Unique Plan Description: Vasc General Clinic
Plan Selection Display: Vasc General Clinic
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2011-12-09 14:19:54
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2022-12-13 10:24:04
Available at all facilities: Yes

Vasc General Clinic
Laboratory
	INR - MH/WH/JE
		T;N, Routine, spec type = Blood
	CBC with Diff
		T;N, Routine, spec type = Blood
	D-Dimer - MH/WH/JE
		T;N, Routine, spec type = Blood
	Uric Acid
		T;N, Routine, spec type = Blood
	Protein C Functional
		T;N, Routine, spec type = Blood
	Protein S Functional
		T;N, Routine, spec type = Blood
	Anti-Thrombin III Enzymatic (Activity)
		T;N, Routine, spec type = Blood
	Cardiolipin Antibodies IgG and IgM
		T;N, Routine, spec type = Blood
	Factor V Leiden Mutation  (PreAuth Req)
		T;N, Routine, spec type = Blood
	Homocysteine Total
		T;N, Routine, spec type = Blood
	Lupus Anticoagulant Panel
		T;N, Routine, spec type = Blood
	Basic Metabolic Panel
		T;N, Routine, spec type = Blood
	Comprehensive Metabolic Panel
		T;N, Routine, spec type = Blood
Point of Care
	Coumadin POC - PC
		T;N, Blood
	INR POC
		T;N, Blood
Diagnostic Tests

	ECG
		T;N
	Abd Aorta Sizing
		T;N
	AV Fistula
		T;N
	Bypass Graft Bil Lower
		T;N
	Bypass Graft Bil Upper
		T;N
	Bypass Graft Unilat Lower
		T;N
	Bypass Graft Unilat Upper
		T;N
	Carotid Artery Duplex Bil
		T;N
	Carotid Artery Duplex Unilat
		T;N
	Endograft
		T;N
	FEMPOP Aneurysm Check
		T;N
	Native Artery Duplex Bil Lower
		T;N
	Native Artery Duplex Bil Upper
		T;N
	Native Artery Duplex Unilat Lower
		T;N
	Native Artery Duplex Unilat Upper
		T;N
	Reflux Exam w Perforator Bil
		T;N
	Reflux Exam w Perforator Unilat
		T;N
	Renal Arteries Duplex
		T;N
	Segmental Arterial Pressure Exercise
		T;N
	Segmental Arterial Pressures
		T;N
	Segmental Arterial Pressures Upper
		T;N
	Superior Mesenteric Artery Celiac Limit
		T;N
	Vein Mapping Bil Upper or Lower
		T;N
	Vein Mapping Unilat Upper or Lower
		T;N
	Venous Duplex Bil Upper or Lower
		T;N
	Venous Duplex Unilat Upper or Lower
		T;N
Radiology
	Chest 1 View
		T;N, Routine
	Venous Duplex Bil Upper or Lower
		T;N, Routine
	Venous Duplex Unilat Upper or Lower
		T;N, Routine
	Native Artery Duplex Bil Upper
		T;N, Routine
	Native Artery Duplex Unilat Upper
		T;N, Routine
	Segmental Arterial Pressures
		T;N, Routine
	Segmental Arterial Pressures Upper
		T;N, Routine
	US Abd Limited
		T;N, Routine
	US Abd Aortic Aneurysm Screen
		T;N, Routine
	US Duplex Abd Pelvis Renal Scrotum Limited
		T;N, Routine
	US Duplex Abd Pelvis Renal Scrotum Complete
		T;N, Routine
	US Renal Retro Complete
		T;N, Routine
	Native Artery Duplex Bil Lower
		T;N, Routine
	Native Artery Duplex Unilat Lower
		T;N, Routine
	Segmental Arterial Pressure Exercise
		T;N, Routine
CT
	CT Abd Pelvis w & w/o Cont
		T;N, Routine
	CT Abd Pelvis w Contrast
		T;N, Routine
	CT Abd Pelvis w/o Contrast
		T;N, Routine
	CTA Abd Pelvis
		T;N, Routine
			Comment: endograft protocol
	CTA Aorta Runoff
		T;N, Routine
	CTA Head
		T;N, Routine
	CTA Neck
		T;N, Routine
	CT Venogram for May Thurner
		T;N, Routine
MRI
	MRI Brain w & w/o Contrast
		T;N, Routine
	MRI Brain w Contrast
		T;N, Routine
	MRI Brain w/o Contrast
		T;N, Routine
	MRA Neck w & w/o Contrast
		T;N, Routine
	MRA Neck w Contrast
		T;N, Routine
	MRA Neck w/o Contrast
		T;N, Routine
	MRA Head w & w/o Contrast
		T;N, Routine
	MRA Head w Contrast
		T;N, Routine
	MRA Head w/o Contrast
		T;N, Routine
Medications

