To
The Cashless Deptt.,
Vidal Health TPA
Subject : Query Reply – Mrs Vandana (29 yrs/F)
Sir/Madam,
DIAGNOSIS:
Acute Calculus Cholecystitis.
Peritubal leak with collection.
Surgical Intervention –
ERCP + Stenting done on 15/May/2025 (100 %)
Lap and proceed in acute abdomen + Lap cholecystectomy + Lap
CBD repair was done under G.A on 16/May/2025. (100 % & 50 %
respectively)
Drainage of loculated collection + Z-Plasty and suturing was done
under wide filed block on 18/May/2025. (100 %)
Indication –
Patient was admitted with complaints of severe pain abdomen, multiple
episodes of vomiting, decreased oral intake and nausea. Patient’s relevant
investigations were done.
MRCP revealed
Cholelitiasis with cholecystitis
Small calculus in Distal CBD causing mild obstructive biliopathy
Mild bulky pancreas
Intraoperatively, proceeded with the laproscope it was found that GB
inflamed & mirzzi syndrome noted & omentum stucked for which Lap and
proceed in acute abdomen + Lap cholecystectomy + Lap CBD repair
was done as GB was densly stuted to CBD. First GB separated from
CBD then GB lifted from the liver bed & ligated & cut Pancreas was
inflamed which increases the complexity of the procedure. This
complete procedure took 70 minutes which is more than the norma;l
Lap Cholecystectomy. In view of the above mentioned inoperative
findings which explains the complexity of the case. Lap Repair of
CBD was billed as it was done & medically indicated in this case.
Post operatively , patient developed discharge from the Tube site.
Hence Drainage of loculated collection + Z-Plasty and suturing was
done under wide filed block on 18/May/2025
Hence the deductions made are not justified. Kindly enhance the
approval (billing done as per agreed SOC and medical condition of
the patient). - Tariff Enclosed
Thanks
To
The Cashless Deptt.,
Vidal Health TPA
Subject : Query Reply – Mr Anil Kumar (51 yrs/M)
Sir/Madam,
DIAGNOSIS:
CBD sludge (Post ERCP) with Pancreatitis.
Acute Calculous Cholecystitis.
CAD – Post PTCA.
Surgical Intervention –
ERCP + Papillotomy done + Balloon Dilatation done + Stone Extraction + Biliary
Stenting done by DR. Neeraj Dhar under G.A on 15/May/2025. (100 %)
Lap and Proceed in Acute abdomen (50%) + Lap. Cholecystectomy (100 %) + Lap.
CBD repair (25%) under G.A on 19/May/2025
Indication –
Patient was admitted with complaints of severe pain abdomen, multiple episodes of vomiting,
nausea. Patient’s relevant investigations were done.
MRCP revealed -acute calculus Cholecystitis, mild hepatomegaly, prominent main pancreatic
duct.
Gastro consultation was done and advised ERCP & Biliary Stenting. Patient shifted to OT.
ERCP + Papillotomy done + Balloon Dilatation done + Stone Extraction + Biliary Stenting
done by DR. Neeraj Dhar under G.A on 15/May/2025.
Follwing ERCP, patient had Acute Pancreatitis and was treated conservatively for 3 days.
Still Patient having pain abdomen, nausea & vomiting so case again review with
Gastroenterologist managed with supportive treatment. In view of persistent pain abdomen,
nausea and vomiting and advised for Surgery. After taking written consent, patient was taken up
for surgery.
Intraoperatively, proceeded with the laproscope it was found that GB inflamed & mirzzi
syndrome noted & omentum stucked for which Lap and Proceed in Acute abdomen + Lap.
Cholecystectomy + Lap. CBD repair under G.A on 19/May/2025 as GB was densly stuted
to CBD. First GB separated from CBD then GB lifted from the liver bed & ligated & cut
Pancreas was inflamed which increases the complexity of the procedure. This complete
procedure took 90 minutes which is more than the norma;l Lap Cholecystectomy. In view
of the above mentioned inoperative findings which explains the complexity of the case. Lap
Repair of CBD was billed as it was done & medically indicated in this case.
Hence patient was hospitalized from 14th – 20th May 2025 which is fully justified.
Accordingly billing done as per agreed SOC and medical condition of the patient. Kindly
approve the case.
Thanks
To
The Cashless Deptt.,
Vidal Health TPA
Subject : Reconsideration regarding deductions made in the claim amount of – Mr.
Anil Kumar (51 Yrs/M)
Sir/Madam,
Patient is F/U/C Post Lap Cholecystectomy with ERCP stenting pancreatitis, CBD stent/sludge.
He was admitted with c/o severe pain abdomen and vomitings.
On Examination _
Temp :98 Deg F
CVS : S1S2 +
Abdomen : Tenderness +
DIAGNOSIS:
1. F/U/C of Post Lap Cholecystectomy with ERCP stenting pancreatitis.
2. CBD stent/sludge
3. CAD - Post PTCASurgical Intervention –
He needed urgent IV medication intervention and was medically managed with IV
antibiotics, IV antipyretics, Iv analgesics, IV PPI, IV fluids and other supportive care. –
Accordingly open billing done as patient was managed conservatively. When patient had
no relief and symptoms increased then ERCP was planned.
Gastroenterology consultation done followed by ERCP with stent removal under GA.
Accordingly GIPSA billing done. (Tariff – enclosed)
Hence his hospitalization from 2nd July to 4h July 2025 is fully justified along with the
billing done. And the deductions made are not justified. You are, therefore, requested
kindly to approve –
1. Conservative Management for 2nd July 2025 – Open Billing
2. ERCP with stent removal – GIPSA Billing (Tariff – enclosed)
Thanks
