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/clinical/cckm-tools/content/order-sets/ambulatory/cardiologyct-surgery/name-98589-en.cckm

201606170

page

100

UWHC,UWMF,

Clinical Hub,UW Health Clinical Tool Search,UW Health Clinical Tool Search,Order Sets,Ambulatory,Cardiology/CT Surgery

FDS - Cardiac Surgery - Adult - Preoperative [2809]

FDS - Cardiac Surgery - Adult - Preoperative [2809] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Ambulatory, Cardiology/CT Surgery


FDS - Cardiac Surgery - Adult - Preoperative [2809]
Intended for Adult Patients Only
Pre-Day of Procedure
Medications-MRSA/MSSA Positive [138973]
Note: Please select the orders below if patient is MRSA or MSSA positive
mupirocin (BACTROBAN) 2 % ointment [45826] 1 Tube, 0, starting 9/8/15, E-Prescribe
chlorhexidine gluconate (HIBICLENS) 4 % topical liquid
[64730]
237 mL, , starting 9/8/15, E-Prescribe
Labs - MRSA and MSSA Screening [138594]
MRSA/MSSA BY PCR [HCMSSA] Status: Standing, Expires:1/8/16 Manual,Count:1, Office
collect, Routine, A Pre-Surgical screen consists of one
culturette swab from both left and right nares.
This assay cannot detect MSSA when MRSA is present.
Laboratory [88799]
BILIRUBIN, TOTAL [TBIL] Status: Standing, Expires:10/23/15 MANUAL,Count:1,
Normal, Routine
CBC WITHOUT DIFFERENTIAL [HEMO] Status: Standing, Expires:10/23/15 MANUAL,Count:1,
Normal, Routine
ELECTROLYTES [LYTE] Status: Standing, Expires:10/23/15 MANUAL,Count:1,
Normal, Routine
GLUCOSE [GLU] Status: Standing, Expires:10/23/15 MANUAL,Count:1,
Normal, Routine
BUN [BUN] Status: Standing, Expires:10/23/15 MANUAL,Count:1,
Normal, Routine
CREATININE [CRET] Status: Standing, Expires:10/23/15 MANUAL,Count:1,
Normal, Routine
CALCIUM [CA] Status: Standing, Expires:10/23/15 MANUAL,Count:1,
Normal, Routine
PROTHROMBIN TIME/INR [PT] Status: Standing, Expires:10/23/15 MANUAL,Count:1,
Normal, Routine
MAGNESIUM [MAG] Status: Standing, Expires:10/23/15 MANUAL,Count:1,
Normal, Routine
URINALYSIS WITH MICROSCOPY AND CULTURE IF
>5 WBC/HPF [HCUACULT]
Status: Standing, Expires:10/23/15 MANUAL,Count:1,
Normal, Routine
COLD AGGLUTININS, QUAL - Note: Order for
Reoperative Cardiac Surgery, ascending aortic repair,
and circulatory arrest patient. [COLD]
Status: Standing, Expires:10/23/15 MANUAL,Count:1,
Normal, Routine
Labs - Blood Bank [127748]
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:10/23/15 MANUAL,Count:1,
Normal, Routine
ABO AND RH TYPING [ABO] Status: Standing, Expires:10/23/15 MANUAL,Count:1,
Normal, Routine
Diagnostic Tests and Imaging [88800]
ECG - 12 Lead [EKG0008] Status: Future, Expires: 10/8/16, Normal, Routine
X-RAY CHEST PA & LAT VIEWS [R71020] Status: Future, Expires: 11/8/16, Normal, Routine
X-Ray Chest PA & LAT Views Dual Energy [R71020A] Status: Future, Expires: 11/8/16, Normal, Routine
Pre-Op Device Check - Order if Patient has an Internal Cardiac Defibrillator (ICD) or Pacemaker [154570]
Pre-op Device Check [CARD0017] Status: Future, Expires: 10/8/16, Normal, Routine, Qty-1
PreOp Day of Procedure
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Isolation Status [97372]
Isolation - Enhanced Contact - Clostridium Difficile
[ISO0010]
CONTINUOUS, Separate order must be placed for isolation
cart., Pre-Op Day Of Procedure
Isolation - Contact - MRSA [ISO0039] CONTINUOUS, Separate order must be placed for isolation
cart., Pre-Op Day Of Procedure
Isolation - Contact - VRE [ISO0051] CONTINUOUS, Separate order must be placed for isolation
cart., Pre-Op Day Of Procedure
Isolation - Protective Precautions - Panel [116356]
