem,Inj.
Vancomycin,inj.Phenibarbitone,inj.Phenytoin,Anticonv
ulsants
M4 PEDIATRICS M4.2 PEDIATRIC INTENSIVE CARE M4.2.8.2 Medical Management of Scorpion Sting With Myocarditis And IP 41048 arterial blood pressure,ECG,ECHO,ABG 8 hrly (3/day X 4 days),Blood sugar 8 hrly,CVP monitoring Evidence for Clinical Improvement with lab investigations Antiscorpion Venom,IV fluids,Oxygen,Mechanical
Cardiogenic Shock Requiring Ventilatory Assistance in ventilation,Dopamine,Dobutamine,Adrenaline,Nonadr
Paediatric patients enaline,Inj. Midazolam Infusion .,inotropes,inj.
Meropenem,Inj. Vancomycin,Sodium nitroprusside

M4 PEDIATRICS M4.2 PEDIATRIC INTENSIVE CARE M4.2.8.3 Medical Management of Poison Ingestion/ Aspiration IP 41048 arterial blood pressure,ECG,ECHO,ABG 8 hrly (3/day X 4 days), Blood sugar 8 hrly, CVP monitoring Evidence for Clinical Improvement with biochemical parameters Specific antidote,IV fluids,Oxygen,Mechanical
Requiring Ventilatory Assistance in Paediatric patients ventilation,Dopamine,Dobutamine,Inj. Midazolam
Infusion .,inotropes
M4 PEDIATRICS M4.2 PEDIATRIC INTENSIVE CARE M4.2.8.4 Poisonings with unstable vital signs with ventilator (ICU) ST 30000 CBP,Gastric content analysis,LFT,RFT,Pt,ABG ,Sr electrolytes,Chest Xray,APTT,ECG clinical notes -

M4 PEDIATRICS M4.2 PEDIATRIC INTENSIVE CARE M4.2.8.5 Poisonings with normal vital signs ST 5400 CBP,Gastric content analysis,LFT,RFT,Pt,APTT,ECG clinical notes -
M4 PEDIATRICS M4.2 PEDIATRIC INTENSIVE CARE M4.2.9 Acute severe malnutrition ST 5400 Anthroponetry,CBP,ESR,SR Electrolytes,Sr Proteins,Chest X Ray,Sr creatinine,Mountoux test clinical notes -
M4 PEDIATRICS M4.2 PEDIATRIC INTENSIVE CARE M4.2.9.1 Medical Management of Portal hypertension in Paediatric IP 15000 Liver Biopsy(Major)/Liver Biopsy(Minor),Upper GI endoscopy,USG-Doppler Abdomen,LFT(liver function tests),Bulida Case sheet with clinical improvement,Complete Blood Picture[CBP] -
patient Scan (Hepatobiliary Scan)
M4 PEDIATRICS M4.2 PEDIATRIC INTENSIVE CARE M4.2.9.2 Raised intracranial pressure - ventilator / decompressive ST 7000 Fundal Examination,MRI Brain clinical notes -
craniotomy / ICP monitoring / Shunt procedure / Other
emergency neuro surgical procedures

M4 PEDIATRICS M4.3 GENERAL PEDIATRICS M4.10 Medical Management of Wilson'S Disease IP 15120 Serum Copper,Serum Creatinine Levels ,Serum Ceruloplasmin Levels,24 Hrs Urinary Copper,LFT(liver function Serum Copper,LFT(liver function tests),BT,CT Scan Abdomen With Contrast,Serum -
tests),USG Abdomen Creatinine Levels,Serum Ceruloplasmin Levels
M4 PEDIATRICS M4.3 GENERAL PEDIATRICS M4.11 Medical Management of Acute gastritis in Paediatric patient IP 8330 Serum Electrolytes,Stool For Microscopy,Blood Culture & Sensitivity - Automated,LFT(liver function tests),Complete Case Sheet with treatment details,Serum Electrolytes,Clinical Photograph -
Blood Picture [CBP],C- Reactive Protein
M4 PEDIATRICS M4.3 GENERAL PEDIATRICS M4.12.1 Medical Management of Henoch - schonlein purpura in IP 14380 Clinical Photo,USG Abdomen,Complete Blood Picture [CBP],Platelet Count,Serum Creatinine Levels,CUE (pH,Specific Case Sheet with treatment details,Serum Creatinine Levels,Complete Blood Picture[CBP] -
Paediatric patient Gravity,Sugar,Protein And Microscopy),Renal Profile
M4 PEDIATRICS M4.3 GENERAL PEDIATRICS M4.12.2 Medical Management of Idiopathic thrombocytopenic IP 25000 Platelet Count,Bone Marrow Aspiration ,Prothrombin Time,Activated Partial Thrombo Plastin Time (APTT),Bleeding Case Sheet with treatment details,CBP,Platlet Count -
purpura in Paediatric patient Time And Clotting Time,Complete Blood Picture [CBP],Anti Nuclear Anti Body (ANA) Titres,Renal Profile,USG
Abdomen,C-Reactive Protein
M4 PEDIATRICS M4.3 GENERAL PEDIATRICS M4.13.1 Medical Management of Rickets in Paediatric patient IP 8000 Extremities ,Serum Calcium Levels,Serum Phosphorus Levels,Alkaline Phosphatase Levels -,Blood - Urea,Bones & Case Sheet with treatment details -
Joints AP & Lateral View(2 Film),X-ray/ (Wrists and hands),Chest X-Ray PA View(1 Film),Serum Vitamin D3
levels,Serum Creatinine Levels,USG Abdomen
M4 PEDIATRICS M4.3 GENERAL PEDIATRICS M4.13.2 Medical Management of Muscular dystrophy in Paediatric IP 15000 Complete Blood Picture[CBP],Muscle Biopsy,ENMG (Elektroneuromyography),Anti-DNA Antibodies,Serum Case sheet with clinical improvement -
patient Electrolytes,Serum Cpk-Mb Levels
M4 PEDIATRICS M4.3 GENERAL PEDIATRICS M4.13.3.1 Medical Management of Acute flaccid paralysis in Paediatric IP 35000 Clinical assesment Web EX,MRI Spine,ENMG (Elektroneuromyography),Cerebrospinal Fluid (CSF) Analysis Cell Clinical improment Web EX,Post OP Serum Electrolytes,Case Sheet with treatment -
patient Count,Serum Electrolytes,Complete Blood Picture [CBP] ,Serum Immunoglobulines(Each) IgG Or IgA Or Ig,CT-Scan details
Brain Plain And Contrast
M4 PEDIATRICS M4.3 GENERAL PEDIATRICS M4.13.3.2 Opsoclonus myoclonus syndrome ST 5400 EEG,MRI brain,Sr Electrolytes including Calcium,RBS clinical notes -
M4 PEDIATRICS M4.3 GENERAL PEDIATRICS M4.13.4 Acute ataxia ST 5400 Clinical assesment Web EX,Brain Imaging Clinical improment Web EX,clinical notes -
M4 PEDIATRICS M4.3 GENERAL PEDIATRICS M4.14 Persistent/ Chronic diarrhea ST 3000 Stool Examination,Pancreatic Funtion Tests clinical notes -
M4 PEDIATRICS M4.3 GENERAL PEDIATRICS M4.15 Acute abdomen ST 6000 CRP,US Abdomen,serum Amylase,X -Ray errect abdomen,CBP clinical notes -
M4 PEDIATRICS M4.3 GENERAL PEDIATRICS M4.16 Unexplained jaundice ST 6500 US Abdomen,LFT,HCV,HBS AG clinical notes -
M4 PEDIATRICS M4.3 GENERAL PEDIATRICS M4.17 Unexplained hepatosplenomegaly ST 7000 US Abdomen,LFT,PT,Sr ammonium,APTT,BM Aspiration if required,Peripheral smear,CBP,HBS AG,HCV clinical notes -
M4 PEDIATRICS M4.3 GENERAL PEDIATRICS M4.18 HIV with complications /Minor ST 5400 Investigations pertaining to the complications(conditions),CXR,Western blot Test Investigations showing improment of the condition,clinical notes -
M4 PEDIATRICS M4.3 GENERAL PEDIATRICS M4.19 Infantile cholestasis ST 5400 Hida scan- 3500/-(extra),US abdomen,LFT,PT,APTT TSB,clinical notes -
M4 PEDIATRICS M4.3 GENERAL PEDIATRICS M4.20 Floppy infant ST 6000 2D echo,Brain Imaging,Sr electrolytes,CPK,RFT,Nerve conduction velocity (NCV),Muscle Biopsy,LFT,ECG clinical notes -

M4 PEDIATRICS M4.3 GENERAL PEDIATRICS M4.21 TREATMENT OF SCRUB TYPHUS IP 9200 RFT,Serology clinical photo,CBP,CRP,LFT CBP,Clinical improvement and clinical notes -
M4 PEDIATRICS M4.3 GENERAL PEDIATRICS M4.22 CHICKEN POX WITH CNS COMPLICATIONS IP 20000 culture,CLINICAL PHOTO OF RASH,CBP,RFT,LFT,CXR,CSF ANALYSIS,CSF antibodies for HSV,CT Brain,MRI Brain CLINICAL PICTURE -
scan,Cell count,ADA
M4 PEDIATRICS M4.3 GENERAL PEDIATRICS M4.23 CROUP with Severe respiratory Distress IP 20000 Visual evidence of CROUP exposing the Neck AND Chest,CXR,CBP,CRP,CLINICAL PICTURE CXR -
M4 PEDIATRICS M4.3 GENERAL PEDIATRICS M4.24 HFMD HAND FOOTMOUTH DISEASE IP 10000 CRP,CLINICAL PICTURE,CBP Casesheet -
M4 PEDIATRICS M4.3 GENERAL PEDIATRICS M4.25 MEASLESWITH ASSOCIATED COMPLICATIONS IP 20000 CLINICAL PICTURE,ROUTINE VITALS,CBP Chest X-ray and Video evidence of Respiratory distress,serum electrolytes -
M4 PEDIATRICS M4.3 GENERAL PEDIATRICS M4.26 MUMPS WITH ASSOCIATED COMPLICATIONS IP 20000 CLINICAL PICTURE,CBP CT PAROTID,USG -
M4 PEDIATRICS M4.3 GENERAL PEDIATRICS M4.27 SHIGELLA-DYSENTRY IP 10000 STOOL CULTURE,USG ABDOMEN,CBP,ELECTROLYTES STOOL C/S -
M4 PEDIATRICS M4.3 GENERAL PEDIATRICS M4.28 MANAGEMENT OF KALA AZAR IP 18000 CLINICAL NOTES AND PHOTO EVIDENCE OF ABDOMEN BONE MARROW STUDY,CBP,LFT,RFT,MICROSCOPIC PHOTO EVIDENCE OF -
AMASTIGOTES
M4 PEDIATRICS M4.3 GENERAL PEDIATRICS M4.29 EVALUATION OF DYSMORPHIC BABIES(<1YR) IP 25000 PHOTO EVIDENCE OF DYSMORPHYSM METABOLIC SCREENING,X RAY CHEST AND ABDOMEN,NSG,MR BRAIN,2D -
ECHOCARDIOGRAPHY,US ABDOMEN AND RELEVANT CHROMOSOMAL STUDIES
M4 PEDIATRICS M4.3 GENERAL PEDIATRICS M4.3.1 Medical Management of Acute Broncho Lobar pneumonia IP 25655 Pus culture,X-RAY X-Ray Chest IV Antibiotics (Amoxycillin clavulanate or ceftriaxone ,
With Empyema/ Pleural Effusion in Paediatric Amikacin ,vancomycin),IV fluids,Oxygen,chest
patients(J18.1/J43/J90) physiotherapy, Mechanical ventilation if required and
oral antibiotics,Anti tubercular drugs after discharge

M4 PEDIATRICS M4.3 GENERAL PEDIATRICS M4.3.2 Medical Management of Acute Broncho Lobar pneumonia IP 20524 Pus culture,X-RAY X-Ray Chest Anti tubercular drugs after discharge,IV
With Pyo Pneumothorax in Paediatric patient(J18.1/J86/J93) fluids,Oxygen,nebulisations,IV antibiotics,ICD chest
drain,chest physiotherapy, Mechanical ventilation if
required and oral antibiotics
41 of 47
CODE MAIN CATEGORY Sub SUB CATEGORY NAME CODE SURGERY / THERAPY DESCRIPTION PROCEDURE PACKAGE SPECIAL INVESTIGATION POST OPERATIVE PROCEDURE INVESTIGATION TREATMENT PROTOCOL
Category ID TYPE AMOUNT
M4 PEDIATRICS M4.3 GENERAL PEDIATRICS M4.3.3.2 Medical Management of Urinary Tract Infection With IP 14531 Ultrasound,MCUG ( Micturating cysto urethrogram), Urine for Culture and Sensitivity, Ultrasound,Urine for Culture urine culture Dialysis,IV fluids,IV Antibiotics (Amoxycillin clavulanate
Complications Like Pyelonephritis And Renal Failure in and Sensitivity or ceftriaxone , Amikacin ,vancomycin),oral antibiotics
Paediatric patient(N13.617.9) (Amoxycillin clavulanate or Cefixime),Amikacin and
ofloxacin paracetamol

