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201704118

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OP - Eye and Strabismus Surgery - Pediatric - Postoperative [2905]

OP - Eye and Strabismus Surgery - Pediatric - Postoperative [2905] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Ambulatory, Ophthalmology


OP - Eye and Strabismus Surgery - Pediatric - Postoperative [2905]
PostOp/Phase II
Prior to Discharge [92767]
Patient Must Be Seen by Attending Prior to
Discharge [NURMON0083]
ONCE, Starting today For 1 Occurrences, Routine,
Post-Op/Phase II
Patient Must Be Seen by Resident Prior to
Discharge [NURMON0082]
ONCE, Starting today For 1 Occurrences, Routine,
Post-Op/Phase II
Outpatient Discharge Orders
Activity [91342]
Activity [NURACT0011] Routine, -Progressive ambulation as tolerated
-No underwater activity for 14 days
-No physical education classes for 14 days
-No school or work for 3-5 days, per family and MD
discretion
-Showering and/or bathing are OK with head out of
water
Nutrition [91319]
Diet [NURDIE0013] Routine, Resume preoperative diet as tolerated
Wound Care [91347]
Wound Care [NURWND0018] Routine, Wear patch and shield until seen tomorrow
at clinic. Wear shield over operative eyes while
sleeping for two weeks. Wear glasses during day.
Contingency Parameters [115182]
Contingency Parameters [NURTRT0048] Routine, Call surgeon at 608-263-6414 if increased
pain uncontrolled by pain medications, prolonged
vomiting or unable to eat within 24 hours.
Medications - RIGHT Eye [115079]
tobramycin-dexamethasone (TOBRADEX)
0.3-0.1 % ophthalmic susp [46771]
1 drop, 5 mL, 2, starting 4/27/17, Normal, Phase II
Discharge
prednisolone (PRED FORTE) 1 % ophthalmic
susp [41271]
1 drop, 5 mL, 2, starting 4/27/17, Normal, Phase II
Discharge
sulfacetamide-prednisolone (CETAPRED)
10-0.23 % ophthalmic soln [111967]
1 drop, starting 4/27/17, Normal
May be substituted with SULFACETAMIDE-
PREDNISOLONE 10-0.2 % ophthalmic susp or
ophthalmic ointment.
Phase II Discharge
neomycin-polymyxin-dexamethasone
3.5-10000-0.1 ophthalmic ointment [142697]
1 Dose, starting 4/27/17, Normal, Phase II Discharge
Neomycin-Polymyxin-Dexameth 0.1 %
ophthalmic susp [45861]
1 drop, starting 4/27/17, Normal, Phase II Discharge
flurbiprofen (OCUFEN) 0.03 % ophthalmic soln
[45205]
1 drop, starting 4/27/17, Normal, Phase II Discharge
diclofenac (VOLTAREN) 0.1 % ophthalmic soln
[44946]
1 drop, starting 4/27/17, Normal, Phase II Discharge
ofloxacin (OCUFLOX) 0.3 % ophthalmic soln
[55774]
1 drop, starting 4/27/17, Normal, Phase II Discharge
atropine 1 % ophthalmic soln [34849] 1 drop, starting 4/27/17, Normal, Phase II Discharge
Medications - Left Eye [222338]
tobramycin-dexamethasone (TOBRADEX)
0.3-0.1 % ophthalmic susp [46771]
1 drop, 5 mL, 2, starting 4/27/17, Normal, Phase II
Discharge
Page 1 of 3
Printed by WILLIAMS, HEATHER R S [HRS0] at 4/27/2017 4:25:31 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 04/2017CCKM@uwhealth.org