Protective Precautions [ISO0001] CONTINUOUS
Reason for Protective Precautions:
Pre-Op Day Of Procedure
Protective - Positive Pressure Room [NURCOM0109] CONTINUOUS, Pre-Op Day Of Procedure
Isolation - Contact - Multidrug Resistant Organism -
Panel [116335]
Isolation - Contact - Multidrug Resistant Organism
(MDR) [ISO0006]
CONTINUOUS, Pre-Op Day Of Procedure
Isolation Cart [EQP0016] CONTINUOUS, Routine, Pre-Op Day Of Procedure
Isolation - Contact - Extensively Resistant Organism
(XDR) - Panel [193206]
Isolation - Contact - Extensively Resistant Organism
(XDR) [ISO0320]
CONTINUOUS, Pre-Op Day Of Procedure
Isolation Cart [EQP0016] CONTINUOUS, Routine, Pre-Op Day Of Procedure
Patient Care Orders [88801]
Glucose, POC [IPGLUCOSE] ONCE, Starting today For 1 Occurrences, Routine, Glucose,
POC should always be ordered in conjunction with orders for
hypoglycemia management and monitoring as indicated in
the Hypoglycemia Management (Adult) panel.
If Conditional, What Condition?
Pre-Op Day Of Procedure
Notify Pacemaker/ICD Nurse Regarding OR Date and
Time (If Known) To Facilitate Pacemaker Setting
Changes [NURCOM0052]
ONCE, Routine
Order Name (Only necessary if something other than
"Nursing Communcation" is preferred.):
Notify Pacemaker/ICD Nurse Regarding OR Date and Time
(If Known) To Facilitate Pacemaker Setting Changes, Pre-Op
Day Of Procedure
Chlorhexidine gluconate 2% Cloth (Sage Cloth)
[NURWND0045]
SEE COMMENTS, Routine, Contraindicated for use on open
wounds, on patients 2 months of age and younger or on
patients with a chlorhexidine allergy., Cleanse incision site if
patient has not bathed with Hibiclens morning of surgery.,
Pre-Op Day Of Procedure
Measure Height [NURMON0052] ONCE, Routine, Pre-Op Day Of Procedure
Premedications for Needle Insertion [106313]
Use lidocaine topical dressing kit for stable patient, no lidocaine allergies, have at least 30 minutes time prior to needing
to use IV
Sodium chloride (bacteriostatic) 0.9% intradermal: Useful for patients requiring urgent IV access; onset is within 1 minute.
Choice of medication should be based on patient’s previous experience/preference, history of lidocaine allergy and ease
of access.
lidocaine (LMX) 4% topical dressing kit [66882] Topical, EVERY 1 HOUR PRN, peripheral line insertion - see
Admin Instructions
Do NOT apply to area greater than 200 square centimeters
(maximum 2.5 g/site; maximum 4 sites per hour, 6 times per
day). Do NOT leave on longer than 2 hours. Use for stable
patient, no allergies to lidocaine, with at least 30 minutes time
prior to IV use
Pre-Op Day Of Procedure
lidocaine (XYLOCAINE) 1% injection [39034] 0.1-0.4 mL, Intradermal, PRN, peripheral line insertion - see
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Admin Instructions
Use an insulin or TB syringe with a 25-30 gauge needle to
inject solution and create a wheal. Wait 30 seconds to 1
minute then insert IV catheter into center of wheal. Use if IV
is needed within 30 minutes. Choice of medication should be
based on patient’s previous experience/preference, history of
lidocaine allergy and ease of access
Pre-Op Day Of Procedure
sodium chloride (bacteriostatic) 0.9 % injection [50585] 0.05-0.1 mL, Intradermal, PRN, peripheral line insertion - see
Admin Instructions
Use an insulin or TB syringe with a 25-30 gauge needle to
inject solution and create a wheal. Wait 30 seconds to 1
minute then insert IV catheter into center of wheal. Use if IV
is needed within 30 minutes. Choice of medication should be
based on patient’s previous experience/preference, history of
