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/clinical/cckm-tools/content/order-sets/ambulatory/cardiologyct-surgery/name-98590-en.cckm

20180109

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100

UWHC,UWMF,

Tools,

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

FDS - Cardiac Surgery - Pediatric - Preoperative [2756]

FDS - Cardiac Surgery - Pediatric - Preoperative [2756] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Ambulatory, Cardiology/CT Surgery


FDS - Cardiac Surgery - Pediatric - Preoperative [2756]
Pre-Day of Procedure
Laboratory [121545]
CBC WITH DIFFERENTIAL [CBC] Status: Standing, Expires:2/22/18 MANUAL,Count:1,
Normal, Routine
PROTHROMBIN TIME/INR [PT] Status: Standing, Expires:2/22/18 MANUAL,Count:1,
Normal, Routine
PTT [PTT] Status: Standing, Expires:2/22/18 MANUAL,Count:1,
Normal, Routine
ELECTROLYTES [LYTE] Status: Standing, Expires:2/22/18 MANUAL,Count:1,
Normal, Routine
GLUCOSE [GLU] Status: Standing, Expires:2/22/18 MANUAL,Count:1,
Normal, Routine
BUN [BUN] Status: Standing, Expires:2/22/18 MANUAL,Count:1,
Normal, Routine
CREATININE [CRET] Status: Standing, Expires:2/22/18 MANUAL,Count:1,
Normal, Routine
CALCIUM [CA] Status: Standing, Expires:2/22/18 MANUAL,Count:1,
Normal, Routine
TSH [TSH] Status: Standing, Expires:2/22/18 MANUAL,Count:1,
Normal, Routine
T4, FREE [FT4] Status: Standing, Expires:2/22/18 MANUAL,Count:1,
Normal, Routine
URINALYSIS, NO MICROSCOPY [UACHEM] Status: Standing, Expires:2/22/18 MANUAL,Count:1,
Normal, Routine
Laboratory - Pregnancy Test [87226]
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:2/22/18 MANUAL,Count:1,
Normal, Routine
Labs - Blood Bank [121548]
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.
Type and Screen
Order if specimen collection will be less than 72 hours prior to surgery.
TYPE AND SCREEN [HCTS] Status: Standing, Expires:2/22/18 MANUAL,Count:1,
Normal, Routine
ANTIBODY SCREEN [ABSCR] Status: Standing, Expires:2/22/18 MANUAL,Count:1,
Normal, Routine
ABO AND RH TYPING [ABO] Status: Standing, Expires:2/22/18 MANUAL,Count:1,
Normal, Routine
TYPE AND SCREEN, NEONATAL [HCNTS] Status: Standing, Expires:2/22/18 MANUAL,Count:1,
Normal, Routine
Diagnostic Tests and Imaging [121554]
ECG - 12 Lead (PEDS) [EKG0014] Status: Future, Expires: 2/8/2019, Normal, Routine
X-RAY CHEST 2 VIEWS [R71046] Status: Future, Expires: 3/8/2019, Normal, Routine
Diagnostic Tests and Imaging - For Patients with Down Syndrome [86364]
X-ray cervical spine >= 4 views [R72040] Status: Standing AUTO, Normal, Routine
Page 1 of 9
Printed by LIND, JANNA S [JSL237] at 1/8/2018 1:38:31 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

Pre-Op Day of Procedure
General [117322]
Note: RPH release post-op drips and send to OR
[950018]
ONCE For 1 Doses, Pre-Op Day Of Procedure
Note: RPH release and verify resuscitation meds
and have available on unit [950018]
ONCE For 1 Doses
Resuscitation medications include albumin, atropine,
calcium chloride, epINEPHrine, lidocaine and sodium
bicarbonate injections.
Pre-Op Day Of Procedure
Laboratory - If Not Obtained at Clinic Visit [86362]
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
PROTHROMBIN TIME/INR [PT] 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
PTT [PTT] 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, WHOLE BLOOD
[HCWBLYTS]
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
GLUCOSE, WHOLE BLOOD [HCWBGLU] STAT - RN COLLECT, Starting today For 1
Occurrences, STAT
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, WHOLE BLOOD [HCWBCRET] STAT - RN COLLECT, Starting today For 1
Occurrences, STAT
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
Page 2 of 9
Printed by LIND, JANNA S [JSL237] at 1/8/2018 1:38:31 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

