Unique Plan Description: Ortho Shoulder Clinic
Plan Selection Display: Ortho Shoulder Clinic
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2012-03-21 14:45:51
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2023-10-10 18:26:45
Available at all facilities: Yes

Ortho Shoulder Clinic
Diagnostic Tests
	Clavicle Bil
		T;N, Routine
	Clavicle Lt
		T;N, Routine
	Clavicle Rt
		T;N, Routine
	Elbow 2 View Lt
		T;N, Routine
	Elbow 2 View Rt
		T;N, Routine
	Forearm Lt
		T;N, Routine
	Forearm Rt
		T;N, Routine
	Scapula Lt
		T;N, Routine
	Scapula Rt
		T;N, Routine
	Shoulder Min 2 View Lt
		T;N, Routine
	Shoulder Min 2 View Rt
		T;N, Routine
	Shoulder Min 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)
		3 mg, Injection, IM-Intramuscular, Once, NOW
		6 mg, Injection, IM-Intramuscular, Once, NOW
		9 mg, Injection, IM-Intramuscular, Once, NOW
		12 mg, Injection, IM-Intramuscular, 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, See Special Instructions
	Surgery to Schedule
		Arthroscopy of shoulder w/ rotator cuff repair
		Arthroscopy shoulder, Mumford Procedure
		Arthroscopy shoulder, subacromial space
		Arthroscopy shoulder, surgical debridement
		Claviculectomy, partial
		Repair humerus fracture
		Repair ruptured cuf
		
	Consult Physical Therapy
		Reason for Referral: Eval & Treat
		Reason for Referral: Modalities
		Reason for Referral: Brace/Orthotic
		Reason for Referral: Therapeutic Exercise
		Reason for Referral: Biofeedback
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
		T;N
	99024 EVM - Post Op Visit
		T;N
	99211n EVM - No Charge Professional Service
		T;N
Procedures in Office
	20605 Arthrocentesis asp/inj intermediate joint/bursa
		
	20610 Arthrocentesis asp/inj major joint/bursa
		
	29075 Cast short arm
		
	29065 Cast long arm
		
	29125 Splint short arm
		
	29105 Splint long arm
		
Supplies
	CAST SUPPLIES-FIBERGLASS, LONG ARM ADULT
		
	CAST SUPPLIES-PLASTER, SHORT ARM ADULT
		
	CAST SUPPLIES-FIBERGLASS, SHORT ARM ADULT
		
	CAST SUPPLIES-FIBERGLASS, LONG ARM SPLINT ADULT
		
	CAST SUPPLIES-PLASTER, SHORT ARM SPLINT ADULT
		
	CAST SUPPLIES-FIBERGLASS, SHORT ARM ADULT SPLINT
		
DME Supplies
	Arm Sling
		T;N
	Heel/Elbow Flotation Pad, pr
		T;N
	Tennis Elbow Strap -MPC
		T;N
	Shoulder Immobilizer-MPC
		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