lidocaine allergy and ease of access
Pre-Op Day Of Procedure
IV Fluids [127749]
Insert and Maintain Peripheral IV [NURVAD0013] CONTINUOUS, Routine
Peripheral IV Size: 18 Gauge
Peripheral IV Location:
Peripheral IV Device:
Peripheral IV Status:
Does this need to be inserted/placed?
Pre-Op Day Of Procedure
dextrose 5%-NaCl 0.45% infusion [51613] at 75 mL/hr, Intravenous, CONTINUOUS
For 2nd and 3rd case
Pre-Op Day Of Procedure
Laboratory [88865]
BILIRUBIN, TOTAL [TBIL] STAT - RN COLLECT, Starting today For 1 Occurrences,
Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Pre-Op Day Of Procedure
ALT/SGPT [ALT] STAT - RN COLLECT, Starting today For 1 Occurrences,
Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Pre-Op Day Of Procedure
AST/SGOT [AST] STAT - RN COLLECT, Starting today For 1 Occurrences,
Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Pre-Op Day Of Procedure
GGT [GGT] STAT - RN COLLECT, Starting today For 1 Occurrences,
Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Pre-Op Day Of Procedure
LD, TOTAL [LDH] STAT - RN COLLECT, Starting today For 1 Occurrences,
Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Pre-Op Day Of Procedure
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LIPID PANEL [LIPID] STAT - RN COLLECT, Starting today For 1 Occurrences,
Routine, Test includes Cholesterol, Total; HDL Cholesterol;
Triglyceride; LDL cholesterol, calculated; and non-HDL
cholesterol.
Patient must fast for 12-14 hours and be heparin free for 48
hours prior to specimen collection. The patient can only have
water or black coffee during the fasting period.
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Pre-Op Day Of Procedure
URINALYSIS WITH MICROSCOPY AND CULTURE IF
>5 WBC/HPF [HCUACULT]
ONCE For 1 Occurrences, Routine
Indication:
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Pre-Op Day Of Procedure
CBC WITHOUT DIFFERENTIAL [HEMO] STAT - RN COLLECT, Starting today For 1 Occurrences,
Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Pre-Op Day Of Procedure
ELECTROLYTES [LYTE] STAT - RN COLLECT, Starting today For 1 Occurrences,
Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Pre-Op Day Of Procedure
BUN [BUN] STAT - RN COLLECT, Starting today For 1 Occurrences,
Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Pre-Op Day Of Procedure
CREATININE [CRET] STAT - RN COLLECT, Starting today For 1 Occurrences,
Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Pre-Op Day Of Procedure
Laboratory - Pregnancy Test [81397]
Obtain pregnancy test if female between menarche & menopause and any of: (1) surgery is pelvic, renal, or intra-
abdominal, (2) patient had unprotected intercourse, (3) patient missed menses, (4) patient says she "could" be pregnant.
Urine, Pregnancy Test [UPREG] STAT - RN COLLECT, Starting today For 1 Occurrences,
Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition?
Pre-Op Day Of Procedure
Tests [83980]
TYPE AND SCREEN [HCTS] STAT - RN COLLECT, Starting today For 1 Occurrences,
Routine, As good clinical practice and for patient safety, the
Transfusion Service will automatically crossmatch 2 packed
RBCs on all patients with antibodies to ensure blood would be
available in the event it is needed. If you would like to opt out
of this automatic order for this patient please contact the
UWHC Blood Bank at (608) 263-8367 or The American
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Copyright © 2015 University of Wisconsin Hospitals and Clinics Authority, University of Wisconsin Medical Foundation, Inc, UW-Madison