prednisolone (PRED FORTE) 1 % ophthalmic
susp [41271]
1 drop, 5 mL, 2, starting 4/27/17, Normal, Phase II
Discharge
sulfacetamide-prednisolone (CETAPRED)
10-0.23 % ophthalmic soln [111967]
1 drop, starting 4/27/17, Normal
May be substituted with SULFACETAMIDE-
PREDNISOLONE 10-0.2 % ophthalmic susp or
ophthalmic ointment.
Phase II Discharge
neomycin-polymyxin-dexamethasone
3.5-10000-0.1 ophthalmic ointment [142697]
1 Dose, starting 4/27/17, Normal, Phase II Discharge
Neomycin-Polymyxin-Dexameth 0.1 %
ophthalmic susp [45861]
1 drop, starting 4/27/17, Normal, Phase II Discharge
flurbiprofen (OCUFEN) 0.03 % ophthalmic soln
[45205]
1 drop, starting 4/27/17, Normal, Phase II Discharge
diclofenac (VOLTAREN) 0.1 % ophthalmic soln
[44946]
1 drop, starting 4/27/17, Normal, Phase II Discharge
ofloxacin (OCUFLOX) 0.3 % ophthalmic soln
[55774]
1 drop, starting 4/27/17, Normal, Phase II Discharge
atropine 1 % ophthalmic soln [34849] 1 drop, starting 4/27/17, Normal, Phase II Discharge
Medications - Both Eyes [222339]
tobramycin-dexamethasone (TOBRADEX)
0.3-0.1 % ophthalmic susp [46771]
1 drop, 5 mL, 2, starting 4/27/17, Normal, Phase II
Discharge
prednisolone (PRED FORTE) 1 % ophthalmic
susp [41271]
1 drop, 5 mL, 2, starting 4/27/17, Normal, Phase II
Discharge
sulfacetamide-prednisolone (CETAPRED)
10-0.23 % ophthalmic soln [111967]
1 drop, starting 4/27/17, Normal
May be substituted with SULFACETAMIDE-
PREDNISOLONE 10-0.2 % ophthalmic susp or
ophthalmic ointment.
Phase II Discharge
neomycin-polymyxin-dexamethasone
3.5-10000-0.1 ophthalmic ointment [142697]
1 Dose, starting 4/27/17, Normal, Phase II Discharge
Neomycin-Polymyxin-Dexameth 0.1 %
ophthalmic susp [45861]
1 drop, starting 4/27/17, Normal, Phase II Discharge
flurbiprofen (OCUFEN) 0.03 % ophthalmic soln
[45205]
1 drop, starting 4/27/17, Normal, Phase II Discharge
diclofenac (VOLTAREN) 0.1 % ophthalmic soln
[44946]
1 drop, starting 4/27/17, Normal, Phase II Discharge
ofloxacin (OCUFLOX) 0.3 % ophthalmic soln
[55774]
1 drop, starting 4/27/17, Normal, Phase II Discharge
atropine 1 % ophthalmic soln [34849] 1 drop, starting 4/27/17, Normal, Phase II Discharge
Medications - Analgesics [115082]
acetaMINOPHEN alcohol free (TYLENOL) 160
MG/5ML susp - NOTE: Suggested dose 15
mg/kg (Maximum 650 mg/dose) [43991]
15 mg/kg, 1 Bottle, 0, starting 4/27/17, No Print,
Phase II Discharge
acetaMINOPHEN (TYLENOL) 325 mg tab -
Maximum 650 mg/dose [34149]
starting 4/27/17, Normal
ibuprofen (MOTRIN) 100 MG/5ML susp - NOTE:
Suggested dose 10 mg/kg (Maximum 600
mg/dose [45376]
10 mg/kg, starting 4/27/17, No Print, Phase II
Discharge
ibuprofen (MOTRIN) 200 MG tab - NOTE:
Suggested dose 10 mg/kg (Maximum 600
mg/dose) [38353]
starting 4/27/17, Normal
hydrocodone-acetaMINOPHEN (NORCO) 5-325
MG per tab [750021]
starting 4/27/17, Normal
hydrocodone-acetaMINOPHEN 7.5-325
MG/15ML soln [74885]
starting 4/27/17, Normal
Medication Instructions [90355]
Page 2 of 3
Printed by WILLIAMS, HEATHER R S [HRS0] at 4/27/2017 4:25:31 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 04/2017CCKM@uwhealth.org

Resume medications for operative eye after
patch removed [NURCOM0022]
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
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 WILLIAMS, HEATHER R S [HRS0] at 4/27/2017 4:25:31 PM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 04/2017CCKM@uwhealth.org