Unique Plan Description: GYNONC Chemo Lab Clinic
Plan Selection Display: GYNONC Chemo Lab Clinic
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2015-04-28 07:57:57
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2022-11-08 09:21:10
Available at all facilities: Yes

GYNONC Chemo Lab Clinic
Laboratory
Laboratory
	CBC with Diff
		T;N, Routine, spec type = Blood
	Comprehensive Metabolic Panel
		T;N, Routine, spec type = Blood
	Basic Metabolic Panel
		T;N, Routine, spec type = Blood
	Beta-HCG Quantitative - Pregnancy
		T;N, Routine, spec type = Blood
	HGB A1C
		T;N, Routine, spec type = Blood
	CEA
		T;N, Routine, spec type = Blood
	CA 125
		T;N, Routine, spec type = Blood
	CA 19-9
		T;N, Routine, spec type = Blood
	Inhibin A
		T;N, Routine, spec type = Blood
	Inhibin B
		T;N, Routine, spec type = Blood
	Magnesium Level
		T;N, Routine, spec type = Blood
	Phosphorus
		T;N, Routine, spec type = Blood
	Protein Creatinine Ratio Urine
		T;N, Routine, Routine, spec type = Urine
	Free T3
		T;N, Routine, spec type = Blood
	Free T4
		T;N, Routine, spec type = Blood
	Hepatitis B Core Antibody Total
		T;N, Routine, spec type = Blood
	Hepatitis C Virus (HCV) Antibody with Rflx to PCR Confirmation
		T;N, Routine, spec type = Blood
	HIV-1/2 Ag/Ab Combo - MH/WH/JE
		T;N, Routine, spec type = Blood
	HBsAg
		T;N, Routine, spec type = Blood
	HBsAb
		T;N, Routine, spec type = Blood
	TSH
		T;N, Routine, spec type = Blood
Weekly Labs
	CBC with Diff
		T;N, Orders for Future Visit Every 7 Day(s) For 5 week(s) Grace Period (+/-) 1 Day(s), spec type = Blood
	Comprehensive Metabolic Panel
		T;N, Orders for Future Visit Every 7 Day(s) For 5 week(s) Grace Period (+/-) 1 Day(s), spec type = Blood
	Magnesium Level
		T;N, Orders for Future Visit Every 7 Day(s) For 5 week(s) Grace Period (+/-) 1 Day(s), spec type = Blood
Charges/Supplies

	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
		
	99211 EVM - OP visit estab patient, minimal care < 10 min
		
	99211n EVM - No Charge Professional Service
		
	99212 EVM - OP VISIT ESTAB PATIENT, STRAIGHTFORWARD 10 MIN
		
	99213C EVM - MPC CLINIC AUDIT BY CODER
		
	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

*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