CALCIUM [CA] 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
TSH [TSH] 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
T4, FREE [FT4] 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
URINALYSIS, NO MICROSCOPY [UACHEM] ONCE, 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]
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] 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 [103475]
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 Center Lab at (608) 234-6600 as
appropriate., Pre-Op Day Of Procedure
TYPE AND SCREEN, NEONATAL [HCNTS] 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
Blood Bank [203279]
Notify Blood Bank: Peds Cardiac Surgery Blood
Product Needed [BLB0021]
If patient is less than 12 months, please aliquot 1 unit
of red blood cells into smaller units. Leave remaining
units whole.
Blood Products [83983]
Page 3 of 9
Printed by LIND, JANNA S [JSL237] at 1/8/2018 1:38:31 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

Red Blood Cells (Adult) [BLB0006] 1 UNIT, Starting today For 1 Occurrences, Routine
Reason for Order: R1 Life-threatening hemorrhage or
anticipated/ongoing surgical blood loss
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):
CMV Negative (Heart/Lung Transplant and Neonates
up to 4 Months Only) (May be pre-selected based on
history):
Consent Status:
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:
Consent Status:
Pre-Op Day Of Procedure
Platelets (Adult) [BLB0004] 1 SINGLE, Starting today For 1 Occurrences, 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):
CMV Negative (Heart/Lung Transplant and Neonates
up to 4 Months Only) (May be pre-selected based on
history):
Consent Status:
Pre-Op Day Of Procedure
Cryoprecipitate (Adult) [BLB0005] 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:
Consent Status:
Fibrin Glue, mLs Needed:
Pre-Op Day Of Procedure
Blood Products [83984]
Page 4 of 9
Printed by LIND, JANNA S [JSL237] at 1/8/2018 1:38:31 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

Red Blood Cells (Pediatric) [BLB0013] 1 UNIT, Starting today For 1 Occurrences, Routine
If ordering < 1 unit specify the Total Volume to be
transfused (mL):
Reason for Order: PR5 Acute blood loss or anticipated
surgical blood loss
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):
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):
Consent Status:
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:
Consent Status:
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):
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):
Consent Status:
Pre-Op Day Of Procedure
Page 5 of 9
Printed by LIND, JANNA S [JSL237] at 1/8/2018 1:38:31 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

Cryoprecipitate (Pediatric) [BLB0012] 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:
Consent Status:
Pre-Op Day Of Procedure
Surgical Prophylaxis
First Line [145825]
cefazolin (ANCEF) intraVENOUS - Maximum
Dose = 2000 mg [800000]
30 mg/kg, Intravenous, ON CALL For 1 Doses,
IntraOp
MRSA/Documented MRSA History [145826]
both cefazolin and vancomycinChoose
Cefazolin - Vancomycin [235368]
cefazolin (ANCEF) intraVENOUS - Maximum
Dose = 2000 mg [800000]
30 mg/kg, Intravenous, ON CALL For 1 Doses,
IntraOp
vancomycin (VANCOCIN) intraVENOUS -
Maximum Dose = 2000 mg [800084]
15 mg/kg, Intravenous, ON CALL For 1 Doses, Pre-
Op Day Of Procedure
Patients with Immediate/Severe Reaction to Penicillin or Known Cephalosporin Allergies [145827]
vancomycin (VANCOCIN) intraVENOUS [800084] 15 mg/kg, Intravenous, ON CALL For 1 Doses, Pre-
Op Day Of Procedure
Non-Categorized [145828]
gentamicin (GARAMYCIN) intraVENOUS -
NOTE: Order for patients with a positive UA. Do
NOT redose if given intraoperatively. [800049]
4 mg/kg, Intravenous, ON CALL For 1 Doses
NOTE: For patients with a positive UA. Do NOT
redose if given intraoperatively.
IntraOp
IntraOp
Laboratory [118366]
ACTIVATED CLOTTING TIME, POC
[HCACTPOC]
CONDITIONAL For 1 Days, Routine
If Conditional, What Condition? Monitor heparin
IntraOp
IntraOp
Diagnostic Tests and Imaging [86365]
Transesophageal Echocardiogram (PEDS)
[ECH0020]
ONCE, Starting today For 1 Occurrences, Routine
Current signs and symptoms? Heart Surgery
What specific question(s) would you like answered by
this exam? Evaluate Function and Repair
Relevant recent/past history? Congenital Heart
Disease
To whom can we send the results of the study?
(include clinician and location): Attending Pediatric
Cardiac Surgeon
Last patient height? (will auto pull in value and date in
comment):
Last patient weight? (will auto pull in value and date in
comment):
CONGENITAL HEART DISEASE, IntraOp
Page 6 of 9
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Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

