Guidance document for processing PM-JAY packages
Skull Traction
Procedures covered: 1 Specialty: Neurosurgery
Package name Procedure name HBP 1.0 code HBP 2.0 code Package price (INR)
Skull traction Skull traction S800026 SN027A 8,000
ALOS: 2 days
Minimum qualification of the treating doctor:
Essential: MCh/DNB/Equivalent in Neurosurgery, MS/DNB/Equivalent in Orthopedic Surgery
Special empanelment criteria/linkage to empanelment module: Care at Tertiary Hospital
Disclaimer:
For monitoring and administering the claim management process of Skull traction, NHA shall be following
these guidelines. This document has been prepared for guidance of PROCESSING TEAM and TRANSACTION
MANAGEMENT SYSTEM of AB PM-JAY for the claims of procedures mentioned above. The hospitals can
also refer to this document so that they have the insight on how the claims will be processed. However,
this document doesn’t provide any guidance on clinical and therapeutic management of patient. In that
respect the hospitals and physicians may refer to any other relevant material as per the extant
professional norms.
PART I: Guidelines for Clinicians and Healthcare Providers
1.1 Objective:
The purpose of this section is to act as a guidance & a clinical decision support tool for the
clinicians in deciding the line of treatment, plan clinical management of patient and decide
referral of cases to the appropriate level of care (as required) for treatment of patients under
PMJAY and selection of corresponding Health Benefit Package.
It will also serve as a tool for hospitals to determine and submit the mandatory documents
required for claiming reimbursement of health benefit package under PMJAY.
1.2 Clinical key pointers:
Skull traction can be used to restore sagittal plane alignment in patients with subaxial cervical
spine injuries both in the initial stage of the management before arthrodesis as an adjunct to
surgery or as the definitive treatment. Cervical spine realignment provides for indirect
decompression of the spinal cord.
Indications:
• Cervical spine injuries
• Skeletal traction to the skull can be used to reduce cervical facet dislocations
National Health Authority Version 1.1 Dated September 2020
Contraindications to the application of skull traction in cervical spine injuries will include:
• Distractive injuries
• Associated skull fracture
• Local sepsis
• Stable fractures, especially without neurological signs when only collar or other forms of
bracing may suffice
Types
Many devices are currently used for skeletal skull traction, each with its advantages as well as
risks. Some of the devices use pins, whereas others have tongs, wires, or hooks.
Choice of device: a number of cranial “tongs” are available. Crutchfield tongs require predrilling
holes in the skull. Gardner-Wells tongs are the most common tongs in use. If, after the acute
stabilization, the later use of halo-vest immobilization is anticipated, a halo ring may be used for
the initial cervical traction, and then converted to vest traction at the appropriate time (e.g. post-
fusion).
Complications of Cervical Traction
• Bleeding - temporal artery
• Pressure sore on skull - avoid downwards vector to rope
• Sepsis - from skin to subdural abscess
• Worsening neurological status
• Squint from 6th cranial nerve fallout
Note: Following skull traction surgery is required for cervical spine injury.
1.3 Mandatory documents- For healthcare providers
Following documents should be uploaded by the concerned hospital staff at the time of pre-
authorization and claims submission:
Mandatory document Skull traction
i. At the time of Pre-authorization
Clinical notes Yes
Clinical evaluation Yes
Cervical X-ray/CT/MRI Yes
Planned line of treatment Yes
National Health Authority Version 1.1 Dated September 2020
ii. At the time of claim submission
Detailed Indoor case papers (ICPs) Yes
Post-procedure photograph (optional) Yes
Lateral C-spine X-rays within 6 hours after Yes
application of traction
In case of accident was FIR done (optional) Yes
Detailed Procedure / operative notes Yes
Detailed discharge summary Yes
PART II: GUIDELINES FOR PROCESSING TEAM
2.1 Objective: To provide guidance to the pre-authorization and claims processing team in
ascertaining the medical necessity of procedure carried out vis a vis the patient’s medical
condition as evidenced by supporting documents/investigation reports etc, in deciding the
admissibility and quantum of claim and compliance with mandatory documents by the hospital.
2.2 Following mandatory documents to be diligently reviewed by the pre-auth / claims
processing personnel:
2.2.1 At the time of pre-authorization processing- For pre-authorization processing doctor
(PPD):
a. Clinical notes - detailed history especially accident history, signs & symptoms, planned
line of treatment, indication for procedure?
b. Was clinical evaluation and imaging suggestive of diagnosis?
2.2.2 At the time of claim processing- For claims processing doctor (CPD)
a. Are the detailed ICPs with daily vitals and line of treatment?
b. Are the detailed procedure / Operative Notes available?
c. Is the Discharge summary with follow-up advise at the time of discharge?
d. Was the Cervical X-ray/CT/MRI report indicative of surgery?
e. Was post-operative photograph submitted (optional)?
PART III: GUIDELINES FOR IT
3.1 Objective: To enable setting up of cross check mechanisms / rule engines within the IT
platform (TMS) to ensure compliance with STGs and to prevent fraud / abuse of the Health
Benefit Package.
3.2 Below mentioned are the scenarios where a provision would be built in TMS for pop-ups:
a. Was clinical evaluation and imaging indicative of procedure/surgery? Yes
National Health Authority Version 1.1 Dated September 2020
b. Was there any history of accident documented? If Yes/Not applicable, then
was FIR done? Yes
Till the time the functionality is being developed, the processing doctors shall check the above
manually.
References
1. H. Richard Winn. Youmans & Winn. Neurological Surgery. Seventh Edition. Elsevier
2. Uche E O, Nwankwo O E, Okorie E, Muobike A. Skull traction for cervical spinal injury in
Enugu: A 5-year retrospective multicenter analysis of the clinical outcomes of patients
treated with two common devices. Niger J Clin Pract 2016;19:580-4
3. http://www0.sun.ac.za/ortho/webct-ortho/general/trac/trac-3.html
National Health Authority Version 1.1 Dated September 2020