 

Center Lab at (608) 234-6600 as appropriate., Pre-Op Day Of
Procedure
Blood Products [127750]
Red Blood Cells (Adult) [BLB0006] Starting today, Routine
Reason for Order:
Blood Product Need (It will take approximately 30 to 60
minutes from the time nursing notifies the Blood Bank to
prepare the products): SURGICAL USE
Date Product Needed:
Uncrossmatched **WARNING** Requesting MD verifies that
the clinical situation is sufficiently urgent to require release of
blood before completion of compatibility testing and agrees to
hold UWHC harmless for any and all liability for any injuries
resulting from release of blood before such testing:
Irradiated (See Blood Product Guidelines) (May be pre-
selected based on history):
Indication for Irradiated Blood:
CMV Negative (Heart/Lung Transplant and Neonates up to 4
Months Only) (May be pre-selected based on history):
Has consent been obtained?
Date Consent Obtained (Valid for 1 year):
Patient Weight
No data found for Wt
All cellular products are leukocyte-reduced (CMV safe)
1 Red Blood Cell Unit ~ 350 mL., Pre-Op Day Of Procedure
Plasma (Adult) [BLB0003] Starting today, Routine
Reason for Order:
Blood Product Need (It will take approximately 30 to 60
minutes from the time nursing notifies the Blood Bank to
prepare the products): SURGICAL USE
Date Product Needed:
Has consent been obtained?
Date Consent Obtained (Valid for 1 year):
Patient Weight
No data found for Wt
1 Plasma Unit ~ 200 mL.
NURSING REMINDER: Call UWHC Blood Bank at (608) 263-
8367 or The American Center Lab at (608) 234-6600 as
appropriate 30-60 minutes before transfusion to prepare
products.
Pre-Op Day Of Procedure
Platelets (Adult) [BLB0004] Starting today, Routine
Reason for Order:
Blood Product Need (It will take approximately 30 to 60
minutes from the time nursing notifies the Blood Bank to
prepare the products): SURGICAL USE
Date Product Needed:
Irradiated (See Blood Product Guidelines) (May be pre-
selected based on history):
Indication for Irradiated Blood:
CMV Negative (Heart/Lung Transplant and Neonates up to 4
Months Only) (May be pre-selected based on history):
Has consent been obtained?
Date Consent Obtained (Valid for 1 year):
Patient Weight
No data found for Wt
For refractory patients, call UWHC Blood Back at (608) 263-
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8307 or The American Center Lab at (608) 234-6600 as
appropriate 30-60 minutes (at UWHC) or 2-3 hours (at The
American Center) before transfusion to prepare products.
1 Single Donor Unit ~ 200-250 mL.
All platelet products are leukocyte-reduced (CMV safe).
NURSING REMINDER: Call UWHC Blood Bank at (608) 263-
8367 or The American Center Lab at (608) 234-6600 as
appropriate 30-60 minutes (at UWHC) or 2-3 hours (at The
American Center) before transfusion to prepare products.,
Pre-Op Day Of Procedure
Cryoprecipitate (Adult) [BLB0005] Routine
Reason for Order:
Blood Product Need (It will take approximately 30 to 60
minutes from the time nursing notifies the Blood Bank to
prepare the products): SURGICAL USE
Date Product Needed:
Has consent been obtained?
Fibrin Glue, mLs Needed:
Date Consent Obtained (Valid for 1 year):
Patient Weight
No data found for Wt
Cryoprecipitate is stored frozen as 5 pooled units (approx
120mL). Standard adult dose = 10 units. Suggested dose =
1 unit/10 kg.
Individual cryoprecipitate units are also available for fibrin
glue (approx 10-15 mL each).
NURSING REMINDER: Call UWHC Blood Bank at (608) 263-
8367 or The American Center Lab at (608) 234-6600 as
appropriate 30-60 minutes before transfusion to prepare
products., Pre-Op Day Of Procedure
Blood Products [127751]
Red Blood Cells (Pediatric) [BLB0013] Starting today, Routine
