Unique Plan Description: GYNONC Return Patient Surveillance Clinic
Plan Selection Display: GYNONC Return Patient Surveillance Clinic
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2011-11-29 14:32:44
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2021-12-06 09:12:42
Available at all facilities: Yes

GYNONC Return Patient Surveillance Clinic
Laboratory
	CA 125
		T;N, Routine, spec type = Blood
	Inhibin A
		T;N, Routine, spec type = Blood
	Inhibin B
		T;N, Routine, spec type = Blood
	GYN Pap with Reflex to HPV High Risk
		T;N, Routine TL PAP CERVICAL, Routine
		T;N, Routine TL PAP CV & VAG, Routine
		T;N, Routine TL PAP VAGINAL, Routine
	CBC with Diff
		T;N, Routine, spec type = Blood
Diagnostic Tests
	Chest 2 View
		T;N, Routine
	CT Abd Pelvis w Contrast
		T;N, Routine
	US Pelvis Complete Non OB
		T;N, Routine
	US Transvaginal
		T;N, Routine
Consults/Follow-up
	Consult OB/GYN
		
	Consult PCP
		
	Consult General Surgery
		
	Consult Uro/Gyn
		
	Consult Sexual Medicine
		
	Consult Occupational Therapy
		Reason for Referral: Evaluate and treat, Lymphedema Specialist
Charges/Supplies
	57420 Colposcopy, Vagina
		
	57421 Colposcopy  Vagina and Cervix, Biopsy
		
	56820 Colposcopy of the vulva
		
	57100 Biopsy vaginal mucosa simple
		
	56605 Biopsy vulva or perineum, 1 lesion
		
	56606 Biopsy vulva or perineum, ea addl
		
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
No Charge / Follow Up
	99211n EVM - No Charge Professional Service
		T;N
	99213C EVM - MPC CLINIC AUDIT BY CODER
		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