Imaging in OR [R10000] ONCE-RAD NEXT AVAILABLE For 1 Occurrences,
STAT
Current signs and symptoms? Open Heart Surgery
What specific question(s) would you like answered by
this exam? Evaluate Heart Size, Lung Fields, and
lines
Relevant recent/past history?
IntraOp
PostOp/Phase II
General [100678]
Note: RPH release post-op drips and send to OR.
Medications include: aminocaproic acid,
milrinone, DOPamine, epinephrine,
norepinephrine, esmolol, and nicardipine [950018]
ONCE For 1 Doses, Pre-Op Day Of Procedure
Note: RPH release and verify resuscitation meds
and patency line flushes and have available on
unit. [950018]
ONCE For 1 Doses
Resuscitation medications include albumin, atropine,
calcium chloride, epINEPHrine, lidocaine, and sodium
bicarbonate injections. Sedation drips include fentanyl,
midazolam, dexmedetomidine.
Pre-Op Day Of Procedure
Infusions - Send to OR for intraoperative administration and continuation post-operatively [89025]
aminocaproic acid infusion PEDS [800129] 10 mg/kg/hr, Intravenous, CONTINUOUS, Post-
Op/Phase II
dexmedetomidine (PRECEDEX) infusion PEDS
[800135]
0.1-0.9 mcg/kg/hr, Intravenous, CONTINUOUS
Titrate per Peds ICU Analgesia/Sedation protocol.
Initiate per protocol or current rate and titrate to
sedation goal.
Post-Op/Phase II
DOPamine (INTROPIN) infusion PEDS [800137] 2-10 mcg/kg/min, Intravenous, CONTINUOUS
Do NOT initiate without Attending approval.
Initiate at 2 mcg/kg/min or current rate. Adjust dose
per MD direction.
Post-Op/Phase II
epiNEPHrine infusion PEDS [800138] 0.01-0.1 mcg/kg/min, Intravenous, CONTINUOUS
Do NOT initiate without Attending approval.
Initiate at 0.01 mcg/kg/min or current rate. Adjust
dose per MD direction
Post-Op/Phase II
norepinephrine (LEVOPHED) infusion PEDS
[800160]
0.01-0.1 mcg/kg/min, Intravenous, CONTINUOUS
Do NOT initiate without Attending approval.
Initiate at 0.01 mcg/kg/min or current rate. Adjust
dose per MD direction
Post-Op/Phase II
esmolol (BREVIBLOC) infusion PEDS [800141] 25-500 mcg/kg/min, Intravenous, CONTINUOUS
Initiate 50 mcg/kg/min. Adjust dose per MD direction.
Maximum dose 500 mcg/kg/min
Post-Op/Phase II
FENTanyl infusion PEDS [800143] 0.5-10 mcg/kg/hr, Intravenous, CONTINUOUS
Titrate per Peds ICU Analgesia/Sedation protocol.
Initiate per protocol or current rate and titrate to
sedation goal.
Post-Op/Phase II
Page 7 of 9
Printed by LIND, JANNA S [JSL237] at 1/8/2018 1:38:31 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