M4 PEDIATRICS M4.3 GENERAL PEDIATRICS M4.3.4 BRONCHOPULMONARY DYSPLASIA IP 20000 LFT,CBP,CRP,CXR RFT,CBP,CRP,CXR,LFT -
M4 PEDIATRICS M4.3 GENERAL PEDIATRICS M4.30 ADVERSE EVENTS FOLLOWING IMMUNISATION REQUIRING IP 40000 REFERAL BY THE DOCTOR WHERE THE CHILD WAS IMMUNISED WITH DETAILED CLINICAL H/O ADVERSE EVENTS Allergen Test,CBP,CRP,ESR,IgE -
VENTILATOR SUPPORT FOLLOWING IMMUNISATION
M4 PEDIATRICS M4.3 GENERAL PEDIATRICS M4.30.1 ADVERSE EVENTS FOLLOWING IMMUNISATION NOT IP 20000 REFERAL BY THE DOCTOR WHERE THE CHILD WAS IMMUNISED WITH DETAILED CLINICAL H/O ADVERSE EVENTS Allergen Test,CBP,CRP,ESR,IgE -
REQUIRING VENTILATOR SUPPORT FOLLOWING IMMUNISATION
M4 PEDIATRICS M4.3 GENERAL PEDIATRICS M4.31 Medical Management of Dengue Fever (UnComplicated) IP 10000 USG Abdomen,ICU PHOTO ON VENTILATOR,Chest X-Ray PA View(1 Film),Complete Blood Picture[CBP],Platelet PCV,Case Sheet with treatment details,Platelet Count,Dengue Serology -
Count,Dengue Check
M4 PEDIATRICS M4.3 GENERAL PEDIATRICS M4.31.1 Medical Management of Dengue Haemorrhagic Fever IP 35000 CXR,ICU Photo on Ventilator,Complete Blood Picture[CBP],Platelet Count,CUE(Ph,Specific Gravity,Sugar,Protein And Stool For Microscopy,Case Sheet with treatment details,Platelet Count,PCV,Dengue -
(Complicated) Microscopy),Renal profile,LFT(liver function tests)DENGUE SEROLOGY,RFT Serology
M4 PEDIATRICS M4.3 GENERAL PEDIATRICS M4.32 Medical Management of Falciparum/Vivax Malaria IP 10000 CRT,CBC,CRP,LFT,UREA PERIPHERAL SMEAR -
M4 PEDIATRICS M4.3 GENERAL PEDIATRICS M4.33 MANAGEMENTOF KAWASAKI DISEASE WITH VENTILATORY IP 40000 FOUR OUT OF FIVE CRITERIA FOR KAWASAKI DOSEASE ALL WITH PHOTOS EVDENCE CBP CUE SERIAL 2D ECHO FOR CORONARY ARTERY DILATATION -
SUPPORT
M4 PEDIATRICS M4.3 GENERAL PEDIATRICS M4.33.1 MANAGEMENTOF KAWASAKI DISEASE WITHOUT IP 20000 FOUR OUT OF FIVE CRITERIA FOR KAWASAKI DOSEASE ALL WITH PHOTOS EVDENCE CBP CUE SERIAL 2D ECHO FOR CORONARY ARTERY DILATATION -
VENTILATORY SUPPORT
M4 PEDIATRICS M4.3 GENERAL PEDIATRICS M4.34 Evaluation of NEUROREGRESSION IP 25000 DETAILED HISTORY AND PHOTO EVIDENCE METABOLIC SCREENING,CBP,LFT,RFT,CSF ANALYSIS,ENZYME STUDIES,MRI BRAIN -

M4 PEDIATRICS M4.3 GENERAL PEDIATRICS M4.4.1 Medical Management of Congenital Heart Disease With IP 15393 Pus culture,2D ECHO,ECG X-Ray Chest,2D ECHO,ECG Digoxin,IV fluids,Oxygen,Mechanical
Congestive Cardiac Failure in Paediatric patients ventilation,nebulisations,IV Antibiotics (Ceftriaxone ,
Amikacin or ofloxacin),diuretics
M4 PEDIATRICS M4.3 GENERAL PEDIATRICS M4.4.1.1 Cyanotic spells ST 5400 2D Echo,PCV,CBP,CXR,ECG clinical notes -
M4 PEDIATRICS M4.3 GENERAL PEDIATRICS M4.4.2 Medical Management of Acquired Heart Disease With IP 15393 Pus culture,2D ECHO,ECG X-Ray Chest,2D ECHO,ECG Ace inihibitors,IV fluids,Oxygen,Mechanical
Congestive Cardiac Failure ventilation,nebulisations,IV Antibiotics (Ceftriaxone ,
Amikacin or ofloxacin),diuretics,Digoxin

M4 PEDIATRICS M4.3 GENERAL PEDIATRICS M4.4.3 Medical Management of Viral Myocarditis in Paediatric IP 20524 Pus culture,2D ECHO,ECG X-Ray Chest,2D ECHO,ECG inotropes,IV fluids,Oxygen,IV Antibiotics (Ceftriaxone ,
patient Amikacin or ofloxacin),diuretics,steroids

M4 PEDIATRICS M4.3 GENERAL PEDIATRICS M4.4.4 Medical Management of Pulmonary koch's with complications IP 10000 Clinical Photograph,Cerebrospinal Fluid (CSF) Analysis Cell Count,Complete Blood Picture [CBP],Erythrocyte Case Sheet with treatment details,X-Ray PA View(1 Film) -
in Paediatric patient Sedimentation Rate (ESR),Chest X-Ray PA View(1 Film),CBNAAAT report,Mantoux test,Sputum For Acid- Fast Bacilli
(AFB) Staining
M4 PEDIATRICS M4.3 GENERAL PEDIATRICS M4.5.1 Medical Management of Steroid Resistant Nephrotic IP 25655 Renal biopsy RFT ascitic tap,IV Antibiotics (Ceftriaxone , Amikacin or
Syndrome Complicated Or Resistant in Paediatric patients ofloxacin),diuretics,Antihypertensives,Immunosuppress
ives .,pleural tap

M4 PEDIATRICS M4.3 GENERAL PEDIATRICS M4.5.2.1 Medical Management of Nephrotic syndrome-non steriod IP 15000 CUE(pH,Specific Gravity,Sugar,Protein And Microscopy),USG Abdomen,Chest X-Ray PA View(1 Film),Urine Culture & Case sheet with clinical improvement,CUE(pH,Specific Gravity,Sugar,Protein And -
resistant in Paediatric patient Sensitivity ,Monteux,Serum Total Proteins Levels Microscopy)
M4 PEDIATRICS M4.3 GENERAL PEDIATRICS M4.5.2.2 Medical Management of Acute glomerulonephritis in IP 10000 CUE(pH,Specific Gravity,Sugar,Protein And Microscopy),USG Abdomen,Chest X-Ray PA View(1 Film),Urine Culture & Case sheet with clinical improvement,CUE(pH,Specific Gravity,Sugar,Protein And -
Paediatric patient Sensitivity,Anti-Streptolysin O (ASO) Titres,Blood - Urea,Serum Electrolytes,Serum Creatinine Levels,Erythrocyte Microscopy),Serum Creatinine Levels
Sedimentation Rate (ESR),Lipid Profile,Complete Blood Picture [CBP]

M4 PEDIATRICS M4.3 GENERAL PEDIATRICS M4.5.2.3 Nephrotic syndrome with peritonitis ST 20000 KUB,RFT,CXR,Sr electrolytes,Sr cholestrol,CUE,Urine culture,Sr Protein,US abdomen clinical notes -
M4 PEDIATRICS M4.3 GENERAL PEDIATRICS M4.5.3 Medical Management of Acute Renal Failure in Paediatric IP 20524 collagen vascular profile,RFT,Serum Electrolytes,c3,c1,Complement levels, RFT Haemo dialysis,Peritoneal
patient dialysis,diuretics,Antihypertensives,Antibiotics,Supporti
ve management
M4 PEDIATRICS M4.3 GENERAL PEDIATRICS M4.5.4 Medical Management of Acute Renal Failure With Dialysis in IP 20524 collagen vascular profile,RFT,Serum Electrolytes,c3,c1,Complement levels, RFT Haemo dialysis,Peritoneal
Paediatric patients dialysis,diuretics,Antihypertensives,Antibiotics,Supporti
ve management
M4 PEDIATRICS M4.3 GENERAL PEDIATRICS M4.5.5 Medical Management of Renal Tubular Acidosis IP 18720 Serum Calcium Levels,Renal Profile,LFT(liver function tests),Complete Blood Picture [CBP],Cerebrospinal Fluid (CSF) Post treatment ABG,Renal Profile,Serum Electrolytes -
Analysis Cell Count,Serum Phosphorus Levels,Serum Uric Acid Levels,Anti Nuclear Anti Body (ANA) Titres-,Double
Stranded (DS) DNA,Urine Culture & Sensitivity,Serum Creatinine Levelse,Spot PR/CR (Protein-Creatinine) RatioX-Ray
Pelvis (1 Film),T3,T4,TSH,ABG,USG Abdomen

M4 PEDIATRICS M4.3 GENERAL PEDIATRICS M4.5.6 Medical Management of UTI (Urinary Tract Infection) IP 16310 Urine Culture & Sensitivity,CUE(pH,Specific Gravity,Sugar,Protein And Microscopy),Renal Profile,Random Blood CUV,Case sheet with clinical improvement -
Sugar (RBS),Complete Blood Picture [CBP]
M4 PEDIATRICS M4.3 GENERAL PEDIATRICS M4.6.1 Medical Management of Thalassemia Major Requiring IP 15393 Agargel Electrophosis for Hemoglobin,Hb electrophoresis,Osmotic fragility test,Serum Ferritin,Complete Blood Clinical and Haematological Improvements,Clinical and Haematological Improvements Chelating Agents,IV fluids,Blood transfusion.,Chelating
Chelation Therapy Picture,S.Iron,Liver Function Test,Renal Function Test,Agargel Electrophosis for Hemoglobin,Hb Agents,IV fluids,Blood transfusion.
electrophoresis,Osmotic fragility test,Serum Ferritin,Complete Blood Picture,S.Iron,Liver Function Test,Renal
Function Test
M4 PEDIATRICS M4.3 GENERAL PEDIATRICS M4.6.2 Medical Management of Haemophillia Including Von IP 20524 Coagulation studies and Factor analysis,Coagulation studies and Factor analysis Clinical and Haematological Improvements,Clinical and Haematological Improvements Factor concentrate,Blood and Blood products,Factor
Willibrands disease in Paediatric patients concentrate,Blood and Blood products

M4 PEDIATRICS M4.3 GENERAL PEDIATRICS M4.6.3 Medical Management of Anemia Of Unknown Cause IP 10262 Hb electrophoresis Clinical and Haematological Improvements Hemantinics etc,IV fluids,Bloods transfusion
M4 PEDIATRICS M4.3 GENERAL PEDIATRICS M4.6.4 Medical Management of Auto immune hemolytic anemia in IP 15404 Double Stranded (DS) DNA ,Coomb s Test Direct,Bone Marrow Aspiration,Serum Bilirubin Levels,Platelet Count Case Sheet with treatment details ,Complete Blood Picture [CBP] Cyclosporise A or Dinazole,Blood/Blood product
Paediatric patient ,Complete Blood Picture [CBP],Reticulocyte Count,Grouping And RH Typing ,Anti Nuclear Anti Body (ANA) Titres trasfusion,steroids, IVIG

M4 PEDIATRICS M4.3 GENERAL PEDIATRICS M4.7.1 Medical Management of Pyogenic Meningitis IP 28713 Lumbar Puncture CSF analysis,CT-Scan Repeat CSF Ventilatory Support,IV fluids,IV antibiotics (Amoxycillin
clavulanate ,ceftriaxone , Amikacin or
ofloxacin,vancomycin),Paracetamol, IV dexamethasone
for below 5 yr old children,Anticonvulsants (midazolam
or lorazepam, Phenobarbitone or Phenytoin)

M4 PEDIATRICS M4.3 GENERAL PEDIATRICS M4.7.10 Wheezing/ LRTI ST 1500 CXR,CBP clinical notes -
M4 PEDIATRICS M4.3 GENERAL PEDIATRICS M4.7.11 Acute Exacerbation of asthma ST 3000 Web EX of RD,CBP,CXR,peripheral smear clinical notes -
M4 PEDIATRICS M4.3 GENERAL PEDIATRICS M4.7.12 Hyper Pyrexia ST 4500 CXR,Complete hemogram,CUE clinical notes -
M4 PEDIATRICS M4.3 GENERAL PEDIATRICS M4.7.13 Medical Management of Viral haemmaragic fever with IP 24990 LFT(liver function tests) ,Complete Blood Picture [CBP],Serum Electrolytes,Prothrombin Time,Activated Partial Case Sheet with treatment details -
complicatons in Paediatric patient Thrombo Plastin Time (APTT),Cerebrospinal Fluid (CSF) Analysis Cell Count,Arterial Blood Gas Analysis (ABG),Renal
Profile,Perpheral Smear For Malarial Parasites (MP),CUE(pH,Specific Gravity,Sugar,Protein And Microscopy),Platelet
Count,Immunoglobulin (IgG) Elisa,ELISA for IgM,USG Abdomen

M4 PEDIATRICS M4.3 GENERAL PEDIATRICS M4.7.14 Medical Management of Tetanus in Paediatric patient IP 13550 Bile Culture & Sensitivity,CT Scan Head Without Contrast ,Complete Blood Picture [CBP],Renal Profile ,Serum Case Sheet with treatment details -
Calcium Levels,Serum Electrolytes,Webex,Serum Phosphorus Levels
M4 PEDIATRICS M4.3 GENERAL PEDIATRICS M4.7.15 Chikungunya ST 3000 ELISA,CBP clinical notes -
M4 PEDIATRICS M4.3 GENERAL PEDIATRICS M4.7.2 Medical Management of Neuro Tuberculosis in Paediatric IP 15393 Brain CSF ADA analysis,CT-Scan clinical and lab investigation IV dexamethasone and oral steroids,IV
patient fluids,Nasogastric tube feeds,IV
antibiotics,Paracetamol,Anticonvulsants (midazolam or
lorazepam, Phenobarbitone or Phenytoin),ventilatory
support,anti tubercular therapy, IVMannitol

M4 PEDIATRICS M4.3 GENERAL PEDIATRICS M4.7.3 Medical Management of Neuro Tuberculosis With Ventilation IP 25655 Brain CSF ADA analysis,CT-Scan,ABG clinical and lab investigation mechanical ventilation SUPPORT,IV fluids,Nasogastric
in Paediatric patient tube feeds,IV antibiotics,Paracetamol,Anticonvulsants
(midazolam or lorazepam, Phenobarbitone or
Phenytoin),anti tubercular therapy, IVMannitol,IV
dexamethasone and oral steroids

M4 PEDIATRICS M4.3 GENERAL PEDIATRICS M4.7.4 Medical Management of Enteric Fever Complicated in IP 11014 ABD,USG,Blood culture clinical and lab investigation followed by oral antibiotics ( Cefixime, Ofloxacin),IV
Paediatric patient fluids, Paracetamol,IV antibiotics ceftriaxone, Amikacin
, ofloxacin
M4 PEDIATRICS M4.3 GENERAL PEDIATRICS M4.7.4.1 Medical Management of Typhoid And Paratyphoid Fevers IP 20000 US Abdomen,Complete Blood Picture [CBP],Widal report,Blood Culture & Sensitivity - Automated / Clinical Case Sheet with treatment details -
Photograph

