Unique Plan Description: HN Onc Clinic
Plan Selection Display: HN Onc Clinic
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2012-03-27 09:21:16
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2022-01-03 11:52:24
Available at all facilities: Yes

HN Onc Clinic
Laboratory
	TSH
		T;N, Routine, spec type = Blood
	Free T4
		T;N, Routine, spec type = Blood
	T3 Free
		T;N, Routine, spec type = Blood
	Thyroglobulin Rflx to LC-MS/MS or CIA
		T;N, Routine, spec type = Blood
	Thyroid Antibodies
		T;N, Routine, spec type = Blood
	Thyroid Stimulating Immunoglobulin (TSI)
		T;N, Routine, spec type = Blood
	TSH Receptor Antibody
		T;N, Routine, spec type = Blood
	Calcitonin Level
		T;N, Routine, spec type = Blood
	CEA
		T;N, Routine, spec type = Blood
	LDH
		T;N, Routine, spec type = Blood
	Calcium Level
		T;N, Routine, spec type = Blood
	PTH
		T;N, Routine, spec type = Blood
	Creatinine
		T;N, Routine, spec type = Blood
	24 Hour Urine Calcium
		T;N, Routine, Routine, spec type = Urine
	Protein Urine Timed Set
		T;N, Routine, Routine, spec type = Urine
	Creatinine Urine Timed Set
		T;N, Routine, Routine, spec type = Urine
	Vitamin D 25-Hydroxy Level (preferred for deficiency)
		T;N, Routine, spec type = Blood
	INR - MH/WH/JE
		T;N, Routine, spec type = Blood
	Prothrombin Time (PT) - FH
		T;N, Routine
	PTT - MH/WH/JE
		T;N, Routine, spec type = Blood
	Partial Thromboplastin Time (PTT) - FH
		T;N, Routine, spec type = Diagnostic Blood
	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
	Hepatic Function Panel
		T;N, Routine, spec type = Blood
Diagnostic Tests
	zzDXA Scan
		T;N
	ECG
		T;N
	Nuclear Stress Dobutamine
		T;N
	Nuclear Stress Lexiscan
		T;N
	Nuclear Stress Treadmill
		T;N
	CT Chest Lung Cancer Screen Annual
		T;N
Diagnostics
	Thyroid Uptake Single or Multiple
		T;N, Routine
	Chest 2 View
		T;N, Routine
	Panorex
		T;N, Routine
	Barium Swallow
		T;N, Routine
			Comment: Barium
		T;N, Routine
			Comment: Water Soluble Contrast
	Modified Barium Swallow Study
		T;N
	Native Artery Duplex Bil Lower
		T;N
	Native Artery Duplex Unilat Lower
		T;N
	Native Artery Duplex Bil Upper
		T;N
	Native Artery Duplex Unilat Upper
		T;N
	Segmental Arterial Pressures
		T;N
	Segmental Arterial Pressures Upper
		T;N
Ultrasound
	US Thyroid Neck Soft Tissue
		T;N, Routine
	US Needle Guided
		
CT
	CT Neck w & w/o Contrast
		T;N, Routine
	CT Neck w Contrast
		T;N, Routine
	CT Neck w/o Contrast
		T;N, Routine
	CT Guided Needle Placement
		T;N, Routine
	CT Chest w & w/o Contrast
		T;N, Routine
	CT Chest w Contrast
		T;N, Routine
	CT Chest w/o Contrast
		T;N, Routine
	CT Facial Bones w & w/o Contrast
		T;N, Routine
	CT Facial Bones w Contrast
		T;N, Routine
	CT Facial Bones w/o Contrast
		T;N, Routine
	CT Lung Cancer Screening Baseline
		T;N, Routine
MRI
	MRI Neck Soft Tissue w/o Contrast
		T;N, Routine
	MRI Neck Soft Tissue w & w/o Contrast
		T;N, Routine
PET/CT
	PET CT Skull Base Thigh Study
		T;N, Routine, Head/Neck Cancer
Consults/Follow-up

	Procedure to Schedule
		I-131 Treatment with Thyrogen
	Consult Oncologist
		
	Consult Occupational Therapy
		
	Consult Physical Therapy
		
	Consult Radiation Oncologist
		
	Consult Speech Therapy
		
	Follow-up Appointment
		2 weeks
		4 weeks
		6 weeks
Charges/Supplies
	99406 EVM - Smoking Cess Counseling 3-10 Min
		T;N
	99407 EVM - Smoking Cess Counseling 10 Min or More
		T;N
	G0296 EVM - Counseling visit to discuss need for lung cancer screening using low dose CT scan
		
Procedures in Office
	10021 Fine Needle Asp
		
	10004 FNA biopsy, w/o image guidance, each addtl lesion
		
	76942 Ultrasonic guidance for needle placement
		
	31231 Nasal endoscopy diag uni/bilat
		
	31237 Nasal/sinus endoscopy w bx/polyp
		
	31575 Laryngoscopy flex diagnostic
		
	11102 Tangential biopsy of skin; single lesion
		
	11103 Tangential biopsy of skin; ea addtl lesion
		
	11104 Punch Biopsy of skin; single lesion
		
	11105 Punch biopsy of skin; ea addtl lesion
		
	11106 Incisional biopsy of skin; single lesion
		
	11107 Incisional biopsy of skin; ea addtl lesion
		
	15110 Epidermal autograft, trunk, arms, legs, 1st 100 sq cm.
		
	15111 Epidermal autograft each addtl 100 sq cm.
		
	15115 Epidermal autograft, face, scalp, eyelids, mouth, neck, ears, orbits, hands, feet 1st 100 sq c
		
	15116 Epidermal autograft each addtl 100 sq cm.
		
	30100 Biopsy, Intranasal
		
	41100 Bx of tongue anterior 2/3
		
	41110 Exc les tongue wo closure
		
	41112 Exc les tongue w closure ant 2/3
		
	40490 Biopsy of lip
		
	40808 Biopsy vestibule of mouth
		
	41108 Floor of mouth biopsy
		
	41116 Floor of mouth excision of lesion
		
	42100 Biopsy of Palate, Uvula
		
	42800 Biopsy Oroopharynx
		
	76536 US Head and Neck
		
	11200 Removal of skin tags, up to and inc 15
		
	Thyrogen Medication
		
	96372 Administration of Injection Medication
		
	92511 Nasopharynoscopy w/Enodoscope
		
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
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
	G0296 EVM - Counseling visit to discuss need for lung cancer screening using low dose CT scan
		T;N
No Charge / Follow Up
	99024 EVM - Post Op Visit
		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