If ordering < 1 unit specify the Total Volume to be transfused
(mL):
Reason for Order:
Blood Product Need (It will take approximately 30 to 60
minutes from the time nursing notifies the Blood Bank to
prepare the products): SURGICAL USE
Date Product Needed:
Uncrossmatched **WARNING** Requesting MD verifies that
the clinical situation is sufficiently urgent to require release of
blood before completion of compatibility testing and agrees to
hold UWHC harmless for any and all liability for any injuries
resulting from release of blood before such testing:
Irradiated (See Blood Product Guidelines) (May be pre-
selected based on history):
Indication for Irradiated Blood:
CMV Negative (Heart/Lung Transplant and Neonates up to 4
Months Only) (May be pre-selected based on history):
Volume-Reduced (May be pre-selected based on history):
Has consent been obtained?
Date Consent Obtained (Valid for 1 year):
Patient Weight
No data found for Wt
All cellular products are leukocyte-reduced (CMV safe).
1 Red Blood Cell Unit ~ 350 mL. Suggested dose: 10 mL/kg
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body weight., Pre-Op Day Of Procedure
Plasma (Pediatric) [BLB0010] Starting today, Routine
If ordering < 1 unit specify the Total Volume to be transfused
(mL):
Reason for Order:
Blood Product Need (It will take approximately 30 to 60
minutes from the time nursing notifies the Blood Bank to
prepare the products): SURGICAL USE
Date Product Needed:
Has consent been obtained?
Date Consent Obtained (Valid for 1 year):
Patient Weight
No data found for Wt
1 Plasma Unit ~ 200 mL. Suggested dose: 10-15 mL/kg body
weight.
NURSING REMINDER: Call UWHC Blood Bank at (608) 263-
8367 or The American Center Lab at (608) 234-6600 as
appropriate 30-60 minutes before transfusion to prepare
products., Pre-Op Day Of Procedure
Platelets (Pediatric) [BLB0011] Starting today, Routine
If ordering < 1 unit specify the Total Volume to be transfused
(mL):
Reason for Order:
Blood Product Need (It will take approximately 30 to 60
minutes from the time nursing notifies the Blood Bank to
prepare the products): SURGICAL USE
Date Product Needed:
Irradiated (See Blood Product Guidelines) (May be pre-
selected based on history):
Indication for Irradiated Blood:
CMV Negative (Heart/Lung Transplant and Neonates up to 4
Months Only) (May be pre-selected based on history):
Volume-Reduced (May be pre-selected based on history):
Has consent been obtained?
Date Consent Obtained (Valid for 1 year):
Patient Weight
No data found for Wt
For refractory patients, call UWHC Blood Back at (608) 263-
8307 or The American Center Lab at (608) 234-6600 as
appropriate 30-60 minutes (at UWHC) or 2-3 hours (at The
American Center) before transfusion to prepare products.
Suggested dose = 10-20 mL/kg body weight for neonatal and
pediatric patients. For patients greater than 60 kg, suggested
dose is 1 Single Donor Unit. 1 Single Donor Unit = 200-250
mL. All platelet products are leukocyte-reduced (CMV safe).
NURSING REMINDER: Call UWHC Blood Bank at (608) 263-
8367 or The American Center Lab at (608) 234-6600 as
appropriate 30-60 minutes (at UWHC) or 2-3 hours (at The
American Center) before transfusion to prepare products.,
Pre-Op Day Of Procedure
Cryoprecipitate (Pediatric) [BLB0012] Routine
Reason for Order:
Blood Product Need (It will take approximately 30 to 60
minutes from the time nursing notifies the Blood Bank to
prepare the products): SURGICAL USE
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Date Product Needed:
Has consent been obtained?
Date Consent Obtained (Valid for 1 year):
Patient Weight
No data found for Wt
1 Cryoprecipitate Unit ~ 10-20 mL. Suggested dose: 1 Unit/10
kg body weight. If patient weighs less than 10 kg, give 1 Unit.
