/clinical/,/clinical/cckm-tools/,/clinical/cckm-tools/content/,/clinical/cckm-tools/content/order-sets/,/clinical/cckm-tools/content/order-sets/ambulatory/,/clinical/cckm-tools/content/order-sets/ambulatory/bmtoncologyhematology/,

/clinical/cckm-tools/content/order-sets/ambulatory/bmtoncologyhematology/name-98495-en.cckm

20170237

page

100

UWHC,UWMF,

Tools,

Clinical Hub,UW Health Clinical Tool Search,UW Health Clinical Tool Search,Order Sets,Ambulatory,BMT/Oncology/Hematology

OP - Bone Marrow Harvest - Adult - Clinic Visit [2959]

OP - Bone Marrow Harvest - Adult - Clinic Visit [2959] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Ambulatory, BMT/Oncology/Hematology


OP - Bone Marrow Harvest - Adult - Clinic Visit [2959]
for Adult Patients OnlyIntended
Pre-Day of Procedure
Communication Order [216272]
Scrub lower back with chlorhexidine wash night
before procedure. [NURCOM0066]
Routine
Laboratory [91473]
CBC WITH DIFFERENTIAL [CBC] Status: Standing, Expires:3/19/17 MANUAL,Count:1,
Normal, Routine
PROTHROMBIN TIME/INR [PT] Status: Standing, Expires:3/19/17 MANUAL,Count:1,
Normal, Routine
ELECTROLYTES [LYTE] Status: Standing, Expires:3/19/17 MANUAL,Count:1,
Normal, Routine
GLUCOSE [GLU] Status: Standing, Expires:3/19/17 MANUAL,Count:1,
Normal, Routine
MAGNESIUM [MAG] Status: Standing, Expires:3/19/17 MANUAL,Count:1,
Normal, Routine
CALCIUM [CA] Status: Standing, Expires:3/19/17 MANUAL,Count:1,
Normal, Routine
BUN [BUN] Status: Standing, Expires:3/19/17 MANUAL,Count:1,
Normal, Routine
CREATININE [CRET] Status: Standing, Expires:3/19/17 MANUAL,Count:1,
Normal, Routine
CALCIUM [CA] Status: Standing, Expires:3/19/17 MANUAL,Count:1,
Normal, Routine
URIC ACID [URIC] Status: Standing, Expires:3/19/17 MANUAL,Count:1,
Normal, Routine
PHOSPHATE [PHOS] Status: Standing, Expires:3/19/17 MANUAL,Count:1,
Normal, Routine
ALBUMIN [ALB] Status: Standing, Expires:3/19/17 MANUAL,Count:1,
Normal, Routine
PROTEIN, TOTAL [TP] Status: Standing, Expires:3/19/17 MANUAL,Count:1,
Normal, Routine
BILIRUBIN, TOTAL [TBIL] Status: Standing, Expires:3/19/17 MANUAL,Count:1,
Normal, Routine
AST/SGOT [AST] Status: Standing, Expires:3/19/17 MANUAL,Count:1,
Normal, Routine
ALT/SGPT [ALT] Status: Standing, Expires:3/19/17 MANUAL,Count:1,
Normal, Routine
ALKALINE PHOSPHATASE [ALKP] Status: Standing, Expires:3/19/17 MANUAL,Count:1,
Normal, Routine
GGT [GGT] Status: Standing, Expires:3/19/17 MANUAL,Count:1,
Normal, Routine
LD, TOTAL [LDH] Status: Standing, Expires:3/19/17 MANUAL,Count:1,
Normal, Routine
SICKLE CELL SCREEN [SICKLE] Status: Standing, Expires:3/19/17 MANUAL,Count:1,
Normal, Routine
BMT DONOR IDM SCREEN [HCBMTDS] Status: Standing, Expires:3/19/17 MANUAL,Count:1,
Normal, Routine
URINALYSIS WITH MICROSCOPY AND
CULTURE IF >5 WBC/HPF [HCUACULT]
Status: Standing, Expires:3/19/17 MANUAL,Count:1,
Normal, Routine
STR ENGRAFTMENT UNSEPARATED
LINEAGES, BONE MARROW [HCBMSTWB]
Status: Standing, Expires:3/19/17 MANUAL,Count:1,
Normal, Routine
Page 1 of 3
Printed by STRAKA, KEVIN F [KFS1] at 2/2/2017 3:35:27 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 02/2017CCKM@uwhealth.org

