Unique Plan Description: OBGYN Pelvic Pain Clinic
Plan Selection Display: OBGYN Pelvic Pain Clinic
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2012-03-29 17:24:40
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2024-08-19 16:51:03
Available at all facilities: Yes

OBGYN Pelvic Pain Clinic
Laboratory
	CBC with Diff
		T;N, Routine, spec type = Blood
	Hemogram (CBC no Diff)
		T;N, Routine, spec type = Blood
	hsCRP
		T;N, Routine, spec type = Blood
	Comprehensive Metabolic Panel
		T;N, Routine, spec type = Blood
	HCG Qualitative Serum - PC/FH
		T;N, Routine, spec type = Blood
	Beta-HCG Quantitative - Pregnancy
		T;N, Routine, spec type = Blood
	Herpes Simplex Virus Ab IgG w/ Reflex Typing
		T;N, Routine, spec type = Blood
Point of Care
	Pregnancy Test POC - PC
		T;N, Urine
Urine Studies
	Pregnancy Test Urine
		T;N, Routine, Routine, spec type = Urine
	Urogram
		T;N, Routine, Routine, spec type = Urine
	UA
		T;N, Routine, Routine, spec type = Urine
	UA (Culture Pos)
		T;N, Routine, Routine, spec type = Urine
	Culture Urine
		T;N, Routine, Urine Midstream, spec type = Urine
Cervical/Vaginal Specimens
	GC/Chlamydia PCR-MH/WH/PC
		T;N, Routine, spec type = Cervix
		T;N, Routine, spec type = Vaginal
	Urine GC/Chlamydia PCR - MH/WH/PC
		T;N, Routine, spec type = Urine
	GC/Chlamydia(Rapid) DNA - FH/JE
		T;N, Routine, spec type = Cervix
		T;N, Routine, spec type = Urine
		T;N, Routine, spec type = Vaginal
		T;N, Routine, spec type = Urine
	Trichomonas PCR
		T;N, Routine, spec type = Genital
	Wet Prep - PC/FH
		T;N, Routine, spec type = Genital
	Vaginitis DNA Detection - PC
		T;N, Routine, spec type = Genital
	Vaginitis Panel PCR
		T;N, Routine, spec type = Genital
	Candida Screen
		T;N, Routine, spec type = Vaginal
	Herpes Simplex Virus 1/2 PCR. Other than blood
		T;N, Routine, spec type = Genital
	Yeast and Trich Wet Prep (Trich PCR if Neg) - MH/WH
		T;N, Routine, spec type = Genital
Diagnostic Tests
Radiology
	US Pelvis Complete Non OB
		T;N, Routine
	US Transvaginal
		T;N, Routine
	US Pelvis Limited
		T;N, Routine
	US Abd Complete
		T;N, Routine
	US Abd Limited
		T;N, Routine
	CT Abd Pelvis w & w/o Cont
		T;N, Routine
	CT Abd Pelvis w Contrast
		T;N, Routine
	CT Abd Pelvis w/o Contrast
		T;N, Routine
Consults/Follow-up

	Return to Clinic Women's
		Future Order In Approximately 1 week(s) Grace Period (+/-) 2 Day(s), 2, Day(s), 1, week(s), In Approximately
		Future Order In Approximately 2 week(s) Grace Period (+/-) 2 Day(s), 2, Day(s), 2, week(s), In Approximately
		Future Order In Approximately 3 week(s) Grace Period (+/-) 3 Day(s), 3, Day(s), 3, week(s), In Approximately
		Future Order In Approximately 6 week(s) Grace Period (+/-) 7 Day(s), 7, Day(s), 6, week(s), In Approximately
		Future Order In Approximately 1 month(s) Grace Period (+/-) 7 Day(s), 7, Day(s), 1, month(s), In Approximately
		Future Order In Approximately 2 month(s) Grace Period (+/-) 7 Day(s), 7, Day(s), 2, month(s), In Approximately
		Future Order In Approximately 3 month(s) Grace Period (+/-) 7 Day(s), 7, Day(s), 3, month(s), In Approximately
		Future Order In Approximately 4 month(s) Grace Period (+/-) 7 Day(s), 7, Day(s), 4, month(s), In Approximately
		Future Order In Approximately 6 month(s) Grace Period (+/-) 7 Day(s), 7, Day(s), 6, month(s), In Approximately
		Future Order In Approximately 12 month(s) Grace Period (+/-) 14 Day(s), 14, Day(s), 12, month(s), In Approximately
	Follow-up Appointment
		Follow Up Visit, PRN
		Follow Up Visit, 1 week
		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
		Follow Up Visit, PRN
Charges/Supplies
Est. Pt Visit
	99211 EVM - OP visit estab patient, minimal care < 10 min
		T;N
	99212 EVM - OP VISIT ESTAB PATIENT, STRAIGHTFORWARD 10 MIN
		T;N
	99213 EVM - OP VISIT ESTAB PATIENT, LOW LEVEL 20 MIN
		T;N
	99214 EVM - OP VISIT ESTAB PATIENT, MODERATE 30 MIN
		T;N
	99215 EVM - OP VISIT ESTAB PATIENT, HIGH LEVEL 40 MIN
		T;N
New Pt Visit
	zz99201 EVM-New Pt Visit Problem focused 10m
		T;N
	99202 EVM - OP VISIT NEW PATIENT, STRAIGHTFORWARD 15 MIN
		T;N
	99203 EVM - OP VISIT NEW PATIENT, LOW LEVEL 30 MIN
		T;N
	99204 EVM - OP VISIT NEW PATIENT, MODERATE LEVEL 45 MIN
		T;N
	99205 EVM - OP VISIT NEW PATIENT, HIGH LEVEL 60 MIN
		T;N
No Charge / Follow Up
	99213C EVM - MPC CLINIC AUDIT BY CODER
		T;N
	99211n EVM - No Charge Professional Service
		T;N
Procedures in Office
	Wet Mt Physician Perform
		
	KOH Prep Physician Perform
		
	76857 Limited/Follicular non OB (in office)
		
	76830 US Transvaginal non OB (in office)

*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