Unique Plan Description: Peds Allergy Clinic
Plan Selection Display: Peds Allergy Clinic
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2015-04-02 11:13:37
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2025-04-21 11:07:47
Available at all facilities: Yes

Peds Allergy Clinic
Laboratory
	Allergens Food Common Adult Food IgE (50486)
		T;N, Routine, spec type = Blood
	Allergen Region 9 Respiratory Panel (3001719)
		T;N, Routine, spec type = Blood
	Allergens Pediatric Foods/Inhalants Profile  (55300)
		T;N, Routine, spec type = Blood
	Allergens Food Profile 9 (55104)
		T;N, Routine, spec type = Blood
	Allergens Pediatric Allergy March (Progression) Profile IgE (50529)
		T;N, Routine, spec type = Blood
	Allergen Epidermals and Animal Proteins Cat Dander (55006)
		T;N, Routine, spec type = Blood
	Allergen Insects and Venom Cockroach German (55088)
		T;N, Routine, spec type = Blood
	Allergen Food Corn (55078)
		T;N, Routine, spec type = Blood
	Allergen Mites D. farinae (55064)
		T;N, Routine, spec type = Blood
	Allergen Mites D. pteronyssinus (55063)
		T;N, Routine, spec type = Blood
	Allergen Epidermals and Animal Proteins Dog Dander (99568)
		T;N, Routine, spec type = Blood
	Allergen Food Egg White (55013)
		T;N, Routine, spec type = Blood
	Allergen Food Egg Yolk (55212)
		T;N, Routine, spec type = Blood
	Allergen Occupational Latex IgE Enhanced (99614)
		T;N, Routine, spec type = Blood
	Allergen Food Milk (Cow's) (55020)
		T;N, Routine, spec type = Blood
	Allergen Food Peanut (55024)
		T;N, Routine, spec type = Blood
	Allergen Food Soybean (55031)
		T;N, Routine, spec type = Blood
	Immunoglobulin E
		T;N, Routine, spec type = Blood
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, 6 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
	Consult Allergist
		
	Consult Dermatologist
		
Charges/Supplies
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
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
	99211n EVM - No Charge Professional Service
		T;N
	Audit by Coder
		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