Laboratory - STR Engraftment/Separated Lineages [91632]
Separated Lineages is -MUST Order BOTH if STR Engraftment Population NOTE:
Desired
STR ENGRAFTMENT POPULATION 1
[HCSTR1]
Status: Standing, Expires:3/19/17 MANUAL,Count:1,
Normal, Routine
STR ENGRAFTMENT POPULATION 2
[HCSTR2]
Status: Standing, Expires:3/19/17 MANUAL,Count:1,
Normal, Routine
Laboratory - Pregnancy Test [92302]
surgery is pelvic, renal, pregnancy test if female between menarche & menopause and any of: (1) Obtain
intercourse, (3) patient missed menses, (4) patient says abdominal, (2) patient had unprotected -or intra
pregnant. she "could" be
Urine, Pregnancy Test [UPREG] Status: Standing, Expires:3/19/17 MANUAL,Count:1,
Normal, Routine
Serum, Pregnancy Test [SPREG] Status: Standing, Expires:3/19/17 MANUAL,Count:1,
Normal, Routine
Labs - Blood Bank [91702]
Antibody Screen
Use to prescreen patient for alloantibodies to red blood cell components. Order if specimen collection will
be greater than 72 hours prior to surgery. Blood products cannot be issued on the basis of this test.
ABO and Rh Typing
Use to determine patient blood type. Order if specimen collection will be greater than 72 hours prior to
surgery. Blood products cannot be issued on the basis of this test.
ANTIBODY SCREEN [ABSCR] Status: Standing, Expires:3/19/17 MANUAL,Count:1,
Normal, Routine
ABO AND RH TYPING [ABO] Status: Standing, Expires:3/19/17 MANUAL,Count:1,
Normal, Routine
For patients who have mismatched transplants or have received Anti-thymocyte Globulin [150739]
EBV QUANTITATIVE BY PCR [HCEBVPCR] Status: Standing, Expires:6/4/17 MANUAL,Count:1,
Normal, Routine
Diagnostic Tests and Imaging [91530]
ECG - 12 Lead [EKG0008] Status: Future, Expires: 3/2/18, Normal, Routine
X-RAY CHEST PA & LAT VIEWS [R71020] Status: Future, Expires: 4/2/18, Normal, Routine
X-Ray Chest PA & LAT Views Dual Energy
[R71020A]
Status: Future, Expires: 4/2/18, Normal, Routine
Diagnosis
Diagnosis - Pre Op [711]
Pre-operative general physical examination
[255759]
Other specified pre-operative examination
Level of Service
Office Visit - Established Patients [30779]
99211 - Level I LOS Code
99212 - Level II LOS Code
99213 - Level III LOS Code
99214 - Level IV LOS Code
99215 - Level V LOS Code
99211 - w/ Resident (GC) - Level I LOS Code
99212 - w/ Resident (GC) - Level II LOS Code
99213 - w/ Resident (GC) - Level III LOS Code
Page 2 of 3
Printed by STRAKA, KEVIN F [KFS1] at 2/2/2017 3:35:27 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
02/2017CCKM@uwhealth.org

99214 - w/ Resident (GC) - Level IV LOS Code
99215 - w/ Resident (GC) - Level V LOS Code
Office visit - New Patients [30778]
99201- Level I LOS Code
99202- Level II LOS Code
99203- Level III LOS Code
99204- Level IV LOS Code
99205 - Level V LOS Code
99201- w/ Resident (GC) - Level I LOS Code
99202- w/ Resident (GC) - Level II LOS Code
99203- w/ Resident (GC) - Level III LOS Code
99204- w/ Resident (GC) - Level IV LOS Code
99205- w/ Resident (GC) - Level V LOS Code
Consults [30780]
If Medicare patient, do not use Consult LOS. Choose an Established or New Patient LOS. Add the
appropriate additional E/M Code of 99354-99359 for prolonged office consultations in the LOS
section of the Visit Navigator.
99241 - Level I LOS Code
99242 - Level II LOS Code
99243 - Level III LOS Code
99244 - Level IV LOS Code
99245 - Level V LOS Code
99241- w/ Resident (GC) - Level I LOS Code
99242 - w/ Resident (GC)- Level II LOS Code
99243 - w/ Resident (GC) - Level III LOS Code
99244 - w/ Resident (GC) - Level IV LOS Code
99245 - w/ Resident (GC) - Level V LOS Code
Page 3 of 3
Printed by STRAKA, KEVIN F [KFS1] at 2/2/2017 3:35:27 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
02/2017CCKM@uwhealth.org