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CODE MAIN CATEGORY Sub SUB CATEGORY NAME CODE SURGERY / THERAPY DESCRIPTION PROCEDURE PACKAGE SPECIAL INVESTIGATION POST OPERATIVE PROCEDURE INVESTIGATION TREATMENT PROTOCOL
Category ID TYPE AMOUNT
M4 PEDIATRICS M4.3 GENERAL PEDIATRICS M4.7.5 Medical Management of Cerebral Malaria (Falciparum) IP 25655 Parasite F Test and QBC,Lumbar Puncture CSF analysis clinical and lab investigation blood and platelet transfusion,IV fluids,Mechanical
ventilation,IV antibiotics ceftriaxone, Amikacin ,
ofloxacin,Oral chloroquine,IV quinine,IV artesunate,IV
artesunate,mefloquine

M4 PEDIATRICS M4.3 GENERAL PEDIATRICS M4.7.6 Medical Management of Diphtheria in Paediatric patient IP 15393 Renal Profile ,ECG (Electro Cardiogram) -3Times,Throat Swab For KLB -3 Times,ECHO Cardiogram,Chest X-Ray PA Case sheet with clinical improvement inj Pencillin.Erithromycin,Diph Anti toxin,Anti
View(1 Film) pyrelits,IV fluids,Blood transfusion,inj CCF dijoxin

M4 PEDIATRICS M4.3 GENERAL PEDIATRICS M4.7.7 Medical Management of Croup in Paediatric patient IP 10000 Chest X-Ray PA View(1 Film),X-Ray Craniovertebral Junction(CVJ)Dynamic(Flexon and Extension) Arterial Blood Gas Analysis(ABG),Complete Blood Picture[CBP],C-Reactive Protein -

M4 PEDIATRICS M4.3 GENERAL PEDIATRICS M4.7.8 Medical Management of Acute pharyngo tonsillitis in IP 5000 Erythrocyte Sedimentation Rate(ESR),Fluid For Gram Stain,Blood Culture & Sensitivity - Automated,Chest X-Ray PA Case sheet with clinical improvement,Complete Blood Picture[CBP],C-Reactive Protein -
Paediatric patient View(1 Film),Throat Swab For KLB/ Fluid For Gram Stain/ Pus For Gram Stain

M4 PEDIATRICS M4.3 GENERAL PEDIATRICS M4.7.9 URIT(Pharyngitis/Tonsilitis,Otitis) ST 3000 Clinicla Photos,Throat swab,CBP,Pus culture clinical notes -
M4 PEDIATRICS M4.3 GENERAL PEDIATRICS M4.8.1 Medical Management of Convulsive Disorders/Status IP 12732 Renal Profile,Ct,Eeg,Cbp,Dengue Serology,Malaria Antibodies,Malaria Peripheral Smear,Serum Prolactin Clinical And Lab Investigation Anticonvulsants,Iv Fluids,Ventilator,Oxygen
Epilepticus (Fits)in Paediatric patient
M4 PEDIATRICS M4.3 GENERAL PEDIATRICS M4.8.2 Medical Management of Stroke Syndrome in Paediatric IP 20524 ANGIOGRAM,2D ECHO,CT,EEG clinical and lab investigation Anti Epieptics,IV fluids,Oxygen,Low molecular weight
patient Heparin
M4 PEDIATRICS M4.3 GENERAL PEDIATRICS M4.8.3 Medical Management of Encephalitis / Encephalopathy in IP 25655 Lumbar Puncture CSF analysis,CT clinical and lab investigation Mannitol,IV fluids,inj.Acyclovir,Anticonvulsants
Paediatric patient
M4 PEDIATRICS M4.3 GENERAL PEDIATRICS M4.8.4 Medical Management of Guillian-Barre Syndrome IP 82096 Nerve Conduction studies,ABG,Lumbar Puncture CSF analysis,ENMG clinical and lab investigation physiotherapy,IV fluids,immunoglobin,ventilary and
supportive care
M4 PEDIATRICS M4.3 GENERAL PEDIATRICS M4.9 Medical Management of Rheumatoid Arthritis Requiring IP 30000 LFT(liver function tests),Complete Haemogram,Renal Profile,Anti CCP (Anti-Cyclic Citrullinatid Peptide Anti Case sheet with clinical improvement,Complete Haemogram -
Hospitalisation Bodies),Complete Blood Picture [CBP],Chest X-Ray PA View(1 Film),X-Ray Arthrography,ECHO Cardiogram,Anti
Nuclear Anti Body (ANA) Indirect Immunofluorescence (IIF) / Anti Nuclear Anti Body (ANA) Titres,Erythrocyte
Sedimentation Rate (ESR)
M5 CARDIOLOGY M5 CARDIOLOGY M5.1.1 Medical Management of Acute Mi (Conservative Management IP 10262 2DEcho,ECG,CPKMB,Troponin Lab Investigations,ECG,2DEcho Medical
Without Angiogram)
M5 CARDIOLOGY M5 CARDIOLOGY M5.1.2 Management Of Acute MI With Angiogram IP 30785 Coronary Angiodraphy,ECG,CPKMB,Troponin,2DEcho Lab Investigations,ECG,2DEcho Medical
M5 CARDIOLOGY M5 CARDIOLOGY M5.1.3 Medical Management of Acute MI With Cardiogenic Shock IP 30785 Coronary Angiodraphy,ECG,CPKMB,Troponin,2DEcho Lab Investigations,ECG,2DEcho Medical

M5 CARDIOLOGY M5 CARDIOLOGY M5.1.3.1 Medical Management Cardiogenic Shock (Non AMI) With Out IP 20000 ICU Photo on Ventilator,Arterial Blood Gas Analysis (ABG),ECHO Cardiogram,ECG (Electro Cardiogram),Chest X-Ray Chest X- Ray PA View(1 Film),Arterial Blood Gas Analysis (ABG),Pulse Oxymetry Chart -
Angiogram PA View(1 Film)
M5 CARDIOLOGY M5 CARDIOLOGY M5.1.3.2 Medical Management Cardiogenic Shock (Non AMI) With IP 25000 ICU Photo on Ventilator,Arterial Blood Gas Analysis (ABG),ECHO Cardiogram,ECG (Electro Cardiogram),Chest X-Ray Pulse Oxymetry Chart,Arterial Blood Gas Analysis (ABG),CT Angiography(Coronary -
Angiogram PA View(1 Film) Angiography),Chest X- Ray PA View(1 Film)
M5 CARDIOLOGY M5 CARDIOLOGY M5.1.4 Medical Management of Acute MI Requiring IABP Pump IP 56440 Coronary Angiodraphy,ECG,CPKMB,Troponin,2DEcho Lab Investigations,ECG,2DEcho Medical

M5 CARDIOLOGY M5 CARDIOLOGY M5.1.5 Medical Management of Refractory Cardiac Failure IP 41048 Coronary Angiodraphy,ECG,CPKMB,Troponin,2DEcho Lab Investigations,ECG,2DEcho Medical
M5 CARDIOLOGY M5 CARDIOLOGY M5.10 CHF-Acute Decompensation-Medical Management With IP 30000 Clinical Photograph,ECHO Cardiogram,ECG (Electro Cardiogram),Chest X-ray PA view Case Sheet with treatment details -
Ventilator
M5 CARDIOLOGY M5 CARDIOLOGY M5.11 Medical Management of Deep Vein Thrombosis IP 25000 Clinical Photograph,Venous Doppler,D-Dimer Test,Complete Blood Picture [CBP] Blood Coagulation Analyzer(BCA) Or Coagulation Profile,Color Doppler Sonography -
Single Study,Case sheet with clinical improvement
M5 CARDIOLOGY M5 CARDIOLOGY M5.12 Medical Management of CAD - Chronic Stable Angina DC 10000 2D ECHO With Colour Doppler,Chest X-Ray PA View(1 Film),ECG (Electro Cardiogram) Case Sheet with treatment details -
M5 CARDIOLOGY M5 CARDIOLOGY M5.13 Medical Management Of Vascular Embolisation IP 15000 2D ECHO With Colour Doppler,ECG (Electro Cardiogram) Biopsy -
M5 CARDIOLOGY M5 CARDIOLOGY M5.14 Medical management of Atrial Fibrillation IP 15000 case sheet,ECG casesheet,POST ECG,treatment notes -
M5 CARDIOLOGY M5 CARDIOLOGY M5.15 Management of acute exacerbation of COPD IP 13800 ECG,CT CHEST,ECHO,ABG,chest-x-ray VIRAL MARKERS -
M5 CARDIOLOGY M5 CARDIOLOGY M5.16 MEDICAL MANAGEMENT OF RECENT HEART FAILURE ST 6500 SE-CRE,CBP,ECHO,NA.K,ECG,HB,BLOOD CULTURE ECG,CHEST PA,APTT,PT,ECHO,QBC M,CBP -
M5 CARDIOLOGY M5 CARDIOLOGY M5.17 MEDICAL MANAGEMENT OF END STAGE(stage 4) HEART ST 8000 CHEST PA,ECHO,RAN,SER-CRE HOLTER 24 HRS,ECHO,CBP -
FAILURE
M5 CARDIOLOGY M5 CARDIOLOGY M5.18 AF WITH FVR,LRTI WITH SEPSIS IP 5000 blood culture,ECHO,NA.K,ECG PT,QBCM,CBP,APTT -
M5 CARDIOLOGY M5 CARDIOLOGY M5.19 MEDICAL MANAGEMENT OF ACUTE RIGHT HEART ST 6200 CHEST PA,ECHO,ECG ABG,CBP -
FAILURE/ADVANCED LUNG DISEASE
M5 CARDIOLOGY M5 CARDIOLOGY M5.2 Medical Management of Infective Endocarditis IP 25654 Blood c/s,2D ECHO,ECG Lab Investigations,2D ECHO,ECG MEDICAL
M5 CARDIOLOGY M5 CARDIOLOGY M5.20 OCT guided PTCA (CAD Bifurcation ) IP 50000 ECHO,X-ray chest,ECG,Angiogram,Clinical photo with ventilator or deaturating condition with oxygen,CPAP Mask vital chart,2D-ECHO,Clinical photo with >95% oxygen on room air -

M5 CARDIOLOGY M5 CARDIOLOGY M5.21 FFR IP 45000 ECHO,X-ray chest,ECG,Angiogram,Clinical photo with ventilator or deaturating condition with oxygen,CPAP Mask vital chart,2D-ECHO,Clinical photo with >95% oxygen on room air -

M5 CARDIOLOGY M5 CARDIOLOGY M5.3 Medical Management of Pulmonary Embolism IP 35916 MRI doppler Lab Investigations,DOPPLER MEDICAL
M5 CARDIOLOGY M5 CARDIOLOGY M5.4 Medical Management of Complex Arrhythmias IP 143667 ECG doppler Lab Investigations,2D ECHO,ECG Cartoguided
M5 CARDIOLOGY M5 CARDIOLOGY M5.5 Ablation Therapy for Simple Arrythmias IP 93384 ECG,Color Doppler Lab Investigations,2D ECHO,ECG Focus Ablation
M5 CARDIOLOGY M5 CARDIOLOGY M5.5.1 Medical Management Of Simple Arrhythmias DC 8000 ECG (Electro Cardiogram),2D ECHO With Colour Doppler T4,ECHO Cardiogram ,T3,Chest X-Ray PA View(1Film),TSH,LFT(liver function tests) -

M5 CARDIOLOGY M5 CARDIOLOGY M5.6 Medical Management of Pericardial Effusion, Tamponade IP 16419 DOPPLER Lab Investigations,2D ECHO,ECG Aspiration
with¿Aspiration
M5 CARDIOLOGY M5 CARDIOLOGY M5.6.1 Medical Management Of Pericardial Effusion-Without DC 6000 Procedure CD,Chest X-Ray PA View(1 Film),ECG (Electro Cardiogram),2D ECHO With Colour Doppler ECG (Electro Cardiogram),Chest X-Ray PA View(1 Film),CT SCAN CT Scan Chest Without -
Aspiration Contrast
M5 CARDIOLOGY M5 CARDIOLOGY M5.7 Medical Management of Chronic Heart Failure DC 5000 Clinical Photograph,ECHO Cardiogram,ECG (Electro Cardiogram) Case Sheet with treatment details -
M5 CARDIOLOGY M5 CARDIOLOGY M5.8 Medical Management of Acute Rheumatic Fever IP 15000 ICU Photo,Complete Blood Picture [CBP],Erythrocyte Sedimentation Rate (ESR),ECG (Electro Cardiogram) C-Reactive Protein,Anti-Streptolysin O (ASO) Titres ,ECG(Electro Cardiogram) ,ECHO -
Cardiogram,Throat Swab For KLB ,Complete Blood Picture[CBP],Erythrocyte
Sedimentation Rate(ESR)
M5 CARDIOLOGY M5 CARDIOLOGY M5.9 Medical Management Of Aortic Dissection IP 20000 CT Scan Chest With Contrast,Chest X-ray PA view ,2D ECHO With Colour Doppler Case Sheet with treatment details -
M5 CARDIOLOGY M5 CARDIOLOGY M5.7.1 CHF-Acute Decompensation-Medical Management Without DC 13417 Chest X-ray PA view,ECHO Cardiogram,ECG (Electro Cardiogram),Chest X-ray PA view,ECHO Cardiogram,ECG (Electro Case Sheet with treatment details,Case Sheet with treatment details -
Ventilator Cardiogram)
M6 NEPHROLOGY M6 NEPHROLOGY M6.1 Medical Management of AKI IP 20227 HCD,2D ECHO,ECG,HBSAG,USG,RFT,S.Protein,Calicum,Phosphate,uric acid,Electolytes,HIV,Urine protein other lab investigation,RFT Dialysis and supportive therapy

M6 NEPHROLOGY M6 NEPHROLOGY M6.10 CAPD Peritonitis IP 20000 Peritoneal fluid analysis & culture & sensitivity,Renal Profile,Complete Blood Picture [CBP],LFT(liver function CAPD BAG Photo Pre & Post treatment,Renal Profile,Complete Blood Picture[CBP],CAPD -
tests),CAPD Bag Photo Pre & Post treatment
M6 NEPHROLOGY M6 NEPHROLOGY M6.11 PARAPLEGIA MANAGEMENT IP 38600 CBP,CT spine & Brain,ESR Clinical picture -
M6 NEPHROLOGY M6 NEPHROLOGY M6.12 PYELONEPHRITIS ST 8650 CUE,U/S KUB,Urine C/S,CBP, Xray KUB clinical picture,CUE -
M6 NEPHROLOGY M6 NEPHROLOGY M6.2 Medical Management of Nephrotic Syndrome IP 17333 HIV,RFT,S.Protein other lab investigation,RFT Immunosuppressive RX
M6 NEPHROLOGY M6 NEPHROLOGY M6.3 Medical Management of Rapidly Progressive Renal Failure IP 31572 RFT other lab investigation,RFT Medicines,Steroids parenteral

