Unique Plan Description: OBGYN Menopause Clinic
Plan Selection Display: OBGYN Menopause Clinic
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2013-08-23 09:23:46
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2025-01-07 10:37:13
Available at all facilities: Yes

OBGYN Menopause Clinic
Laboratory
	Hemogram
		T;N, Routine, spec type = Blood
	Glucose Level
		T;N, Routine, spec type = Blood
	TSH
		T;N, Routine, spec type = Blood
	Free T4
		T;N, Routine, spec type = Blood
	Free T3
		T;N, Routine, spec type = Blood
	FSH
		T;N, Routine, spec type = Blood
	LH
		T;N, Routine, spec type = Blood
	Sex Hormone Binding Globulin
		T;N, Routine, spec type = Blood
	Estradiol Level
		T;N, Routine, spec type = Blood
	Prolactin Level
		T;N, Routine, spec type = Blood
	Testosterone Total/Free (Female/Child)
		T;N, Routine, spec type = Blood
	Vitamin D 25-Hydroxy Level (preferred for deficiency)
		T;N, Routine, spec type = Blood
	Anti Mullerian Hormone
		T;N, Routine, spec type = Blood
Urine Studies
	UA
		T;N, Routine, Routine, spec type = Urine
	UA (Culture Pos)
		T;N, Routine, Routine, spec type = Urine
	Culture Urine
		T;N, Routine, Urine Midstream, spec type = Urine
Cervical/Vaginal Specimens
	GYN Request (PAP)
		T;N, Routine TL PAP CERVICAL, Routine
		T;N, Routine TL PAP CV & VAG, Routine
		T;N, Routine TL PAP VAGINAL, Routine
		T;N, Routine PAP CERVICAL, Routine
		T;N, Routine PAP CV & VAG, Routine
		T;N, Routine PAP VAGINAL, Routine
	GYN Pap with HPV High Risk Co-Test
		T;N, Routine TL PAP CERVICAL, Routine
		T;N, Routine TL PAP CV & VAG, Routine
		T;N, Routine TL PAP VAGINAL, Routine
	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
	HPV High Risk with 16 and 18 Genotyping
		T;N, Routine, spec type = Cervix
		T;N, Routine, spec type = Vaginal
	GC/Chlamydia PCR-MH/WH/PC
		T;N, Routine, spec type = Cervix
		T;N, Routine, spec type = Vaginal
	Urine GC/Chlamydia PCR - MH/WH/PC
		T;N, Routine, spec type = Urine
	GC/Chlamydia(Rapid) DNA - FH/JE
		T;N, Routine, spec type = Cervix
		T;N, Routine, spec type = Urine
		T;N, Routine, spec type = Vaginal
		T;N, Routine, spec type = Urine
	Vaginitis Panel PCR
		T;N, Routine, spec type = Genital
	Wet Prep - PC/FH
		T;N, Routine, spec type = Genital
	Q0111 Wet Mt Physician Perform
		
	Q0112 KOH Prep Physician Perform
		
	Tissue Request
		T;N, Routine, Tissue, Cervical, Routine
Diagnostic Tests

	zzDXA Scan
		T;N
Radiology
	Mammo Bil Screen
		T;N, Routine, Encounter for screening mammogram for malignant neoplasm of breast
		T;N, Routine, Personal history of malignant neoplasm of breast | Encounter for screening mammogram for malignant neoplasm of breast
	Mammo Implants Screen
		T;N, Routine, Encounter for screening mammogram for malignant neoplasm of breast
		T;N, Routine, Personal history of malignant neoplasm of breast | Encounter for screening mammogram for malignant neoplasm of breast
	US Pelvis Complete Non OB
		T;N, Routine
	Transvaginal US
		T;N, Routine
Consults/Follow-up

	Follow-up Appointment
		Follow Up Visit, 1 month
		Follow Up Visit, 2 weeks
		Follow Up Visit, 2 months
		Follow Up Visit, 6 months
		Follow Up Visit, PRN
		Follow Up Visit, See Special Instructions
	Consult Physical Therapy
		
	Consult Urogynecologic
		
	Consult Gastroenterologist
		
Charges/Supplies
New Pt Visit
	zz99201 EVM-New Pt Visit Problem focused 10m
		
	99202 EVM - OP VISIT NEW PATIENT, STRAIGHTFORWARD 15 MIN
		
	99203 EVM - OP VISIT NEW PATIENT, LOW LEVEL 30 MIN
		
	99204 EVM - OP VISIT NEW PATIENT, MODERATE LEVEL 45 MIN
		
	99205 EVM - OP VISIT NEW PATIENT, HIGH LEVEL 60 MIN
		
	G0101 EVM - PELVIC & BREAST EXAM
		
	Q0091 EVM - Medicare Scr Pap Collection
		
Est. Pt Visit
	99211 EVM - OP visit estab patient, minimal care < 10 min
		
	99212 EVM - OP VISIT ESTAB PATIENT, STRAIGHTFORWARD 10 MIN
		
	99213 EVM - OP VISIT ESTAB PATIENT, LOW LEVEL 20 MIN
		
	99214 EVM - OP VISIT ESTAB PATIENT, MODERATE 30 MIN
		
	99215 EVM - OP VISIT ESTAB PATIENT, HIGH LEVEL 40 MIN
		
	G0101 EVM - PELVIC & BREAST EXAM
		
	Q0091 EVM - Medicare Scr Pap Collection
		
No Charge / Follow Up
	99024 EVM - Post Op Visit
		
	99211n EVM - No Charge Professional Service
		
	99213C EVM - MPC CLINIC AUDIT BY CODER
		
Procedures in Office
	58100 Endometrial bx wo cervical dilation
		
	57505 Endocervical Curettage

*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