midazolam (VERSED) infusion PEDS [800154] 0.05-0.1 mg/kg/hr, Intravenous, CONTINUOUS
Titrate per Peds ICU Analgesia/Sedation protocol.
Initiate per protocol or current rate and titrate to
sedation goal.
Post-Op/Phase II
milrinone (PRIMACOR) infusion PEDS [800155] 0.25-1 mcg/kg/min, Intravenous, CONTINUOUS
Do NOT initiate without Attending approval. Initiate 50
mcg/kg over 15 min. Adjust dose per MD direction
Post-Op/Phase II
nicardipine (CARDENE) infusion PEDS [800157] Intravenous, CONTINUOUS, Post-Op/Phase II
Medications - Resuscitation [89022]
atropine injection - Minimum dose of 0.1 mg
[760347]
0.02 mg/kg, Intravenous, ONCE PRN For 1 Doses,
bradycardia
Minimum dose of 0.1 mg
for 1 Minutes, Post-Op/Phase II
calcium CHLOride injection 20 mg/kg - (Maximum
Dose = 1 gram) [800104]
20 mg/kg, Intravenous, ONCE PRN For 1 Doses,
emergency resuscitation. To be given only with
physician confirmation that PRN criteria have been
met , Post-Op/Phase II
epINEPHrine (CARDIAC 1:10,000) PEDS 0.1
mg/mL injection CUSTOM [760293]
10 mcg/kg, Intravenous, ONCE PRN For 1 Doses,
emergency resuscitation. To be given only with
physician confirmation that PRN criteria have been
met , Post-Op/Phase II
lidocaine (XYLOCAINE-CARDIAC) injection
[760348]
1 mg/kg, Intravenous, ONCE PRN For 1 Doses,
emergency resuscitation. To be given only with
physician confirmation that PRN criteria have been
met, Post-Op/Phase II
sodium bicarbonate injection [800214] 1 mEq/kg, Intravenous, ONCE PRN For 1 Doses,
emergency resuscitation. To be given only with
physician confirmation that PRN criteria have been
met, Post-Op/Phase II
albumin human 5% infusion - (Maximum Dose =
25 gram) [44038]
0.5 g/kg, Intravenous, PRN For 3 Doses, emergency
resuscitation. To be given only with physician
confirmation that PRN criteria have been met, Post-
Op/Phase II
Flushes [151600]
heparin 1 unit/ml in sodium chloride 0.9 % 50 mL
patency line - Arterial Line IV Flush [700923]
at 1 mL/hr, Intraarterial, CONTINUOUS
For Pediatric Arterial Lines
Post-Op/Phase II
heparin in sodium chloride 0.9 % 50 mL patency
line - Left Arterial Line Flush [700923]
at 1 mL/hr, Intraarterial, CONTINUOUS
For Left Arterial Line Flush
Post-Op/Phase II
heparin in sodium chloride 0.9 % 50 mL patency
line - Central Venous Pressure (CVP) Line Flush
[700923]
at 1 mL/hr, Intravenous, CONTINUOUS
For Pediatric Central Venous Pressure (CVP) Lines
Post-Op/Phase II
heparin in sodium chloride 0.9% 50 mL patency
line - For Right Artial Line Flush [700923]
at 1 mL/hr, Intraarterial, CONTINUOUS
For Right Atrial Line Flush
Post-Op/Phase II
Diagnosis
Diagnosis - Pre Op [711]
Pre-operative general physical examination
[255759]
Other specified pre-operative examination
Level of Service
Page 8 of 9
Printed by LIND, JANNA S [JSL237] at 1/8/2018 1:38:31 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

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
Page 9 of 9
Printed by LIND, JANNA S [JSL237] at 1/8/2018 1:38:31 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org