Unique Plan Description: Ortho Knee Clinic
Plan Selection Display: Ortho Knee Clinic
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2011-11-17 16:39:58
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2023-10-10 18:26:18
Available at all facilities: Yes

Ortho Knee Clinic
Diagnostic Tests
Diagnostics
	Knee 3 View Lt
		T;N, Routine
	Knee 3 View Rt
		T;N, Routine
	Knee Min 4 View Lt
		T;N, Routine
	Knee Min 4 View Rt
		T;N, Routine
	Knee Min 4 View Bil
		T;N, Routine
	Knee 1 or 2 View Lt
		T;N, Routine
	Knee 1 or 2 View Rt
		T;N, Routine
	Knee 1 or 2 View Bil
		T;N, Routine
Medications

	methylPREDNISolone (Depo-Medrol 40 mg/mL) (In Office)
		40 mg, Suspension-Injection, IntraArticular, Once, NOW
		80 mg, Suspension-Injection, IntraArticular, Once, NOW
		120 mg, Suspension-Injection, IntraArticular, Once, NOW
		160 mg, Suspension-Injection, IntraArticular, Once, NOW
	betamethasone acet-betamethasone na phosphate (Celestone Soluspan) (In Office)
		6 mg, Injection, IntraArticular, Once, NOW
		12 mg, Injection, IntraArticular, Once, NOW
		18 mg, Injection, IntraArticular, Once, NOW
		24 mg, Injection, IntraArticular, Once, NOW
	sodium hyaluronate (Euflexxa 20 mg/2mL) (In Office)
		2 mL, Solution, IntraArticular, Once, NOW
	sodium hyaluronate (Supartz FX 10mg/mL  ) (In Office)
		2.5 mL, Solution, IntraArticular, Once, NOW
Consults/Follow-up
	Follow-up Appointment
		Follow Up Visit, PRN
		Follow Up Visit, 1 week
		Follow Up Visit, 2 weeks
		Follow Up Visit, 3 weeks
		Follow Up Visit, 4 weeks
		Follow Up Visit, 6 weeks
		Follow Up Visit, 2 months
		Follow Up Visit, 3 months
		Follow Up Visit, 6 months
		Follow Up Visit, 1 year
		Follow Up Visit, See Special Instructions
	Surgery to Schedule
		Arthroscopy knee w/ menisectomy
		Arthroscopically aided ACL reconstruction
		Arthroscopy knee w/ other surgical proc
		Arthroscopy knee, abrasion arthroplasty
		Total knee replacement
		
	Consult Physical Therapy
		Reason for Referral: Eval & Treat
		Reason for Referral: Modalities
		Reason for Referral: Brace/Orthotic
		Reason for Referral: Therapeutic Exercise
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
	99213C EVM - MPC CLINIC AUDIT BY CODER
		
Procedures in Office
	29345 Cast long leg
		
	29405 Cast short leg
		
	29425 Cast short leg walking
		
	29505 Splint long leg
		
	29515 Splint short leg
		
	20610 Arthrocentesis asp/inj major joint/bursa
		
Supplies
		Fracture Supplies(NOTE)*
	CAST SUPPLIES-FIBERGLASS, LONG LEG ADULT
		
	CAST SUPPLIES-FIBERGLASS,SHORT LEG ADULT
		
	CLS-CAST SUPPLIES-FIBERGLASS, SHORT LEG SPLINT ADULT
		
	CAST SUPPLIES-FIBERGLASS, LONG LEG SPLNT ADULT
		
DME Supplies
	Aluminum Crutches
		T;N
	Knee immobilizer-MPC
		T;N
	Knee Sleeve, Closed
		T;N
	Knee Sleeve, Open
		T;N
	Knee Support, Open/Closed
		T;N
	Lateral J Knee Brace
		T;N
	Townsend Sport Knee Brace
		T;N
	Townsend Sport Post-Op Knee Brace
		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