Unique Plan Description: Peds Headache Clinic
Plan Selection Display: Peds Headache Clinic
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2012-02-14 19:32:56
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2021-12-06 10:41:11
Available at all facilities: Yes

Peds Headache Clinic
Laboratory
	Basic Metabolic Panel
		T;N, Routine, spec type = Blood
	CBC with Diff
		T;N, Routine, spec type = Blood
	Hemogram (CBC no Diff)
		T;N, Routine, spec type = Blood
	Comprehensive Metabolic Panel
		T;N, Routine, spec type = Blood
	Epstein Barr Virus Antibody Panel
		T;N, Routine, spec type = Blood
	Free T4
		T;N, Routine, spec type = Blood
	TSH
		T;N, Routine, spec type = Blood
	Hepatic Function Panel
		T;N, Routine, spec type = Blood
	Infectious Mononucleosis Screen
		T;N, Routine, spec type = Blood
	Strep Group A PCR
		T;N, Routine, spec type = Throat
Diagnostic Tests
	EEG
		T;N
	Sinus <3 View
		T;N, Routine
CT
	CT Head w Contrast
		T;N, Routine
	CT Head w/o Contrast
		T;N, Routine
MRI
	MRI Brain w Contrast
		T;N, Routine
	MRI Brain w & w/o Contrast
		T;N, Routine
Consults/Follow-up

	Follow-up Appointment
		Follow Up Visit, See Special Instructions
		Follow Up Visit, 1 week
		Follow Up Visit, 2 weeks
		Follow Up Visit, 3 weeks
		Follow Up Visit, 6 weeks
		Follow Up Visit, 1 month
		Follow Up Visit, 3 months
		Follow Up Visit, 6 months
		Follow Up Visit, 1 year
		Follow Up Visit, PRN
	Consult Neurologist
		
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
	99024 EVM - Post Op Visit
		T;N
	99211n EVM - No Charge Professional Service
		T;N

*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