Unique Plan Description: All/Imm General Clinic
Plan Selection Display: All/Imm General Clinic
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2011-11-21 12:00:26
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2025-04-21 11:07:31
Available at all facilities: Yes

All/Imm General Clinic
Laboratory
	Allergens Inhalants Environmental Profile 10 (55305)
		T;N, Routine, spec type = Blood
	Allergens Food Common Adult Food IgE (50486)
		T;N, Routine, spec type = Blood
	Allergens Food Cereal Profile (55350)
		T;N, Routine, spec type = Blood
	Allergens Food Comprehensive Profile 1 (55100)
		T;N, Routine, spec type = Blood
	Allergens Food Profile 9 (55104)
		T;N, Routine, spec type = Blood
	Allergens Inhalants Midwest Comprehensive 1 (55138)
		T;N, Routine, spec type = Blood
		T;N, Routine, spec type = Blood
	Allergens Mold Profile (55125)
		T;N, Routine, spec type = Blood
	Allergens Food Nut Mix Profile (55345)
		T;N, Routine, spec type = Blood
	Allergens Pediatric Foods/Inhalants Profile  (55300)
		T;N, Routine, spec type = Blood
	Allergens Pediatric Allergy March (Progression) Profile IgE (50529)
		T;N, Routine, spec type = Blood
	Allergens Inhalants/Foods Profile A (55126)
		T;N, Routine, spec type = Blood
	Allergens Weed Profile 5 (55112)
		T;N, Routine, spec type = Blood
	Allergen Fungi and Molds Alternaria alternata (tenuis)  (55001)
		T;N, Routine, spec type = Blood
	Allergen Food Alpha-Lactalbumin  (99543)
		T;N, Routine, spec type = Blood
	Allergen Parasite Ascaris (55213)
		T;N, Routine, spec type = Blood
	Allergen Food Beef (55096)
		T;N, Routine, spec type = Blood
	Allergen Grass Bermuda (55070)
		T;N, Routine, spec type = Blood
	Allergen Food Beta-Lactoglobulin (55074)
		T;N, Routine, spec type = Blood
	Allergen Tree Box Elder/Maple Tree (55003)
		T;N, Routine, spec type = Blood
	Allergen Epidermals and Animal Proteins Cat Dander (55006)
		T;N, Routine, spec type = Blood
	Allergen Insects and Venom Cockroach German (55088)
		T;N, Routine, spec type = Blood
	Allergen Food Corn (55078)
		T;N, Routine, spec type = Blood
	Allergen Epidermals and Animal Proteins Cow Hair and Dander  (55044)
		T;N, Routine, spec type = Blood
	Allergen Mites D. farinae (55064)
		T;N, Routine, spec type = Blood
	Allergen Mites D. pteronyssinus (55063)
		T;N, Routine, spec type = Blood
	Allergen Epidermals and Animal Proteins Dog Dander (99568)
		T;N, Routine, spec type = Blood
	Allergen Tree Elm Tree (55042)
		T;N, Routine, spec type = Blood
	Allergen Food Egg White (55013)
		T;N, Routine, spec type = Blood
	Allergen Food Egg Yolk (55212)
		T;N, Routine, spec type = Blood
	Allergen Epidermals and Proteins Feather Mix (55037)
		T;N, Routine, spec type = Blood
	Allergen Region 9 Respiratory Panel (3001719)
		T;N, Routine, spec type = Blood
	Allergen House Dust Greer (55091)
		T;N, Routine, spec type = Blood
	Allergen Grass Johnson Grass (55047)
		T;N, Routine, spec type = Blood
	Allergen Grass June Grass/Kentucky Bluegrass (55017)
		T;N, Routine, spec type = Blood
	Allergen Occupational Latex IgE Enhanced (99614)
		T;N, Routine, spec type = Blood
	Allergen Food Milk (Cow's) (55020)
		T;N, Routine, spec type = Blood
	Allergen Food Peanut (55024)
		T;N, Routine, spec type = Blood
	Allergen Drugs Penicillin G (major)  (99628)
		T;N, Routine, spec type = Blood
	Allergen Drugs Penicillin V (minor) (99629)
		T;N, Routine, spec type = Blood
	Allergen Fungi and Molds Penicillium notatum (55080)
		T;N, Routine, spec type = Blood
	Allergen Fungi and Molds Phoma betae (55390)
		T;N, Routine, spec type = Blood
	Allergen Epidermals and Animal Proteins Pig (Swine) Epithelium IgE (55195)
		T;N, Routine, spec type = Blood
	Allergen Food Pork (99780)
		T;N, Routine, spec type = Blood
	Allergen Weed False Ragweed  (55014)
		T;N, Routine, spec type = Blood
	Allergen Weed Giant Ragweed (55084)
		T;N, Routine, spec type = Blood
	Allergen Weed Common/Short Ragweed (55085)
		T;N, Routine, spec type = Blood
	Allergen Weed Western Ragweed (55035)
		T;N, Routine, spec type = Blood
	Allergen Tree Birch Tree (55058)
		T;N, Routine, spec type = Blood
	Allergen Food Soybean (55031)
		T;N, Routine, spec type = Blood
	Allergen Grass Timothy Grass  (55032)
		T;N, Routine, spec type = Blood
	Allergen Food Tomato (55033)
		T;N, Routine, spec type = Blood
	Allergen Food Wheat (55034)
		T;N, Routine, spec type = Blood
	Thyroid Antibodies
		T;N, Routine, spec type = Blood
	ANA Screen
		T;N, Routine, spec type = Blood
	ALT
		T;N, Routine, spec type = Blood
	AST
		T;N, Routine, spec type = Blood
	CBC with Diff
		T;N, Routine, spec type = Blood
	Celiac Disease Reflexive Cascade
		T;N, Routine, spec type = Blood
	C1 Esterase Inhibitor Quantitative
		T;N, Routine, spec type = Blood
	Complement C3
		T;N, Routine, spec type = Blood
	Complement C4
		T;N, Routine, spec type = Blood
	Creatinine
		T;N, Routine, spec type = Blood
	Sed Rate
		T;N, Routine, spec type = Blood
	Hepatic Function Panel
		T;N, Routine, spec type = Blood
	Immunoglobulin A
		T;N, Routine, spec type = Blood
	Immunoglobulin G
		T;N, Routine, spec type = Blood
	Immunoglobulin M
		T;N, Routine, spec type = Blood
	Immunoglobulins (GAM)
		T;N, Routine, spec type = Blood
	Neutrophil Oxidative Burst
		T;N, Routine, spec type = Blood
	Streptococcus pneumoniae Antibodies IgG (14 Serotypes)
		T;N, Routine, spec type = Blood
	Rheumatoid Factor Quantitative
		T;N, Routine, spec type = Blood
	Cyclic Citrullinated Peptide Antibodies IgG and IgA 3016632
		T;N, Routine, spec type = Blood
	Thyroxine Total T4 (not for screening)
		T;N, Routine, spec type = Blood
	Thyroglobulin Antibody
		T;N, Routine, spec type = Blood
	TSH
		T;N, Routine, spec type = Blood
	Microsomal Antibody
		T;N, Routine, spec type = Blood
Diagnostic Tests
	Chest 2 View
		T;N, Routine
	Sinus <3 View
		T;N, Routine
	CT Sinus w/o Contrast
		T;N, Routine
	Complete pre and post PFT's
		T;N
	zzDXA Scan
		
