Unique Plan Description: PMR SCI/Brain/ Injury/Stroke Clinic
Plan Selection Display: PMR SCI/Brain/ Injury/Stroke Clinic
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2012-04-16 15:38:20
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2021-12-06 10:48:54
Available at all facilities: Yes

PMR SCI/Brain/ Injury/Stroke Clinic
Diagnostic Tests
	MRI Brain w & w/o Contrast
		T;N, Routine
	MRI Brain w Contrast
		T;N, Routine
Medications
	Baclofen (Gablofen Intrathecal) 10mg/20mL (500mcg/mL)  (In Office)
		10 mg, Kit, IntraThecal, Once, T;N
		20 mg, Kit, IntraThecal, Once, T;N
	Baclofen (Gablofen Intrathecal) 40mg/20mL (2000mcg/mL) (In Office)
		40 mg, Kit, IntraThecal, Once, T;N
		80 mg, Kit, IntraThecal, Once, T;N
	onabotulinumtoxinA (Botox) (In Office)
		100 units, Injection, SUBCUTANEOUS, Once, NOW
Consults/Follow-up
	Follow-up Appointment
		Follow Up Visit, 1 month
	Procedure to Schedule
		
	Consult Physical Therapy
		Reason for Referral: Serial Casting
		Reason for Referral: Wheelchair Evaluation
		Reason for Referral: Issue Wheelchair
		Reason for Referral: Issue Walker
		Reason for Referral: Issue Cane
		Reason for Referral: Issue Sling
	Consult Occupational Therapy
		Reason for Referral: Driver Evaluation
		Reason for Referral: Wheelchair Evaluation
		Reason for Referral: Serial Casting
	Consult Speech Therapy
		Reason for Referral: Communication Augmentation Device
		Reason for Referral: Barium Swallow
Charges/Supplies
	U2369 Nurse Refill w/ Reprogramming
		
	U5990 Nurse Refill w/o Reprogramming
		
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
Prolonged Care
	zz99354 EVM - Prolonged Care, Outpatient, 1 Hr
		T;N
	99355 EVM - Prolonged Care, Outpatient, Ea Addl 30 Min
		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