	levoFLOXacin 500 mg oral tablet
		1 TAB BY MOUTH DAILY, X 7 Day(s), # 7 TAB, 0 Refill(s), Hard Stop
	cefadroxil  500 mg oral capsule
		1 CAP BY MOUTH BID, X 7 Day(s), # 14 CAP, 0 Refill(s), Hard Stop
	Lasix 20 mg oral tablet
		1 TAB, BY MOUTH, DAILY, # 30 TAB, 1 Refill(s), Soft Stop
	Plavix  75 mg oral tablet
		1 TAB, BY MOUTH, DAILY, # 30 TAB, 3 Refill(s), Soft Stop
	Lovenox  40 mg/0.4 mL subcutaneous solution
		0.4 mL SUBCUTANEOUS Q12H, X 7 Day(s), # 5.6 mL, 0 Refill(s), Hard Stop
	Lovenox  60 mg/0.6 mL subcutaneous solution
		0.6 mL SUBCUTANEOUS Q12H, X 7 Day(s), # 8.4 mL, 0 Refill(s), Hard Stop
	Lovenox  80 mg/0.8 mL subcutaneous solution
		0.8 mL, SUBCUTANEOUS, DAILY, X 7 Day(s), # 5.6 mL, 0 Refill(s), Hard Stop
	Lovenox 120 mg/0.8 mL injectable solution
		0.8 mL SUBCUTANEOUS Q12H, X 7 Day(s), # 5.6 mL, 0 Refill(s), Hard Stop
	acetaminophen-hydrocodone 325 mg-5 mg oral tablet
		1 TAB, By Mouth, Q4H, PRN pain-mild, X 7 Day(s), # 25 TAB, 0 Refill(s)
	acetaminophen-hydrocodone 325 mg-7.5 mg oral tablet
		1 TAB, By Mouth, Q4H, PRN pain-moderate, X 7 Day(s), # 25 TAB, 0 Refill(s), Hard Stop
	acetaminophen-hydrocodone 325 mg-10 mg oral tablet
		1 TAB, By Mouth, Q4H, PRN pain-severe, X 7 Day(s), # 25 TAB, 0 Refill(s)
	Neurontin 300 mg oral capsule
		See instructions, Take 1 CAP BY MOUTH at Bedtime on Day 1, then 1 CAP BY MOUTH BID on Day 2, then 1 CAP BY MOUTH TID on Day 3 and every day after. Must taper off meds., # 90 CAP, 1 Refill(s)
	Lyrica  50 mg oral capsule
		See instructions, Take 1 CAP BY MOUTH at bedtime on Day 1, 1 CAP BY MOUTH BID on Day 2, 1 CAP BY MOUTH TID on Day 3 and every day after. Must taper off meds., # 90 CAP, 1 Refill(s)
	warfarin 2.5 mg oral tablet
		See Instructions, Take by mouth as directed, # 100 TAB, 0 Refill(s), Soft Stop
		1 TAB, BY MOUTH, DAILY, # 30 TAB, 0 Refill(s), Soft Stop
	warfarin 5 mg oral tablet
		See Instructions, Take by mouth as directed, # 100 TAB, 0 Refill(s), Soft Stop
		1 TAB, BY MOUTH, DAILY, # 30 TAB, 0 Refill(s), Soft Stop
	warfarin 7.5 mg oral tablet
		See Instructions, Take by mouth as directed, # 100 TAB, 0 Refill(s), Soft Stop
		1 TAB, BY MOUTH, DAILY, # 30 TAB, 0 Refill(s), Soft Stop
	warfarin 10 mg oral tablet
		See Instructions, Take by mouth as directed, # 100 TAB, 0 Refill(s), Soft Stop
		1 TAB, BY MOUTH, DAILY, # 30 TAB, 0 Refill(s), Soft Stop
	Graduated Compression Stockings Script (Knee High)
		Support 12-18 mmHg (Left), 1 EA, 0 Refill(s)
		Support 12-18 mmHg (Right), 1 EA, 0 Refill(s)
		Support 12-18 mmHg (Pair), 1 EA, 0 Refill(s)
		Class I 20-30 mmHg (Left), 1 EA, 0 Refill(s)
		Class I 20-30 mmHg (Right), 1 EA, 0 Refill(s)
		Class I 20-30 mmHg (Pair), 1 EA, 0 Refill(s)
		Class II 30-40 mmHg (Left), 1 EA, 0 Refill(s)
		Class II 30-40 mmHg (Right), 1 EA, 0 Refill(s)
		Class II 30-40 mmHg (Pair), 1 EA, 0 Refill(s)
		Class III 40-50 mmHg (Left), 1 EA, 0 Refill(s)
		Class III 40-50 mmHg (Right), 1 EA, 0 Refill(s)
		Class III 40-50 mmHg (Pair), 1 EA, 0 Refill(s)
		Class IV 60+ mmHg (Left), 1 EA, 0 Refill(s)
		Class IV 60+ mmHg (Right), 1 EA, 0 Refill(s)
		Class IV 60+ mmHg (Pair), 1 EA, 0 Refill(s)
	Graduated Compression Stockings Script (Pantyhose)
		Support 12-18 mmHg (Pair), 1 EA, 0 Refill(s)
		Class I 20-30 mmHg (Pair), 1 EA, 0 Refill(s)
		Class II 30-40 mmHg (Pair), 1 EA, 0 Refill(s)
		Class III 40-50 mmHg (Pair), 1 EA, 0 Refill(s)
