Unique Plan Description: Bari Surg Pre Surg Testing Clinic
Plan Selection Display: Bari Surg Pre Surg Testing Clinic
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2012-02-28 20:28:38
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2023-01-26 08:05:40
Available at all facilities: Yes

Bari Surg Pre Surg Testing Clinic
Laboratory
	Comprehensive Metabolic Panel
		T;N, Routine, spec type = Blood
	Lipid Panel
		T;N, Routine, spec type = Blood
	Urogram
		T;N, Routine, Routine, spec type = Urine
	UA
		T;N, Routine, Routine, spec type = Urine
	UA (Culture if Positive)
		T;N, Routine, Routine, spec type = Urine
	CBC with Diff
		T;N, Routine, spec type = Blood
	INR - MH/WH/JE
		T;N, Routine, spec type = Blood
	PTT - MH/WH/JE
		T;N, Routine, spec type = Blood
	TSH
		T;N, Routine, spec type = Blood
	Acute Hepatitis Panel with Rflx to Hepatitis C Confirm
		T;N, Routine
	Helicobacter pylori Stool Antigen - MH/WH/JE
		T;N, Routine, spec type = Stool
	Helicobacter pylori Stool Antigen - FH
		T;N, Routine, spec type = Stool
	Toxicology Screen DAU - MH/WH/JE
		T;N, Routine, Routine, spec type = Urine
	Nicotine and Metabolites Urine Quantitative
		T;N, Routine, Routine, spec type = Urine
	hsCRP
		T;N, Routine, spec type = Blood
	Prealbumin
		T;N, Routine, spec type = Blood
	Folate
		T;N, Routine, spec type = Blood
	Vitamin B1 Whole Blood
		T;N, Routine, spec type = Blood
	Vitamin A Level
		T;N, Routine, spec type = Blood
	Hemoglobin A1C
		T;N, Routine, spec type = Blood
	Vitamin D 25-Hydroxy Level (preferred for deficiency)
		T;N, Routine, spec type = Blood
	Vitamin B6 Assay
		T;N, Routine, spec type = Blood
	Vitamin B12 Level
		T;N, Routine, spec type = Blood
	Zinc Level
		T;N, Routine, spec type = Blood
	Copper Level
		T;N, Routine, spec type = Blood
	Iron Panel - MH/WH/JE
		T;N, Routine, spec type = Blood
	Blood Gases Arterial (ABG) - MH/WH/JE
		T;N, Routine, spec type = Blood
	Blood Gases Arterial (ABG) - FH
		T;N, Routine, spec type = Blood
Point of Care
	Coumadin POC - PC
		T;N, Blood
	INR POC
		T;N, Blood
Diagnostic Tests

	Echo Stress
		T;N
	ECG
		T;N
	Complete pre and post PFT's
		T;N
	Nuclear Stress Lexiscan
		T;N
	Nuclear Stress Dobutamine
		T;N
	Nuclear Stress Treadmill
		T;N
	Abdomen/Pelvis w/o Contrast CT
		T;N
	Abdomen/Pelvis w/Contrast CT
		T;N
Diagnostics
	Chest 2 View
		T;N, Routine
	Upper GI Series
		T;N, Routine
	US Abd Limited
		T;N, Routine
Patient Care

	ECG w/ interpretation and report
		
Consults/Follow-up
	Follow-up Appointment
		Follow Up Visit, PRN
		Follow Up Visit, 2 weeks
		Follow Up Visit, 3 weeks
		Follow Up Visit, 1 month
		Follow Up Visit, 3 months
		Follow Up Visit, 6 months
		Follow Up Visit, 1 year
		Follow Up Visit, See Special Instructions
	Consult Primary Care Provider
		
	Consult Cardiologist
		
	Consult Psychiatrist
		
	Consult Pulmonologist
		
	Consult Gastroenterologist
		
	Consult Hematologist/Oncologist
		
	Consult Vascular Surgeon
		
	Consult Home Health
		
Charges/Supplies
New Pt Visit
	zz99201 EVM-New Pt Visit Problem focused 10m
		
	99202 EVM - OP VISIT NEW PATIENT, STRAIGHTFORWARD 15 MIN
		
	99203 EVM - OP VISIT NEW PATIENT, LOW LEVEL 30 MIN
		
	99204 EVM - OP VISIT NEW PATIENT, MODERATE LEVEL 45 MIN
		
	99205 EVM - OP VISIT NEW PATIENT, HIGH LEVEL 60 MIN
		
Est. Pt Visit
	99211 EVM - OP visit estab patient, minimal care < 10 min
		
	99212 EVM - OP VISIT ESTAB PATIENT, STRAIGHTFORWARD 10 MIN
		
	99213 EVM - OP VISIT ESTAB PATIENT, LOW LEVEL 20 MIN
		
	99214 EVM - OP VISIT ESTAB PATIENT, MODERATE 30 MIN
		
	99215 EVM - OP VISIT ESTAB PATIENT, HIGH LEVEL 40 MIN
		
No Charge / Follow Up
	99213C EVM - MPC CLINIC AUDIT BY CODER
		
	MPC_99211N EVM -  No Charge Professional Service
		
	99024 EVM - Post Op Visit
		
Procedures in Office
	10060 I&D abscess simple/single
		
	97598 Debride open wound, per session, ea addl 20sq cm or part of
		
	97597 Debride open wound, per session, first 20sq cm or less
		
	43999 Gastric lap band fit and adjust (medicare only)
		
	S2083 Adjust gastric band
		
	83013 H Pylori breath test

*Report Legend:
DEF - This order sentence is the default for the selected order
GOAL - This component is a goal
IND - This component is an indicator
INT - This component is an intervention
IVS - This component is an IV Set
NOTE - This component is a note
Rx - This component is a prescription
SUB - This component is a sub phase