Unique Plan Description: Ortho Wrist Clinic
Plan Selection Display: Ortho Wrist Clinic
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2012-03-21 15:17:14
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2021-12-06 10:29:47
Available at all facilities: Yes

Ortho Wrist Clinic
Diagnostic Tests
	EMG & NCV
		T;N
			Comment: EMG/NCV
	Finger 2nd Lt
		T;N, Routine
	Finger 3rd Lt
		T;N, Routine
	Finger 4th Lt
		T;N, Routine
	Finger 5th Lt
		T;N, Routine
	Finger Thumb Lt
		T;N, Routine
	Finger 2nd Rt
		T;N, Routine
	Finger 3rd Rt
		T;N, Routine
	Finger 4th Rt
		T;N, Routine
	Finger 5th Rt
		T;N, Routine
	Finger Thumb Rt
		T;N, Routine
	Hand 2 View Lt
		T;N, Routine
	Hand 2 View Rt
		T;N, Routine
	Hand 3 View Lt
		T;N, Routine
	Hand 3 View Rt
		T;N, Routine
	Wrist 2 View Lt
		T;N, Routine
	Wrist 2 View Rt
		T;N, Routine
	Wrist Min 3 View Lt
		T;N, Routine
	Wrist Min 3 View Rt
		T;N, Routine
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
			Comment: 6 Weeks
		Follow Up Visit, 2 months
		Follow Up Visit, 3 months
		Follow Up Visit, 6 months
		Follow Up Visit, See Special Instructions
			Comment: 6 Weeks
	Surgery to Schedule
		Carpal Tunnel Release
		A1 pulley release (trigger finger release)
		1st dorsal compartment release (DeQuervain's release)
		anterior transpositon of ulnar nerve
		Cubital tunnel release
		ORIF of phalanx
		ORIF of metacarpal
		ORIF of distal radius
		ORIF of ulna
		
	Consult Physical Therapy
		
	Consult Occupational Therapy
		
Charges/Supplies
No Charge / Follow Up
	99211n EVM - No Charge Professional Service
		T;N
	99024 EVM - Post Op Visit
		T;N
	99213C EVM - MPC CLINIC AUDIT BY CODER
		T;N
New Pt Visit
	99205 EVM - OP VISIT NEW PATIENT, HIGH LEVEL 60 MIN
		T;N
	99204 EVM - OP VISIT NEW PATIENT, MODERATE LEVEL 45 MIN
		T;N
	99203 EVM - OP VISIT NEW PATIENT, LOW LEVEL 30 MIN
		T;N
	99202 EVM - OP VISIT NEW PATIENT, STRAIGHTFORWARD 15 MIN
		T;N
	zz99201 EVM-New Pt Visit Problem focused 10m
		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
Procedures in Office
	29065 Cast long arm
		
	29075 Cast short arm
		
	29105 Splint long arm
		
	29125 Splint short 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
		
	Finger Splint, Frog
		
	Neoprene/Elastic Wrist Splint
		T;N
	Rolyan D-Ring Wrist Brace
		
	Tennis Elbow Strap -MPC
		T;N
	Thumb Spica Splint
		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