M6 NEPHROLOGY M6 NEPHROLOGY M6.4 Medical Management of Chronic Renal Failure 1 (Crf ) IP 31680 HB Sag,X-Ray Chest,RFT,S.Protein,S.Calcium,S.Uric acid,Alb/Globulin ratio,S.electrolytes, 24 hrs urine,Spot other lab investigation,RFT Initial treatment,Dialysis and supportive therapy
Urine/Creatinine ratio, HCV
M6 NEPHROLOGY M6 NEPHROLOGY M6.5 Maintenance Hemodialysis For Crf IP 20560 2D ECHO,HB Sag,HB Sag,HCV,HCV, Spot Urine/Creatinine ratio, Spot Urine/Creatinine ratio, 24 hrs urine, 24 hrs RFT,other lab investigation,other lab investigation,RFT Dialysis and supportive therapy (Minimum of 10
urine,S.electrolytes,S.electrolytes,Alb/Globulin ratio,Alb/Globulin ratio,S.Uric acid,S.Uric dialysis),Dialysis and supportive therapy (Minimum of
acid,S.Po4,S.Po4,S.Calcium,S.Calcium,S.Protein,S.Protein,RFT,RFT,X-Ray Chest,X-Ray Chest,2D ECHO 10 dialysis)
M6 NEPHROLOGY M6 NEPHROLOGY M6.6 Medical Management of Acute Glomerulo Nephritis IP 26702 24 Hrs Urinary Protein ,Renal Profile,LFT(liver function tests),Complete Blood Picture [CBP],ECG (Electro CUE (pH , Specific Gravity , Sugar , Protein And Microscopy),Renal Profile Supportive Management,Antibiotics
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)
M6 NEPHROLOGY M6 NEPHROLOGY M6.7 Medical Management of Renal Tubular Acidosis IP 18720 USG Abdomen,ABG ,Renal Profile,Serum Bicardonate,LFT(liver function tests),Serum Calcium Levels,Serum Serum Electrolytes,Renal Profile -
Phosphorus Levels,Serum Uric Acid Levels,Anti Nuclear Anti Body (ANA) Titres-,Double Stranded (DS) DNA,Urine
Culture & Sensitivity,Serum Creatinine Levelse,Spot PR/CR(Protein-Creatinine) Ratio X-Ray Pelvis(1
Film),TSH,T3,T4,Complete Blood Picture [CBP],Cerebrospinal Fluid (CSF) Analysis Cell Count

M6 NEPHROLOGY M6 NEPHROLOGY M6.8 Medical Management of UTI (Urinary Tract Infection) IP 10000 Urine Culture & Sensitivity,CUE(pH,Specific Gravity,Sugar,Protein And Microscopy),Blood Culture & Sensitivity,Renal Case sheet with clinical improvement -
Profile,Random Blood Sugar(RBS) Test,USG Abdomen,Clinical Photograph,Complete Blood Picture [CBP]

M6 NEPHROLOGY M6 NEPHROLOGY M6.9 Medical Management of Post Transplant Sepsis IP 20000 Urine Culture & Sensitivity,Renal Profile ,Complete Blood Picture [CBP],LFT(liver function tests),USG Abdomen,Blood High Resolution CT Chest & Abdomen,Renal Profile ,USG Abdomen -
Culture & Sensitivity - Automated/ manual,CXR,HRCT Chest & Abdomen,CSF For Fungal Culture,CSF Viral Culture -

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CODE MAIN CATEGORY Sub SUB CATEGORY NAME CODE SURGERY / THERAPY DESCRIPTION PROCEDURE PACKAGE SPECIAL INVESTIGATION POST OPERATIVE PROCEDURE INVESTIGATION TREATMENT PROTOCOL
Category ID TYPE AMOUNT
M7 NEUROLOGY M7 NEUROLOGY M7.1 Medical Management of ADEM IP 20524 HIV profile,CSF analysis,MRI Brain, Evoked Potentials,CSF Monoclonal Bands, clinical and lab investigation supportive care,Ventilatory
Support,physiotherapy,Dialysis and supportive therapy
(Minimum of 8 dialysis),Inj. Methylprednisolone,
antacids,vitamin supplementaion,Oral steroids for 4
weeks
M7 NEUROLOGY M7 NEUROLOGY M7.10 Medical Management of Guillian-Barre Syndrome IP 82096 Nerve Biopsy (2000),,CSF analysis,NCS / EMG(1000) clinical and lab investigation vitamin supplementation,Ventilatory Care,Inj. Methyl
prednisolone,physiotherapy, antacids,supportive care

M7 NEUROLOGY M7 NEUROLOGY M7.11 Medical Management of Optic Neuritis IP 11176 MRI Brain and Optic nerves,Lumbar Puncture CSF analysis,VEPs clinical and lab investigation oral steroids for 2 weeks,Inj. Methyl prednisolone,
antacids,vitamin supplementation

M7 NEUROLOGY M7 NEUROLOGY M7.12 Management with Immunoglobulin Therapy - Iv IP 102620 Investigations indicative of diseases clinical and lab investigation -
M7 NEUROLOGY M7 NEUROLOGY M7.13 Medical Management of Wilson'S Disease IP 15120 USG Abdomen,Serum Creatinine Levels ,24 Hrs Urinary Copper,Serum Ceruloplasmin Levels,LFT(liver function tests) CT Scan Abdomen With Contrast,LFT(liver function tests),BT -

M7 NEUROLOGY M7 NEUROLOGY M7.14 Medical Management of Parkinsonism IP 12190 Case sheet with clinical History,MRI Brain Without Contrast Case Sheet with treatment details -
M7 NEUROLOGY M7 NEUROLOGY M7.15 Medical Management of Dementia IP 12940 EEG (Electroencephalogram) \ Video,MRI Brain Without Contrast,T4,T3,TSH,Cerebrospinal Fluid (CSF) Analysis Cell Diagnostic Psychometry -
Count Analysis
M7 NEUROLOGY M7 NEUROLOGY M7.16 Medical Management of Migraine IP 1500 Case sheet with clinical History,CT-Scan Brain Plain And Contrast Case Sheet with treatment details -
M7 NEUROLOGY M7 NEUROLOGY M7.17 Medical Management of Epilepsy - Idiopathic IP 15680 Erythrocyte Sedimentation Rate (ESR),CT-Scan Brain Plain And Contrast /MRI Brain With Contrast,CSF- Adenosine EEG(Electroencephalogram)\Video EEG,CT-Scan Brain Plain And Contrast/MRI Brain -
Neurocysticercosis Tuberculoma Deaminase (ADA) Analysis,EEG (Electroencephalogram) \ Video EEG,Complete Blood Picture [CBP] With Contrast

M7 NEUROLOGY M7 NEUROLOGY M7.18 THRAMBOLYTIC THERAPY CVA,A/S IP 13800 CAROTID DOPPLER,CBP,CUE,RBS,PT,APTT LFT,ECHO,PT,APTT,LIPIDS -
M7 NEUROLOGY M7 NEUROLOGY M7.18.1 THROMBOLYTIC THERAPY FOR ACUTE ISCHEMIC STROKE IP 30000 CT brain plain,RBS photo of drug vial with batch number,2DECHO,Lipid profile,C/V Doppler,Video of -
injecting the drug to patient
M7 NEUROLOGY M7 NEUROLOGY M7.19 PLASMAPHERESIS FOR NEUROLOGICAL DISORDERS IP 100000 VEP,CSF analysis,EEG,CSF Analysis photo of patient undergoing plasmapherisis.MYASTHENIA GRAVIS IN CXR,clinical note with treatment details -
CRISIS:clinical notes,photo of patient undergoing plasmapheresis AUTOIMMUNE ENCEPHALITIS:clinical notes MRI
Brain,Repititive nerve stimulation RNS,CXR,patient on 02 mask or ventilator or NIV or patient on Ryles tube,photo of
patient undergoing plasmapheresis ,MRI spine and brain

M7 NEUROLOGY M7 NEUROLOGY M7.2 Medical Management of Chronic Inflammatory Demyelinating IP 14715 Carotid and vertebral Doppler etc. special tests for Evaluation of cause,ECG,EMG,CSF analysis,CT Brain,NCS,Serum clinical and lab investigation Ajathioprine,physiotherapy,vitamin
Polyneuropathy(CIDP) Protein electropheresis, Nerve Biopsy .,MRI Brain,MRV /MRA, Echocardiography,repeated blood tests for supplementaion,Oral steroids
electrolytes and glucose,Lipid profile
M7 NEUROLOGY M7 NEUROLOGY M7.20 RITUXIMAB FOR NEUROLOGICAL DISORDERS-INITIAL DOSE ( IP 50000 Ach R antibody or MUSK antibody CBC,MULTIPLE SCLEROSIS:clinical notes,MRI Brain and spine,CSF- photos of drug vials with Batch number,clinical notes and photos of infusion of drug -
Day 1 - 1000mg Day 14 - 1000mg) OCBs,VEP,CBC.NMOSD(Antibody positive):clinical notes MRI Brain,Positive auto antibody Report (AQPO4,or Anti
MOG antibody),CBC.Antibody positive AUTOIMMUNE ENCEPHALITIS:clinical notes MRI brain report,positive
autoimmune encephaltis panel report,CBC.REFRACTORY MYASTHENIA GRAVIS:RNS,CXR

M7 NEUROLOGY M7 NEUROLOGY M7.21 RITUXIMAB FOR NEUROLOGICAL DISORDERS-MAINTENANCE IP 22500 SGPT,CBC,CXR,SGOT photos of drug vials with Batch number,clinical notes and photos of infusion of drug -
DOSE (1000 mg ever 6 months from the initial dose )

M7 NEUROLOGY M7 NEUROLOGY M7.3 Medical Management of Hemorrhagic IP 31843 Enchocardiography,CT BRAIN,MRI BRAIN,MRV,MRA,ECG,Carotid and Vertebral Doppler etc.,Special tests for clinical and lab investigation Surgery if necessary, IVMannitol,IV fluids,
Stroke/Strokes(I61/I62/I63/I64) Evaluation of Cause,4-Vessel Cerebral Angio if necessary (DSA),Lipid profile antacids,Antihypertensives, Antidiabetics
M7 NEUROLOGY M7 NEUROLOGY M7.4 Medical Management of Ischemic Strokes IP 20524 Carotid and vertebral Doppler etc. special tests for Evaluation of cause,ECG,CT Brain,MRI Brain,MRV /MRA, clinical and lab investigation surgery in some cases, IVMannitol,IV fluids,
Echocardiography,repeated blood tests for electrolytes and glucose,Lipid profile antacids,Antihypertensives, Antidiabetics,Heparanoids
for 5 days
M7 NEUROLOGY M7 NEUROLOGY M7.5 Medical Management of Acquired Myopathies IP 19970 Serum calcium,NCS, /EMG,Serum CPK,Phosphate and alkaline phophatase,endocrine evaluation,Muscle Biopsy clinical and lab investigation endocrine therapy,Prednisolone,Azathiaprine,Calcium
supplementation,vitamin supplementation

M7 NEUROLOGY M7 NEUROLOGY M7.6 Medical Management of Neuroinfections -Fungal Meningitis IP 55754 Fungal studies,CSF analysis,CT Brain,MRI Brain scan,Cell count,ADA,culture, CSF serology for tuberculous antigens clinical and lab investigation Antifungal drugs,steroids, IVMannitol,IV fluids, antacids

M7 NEUROLOGY M7 NEUROLOGY M7.7 Medical Management of Neuroinfections -Pyogenic IP 28713 culture,CSF analysis,CT Brain,MRI Brain scan,Cell count,ADA clinical and lab investigation Higher antibiotics,steroids, IVMannitol,IV
Meningitis(Bacterial) fluids,antacids, Surgery if necessary
M7 NEUROLOGY M7 NEUROLOGY M7.8 Medical Management of Neuroinfections -Viral IP 38503 CSF antibodies for HSV,CSF analysis,CT Brain,MRI Brain scan,Cell count,ADA,culture clinical and lab investigation acyclovir, IVMannitol,IV fluids, antacids, Methyl
Meningoencephalitis (Including Herpes Encephalitis) prednisolone
M7 NEUROLOGY M7 NEUROLOGY M7.9 Medical Management of Neuromuscular disorders IP 21910 Thyroid profile,CT-Abdomen,CT-Chest,RNS,Neostgmine test clinical and lab investigation neostignime,Ventilatory
(Myasthenia Gravis) Care,Prednisolone,Azathiaprine,Calcium
supplementation
M8 PULMONOLOGY M8 PULMONOLOGY M8.1 Medical Management of Bronchiectasis with Repeated IP 30787 drug susceptability,Spirometry,HRCT Chest,FOB,Sputum culture clinical and lab investigation According to International Guide lines
Hospitalisation>6per Year
M8 PULMONOLOGY M8 PULMONOLOGY M8.1.1 Bronchiectasis ST 4500 Chest X Ray ESR,CBP,Chest X Ray,stable clinical condition -
M8 PULMONOLOGY M8 PULMONOLOGY M8.10 Medical Management of Pleural Effusion IP 5000 Serum Creatinine Levels,Complete Blood Picture [CBP],Erythrocyte Sedimentation Rate (ESR),Random Blood Sugar Chest X-Ray PA View(1 Film) -
(RBS) Test,Blood - Urea,Pleural Fluid Analysis,Adenosine Deaminase Test (ADA),Lactate Dehydrogenase
(LDH)),Sputum For Acid-Fast Bacilli (AFB) Staining,Fluid For Gram Stain,Fluid for Fungal Stain,Urine Culture &
Sensitivity,Chest &Abdomen,High Resolution CT Chest/CT Scan Abdomen Without Contrast/Pleural Biopsy,ECHO
Cardiogram,HBV (Hepatitis B),Deoxyribonucleic Acid (DNA) Quantitative,Anti HCV (Hepatitis C) Antibodies/CSF Viral
Culture,Viral Markers,Chest X-Ray PA View(1 Film)