NURSING REMINDER: Call UWHC Blood Bank at (608) 263-
8367 or The American Center Lab at (608) 234-6600 as
appropriate 30-60 minutes before transfusion to prepare
products., Pre-Op Day Of Procedure
Surgical Prophylaxis
First Line (Single Response) [141396]
cefuroxime (ZINACEF) intraVENOUS - NOTE: Patients
who are 40-120 kg [800030]
1.5 g, Intravenous, ON CALL For 1 Doses, IntraOp
cefuroxime (ZINACEF) intraVENOUS - NOTE: Patients
who are 121 kg or greater [800030]
3 g, Intravenous, ON CALL For 1 Doses, IntraOp
First Line for Valve Patients OR Non-valve Patients with MRSA (Single Response) [141394]
Patients who are 40-120 kg [192847]
cefuroxime (ZINACEF) intraVENOUS [800030] 1.5 g, Intravenous, ON CALL For 1 Doses, IntraOp
vancomycin (VANCOCIN) intraVENOUS [800084] 20 mg/kg, Intravenous, ON CALL For 1 Doses, Pre-Op
Day Of Procedure
Patients who are 121 kg or greater [192745]
cefuroxime (ZINACEF) intraVENOUS [800030] 3 g, Intravenous, ON CALL For 1 Doses, IntraOp
vancomycin (VANCOCIN) intraVENOUS [800084] 20 mg/kg, Intravenous, ON CALL For 1 Doses, Pre-Op
Day Of Procedure
Non-valve Patients with Immediate/Severe Reactions to Penicillin or Known Cephalosporin Allergies and MRSA
negative (Single Response) [141395]
Patients who are 40-120 kg [193050]
ciprofloxacin (CIPRO) intraVENOUS [800031] 400 mg, Intravenous, ON CALL For 1 Doses, Pre-Op Day
Of Procedure
vancomycin (VANCOCIN) intraVENOUS [800084] 20 mg/kg, Intravenous, ON CALL For 1 Doses, Pre-Op
Day Of Procedure
patients who are 121-159 kg [193056]
ciprofloxacin (CIPRO) intraVENOUS [800031] 600 mg, Intravenous, ON CALL For 1 Doses, Pre-Op Day
Of Procedure
vancomycin (VANCOCIN) intraVENOUS [800084] 20 mg/kg, Intravenous, ON CALL For 1 Doses, Pre-Op
Day Of Procedure
Patients who are 160 kg or greater [193053]
ciprofloxacin (CIPRO) intraVENOUS [800031] 800 mg, Intravenous, ON CALL For 1 Doses, Pre-Op Day
Of Procedure
vancomycin (VANCOCIN) intraVENOUS [800084] 20 mg/kg, Intravenous, ON CALL For 1 Doses, Pre-Op
Day Of Procedure
Valve Patients with Immediate/Severe Reactions to Penicillin or Known Cephalosporin Allergies and MRSA negative
(Single Response) [142359]
Patients who are 40-120 kg [193080]
ciprofloxacin (CIPRO) intraVENOUS [800031] 400 mg, Intravenous, ON CALL For 1 Doses, Pre-Op Day
Of Procedure
vancomycin (VANCOCIN) intraVENOUS [800084] 20 mg/kg, Intravenous, ON CALL For 1 Doses, Pre-Op
Day Of Procedure
Patients who are 121-159 kg [193086]
ciprofloxacin (CIPRO) intraVENOUS [800031] 600 mg, Intravenous, ON CALL For 1 Doses, Pre-Op Day
Of Procedure
vancomycin (VANCOCIN) intraVENOUS [800084] 20 mg/kg, Intravenous, ON CALL For 1 Doses, Pre-Op
Day Of Procedure
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Copyright © 2015 University of Wisconsin Hospitals and Clinics Authority, University of Wisconsin Medical Foundation, Inc, UW-Madison

 

Patients who are 160 kg or greater [193083]
ciprofloxacin (CIPRO) intraVENOUS [800031] 800 mg, Intravenous, ON CALL For 1 Doses, Pre-Op Day
Of Procedure
vancomycin (VANCOCIN) intraVENOUS [800084] 20 mg/kg, Intravenous, ON CALL For 1 Doses, Pre-Op
Day Of Procedure
IntraOp
Laboratory [118366]
ACTIVATED CLOTTING TIME, POC [HCACTPOC] CONDITIONAL For 1 Days, Routine
If Conditional, What Condition? Monitor heparin IntraOp
IntraOp
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
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 - New or Established [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
Preoperative Exam (Global) [1265]
Preoperative H&P, No Charge, Surgical Package LOS Code
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Copyright © 2015 University of Wisconsin Hospitals and Clinics Authority, University of Wisconsin Medical Foundation, Inc, UW-Madison