Medications
	influenza vaccine, TRIvalent (*FluLaval) (In Office)
		0.5 mL, Suspension, IM-Intramuscular, Once, T;N, Encounter for immunization
	meningococcal conjugate vaccine (MenQuadfi) (In Office)
		0.5 mL, Solution, IM-Intramuscular, Once, T;N, Encounter for immunization
	measles/mumps/rubella virus vaccine (MMR) (In Office)
		0.5 mL, Injection, SUBCUTANEOUS, Once, NOW, Encounter for immunization
	pneumococcal 20-valent conjugate vaccine (Prevnar 20) (In Office)
		0.5 mL, Suspension, IM-Intramuscular, Once, T;N, Encounter for immunization
	poliovirus vaccine, inactivated (Ipol) (In Office)
		0.5 mL, Solution-Injection, IM-Intramuscular, Once, T;N, Encounter for immunization
	tuberculin purified protein derivative (PPD) (In Office)
		0.1 mL, Injection, IntraDermal, Once, NOW
	tetanus/diphth/pertuss (Tdap/Adacel) (In Office)
		0.5 mL, Suspension-Injection, IM-Intramuscular, Once, T;N, Encounter for immunization
	tetanus-diphth toxoids adult/adol (Td-Tenivac)(In Office)
		0.5 mL, Injection, IM-Intramuscular, Once, NOW
Patient Care
	94010 Spirometry Clinic
		
	94640 Inhalation treatment
		
Consults/Follow-up
	Consult Gastroenterologist
		
	Consult Ear Nose and Throat
		
	Consult Dermatologist
		
	Consult Other
		
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
	99211n EVM - No Charge Professional Service
		T;N
	99024 EVM - Post Op Visit
		T;N
	99213C EVM - MPC CLINIC AUDIT BY CODER
		T;N
Procedures in Office
	95117 Allergy inject multiple
		
	95115 Allergy inject single
		
	95165 Allergy serum, per dose
		
	94060 Bronchospasm evaluation
		
	95018 Allergy Testing
		
	95004 Percutaneous allergy test, each
		
	69210 Remove Cerumen Impaction

*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