M8 PULMONOLOGY M8 PULMONOLOGY M8.11 Medical Management of Empyema IP 20000 Serum Creatinine Levels,Complete Blood Picture [CBP],Erythrocyte Sedimentation Rate (ESR),Random Blood Sugar Chest X-Ray PA View(1 Film),Pleural Fluid analysis -
(RBS) Test,Blood - Urea,Pleural Fluid Analysis,Adenosine Deaminase Test (ADA),Lactate Dehydrogenase
(LDH)),Sputum For Acid-Fast Bacilli (AFB) Staining,Fluid For Gram Stain,Fluid for Fungal Stain,Urine Culture &
Sensitivity,Chest &Abdomen,High Resolution CT Chest/CT Scan Abdomen Without Contrast/Pleural Biopsy,ECHO
Cardiogram,/HBV (Hepatitis B),Deoxyribonucleic Acid (DNA) Quantitative,Anti HCV (Hepatitis C) Antibodies,Viral
Markers,ABG,Spirometry,Chest X-Ray PA View(1 Film)

M8 PULMONOLOGY M8 PULMONOLOGY M8.12 Medical Management of Inhalational Lung Injuries IP 20000 Arterial Blood Gas Analysis (ABG),Complete Blood Picture [CBP],Erythrocyte Sedimentation Rate (ESR),Random Chest X-Ray PA View(1 Film),Complete Blood Picture[CBP],Spirometry -
Blood Sugar (RBS) Test,Blood - Urea,Serum Electrolytes,CT scan Lower Abdomen Without Contrast/CT Scan Chest
With Contrast,Spirometry,HBV (Hepatitis B),Deoxyribonucleic Acid (DNA) Quantitative,Anti HCV (Hepatitis C)
Antibodies,Viral Markers,Chest X-Ray PA View(1 Film)
M8 PULMONOLOGY M8 PULMONOLOGY M8.13 Medical Management of Chronic Persistent Asthama IP 15000 Serum Immunoglobulines(Each) IgG Or IgA Or Ig,Complete Blood Picture [CBP],Erythrocyte Sedimentation Rate Spirometry,Complete Blood Picture[CBP] -
(ESR),Random Blood Sugar (RBS) Test,Chest X-Ray PA View(1 Film),Serum Electrolytes,Arterial Blood Gas Analysis
(ABG)/ CT scan Lower Abdomen Without Contrast,CT Scan Chest With Contrast/Spirometry/Fluid For Gram Stain
/ECHO Cardiogram / Bronchoscopy/ Pulmonary Function Test(Major),Absolute Eosinophilic Count,X-Ray PNS

M8 PULMONOLOGY M8 PULMONOLOGY M8.14 Medical Management of Emphysema Without Respirative IP 15000 Chest X-Ray PA View(1 Film),Complete Blood Picture [CBP] ,Erythrocyte Sedimentation Rate (ESR),Random Blood spirometry,C-Reactive Protein,Chest X-Ray PA View(1 Film) -
Failure Sugar (RBS) Test,Serum Creatinine Levels,Arterial Blood Gas Analysis (ABG),C-Reactive Protein,spirometry,Alpha Anti-
Trypsin Levels,High Resolution CT Chest,/Dlco/ECHO Cardiogram/LFT(liver function tests),USG Abdomen,Blood -
Urea
M8 PULMONOLOGY M8 PULMONOLOGY M8.15 Medical Management of Pulmonary Vasculitis IP 20000 C-Reactive Protein,Complete Blood Picture [CBP] ,Erythrocyte Sedimentation Rate (ESR),Random Blood Sugar (RBS) Chest X-Ray PA View(1 Film),Erythrocyte Sedimentation Rate(ESR),Complete Blood -
Test,Serum Creatinine Levels,Collagen Profile ,ANCA (Anti Neutrophil Cyto Plasmic Anti Body),High Resolution CT Picture [CBP] ,C-Reactive Protein
Chest ,Arterial Blood Gas Analysis (ABG),ECHO Cardiogram,Pulmonary Angiogram(CT Angio Chest) - ,Renal
Profile,Bronchoscopy,CUE(pH,Specific Gravity,Sugar,Protein And Microscopy),Serum Immunoglobulines(Each) IgG Or
IgA Or Ig,/LFT(liver function tests)/Serum Electrolytes and Routine Histopathological Examination,Blood - Urea

M8 PULMONOLOGY M8 PULMONOLOGY M8.16 Medical Management of Cystic Fibrosis IP 20000 High Resolution CT Chest,Complete Blood Picture [CBP] ,Erythrocyte Sedimentation Rate (ESR),Random Blood Sugar Chest X-Ray PA View(1 Film) -
(RBS) Test,Serum Creatinine Levels,Bronchoscopy,Serum Immunoglobulines(Each) IgG Or IgA Or Ig,Nasal
endoscopy,CFTR(Cystic Fibrosis Transmembrane Regulator Gene),Arterial Blood Gas Analysis (ABG),Sweat Chloride
Test(Chloride Levels),USG Abdomen,Chest X-Ray PA View(1 Film),X-Ray PNS/Fluid For Gram Stain,Sputum Culture &
Sensitivity,Blood - Urea

M8 PULMONOLOGY M8 PULMONOLOGY M8.17.1 Medical Management of Aspergilloma IP 24850 Chest X-Ray PA View(1 Film),Complete Blood Picture [CBP],Erythrocyte Sedimentation Rate (ESR),Random Blood Chest X-Ray PA View(1 Film),Complete Blood Picture[CBP] -
Sugar (RBS) Test,Serum Creatinine Levels ,Sputum For Acid-Fast Bacilli (AFB) Staining,Fluid For Gram Stain,Fluid for
Fungal Stain,Serum Immunoglobulines(Each) IgG Or IgA Or IgE,CT Scan Chest With Contrast ,Blood Grouping And RH
Typing /Blood Fungal Culture/Bronchoscopy,Blood - Urea

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CODE MAIN CATEGORY Sub SUB CATEGORY NAME CODE SURGERY / THERAPY DESCRIPTION PROCEDURE PACKAGE SPECIAL INVESTIGATION POST OPERATIVE PROCEDURE INVESTIGATION TREATMENT PROTOCOL
Category ID TYPE AMOUNT
M8 PULMONOLOGY M8 PULMONOLOGY M8.17.2 Medical Management of A.B.P.A (Alergic Broncho Pulmonary IP 24850 Blood - Urea,CXR,Complete Blood Picture [CBP],Erythrocyte Sedimentation Rate(ESR),Random Blood Sugar (RBS) Serum Immunoglobulines(Each) IgG Or IgA Or Ig,spirometry,Chest X-Ray PA View(1 Film) -
Aspergillosis) Test,Absolute Eosinophil Count,Chest X-Ray PA View(1 Film),X-Ray PNS,High Resolution CT Chest ,Arterial Blood Gas
Analysis (ABG),Sputum For Acid-Fast Bacilli (AFB) Staining ,Fluid For Gram Stain,Fluid for Fungal Stain ,Serum
Electrolytes,Serum Immunoglobulines(Each) IgG Or IgA Or Ig,S.Precipitin test(IgG) ,Skin Prick Test,spirometry/Blood
Fungal Culture/Bronchoscopy,Serum Creatinine Levels

M8 PULMONOLOGY M8 PULMONOLOGY M8.18 Medical Management of Cold Abscess Chest Wall IP 5000 Chest X-Ray PA View(1 Film),Complete Blood Picture [CBP],Erythrocyte Sedimentation Rate (ESR),Random Blood Case sheet with clinical improvement,Clinical Photograph -
Sugar (RBS) Test,Serum Creatinine Levels,Sputum For Acid-Fast Bacilli (AFB) Staining,Fluid For Gram Stain ,Fluid for
Fungal Stain,Fine Needle Aspiration Cytology (FNAC),High Resolution CT Chest/USG local area,Blood - Urea

M8 PULMONOLOGY M8 PULMONOLOGY M8.19 Medical Management of Sarcoidosis IP 15000 Chest X-Ray PA View(1 Film) spirometry,Complete Blood Picture [CBP] ,Erythrocyte Sedimentation Rate C-Reactive Protein,Angiotensin Converting Enzymes -,Chest X-Ray PA View(1 Film) -
(ESR),Random Blood Sugar (RBS) Test,Serum Creatinine Levels,CT Scan Chest With Contrast,Collagen ,Routine Histopathological Examination
Profile,Bronchoscopy,LFT(liver function tests),C-Reactive Protein,Mantoux test,Serum Calcium Levels,24 Hrs Urinary
Calcium/Pulmonary Function Test(Major)/Fundus floroscence,Extremities ,Bones & Joints AP & Lateral View(2
Film),Angiotensin Converting Enzymes,Routine Histopathological Examination,Sputum AFB,Blood - Urea

M8 PULMONOLOGY M8 PULMONOLOGY M8.2 Medical Management of Lung Abscess ,Non Resolving IP 35918 PUS c/s,CT-Chest,FOB clinical and lab investigation Bronchial toilet,Antibiotics
M8 PULMONOLOGY M8 PULMONOLOGY M8.3 Medical Management of Pneumothorax (Large/Recurrent) IP 30787 VATS,HRCT Chest clinical and lab investigation Pleuredesis,MICU,Antimicrobials,Oxygen,Thoracostom
y
M8 PULMONOLOGY M8 PULMONOLOGY M8.4 Medical Management of Interstitial Lung Diseases IP 30786 collagen profile,2D ECHO,Bronchoscopy,Spirometry,HRCT Chest clinical and lab investigation steroids,MICU,Antimicrobials
M8 PULMONOLOGY M8 PULMONOLOGY M8.5 Medical Management of Pneumoconiosis IP 35918 collagen profile,2D ECHO,Bronchoscopy,Spirometry,HRCT Chest clinical and lab investigation Medical management,MICU
M8 PULMONOLOGY M8 PULMONOLOGY M8.6 Medical Management of Acute Respiratory Failure (Without IP 25656 ET suction for analysis,2D ECHO,Bronchoscopy,ECG,ABG,Serum Electrolytes,sputum,Bronchial washing clinical and lab investigation Supportive therapy in MICU,Antimicrobials,Oxygen
Ventilator)
M8 PULMONOLOGY M8 PULMONOLOGY M8.7 Medical Management of Acute Respiratory Failure (With IP 51311 ET suction for analysis,2D ECHO,Bronchoscopy,ECG,ABG,Serum Electrolytes,sputum,Bronchial washing clinical and lab investigation Supportive therapy in RICU,Antimicrobials,Oxygen
Ventilator)
M8 PULMONOLOGY M8 PULMONOLOGY M8.8 Medical Management of Pneumonias IP 30786 Blood Culture & Sensitivity,Complete Blood Picture [CBP],Erythrocyte Sedimentation Rate (ESR),Random Blood C-Reactive Protein,Chest X-Ray PA View(1 Film),Complete Blood Picture [CBP] Supportive Management,Antibiotics, IV fluids
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)

M8 PULMONOLOGY M8 PULMONOLOGY M8.9 Medical Management of Haemoptysis For Evaluation IP 10000 Chest X-Ray PA View(1 Film),Complete Blood Picture [CBP] ,Erythrocyte Sedimentation Rate (ESR),Random Blood Chest X-Ray PA View(1 Film),Erythrocyte Sedimentation Rate(ESR),Complete Blood -
Sugar (RBS) Test,Serum Creatinine Levels,CT scan Lower Abdomen Without Contrast,Serum Electrolytes,Platelet Picture [CBP] ,Platelet Count
Count,Blood Coagulation Analyzer (BCA) Or Coagulation Profile,Renal Profile,LFT(liver function tests),Blood
Grouping And RH Typing /CT scan Lower Abdomen Without Contrast,CT Scan Chest With Contrast/Arterial Blood
Gas Analysis (ABG),Upper GI endoscopy ,ANCA (Anti Neutrophil Cyto Plasmic Anti Body),Blood - Urea

M9 DERMATOLOGY M9 DERMATOLOGY M9.1 Medical management of Pemphigus IP 28498 Skin biopsy - HPE,Tzanck Smear,DIF clinical and lab investigation Pulse therapy,IV antibiotics,IV fluids,IV steroids
M9 DERMATOLOGY M9 DERMATOLOGY M9.10 Medical Management of Bullous Disorders IP 23000 Serum Electrolytes,Skin Biopsy,Skin Biopsy - Routine Histopathological Examination,Tzanck Smear,Direct Clinical Photograph -
(Pemphigoid/Pemphigois) Immunoflorscence
M9 DERMATOLOGY M9 DERMATOLOGY M9.11 Medical Management of Acute Contact Allergic Dermatitis IP 15000 Clinical Photograph Patch Test,LFT(liver function tests),USG Abdomen,Urine Culture & Sensitivity,Routine -
Histopathological Examination
M9 DERMATOLOGY M9 DERMATOLOGY M9.12 Medical Management of Pustular Psoriasis IP 15000 Skin-Biopsy,Clinical Photograph Clinical Photograph -
M9 DERMATOLOGY M9 DERMATOLOGY M9.13 Medical Management of Adverse Drug Reactions IP 14340 AEC,Clinical Photograph,ESR ,CBP Clinical Photograph -
M9 DERMATOLOGY M9 DERMATOLOGY M9.14 Medical Management of Acute Urticaria IP 14000 CBP,Clinical Photograph,ESR Clinical Photograph -
M9 DERMATOLOGY M9 DERMATOLOGY M9.15 Medical Management of Erythema Multiforme IP 8640 CBP,Clinical Photograph,ESR Clinical Photograph -
M9 DERMATOLOGY M9 DERMATOLOGY M9.16 Medical Management of Erythroderma IP 20000 Skin Biopsy Clinical Photograph -
M9 DERMATOLOGY M9 DERMATOLOGY M9.17 Medical Management of Dermatomyositis IP 20000 Serum Aldose Levels,Skin Biopsy,Muscle Biopsy -Routine Histopathological Examination,MRI Muscle,Anti Nuclear Serum Creatinine Levels,Routine Histopathological -
Anti Body (ANA) Titres,ENMG(Elektroneuromyography),Clinical Photograph,CPK,Serum Creatinine Levels Examination,ENMG(Elektroneuromyography),Anti Nuclear Anti Body (ANA) Titres,Serum
Aldose Levels,Clinical Photograph
M9 DERMATOLOGY M9 DERMATOLOGY M9.18.1 Medical Management of Connective Tissue Disorders - IP 20000 ECG,Skin Biopsy,Collagen Profile,CBP,RFT,LFT,ECHO,PFT Clinical Photograph,Routine Histopathological Examination,Case Sheet with treatment -
Systemic Sclerosis details
M9 DERMATOLOGY M9 DERMATOLOGY M9.18.2 Medical Management of Connective Tissue Disorders - IP 20230 Collagen Profile,Serum Cpk-Mb Levels/ENMG (Elektroneuromyography),Clinical Photograph Clinical Photograph,Case Sheet with treatment details -
Dermatomyositis / Polymyositis
M9 DERMATOLOGY M9 DERMATOLOGY M9.19 Medical Management of Vitiligo Medical (OP Management) DC 15000 Skin Biopsy Clinical Photograph -