		Class IV 60+ mmHg (Pair), 1 EA, 0 Refill(s)
	Graduated Compression Stockings Script (Thigh high)
		Support 12-18 mmHg (Left), 1 EA, 0 Refill(s)
		Support 12-18 mmHg (Right), 1 EA, 0 Refill(s)
		Support 12-18 mmHg (Pair), 1 EA, 0 Refill(s)
		Class I 20-30 mmHg (Left), 1 EA, 0 Refill(s)
		Class I 20-30 mmHg (Right), 1 EA, 0 Refill(s)
		Class I 20-30 mmHg (Pair), 1 EA, 0 Refill(s)
		Class II 30-40 mmHg (Left), 1 EA, 0 Refill(s)
		Class II 30-40 mmHg (Right), 1 EA, 0 Refill(s)
		Class II 30-40 mmHg (Pair), 1 EA, 0 Refill(s)
		Class III 40-50 mmHg (Left), 1 EA, 0 Refill(s)
		Class III 40-50 mmHg (Right), 1 EA, 0 Refill(s)
		Class III 40-50 mmHg (Pair), 1 EA, 0 Refill(s)
		Class IV 60+ mmHg (Left), 1 EA, 0 Refill(s)
		Class IV 60+ mmHg (Right), 1 EA, 0 Refill(s)
		Class IV 60+ mmHg (Pair), 1 EA, 0 Refill(s)
	Graduated Compression Stockings Script (Maternity Pantyhose)
		Support 12-18 mmHg (Pair), 1 EA, 0 Refill(s)
		Class I 20-30 mmHg (Pair), 1 EA, 0 Refill(s)
		Class II 30-40 mmHg (Pair), 1 EA, 0 Refill(s)
		Class III 40-50 mmHg (Pair), 1 EA, 0 Refill(s)
		Class IV 60+ mmHg (Pair), 1 EA, 0 Refill(s)
	Graduated Compression Stockings Script (Thigh high w/ hip attachment)
		Support 12-18 mmHg (Left), 1 EA, 0 Refill(s)
		Support 12-18 mmHg (Right), 1 EA, 0 Refill(s)
		Support 12-18 mmHg (Pair), 1 EA, 0 Refill(s)
		Class I 20-30 mmHg (Left), 1 EA, 0 Refill(s)
		Class I 20-30 mmHg (Right), 1 EA, 0 Refill(s)
		Class I 20-30 mmHg (Pair), 1 EA, 0 Refill(s)
		Class II 30-40 mmHg (Left), 1 EA, 0 Refill(s)
		Class II 30-40 mmHg (Right), 1 EA, 0 Refill(s)
		Class II 30-40 mmHg (Pair), 1 EA, 0 Refill(s)
		Class III 40-50 mmHg (Left), 1 EA, 0 Refill(s)
		Class III 40-50 mmHg (Right), 1 EA, 0 Refill(s)
		Class III 40-50 mmHg (Pair), 1 EA, 0 Refill(s)
		Class IV 60+ mmHg (Left), 1 EA, 0 Refill(s)
		Class IV 60+ mmHg (Right), 1 EA, 0 Refill(s)
		Class IV 60+ mmHg (Pair), 1 EA, 0 Refill(s)
Patient Care
		Prep for contrast procedure for for pts with mild renal failure:(NOTE)*
	Patient Instructions
		Hold ACE, ARB, and diuretics the day before and the day of procedure, increase salt intake the day before the procedure by eating chips or pretzels.
Consults/Follow-up
	Follow-up Appointment
		Follow Up Visit, 3 months
		Follow Up Visit, 1 week
		Follow Up Visit, 2 weeks
		Follow Up Visit, 3 weeks
		Follow Up Visit, 1 month
		Follow Up Visit, 6 months
		Follow Up Visit, 1 year
		Follow Up Visit, See Special Instructions
		Follow Up Visit, PRN
	Surgery to Schedule
		Abd aortic aneurysm repair
		Abd aortic aneurysm repair with endograft
		Abdominal aortogram with runoffs
		Amputation- above knee
		Amputation- below knee
		Aortic arch and carotid arteriogram
		Axillo-femoral bypass graft
		Carotid endarterectomy
		Central venous cath insertion
		Femoral-femoral bypass graft
		Femoral-popiteal bypass graft
		Femoral-tibial bypass graft
		Femoral endarterectomy
		Fistulogram
		Hemodialysis access-fistula formation
		Hemodialysis access with PTFE graft
		Hemodialysis access revision
		Iliac aneurysm repair
		Inferior vena cava filter insertion
		Peritoneal catheter placment
		Popliteal tibial bypass graft
		Popliteal aneurysm repair
		Power port placement
		Ray amputation
		Renal arteriogram
		Saphenous vein ligation and stripping
		Stab phlebectomies
		Toe amputation
		Venogram
		VNUS procedure
		Wound debridement
	Consult Cardiologist
		
