Unique Plan Description: OBGYN Procedures in Clinic
Plan Selection Display: OBGYN Procedures in Clinic
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2012-03-01 15:48:24
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2021-12-06 10:26:28
Available at all facilities: Yes

OBGYN Procedures in Clinic
Laboratory
	Pregnancy Test Urine
		T;N, Routine, Routine, spec type = Urine
	Hemogram (CBC no Diff)
		T;N, Routine, spec type = Blood
	Tissue Request
		T;N, Routine, Routine
Medications
	ketorolac 30mg/1mL (Toradol) (In Office)
		30 mg, Injection, IM-IntraMUSCULAR, Once, NOW
Patient Care
	Obtain Consent/Permit for:
		T;N, IUD Insertion
		T;N, Hysterscopy with Essure Permanent Sterilization
		T;N, Hysterscopy with Endometrial Thermal Ablation
		T;N, Hysteroscopy
		T;N, Hysteroscopy with Biopsy
		T;N, Hysteroscopy with Dilation and Curettage
		T;N, Dilation and Evacuation
		T;N, Hysteroscopy with IUD removal
		T;N, Colposcopy
		T;N, Endometrial Biopsy
	64581 Incise for Implant Neurostimulator, Sacral Nerve
		
	57105 Biopsy of Vaginal Mucosa Extensive
		
Consults/Follow-up
	Return to Clinic Women's
		Future Order In Approximately 1 week(s) Grace Period (+/-) 2 Day(s), 2, Day(s), 1, week(s), In Approximately
		Future Order In Approximately 2 week(s) Grace Period (+/-) 2 Day(s), 2, Day(s), 2, week(s), In Approximately
		Future Order In Approximately 3 week(s) Grace Period (+/-) 3 Day(s), 3, Day(s), 3, week(s), In Approximately
		Future Order In Approximately 6 week(s) Grace Period (+/-) 7 Day(s), 7, Day(s), 6, week(s), In Approximately
		Future Order In Approximately 1 month(s) Grace Period (+/-) 7 Day(s), 7, Day(s), 1, month(s), In Approximately
		Future Order In Approximately 2 month(s) Grace Period (+/-) 7 Day(s), 7, Day(s), 2, month(s), In Approximately
		Future Order In Approximately 3 month(s) Grace Period (+/-) 7 Day(s), 7, Day(s), 3, month(s), In Approximately
		Future Order In Approximately 4 month(s) Grace Period (+/-) 7 Day(s), 7, Day(s), 4, month(s), In Approximately
		Future Order In Approximately 6 month(s) Grace Period (+/-) 7 Day(s), 7, Day(s), 6, month(s), In Approximately
		Future Order In Approximately 12 month(s) Grace Period (+/-) 14 Day(s), 14, Day(s), 12, month(s), In Approximately
	Follow-up Appointment
		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, 6 months
		Follow Up Visit, 1 year
		Follow Up Visit, See Special Instructions
		3 months, HSG
	Communication to CLINIC Nurse
		Take BP, TPR prior to procedure
		Assure patient has taken preop meds as prescribed by MD.
Charges/Supplies
Procedures in Office
	59820 TREATMENT OF MISCARRIAGE
		
	64590 Insert/Repair  Peripheral Neurostimulator Receiver/Generator
		
	95972 Analyze neurostimulator, w/ program, 1st hr
		
	58563 Hysteroscopy, w/Ablation
		
	58562 Hysteroscopy Removal of IUD
		
	58301 IUD removal
		
	58300 Insert IUD
		
	58120 D&C (Dilation & Curettage)
		
	58565 Hysteroscopy, Surgical, w/Bilateral Fallopian Tubes
		
	58340 Injection for HSG or SIS
		
	74740 HSG radiologic S&I
		
	76831 SIS US S&I
		
	58345 Transcervical Fallopian Catheter
		
	64581 Incise for Implant Neurostimulator, Sacral Nerve
		
	58555 Hysteroscopy, Diagnostic
		
	58558 Hysteroscopy w/Biopsy Endometrium
		
	57100 Biopsy vaginal mucosa simple
		
	56605 Biopsy vulva or perineum, 1 lesion
		
	56606 Biopsy vulva or perineum, ea addl
		
	57105 Biopsy of Vaginal Mucosa Extensive
		
	57420 Colposcopy, Vagina
		
	57061 Destruct Vaginal Lesion, Simple
		
	56501 Destruct Lesion, Vulva, Simple
		
	56515 Destruct Lesion, Vulva, Extensive
		
	56405 I&D Vulva or Perineal Abscess
		
	56420 I&D Bartholin Gland Abscess
		
	57452 Colposcopy  Cervix and Upper Vagina
		
	57454 Colposcopy  Cervix and Upper Vagina, Biopsy/Curettage
		
	57455 Colposcopy  Cervix , Biopsy
		
	57456 Colposcopy  Cervix, w/ endocervical curettage
		
	57522 Conization Cervix LEEP
		
	57511 Cryotherapy Cervix
		
	58100 Endometrial bx wo cervical dilation
		
	58110 Endometrial Biopsy during Colposcopy
		
	58555 Hysteroscopy, Diagnostic
		
	57500 Cervical Biopsy/Polypectomy
		
	76000 Fluroscopic Guidance, up to 1 hour physician time
		
New Pt Visit
	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
No Charge / Follow Up
	99213C EVM - MPC CLINIC AUDIT BY CODER

*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