M9 DERMATOLOGY M9 DERMATOLOGY M9.2 Medical management of Toxic Epidermal Necrolysis IP 38791 Echo-Cardiogram,LFT,Blood culture,urine culture,Skin swab,,USG abdomen,Skin biopsy - HPE, clinical and lab investigation IV steroids,IV antibiotics,IV fluids
M9 DERMATOLOGY M9 DERMATOLOGY M9.3 Medical management of Stevens- Johnson Syndrome IP 22224 Echo-Cardiogram,LFT,Blood culture,urine culture,Skin swab,,USG abdomen,Skin biopsy - HPE clinical and lab investigation IV steroids,IV antibiotics,IV fluids
M9 DERMATOLOGY M9 DERMATOLOGY M9.4 Medical Management of Rheumatoid Arthritis Requiring IP 30000 Chest X-Ray PA View(1 Film),Complete Haemogram,Renal Profile,Anti CCP (Anti-Cyclic Citrullinatid Peptide Anti Case sheet with clinical improvement,Complete Haemogram -
Hospitalisation Bodies),Complete Blood Picture [CBP],Erythrocyte Sedimentation Rate (ESR),X-Ray Arthrography,ECHO
Cardiogram,Anti Nuclear Anti Body (ANA) Indirect Immunofluorescence (IIF) / Anti Nuclear Anti Body (ANA)
Titres,LFT(liver function tests)
M9 DERMATOLOGY M9 DERMATOLOGY M9.5 Medical Management of Leprosy Reactions and Deformities IP 20000 Case sheet with clinical History Skin Swab For Culture & Sensitivity,LFT(liver function tests) ,Urine Culture & -
(Type I and Type Ii) Sensitivity,Blood Culture & Sensitivity - Automated,USG Abdomen,Skin Biopsy,Routine
Histopathological Examination,ECHO Cardiogram,Direct Immunofluorescence,Sputum
For Acid-Fast Bacilli(AFB) Staining
M9 DERMATOLOGY M9 DERMATOLOGY M9.6 Medical Management of Chlamydial Tests IP 27290 FREI Test,Cervical Swab Culture Case Sheet with treatment details,Cervical Swab Culture,Routine Histopathological -
Examination,FREI Test
M9 DERMATOLOGY M9 DERMATOLOGY M9.7 Medical Management of Herpes Zoster Post Herpetic IP 12720 Clinical Photograph Case Sheet with treatment details -
Neuralgia
M9 DERMATOLOGY M9 DERMATOLOGY M9.8 Medical Management of Electro/Cryocautery For Warts IP 8210 Clinical Photograph Case Sheet with treatment details -
M9 DERMATOLOGY M9 DERMATOLOGY M9.9.1 Medical Management of Cutaneous Malignancies -Malignant IP 13380 Case sheet with clinical History,Clinical Photograph Skin Swab For Culture & Sensitivity,LFT(liver function tests),Urine Culture & -
Melanoma Sensitivity,Blood Culture & Sensitivity - Manual,USG Abdomen,Skin Biopsy-Routine
Histopathological Examination,ECHO Cardiogram
M9 DERMATOLOGY M9 DERMATOLOGY M9.9.2 Medical Management of Cutaneous Malignancies (Sq. Cell Ca IP 13380 Case sheet with clinical History,Clinical Photograph Skin Swab For Culture & Sensitivity,LFT(liver function tests),Urine Culture & -
,Bcc, Lymphomas ) Sensitivity,Blood Culture & Sensitivity - Manual,USG Abdomen,Skin Biopsy-Routine
Histopathological Examination,ECHO Cardiogram
M10 RHEUMATOLOGY M10 RHEUMATOLOGY M10.1.1 Medical management of SLE (Systemic Lupus Erythematosis) IP 26323 EN ANTIGEN,ANA PROFILE,KIDNEYBIOPSY,24 Hrs URINARY PROTEIN,dSDNA,ACL ANTIBODIES,HR CT clinical and lab investigation As per American College of Rheumatology Guidelines.

M10 RHEUMATOLOGY M10 RHEUMATOLOGY M10.1.2 Medical management of Sle (Systemic Lupus Erythematosis) IP 73116 - - -
with sepsis
M10 RHEUMATOLOGY M10 RHEUMATOLOGY M10.1.3 Medical Management of Anti Phospho Lipid Antibody IP 10000 Anti Nuclear Anti Body (ANA) Titres,APLA(Anti Phospholipid Anti Body Test),Complete Haemogram,Lupus Anti Case Sheet with treatment details -
Syndrome With Ischemia Coagulant,Prothrombin Time,Double Stranded (DS) DNA,Complete Blood Picture [CBP] ,Erythrocyte Sedimentation
Rate (ESR),Serum Creatinine Levels,Alanine Aminotransferase - Blood ,CUE(pH,Specific Gravity,Sugar,Protein And
Microscopy),Case sheet with clinical History,Evidence of Ischemia,Activated Partial Thrombo Plastin Time (APTT)

M10 RHEUMATOLOGY M10 RHEUMATOLOGY M10.1.4 Medical Management of Severe Lupus Erythamatosis IP 30000 Erythrocyte Sedimentation Rate (ESR),Anti Nuclear Anti Body (ANA) Titres,Double Stranded(DS)DNA,Complement Complete Haemogram,Case Sheet with treatment details -
Levels(C3,C4),Serum Uric Acid Levels,Serum Creatinine Levels,LFT(liver function tests),CUE(pH,Specific
Gravity,Sugar,Protein And Microscopy),Urine Culture & Sensitivity,Serum Total Proteins Levels,Clinical
Photograph,Case sheet with clinical History,Complete Blood Picture [CBP]

M10 RHEUMATOLOGY M10 RHEUMATOLOGY M10.10 Medical Management of Osteomalacia IP 12950 Serum Vitamin D3 Levels,Extremities ,Bones & Joints AP & Lateral View(2 Film),Serum Calcium Levels,Serum Serum Calcium Levels,Serum Vitamin D3 Levels -
Phosphorus Levelss,P.T.H Assay(Parathyroid Assay)
M10 RHEUMATOLOGY M10 RHEUMATOLOGY M10.11 Medical Management of Gout IP 10000 T3,Serum Uric Acid Levels,X-Ray,Synovial Fluid Analysis,FBS (Fasting Blood Sugar)/Post Lunch Blood Sugar Serum Uric Acid Levels -
(PLBS),TSH,T4,Lipid Profile
M10 RHEUMATOLOGY M10 RHEUMATOLOGY M10.2 Medical management of Scleroderma IP 30786 SKIN BIOPSY WITH HPE REPORT,2D ECHO,ANA PROFILE,RENAL DOPPLER clinical and lab investigation As per American College of Rheumatology Guidelines.

M10 RHEUMATOLOGY M10 RHEUMATOLOGY M10.3 Medical management of Mctd Mixed Connective Tissue IP 25654 24 Hrs URINARY PROTEIN,CPK,LDH,ENMG,MRI OF MUSCLES,MRI OF HANDS,KIDNEYBIOPSY clinical and lab investigation As per American College of Rheumatology Guidelines.
Disorder
M10 RHEUMATOLOGY M10 RHEUMATOLOGY M10.3.1 Medical Management of Undifferentiated Connective Tissue IP 20290 Case sheet with clinical History,Anti Nuclear Anti Body (ANA) Titres Case Sheet with treatment details -
Disorder
M10 RHEUMATOLOGY M10 RHEUMATOLOGY M10.4 Medical management of Primary Sjogren\'S Syndrome IP 20524 24 Hrs URINARY PROTEIN,CANCA,pANCA,ANA PROFILE,CPK,LDH,ENMG,MRI OF MUSCLES,MRI OF clinical and lab investigation As per American College of Rheumatology Guidelines.
HANDS,KIDNEYBIOPSY
M10 RHEUMATOLOGY M10 RHEUMATOLOGY M10.5 Medical management of Vasculitis IP 30786 - clinical and lab investigation As per American College of Rheumatology Guidelines.

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CODE MAIN CATEGORY Sub SUB CATEGORY NAME CODE SURGERY / THERAPY DESCRIPTION PROCEDURE PACKAGE SPECIAL INVESTIGATION POST OPERATIVE PROCEDURE INVESTIGATION TREATMENT PROTOCOL
Category ID TYPE AMOUNT
M10 RHEUMATOLOGY M10 RHEUMATOLOGY M10.6.1 Medical Management of Rheumatoid Arthritis Requiring IP 30000 Erythrocyte Sedimentation Rate (ESR),RA Factor,Complete Haemogram,Renal Profile,Anti CCP (Anti-Cyclic Complete Haemogram,Case sheet with clinical improvement -
Hospitalisation Citrullinatid Peptide Anti Bodies),LFT(liver function tests),Chest X-Ray PA View(1 Film),X-Ray Arthrography,ECHO
Cardiogram,Anti Nuclear Anti Body (ANA) Indirect Immunofluorescence (IIF) / Anti Nuclear Anti Body (ANA)
Titres,Complete Blood Picture [CBP]
M10 RHEUMATOLOGY M10 RHEUMATOLOGY M10.6.2 Medical Management of Severe Psoriatic Arthritis IP 30000 Clinical Photograph,Complete Haemogram,Contrast Enhanced USG,USG local area Case Sheet with treatment details,Clinical Photograph -
M10 RHEUMATOLOGY M10 RHEUMATOLOGY M10.6.3 Medical Management of Juvenile Idiorpathic Arthritis IP 10000 Clinical Photograph Complete Haemogram,Case sheet with clinical -
M10 RHEUMATOLOGY M10 RHEUMATOLOGY M10.6.4 Medical Management of Juvenile Idiorpathic Arthritis with IP 15000 Serum Creatinine Levels,Complete Haemogram,Serum Ferritin Levels,C-Reactive Protein,LFT(liver function C-Reactive Protein,Serum Ferritin Levels,Complete Haemogram,Case sheet with clinical -
systemic onset tests),Lactate Dehydrogenase (LDH),Bone Marrow Aspiration,Routine Histopathological Examination,Fine Needle improvement
Aspiration Cytology (FNAC),Lymph Node Biopsy For Routine Histopathological Examination,Clinical
Photograph,Serum Uric Acid Levels
M10 RHEUMATOLOGY M10 RHEUMATOLOGY M10.6.5 Medical Management of Infection Related Arthrites IP 10000 Synovial Fluid Analysis,Complete Haemogram,C-Reactive Protein,X-Ray,Cerebrospinal Fluid (CSF) Analysis Cell Count Case Sheet with treatment details -

M10 RHEUMATOLOGY M10 RHEUMATOLOGY M10.6.6 Medical Management of Undifferentiated Inflammatory IP 15000 Clinical Photograph,Complete Haemogram,Renal Profile Complete Haemogram,Case sheet with clinical -
Arthritis
M10 RHEUMATOLOGY M10 RHEUMATOLOGY M10.6.7 Medical Management of Severe Spondylo Arthropathies IP 24750 Clinical Photograph,X-Ray Dorso Lumbar Spine,Human Leukocyte Antigen (HLA) B27,Complete Haemogram ,MRI Case sheet with clinical improvement -
Spine/MRI Ankle Both Joints Without Contrast
M10 RHEUMATOLOGY M10 RHEUMATOLOGY M10.7 Medical Management of Sarcoidosis IP 15000 Chest X-Ray PA View(1 Film) spirometry,Complete Blood Picture [CBP] ,Erythrocyte Sedimentation Rate C-Reactive Protein,Angiotensin Converting Enzymes -,Chest X-Ray PA View(1 Film) -
(ESR),Random Blood Sugar (RBS) Test,Serum Creatinine Levels,CT Scan Chest With Contrast,Collagen ,Routine Histopathological Examination
Profile,Bronchoscopy,LFT(liver function tests),C-Reactive Protein,Mantoux test,Serum Calcium Levels,24 Hrs Urinary
Calcium/Pulmonary Function Test(Major)/Fundus floroscence,Extremities ,Bones & Joints AP & Lateral View(2
Film),Angiotensin Converting Enzymes,Blood - Urea