	Consult Gastroenterologist
		
	Consult Hematologist/Oncologist
		
	Consult Nephrologist
		
	Consult Neurologist
		
	Consult Ophthalmologist
		
	Consult Neurosurgery
		
	Consult Pain Management
		
	Consult Primary Care Provider
		
	Consult Pulmonologist
		
	Consult Physical Therapy
		
	Consult Occupational Therapy
		
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
	99213C EVM - MPC CLINIC AUDIT BY CODER
		T;N
	99211n EVM - No Charge Professional Service
		T;N
	99024 EVM - Post Op Visit
		T;N
Procedures in Office
	10060 I&D abscess simple/single
		
	10061 I&D abscess complicated/multiple
		
	10180 I&D postop wound infection
		
	11042 Debride subcu tissue </= 20 sq cm
		
	11055 Paring/cutting corn/callus; single lesion
		
	11056 Paring/cutting corn/callus; 2-4 lesions
		
	11057 Paring/cutting corn/callus; more than 4
		
	36589 Rem Central Vein Device Tunneled
		
	36468 Inj spider vein limb
		
	29580 Apply Bilateral Boot

Hypercoagulation Tests
Laboratory

	INR - MH/WH/JE
		T;N, Routine, spec type = Blood
	Prothrombin Time (PT) - FH
		T;N, Routine, spec type = Diagnostic Blood
		T;N, Routine, spec type = Therapeutic Blood
	CBC with Diff
		T;N, Routine, spec type = Blood
	D-Dimer - MH/WH/JE
		T;N, Routine, spec type = Blood
	D-Dimer Level - FH
		T;N, Routine, spec type = Blood
	Creatinine
		T;N, Routine, spec type = Blood
	Uric Acid
		T;N, Routine, spec type = Blood
	Protein C Functional
		T;N, Routine, spec type = Blood
	Protein S Functional
		T;N, Routine, spec type = Blood
	Anti-Thrombin III Enzymatic (Activity)
		T;N, Routine, spec type = Blood
	Cardiolipin Antibodies IgG and IgM
		T;N, Routine, spec type = Blood
	Factor V Leiden Mutation  (PreAuth Req)
		T;N, Routine, spec type = Blood
	Homocysteine Total
		T;N, Routine, spec type = Blood
	Lupus Anticoagulant Panel
		T;N, Routine, spec type = Blood

*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