|
SERIAL NUMBER
|
Procedure
|
1st Qtr
|
Per Qtr (for next 3 Qtrs)
|
Requirements while submitting for follow-up Preauth
|
Requirements while submitting for follow-up Claims
|
|
9
|
FP0009 : Coronary Balloon Angioplasty
|
4,000
|
2,000
|
Previous Discharge Summary
|
(INR Levels, ECG, Clinical Evaluation, ECHO-M-Mandatory)
|
|
10
|
FP0010 : Renal Angioplasty
|
4,000
|
2,000
|
Previous Discharge Summary
|
(BP, Clinical Evaluation, Doppler, PT/INR, USG-KUB-Mandatory)
|
|
11
|
FP0011 : Peripheral Angioplasty
|
4,000
|
2,000
|
Previous Discharge Summary
|
(Color Doppler, Capillary Filling Period, Claudications, Clinical Evaluation,PT/INR-Mandatory)
|
|
12
|
FP0012 : Vertebral Angioplasty
|
4,000
|
2,000
|
Previous Discharge Summary
|
(Color Doppler, Clinical Evaluation, PT/INR-Mandatory)
|
|