M10 RHEUMATOLOGY M10 RHEUMATOLOGY M10.8.1 Medical Management of Inflamatory Myositis IP 15000 Clinical Photograph,Serum Cpk-Mb Levels/ENMG (Elektroneuromyography) Case Sheet with treatment details -
M10 RHEUMATOLOGY M10 RHEUMATOLOGY M10.8.2 Medical Management of Severe Myositis Requiring IVIG IP 30000 Clinical Photograph,(Elektroneuromyography),Anti Nuclear Anti Body (ANA) Titres,Double Case Sheet with treatment details -
Stranded(DS)DNA,Collagen Profile
M10 RHEUMATOLOGY M10 RHEUMATOLOGY M10.9 Medical Management of Osteoporosis With Recent Painful IP 14110 Serum Vitamin D3 Levels,Extremities ,Bones & Joints AP & Lateral View(2 Film),Alkaline Phosphatase Levels,Bone X-Ray,Serum Calcium Levels -
Yertebral Fracture Mineral Density\Densitometry(BMD)-Three Sites(Spine,Hip and Extremity),P.T.H Assay (Parathyroid Assay),Dexa
Scan (Hip and Spine/Heel)(Bone Scan),Serum Calcium Levels
M11 ENDOCRINOLOGY M11.1 Uncontrolled Diabetes mellitus M11.1.1 Medical management of Pyelonephritis in uncontrolled IP 22074 USG,Urine C and S clinical and lab investigation other therapy with treatment of
with infectious emergencies Diabetes melitus Diabetics,Antibiotics,IV fluids
M11 ENDOCRINOLOGY M11.1 Uncontrolled Diabetes mellitus M11.1.2 Medical management of Lower Respiratoy Tract Infection IP 23603 Sputum C/S,CXR clinical and lab investigation other therapy with treatment of
with infectious emergencies Diabetics,Antibiotics,IV fluids
M11 ENDOCRINOLOGY M11.1 Uncontrolled Diabetes mellitus M11.1.3 Medical management of Fungal Sinusitis IP 42013 CT PNS clinical and lab investigation Anti-fingal agents,Antibiotics,IV fluids,other therapy
with infectious emergencies with treatment of Diabetics
M11 ENDOCRINOLOGY M11.1 Uncontrolled Diabetes mellitus M11.1.4 Medical management of Cholecystitis IP 30479 USG,CT-Abdomen clinical and lab investigation other therapy with treatment of
with infectious emergencies Diabetics,Antibiotics,IV fluids
M11 ENDOCRINOLOGY M11.1 Uncontrolled Diabetes mellitus M11.1.5 Medical management of Cavernous Sinus Thrombosis in IP 42085 Venogram,MRI clinical and lab investigation other therapy with treatment of
with infectious emergencies uncontrolled Diabetes melitus Diabetics,Antibiotics,IV fluids
M11 ENDOCRINOLOGY M11.1 Uncontrolled Diabetes mellitus M11.1.6 Medical management of Rhinocerebral Mucormycosis IP 52973 CT-Scan clinical and lab investigation Anti-fingal agents,Antibiotics,IV fluids,other therapy
with infectious emergencies with treatment of Diabetics
M11 ENDOCRINOLOGY M11.2 OTHER ENDOCRINAL DISORDERS M11.2.1 Initial evaluation and management of Hypopituitarism with IP 26681 t3 t4TSH,FSH,LH,testosterone,estradiol clinical and lab investigation Hormone Therapy for three months
growth harmone
M11 ENDOCRINOLOGY M11.2 OTHER ENDOCRINAL DISORDERS M11.2.2 Hormonal therapy for Pituitary - Acromegaly IP 18923 Visual field,2D ECHO,FSH,LH,testosterone,estradiol,Post glucose on assay,prolactin, t3 t4TSH,Basal cortisal cost clinical and lab investigation Hormone Therapy for three months
ACTH,water deprivation test(if needed),,MRI colonoscopy if needed,
M11 ENDOCRINOLOGY M11.2 OTHER ENDOCRINAL DISORDERS M11.2.3 Medical Management of Cushings Syndrome IP 30787 Dexa of Hip spine,Cortisol assay after dexamethasone,ACTH assay,DHEAS,MRI pituitary CT ABD,CT Chest clinical and lab investigation surgery,Diabetis mellitus
drugs,Hypertension,Osteoporesis,infection with
antibiotics
M11 ENDOCRINOLOGY M11.2 OTHER ENDOCRINAL DISORDERS M11.2.4 Hormonal therapy for Delayed Puberty Hypogonadism- IP 14880 MRI brain DEXA,2D ECHO,FSH,LH, testosterone,estradiol,USG pelvis karyotyping,T4 TSH X-ray bone age,X-ray skull clinical and lab investigation oc pills,Inj Testosterone250mg/ 3 wks
Turners Syndrome/Kleinfelter Syndrome(Q98.4)
M11 ENDOCRINOLOGY M11.2 OTHER ENDOCRINAL DISORDERS M11.2.5 Hypopiturasim Initial Evaluation And Management With IP 26681 Growth Hormone (Basal, Post Glucose Load),T3, T4, TSH,Basal Cortisol Levels (Adrenal Corticotrophin Stimulation T4,Case sheet with clinical improvement Hormone Therapy for three months
Growth Hormone Test),Cortisol Assay After Dexamethasone
M11 ENDOCRINOLOGY M11.2 OTHER ENDOCRINAL DISORDERS M11.2.6 Hypopiturasim Maintanance Phase Monthly Package For IP 13915 Growth Hormone (Basal, Post Glucose Load),T3, T4, TSH,Basal Cortisol Levels (Adrenal Corticotrophin Stimulation T4,Case sheet with clinical improvement Hormone Therapy for three months
Growth Hormone Test),Cortisol Assay After Dexamethasone
M11 ENDOCRINOLOGY M11.2 OTHER ENDOCRINAL DISORDERS M11.2.7 Medical Management of Graves Disease IP 10323 T3, T4, TSH Case Sheet with treatment details Antithypoid medication

M11 ENDOCRINOLOGY M11.2 OTHER ENDOCRINAL DISORDERS M11.2.8 Medical Management of Precocious Puberty IP 15000 Skeletal Survey ,FSH(Follicle-Stimulating Hormone) Levels,Luteinizing Hormone (Lh) Levels,Serum Free Testosterone Case sheet with clinical improvement,Serum Luteinizing Hormone(Lh) Levels -
Levels/ Estradiol Levels,T3,T4,X-Ray Skull,USG Abdomen & Pelvis,TSH
M11 ENDOCRINOLOGY M11.2 OTHER ENDOCRINAL DISORDERS M11.2.9 Medical Management of Osteoporosis IP 11090 Xray Spine,Dexa Scan (Hip & Spine / Heel) (Bone Scan)/ Bone Mineral Density\Densitometry -Whole Body P.T.H Assay (Parathyroid Assay),Serum Calcium Levels,Serum Vitamin D3 Levels,Serum -
Phosphorus Levelss,Case sheet with clinical improvement
M12 GASTROENTEROLOGY M12 GASTROENTEROLOGY M12.1 Medical management of Corrosive Oesophageal Injury IP 21868 Endoscopic dilatation-video/photo Barium swallow MICU stay,Medical treatment
M12 GASTROENTEROLOGY M12 GASTROENTEROLOGY M12.1.1 Medical Management of Infective Oesophagitis (Candida IP 12080 Viral Markers,Upper GI endoscopy ,Clinical Photograph,HIV,HCV,HBS Ag Clinical Photograph,Case Sheet with treatment details -
Viralbacterial)
M12 GASTROENTEROLOGY M12 GASTROENTEROLOGY M12.10 Medical management of Acute Pancreatitis (Mild) IP 51310 MRCP,CT-Abdomen + Pelvis,EUS Lab Investigations,USG MICU
M12 GASTROENTEROLOGY M12 GASTROENTEROLOGY M12.11 Medical management of Acute Pancreatitis (Severe) IP 153930 CT-Abdomen + Pelvis Lab Investigations,USG MICU
M12 GASTROENTEROLOGY M12 GASTROENTEROLOGY M12.12 Conservative management of Acute Pancreatitis With IP 30785 Post procedure USG,CT-Abdomen + Pelvis,EUS Lab Investigations,USG surgical drainage,MICU,Endoscopy
Pseudocyst (Infected) drainage,Percutaneous drainage
M12 GASTROENTEROLOGY M12 GASTROENTEROLOGY M12.13 Conservative management of Chronic Pancreatitis with Severe IP 30785 EUS,CT-Abdomen + Pelvis Lab Investigations Celiac ganglion
Pain block,ERCP,MICU,Conservative,ERCP+Stenting,EUS
guided
M12 GASTROENTEROLOGY M12 GASTROENTEROLOGY M12.13.1 Medical Management of Chronic Pancreatitics With IP 10000 Breath Test,LFT(liver function tests),USG Abdomen,Upper GI endoscopy,CT scan Lower Abdomen Without Case sheet with clinical improvement -
Maldigestion Contrast/MRCP,HBS Ag,HCV,HIV,Fecal Elastase
M12 GASTROENTEROLOGY M12 GASTROENTEROLOGY M12.13.2 Medical Management of Chronic Pancreatitis With Pseudocyst IP 30000 RFT,USG Abdomen/ CT scan Upper Abdomen Without Contrast,Serum Amylase Levels,HBS Ag,HCV,HIV,ESR,CBP,LFT Endoscopic Photograph,X-Ray -
Infected
M12 GASTROENTEROLOGY M12 GASTROENTEROLOGY M12.14 Conservative management of Obscure GI Bleed IP 51309 Enteroscopy biopsy,BMFT,Capsule Endoscopy Endoscopic photograph Argon Laser Rx
M12 GASTROENTEROLOGY M12 GASTROENTEROLOGY M12.14.1 Medical Management of Lower GI Bleed IP 20000 Enteroscopy,Upper GI endoscopy/ Colono Scopy,HIV,HCV,HBS Ag Intra Op Photo -
M12 GASTROENTEROLOGY M12 GASTROENTEROLOGY M12.15 Conservative management of Cirrhosis with Hepatic IP 41048 Ascitic fluid analysis,UGI Endoscopy Lab Investigations EVL-EST,MICU 10 days
Encephalopathy
M12 GASTROENTEROLOGY M12 GASTROENTEROLOGY M12.16 Medical management of Cirrhosis with Hepato Renal IP 41048 Reports of Serum Chemistry Lab Investigations EVL-EST,MEDICAL,MICU 10 days
Syndrome
M12 GASTROENTEROLOGY M12 GASTROENTEROLOGY M12.17.1 Medical management of Post op stent IP 48057 PTBD,ERCP,EUS,MRCP Radiological and endoscopic image Biliary stent,MEDICAL
M12 GASTROENTEROLOGY M12 GASTROENTEROLOGY M12.17.2 Medical management of Post op leaks IP 48539 PTBD,ERCP,EUS,MRCP Radiological and endoscopic image Biliary stent,MEDICAL
M12 GASTROENTEROLOGY M12 GASTROENTEROLOGY M12.17.3 Medical management of Sclerosing Cholangitis IP 76965 PTBD,ERCP,EUS,MRCP Radiological and endoscopic image MEDICAL,Biliary stent
M12 GASTROENTEROLOGY M12 GASTROENTEROLOGY M12.18 Medical Management of Cirrhosis Decompensated Including IP 37836 Rna Quantitative,LFT(liver function tests),USG Abdomen,Upper GI endoscopy,Fluid Analysis,HBs Ag,HCV Geno Case Sheet with treatment details,Case sheet with clinical History Ritaximin,Antibiotics,Betablockers,Banding of
SBP, Portal HTN, Bleed Type/HCV varices,Lactulose
M12 GASTROENTEROLOGY M12 GASTROENTEROLOGY M12.18.1 Medical Management of Compensated Cirrhosis IP 23270 HBS Ag,LFT(liver function tests),USG Abdomen,Upper GI endoscopy,CBP,HIV,Serum Creatinine,Serum Case sheet with clinical improvement -
Electrolytes,HCV
M12 GASTROENTEROLOGY M12 GASTROENTEROLOGY M12.19 Medical Management of Acute Hepatitis (Viral, Alcohol, Drugs, IP 15392 Case sheet with clinical History,LFT(liver function tests),USG Abdomen,HBs Ag,HCV Geno Type /HCV,Rna Case sheet with clinical improvement ,LFT(liver function tests) Stop offending agent.,Supportive Mgmt,Antiviral Drugs
Misc. Infections) Quantitative,Anti-Endomysial Antibodies,IgA/IgG/IgM,Anti-HAV IgM (IgM Antibody To Hepatitis A Antigen)

M12 GASTROENTEROLOGY M12 GASTROENTEROLOGY M12.2 Conservative management of Oesophageal Foreign Body IP 8137 Foreign body removal - photo of the procedure Endoscopic photograph Conservative

M12 GASTROENTEROLOGY M12 GASTROENTEROLOGY M12.20 Medical Management of Ascities Of Any Etiology (Tubercolor, IP 15403 Ascitic Fluid Analysis- Routine,USG Abdomen Fluid Analysis treat the cause,Paracentesis
Melignant, Pancreatic, Biliary)
M12 GASTROENTEROLOGY M12 GASTROENTEROLOGY M12.21.1 Medical Management of Other Bacterial Intestinal Infections IP 17150 HBS Ag,Upper GI endoscopy/Colono Scopy,Stool For Microscopy ,Case sheet with clinical History,US Endoscopic Photograph -
Abdomen,HIV,HCV
M12 GASTROENTEROLOGY M12 GASTROENTEROLOGY M12.21.2 Medical Management of Viral And Other Specified Intestinal IP 17150 Stool Culture Sensitivity,Upper GI endoscopy/Colono Scopy,Stool For Microscopy ,Case sheet with clinical Endoscopic Photograph -
Infections History,HIV,HCV,HBS Ag
M12 GASTROENTEROLOGY M12 GASTROENTEROLOGY M12.21.3 Medical Management of Infective Proctitis entero Colitis IP 17150 Stool Culture Sensitivity,Stool For Microscopy,Sigmoidoscopy (REGID),HIV,HCV,HBS Ag,US Abdomen Endoscopic Photograph -

M12 GASTROENTEROLOGY M12 GASTROENTEROLOGY M12.22 Medical Management of Abdominal Tuberculosis IP 20000 Montoux test/TB gold,Colono Scopy,Upper GI endoscopy,Routine Histopathological Examination,Barium Ascitic Fluid Analysis- Routine,Routine Histopathological Examination/X-Ray PA View(1 -
Studies/Ascitic Fluid Analysis-Routine/CT scan Lower Abdomen Without Contrast(Any One),HBS Ag,HCV,HIV,ESR Film)

M12 GASTROENTEROLOGY M12 GASTROENTEROLOGY M12.23 Medical Management - SEMS (Stent) For Paliation Of IP 33920 GI Endoscopy,CT Scan Abdomen With Contrast,HIV,HCV,HBS Ag Endoscopic Photograph -
Advanced GI Malignancy

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CODE MAIN CATEGORY Sub SUB CATEGORY NAME CODE SURGERY / THERAPY DESCRIPTION PROCEDURE PACKAGE SPECIAL INVESTIGATION POST OPERATIVE PROCEDURE INVESTIGATION TREATMENT PROTOCOL
Category ID TYPE AMOUNT
M12 GASTROENTEROLOGY M12 GASTROENTEROLOGY M12.24 Medical Management of Budd-Chiari Syndrome IP 34240 Upper GI endoscopy,USG Abdomen,LFT(liver function tests),Doppler For Hepatic Veins,MRI Abdomen With MRI Abdomen With Contrast,USG Abdomen -
Contrast,Prothrombin Time,HIV,HCV,HBS Ag,Angiography,Protein C/ protein S
M12 GASTROENTEROLOGY M12 GASTROENTEROLOGY M12.25.1 Medical Management ofGastro Esophageal Reflux Disease IP 7430 HBS Ag,Upper GI endoscopy ,Oesophageal manometry,HIV,HCV Clinical Photograph,Case Sheet with treatment details -

