Unique Plan Description: Neuro MS Clinic
Plan Selection Display: Neuro MS Clinic
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2012-02-28 19:37:25
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2023-05-15 14:06:22
Available at all facilities: Yes

Neuro MS Clinic
Laboratory
	TSH
		T;N, Routine, spec type = Blood
	Free T4
		T;N, Routine, spec type = Blood
	Hepatic Function Panel
		T;N, Routine, spec type = Blood
	CBC with Diff
		T;N, Routine, spec type = Blood
	HIV-1/2 Ag/Ab Combo - MH/WH/JE
		T;N, Routine, spec type = Blood
	Anti-nuclear Antibody Screen
		T;N, Routine, spec type = Blood
	Sed Rate
		T;N, Routine, spec type = Blood
	Borrelia burgdorferi(Lyme)Abs Rflx IgM-IgG
		T;N, Routine, spec type = Blood
	Angiotensin Converting Enzyme
		T;N, Routine, spec type = Blood
	ACE CSF
		T;N, Routine, spec type = Cerebrospinal Fluid
	Vitamin B12 Level
		T;N, Routine, spec type = Blood
	Folate
		T;N, Routine, spec type = Blood
	Unlisted Laboratory Procedure
		T;N, Routine, spec type = Blood
			Comment: Fatty Acids Very Long Chain
	Rheumatoid Factor Quantitative
		T;N, Routine, spec type = Blood
	Vitamin E Level
		T;N, Routine, spec type = Blood
Diagnostic Tests
MRI
	MRI Brain w Contrast
		T;N, Routine
	MRI Brain w/o Contrast
		T;N, Routine
	MRI Brain w & w/o Contrast
		T;N, Routine
	MRI Cervical w & w/o Contrast
		T;N, Routine
	MRI Cervical w/o Contrast
		T;N, Routine
	MRI Thoracic w & w/o Contrast
		T;N, Routine
	MRI Thoracic w/o Contrast
		T;N, Routine
	MRI Lumbar w & w/o Contrast
		T;N, Routine
	MRI Lumbar w/o Contrast
		T;N, Routine
CT
	CT Head w & w/o Contrast
		
	CT Head w/o Contrast
		
Consults/Follow-up

	Follow-up Appointment
		Follow Up Visit, 6 months
		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, 1 year
		Follow Up Visit, See Special Instructions
		Follow Up Visit, PRN
	Request for Service
		visual evoked potential, T;N
	Consult Physical Therapy
		
	Consult Occupational Therapy
		
	Consult Speech Therapy
		
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
	99024 EVM - Post Op Visit
		T;N
	99211n EVM - No Charge Professional Service
		T;N
	99213C EVM - MPC CLINIC AUDIT BY CODER
		T;N

Neuro CSF Studies Clinic
Laboratory

	Culture Routine
		T;N, Routine, spec type = Cerebrospinal Fluid
			Comment: Tube 2
	Cell Count and Diff CSF
		T;N, Routine, spec type = Cerebrospinal Fluid
	Glucose CSF
		T;N, Routine, spec type = Cerebrospinal Fluid
			Comment: Tube 3
	Protein CSF
		T;N, Routine, spec type = Cerebrospinal Fluid
			Comment: Tube 3
	Oligoclonal Band Profile
		T;N, Routine, spec type = Blood/CSF
			Comment: Tube 4 save

*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