M12 GASTROENTEROLOGY M12 GASTROENTEROLOGY M12.25.2 Medical Management of Mallory Weiss Tear IP 10000 HBS Ag,Upper GI endoscopy,HIV,HCV Endoscopic Photograph -
M12 GASTROENTEROLOGY M12 GASTROENTEROLOGY M12.26 Medical Management of Duodenal Ulcer IP 11240 H Pylori test,Upper GI endoscopy,HIV,HCV,HBS Ag,USG Abdomen Endoscopic Photograph -
M12 GASTROENTEROLOGY M12 GASTROENTEROLOGY M12.27.1 Medical Management of Gastric Ulcer IP 11910 H Pylori test,Upper GI endoscopy,HIV,HCV,HBS Ag Endoscopic Photograph -
M12 GASTROENTEROLOGY M12 GASTROENTEROLOGY M12.27.2 Medical Management of Erosive Gastritis IP 10640 Routine Histopathological Examination,Stool For Occult Blood,Stool For Microscopy,LFT(liver function Case Sheet with treatment details,Serum Electrolytes -
tests),Complete Blood Picture [CBP] ,C-Reactive Protein,Rapid Ureae Test,HIV,HCV,HBS Ag,H Pylori test,Upper GI
endoscopy
M12 GASTROENTEROLOGY M12 GASTROENTEROLOGY M12.27.3 Medical Management of Gastric Outlet Obstruction IP 12610 H Pylori test,Upper GI endoscopy /Barium Meal Follow Through,HIV,HCV,HBS Ag Endoscopic Photograph -
M12 GASTROENTEROLOGY M12 GASTROENTEROLOGY M12.27.4 Medical Management of Gastric Polyp IP 11080 Routine Histopathological Examination,Upper GI endoscopy,HIV,HCV,HBS Ag Routine Histopathological Examination,Endoscopic Photograph -
M12 GASTROENTEROLOGY M12 GASTROENTEROLOGY M12.28.1 Medical Management of Ulcerative Colitis IP 25370 USG Abdomen,Colono Scopy/ Barium Swallow / Sigmoidoscopy (REGID) (Any One),HIV,HCV,HBS Ag Routine Histopathological Examination -
M12 GASTROENTEROLOGY M12 GASTROENTEROLOGY M12.28.2 Medical Management of Ischaemic Bowel Disease IP 28700 HBS Ag,CT scan Lower Abdomen Without Contrast,Colono scopy,USG,HIV,HCV Routine Histopathological Examination -
M12 GASTROENTEROLOGY M12 GASTROENTEROLOGY M12.28.3 Medical Management of Crohn'S Disease IP 15000 LFT,Upper GI endoscopy /Barium Meal Follow Through/Colono Scopy/CT scan Lower Abdomen Without Routine Histopathological Examination/Endoscopic Photograph -
Contrast/MRI Enterography,Capsule Enteroscopy/Balloon Enteroscopy(Any One),HBS Ag,HCV,HIV,CBP,RFT

M12 GASTROENTEROLOGY M12 GASTROENTEROLOGY M12.28.4 Medical Management of Malabsorption Syndrome IP 20000 Routine Histopathological Examination,Upper GI endoscopy/ Barium Meal Follow Through/ CT scan Lower Biopsy,Serum Vitamin D3 Levels -
Abdomen Without Contrast,HIV,HCV,HBS Ag
M12 GASTROENTEROLOGY M12 GASTROENTEROLOGY M12.29.1 Medical Management of Rectal Polyp Medical Management IP 7040 Histopathological examination,Sigmoidoscopy (REGID)/Colono Scopy/Barium Enema (Single Contrast\Double Clinical Photograph -
Contrast)(Any One),HBS Ag,HCV,HIV
M12 GASTROENTEROLOGY M12 GASTROENTEROLOGY M12.29.2 Medical Management of Solitary Rectal Ulcer Syndrome IP 10240 APC,Sigmoidoscopy (REGID)/Colono Scopy/Barium Enema (Single Contrast\Double Contrast) (Any One),LASER Argon Clinical Photograph,Routine Histopathological Examination -
plasma coagulation,HIV,HCV,HBS Ag
M12 GASTROENTEROLOGY M12 GASTROENTEROLOGY M12.29.3 Medical Management of Radiation Proctitis IP 10190 HBS Ag,Sigmoidoscopy (REGID)/Colono Scopy,HIV,HCV Clinical Photograph -
M12 GASTROENTEROLOGY M12 GASTROENTEROLOGY M12.29.4 Medical Management of Colorectal Polyps IP 10000 HCV,Sigmoidoscopy (REGID)/Colono Scopy/Barium Enema (Single Contrast\Double Contrast)(Any Clinical Photograph -
One),HIV,Histopathological examination,HBS Ag
M12 GASTROENTEROLOGY M12 GASTROENTEROLOGY M12.3 Conservative management of Oesophageal Perforation IP 51309 CT scan thorax,and abdomen, - Conservative,MICU stay

M12 GASTROENTEROLOGY M12 GASTROENTEROLOGY M12.30.1 Medical Management of Chronic Hepatitis (Viral , Alchohol, IP 22060 CBC,LFT(liver function tests),USG Abdomen,Case sheet with clinical History,HIV,HCV,Serum Creatinine,Serum Case Sheet with treatment details,Case sheet with clinical History -
NASH, Drug, auto Immune, metabolic) Electrolytes,FIBRO Scan,AFP,DNA/RNA Viral,HBS Ag
M12 GASTROENTEROLOGY M12 GASTROENTEROLOGY M12.30.2 Chronic hepatitis, unspecified IP 12920 Serum Creatinine,AST- Aspartate Transaminase(SGOT),ALT - Alanine Aminotransferase - Blood ,Liver Biopsy (Major) Case Sheet with operation Notes -
,Random Blood Sugar (RBS) Test,Serum Albumin Levels ,HCV RNA Quantitative,Anti HCV (Hepatitis C)
Antibodies,HBV (Hepatitis B) Deoxyribonucleic Acid (DNA) Quantitative ,Anti-HBS (Antibody To Hepatitis B Surface
Antigen),Anti Nuclear Anti Body (ANA) Titres,Bilirubin,Qualitative - Urine,Bile Salts And Pigments,CBP,Prothrombin
time,Renal Profile,Serum Electolytes,Alpha Anti-Trypsin Levels ,Serum Copper Levels/24 Hrs Urinary Copper,CT Local
area,MRI Local Area,Alpha Feto Protiens Levels,HIV,AMA,ASM Ab,ALKM Ab,APRI Scan,FIBRO Scan,LFT

M12 GASTROENTEROLOGY M12 GASTROENTEROLOGY M12.31.1 Medical Management of Fissure IP 5000 Coagulation Profile,Proctoscopy,Sigmoidoscopy (REGID),HIV,HCV,HBS Ag Case Sheet with treatment details -
M12 GASTROENTEROLOGY M12 GASTROENTEROLOGY M12.31.2 Medical Management of Haemorrhoids IP 10130 HBS Ag,Sigmoidoscopy (REGID) /Colono Scopy,HIV,HCV Endoscopic Photograph -
M12 GASTROENTEROLOGY M12 GASTROENTEROLOGY M12.32 Medical Management of Liver Abscess (Amoebic, Pyogenic IP 30000 Rapid AFB Culture,USG Abdomen/CT scan Lower Abdomen Without Contrast,LFT(liver function tests),HBS USG Abdomen,LFT(liver function tests),Case sheet with clinical improvement -
and Misc. Infections) Ag,HCV,CBP,RFT,HIV
M12 GASTROENTEROLOGY M12 GASTROENTEROLOGY M12.33 Medical Management of Billiary Stricture IP 15000 Serum Creatinine,USG-Doppler Abdomen,LFT(liver function tests) /CT scan Lower Abdomen Without Intra Op Photo -
Contrast/Magnetic Resonance Cholangiopancreatography (MRCP),ERCP,HIV,HCV,CBP,RFT,HBS Ag
M12 GASTROENTEROLOGY M12 GASTROENTEROLOGY M12.34 Medical Management of Acute Liver Failure IP 30000 HCV,LFT(liver function tests),USG Abdomen,Arterial Blood Gas Analysis (ABG),Serum Ammonia Levels,Cerebrospinal Case sheet with clinical improvement,LFT(liver function tests) -
Fluid (CSF) Analysis Cell Count,HBS Ag,CBP,RFT,RBS,HIV
M12 GASTROENTEROLOGY M12 GASTROENTEROLOGY M12.35.1 Medical Management - SEMS (Stent) For Paliation Of IP 51660 ERCP/PTBD,CT Scan Abdomen With Contrast,HIV,HCV,HBS Ag Endoscopic Photograph -
Advanced Biliary Malignancy
M12 GASTROENTEROLOGY M12 GASTROENTEROLOGY M12.35.2 Medical Management- SEMS (Stent) For Paliation Of IP 51660 ERCP,CT Scan Abdomen With Contrast,HIV,HCV,HBS Ag Endoscopic Photograph -
Advanced Pancreatic Malignancy
M12 GASTROENTEROLOGY M12 GASTROENTEROLOGY M12.36 Any Variceal Bleed ST 9000 LFT,HB,ECG,GRBS,Endoscopy/ colonoscopy IRON,CERULOPLASMIN,HB,Clinical photo ,TIBC -
M12 GASTROENTEROLOGY M12 GASTROENTEROLOGY M12.4 Medical management of Achalasia Cardia IP 13638 UGI Endoscopy Endoscopic photograph Taxim inj.,Dilatation,Botulinum
M12 GASTROENTEROLOGY M12 GASTROENTEROLOGY M12.5 Medical Management of Oesophageal Varices using Variceal IP 12509 UGI Endoscopy Endoscopic photograph Endoscopic variceal banding
Banding
M12 GASTROENTEROLOGY M12 GASTROENTEROLOGY M12.6 Medical Management of Oesophageal Varices with IP 10364 UGI Endoscopy Endoscopic photograph Endoscopic sclerotherapy injection
Sclerotherapy
M12 GASTROENTEROLOGY M12 GASTROENTEROLOGY M12.7 Medical management of Oesophageal Fistula IP 30786 CT Thorax Gastrograffin contrast picture Photograph of stent in position Covered esophageal stent -MICU
M12 GASTROENTEROLOGY M12 GASTROENTEROLOGY M12.8 Medical management of GAVE(Gastric Antral Vascular Ectasia) IP 20524 UGI Endoscopyphoto,Argon laser coagulation Endoscopic photograph Argon laser,MEDICAL

M12 GASTROENTEROLOGY M12 GASTROENTEROLOGY M12.9 Medical management of Gastric Varices IP 15290 Endoscopic Glue injection,UGI Endoscopy Endoscopic photograph MICU
M13 Psychiatry M13 PSYCHIATRY M13.1.1 Pre- Electro Convulsive Therapy (ECT) and Pre- Transcranial DC 10000 ECG,Cognitive Tests,Complete Haemogram,LFT,RFT,CT/MRI Brain,Electroencephalogram,Thyroid Function Clinical assessment& report/Mental Status Examination -
Magnetic Stimulation (TMS) Package Test,VDRL,HIV Test,Vitamin B12 levels,Folate levels,Lipid Profile,Homocysteine levels,Serum Electrolytes

M13 Psychiatry M13 PSYCHIATRY M13.1.2 Electro Convulsive Therapy (ECT) - per session DC 3000 Clinical assessment Clinical assessment& report/Mental Status Examination -
M13 Psychiatry M13 PSYCHIATRY M13.2 Transcranial Magnetic Stimulation (TMS) - per session DC 1000 Clinical assessment Clinical assessment& report/Mental Status Examination -
M13 Psychiatry M13 PSYCHIATRY M13.3 Medical Management of Bipolar Affective Disorder (A. Type-1) IP 30500 CT Scan,Case sheet with clinical History Case Sheet with treatment details -

M13 Psychiatry M13 PSYCHIATRY M13.4 Medical Management of Acute Psychotic Episode IP 25000 CT Scan,Case sheet with clinical History Case Sheet with treatment details -
M13 Psychiatry M13 PSYCHIATRY M13.5 Medical Management of Schizophrenia IP 28690 CT Scan,Case sheet with clinical History Case Sheet with treatment details -
M13 Psychiatry M13 PSYCHIATRY M13.6 FUNCTIONAL,PANIC ATTACK ST 6000 Clinical picture,SERUM CE,RAN.VIRAL MARKERS SERUM SODIUM,SERUM POTASIUM,RBS ,LFT,CBP -
M14 Epidemic Disease M14.1 COVID - 19 M14.1.23 Post COVID Management with NIV (Nasal O2,CPAP, BIPAP, IP 2930 2D Echo,CRP,Hemogram,ECG,RFT,HRCT Chest,ABG - -
HFNO)
M14 Epidemic Disease M14.1 COVID - 19 M14.1.24 Non Critical COVID 19 Treatment per day IP 3600
M14 Epidemic Disease M14.1 COVID - 19 M14.1.25 Non Critical COVID 19 Treatment with O2 IP 5850
M14 Epidemic Disease M14.1 COVID - 19 M14.1.26 Critical Care - ICU with NIV (CBAP, BIPAP, HFNO) per day IP 10800

M14 Epidemic Disease M14.1 COVID - 19 M14.1.27 Critical Care - ICU with Invasive Ventilatory Support IP 14440
M14 Epidemic Disease M14.1 COVID - 19 M14.1.28 Post Covid with Mucor Mycosis Management IP 41968
S19 ORGAN TRANSPLANTATION S19.2 HEART TRANSPLANTATION S19.2.1 Heart Transplantation Surgery IP 1077510 PRA,Serological Tests for HBV,Cardiac Cath with CAG and calculation OF TPG and / or PVR,USG Abdomen, HR CT - -
SURGERY SURGERY Chest,PFT,Oxygen Saturation Values at Rest and Exercise,Coagulation Profile – BT, CT, APTT, PT,Blood Group RH
Type,C/S Of Nasal, Axillary, Groin, Dorsum of Hands for MRSA,VO2,PRA,Serological Tests for HBV,Cardiac Cath with
CAG and calculation OF TPG and / or PVR,USG Abdomen, HR CT Chest,PFT,Oxygen Saturation Values at Rest and
Exercise,Coagulation Profile – BT, CT, APTT, PT,Blood Group RH Type,C/S Of Nasal, Axillary, Groin, Dorsum of Hands
for MRSA,VO2

S19 ORGAN TRANSPLANTATION S19.2 HEART TRANSPLANTATION S19.2.2 Heart Transplantation Rejection IP 307860 - - -
SURGERY SURGERY

S19 ORGAN TRANSPLANTATION S19.2 HEART TRANSPLANTATION S19.2.3 Heart Transplantation Infection IP 153930 - - -
SURGERY SURGERY

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