/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/pulmonary/,

/clinical/cckm-tools/content/order-sets/ambulatory/pulmonary/name-98532-en.cckm

20180232

page

100

UWHC,UWMF,

Tools,

Clinical Hub,UW Health Clinical Tool Search,UW Health Clinical Tool Search,Order Sets,Ambulatory,Pulmonary

OP/FDS - Bronchoscopy - Pediatric - Pre/Postprocedure [2922]

OP/FDS - Bronchoscopy - Pediatric - Pre/Postprocedure [2922] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Ambulatory, Pulmonary


OP/FDS - Bronchoscopy - Pediatric - Pre/Postprocedure [2922]
Pre-Day of Procedure
Consults [90506]
CONSULT TO UWH ANESTHESIA PASS
PREOP SERVICE [1009482]
Please indicate Surgical/Procedural Service (if not in
case request):
Who is Surgeon or Proceduralist? (if not in case
request):
Service contact + Pager/Phone. Essential for follow-
up!!:
If you want patient to be seen IN-PERSON at the
PASS Clinic, please select the reason:
CARDIOVASCULAR, chart review only:
PULMONARY OR AIRWAY, chart review only:
MEDICATION, chart review only:
OTHER REASONS, chart review only:
Who will complete the H&P?
If H&P to be done by non-UWH provider, what facility?
Approximately when will H&P be completed, from
today? (Reminder - H&Ps are required by CMS to be
done within 30 days):
Pre-Op Day of Procedure
Isolation Status [97372]
Enhanced Contact Isolation - CDIFF [ISO0348] What is the reason for isolation?
Separate order must be placed for isolation cart., Pre-
Op Day Of Procedure
Contact Isolation - MDRO (MRSA) [ISO0334] CONTINUOUS
What is the Reason for Isolation? MRSA
Separate order must be placed for isolation cart., Pre-
Op Day Of Procedure
Contact Isolation - MDRO (VRE) [ISO0334] CONTINUOUS
What is the Reason for Isolation? VRE
Separate order must be placed for isolation cart., Pre-
Op Day Of Procedure
Isolation - Protective Precautions [240760]
Protective Precautions [ISO0349] What is the Reason for Isolation?
Pre-Op Day Of Procedure
Isolation Cart [EQP0016] CONTINUOUS, Routine, Pre-Op Day Of Procedure
Protective - Positive Pressure Room
[NURCOM0109]
CONTINUOUS
Isolation - Contact - Multidrug Resistant
Organism (MDRO) [233557]
Contact Isolation - MDRO [ISO0334] CONTINUOUS
What is the Reason for Isolation? MDR
Pre-Op Day Of Procedure
Isolation Cart [EQP0016] CONTINUOUS, Routine, Pre-Op Day Of Procedure
Isolation - Contact - Multidrug Resistant
Organism (XDR) [233558]
Contact Isolation - MDRO (XDR) [ISO0334] CONTINUOUS
What is the Reason for Isolation? XDR
Pre-Op Day Of Procedure
Isolation Cart [EQP0016] CONTINUOUS, Routine, Pre-Op Day Of Procedure
IntraOp
Page 1 of 6
Printed by WILLIAMS, HEATHER R [HRS0] at 1/31/2018 1:28:18 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

Laboratory - Bronchoscopy - Bronchoalveolar Lavage [90507]
CELL COUNT, BAL [HCBALCC] STAT, 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?
Please evaluate for hemosiderin-laden macrophages,
IntraOp
CULTURE, BAL, QUANT WITH GRAM STAIN
[HCBALC]
STAT, 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?
IntraOp
CULTURE, FUNGAL, WITH SMEAR
[HCFCULTS]
STAT, Starting today For 1 Occurrences, Routine,
Smears not routinely performed on CSF. If CSF,
order Culture, Fungal.
Indicate source if other:
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
IntraOp
AFB SMEAR AND CULTURE [130496]
AFB SMEAR [AFBSMR] ONCE For 1 Occurrences, Routine
If add on test, what should lab do if unable to add
test to previous specimen?
If Conditional, What Condition?
AFB CULTURE [AFBCX] ONCE For 1 Occurrences, Routine, Smear and
culture should be ordered for diagnostic specimens.
M. avium complex PCR is performed on the first
smear positive respiratory specimen from patients
not previously diagosed with tuberculosis.
Susceptibility testing is performed automatically on
all initial M. tuberculosis isolates. Susceptibility
testing for some non-tuberculous mycobacteria is
available.
The initial M. tuberculosis isolate from each patient is
also genotyped as part of the CDC Universal
Genotyping Program.
If add on test, what should lab do if unable to add
test to previous specimen?
If Conditional, What Condition?
Airborne Isolation - Suspect Pulmonary TB
[ISO0326]
CONTINUOUS
Airborne Isolation - Confirmed Pulmonary TB
[ISO0325]
Details
Isolation - Airborne - Negative Pressure Room
[NURCOM0108]
CONTINUOUS
Isolation - Airborne - Cart - Powered Air Purifying
Respirator (PAPR) [EQP0099]
CONTINUOUS, Routine
PNEUMOCYSTIS JIROVECII STAIN, BAL
[HCTBOBAL]
STAT, 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?
IntraOp
Page 2 of 6
Printed by WILLIAMS, HEATHER R [HRS0] at 1/31/2018 1:28:18 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

CMV QUALITATIVE BY PCR, BAL [HCCMVBAL] STAT, 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?
IntraOp
RESPIRATORY VIRUS PANEL, PCR [131004]
RESPIRATORY VIRUS PANEL WITH
BORDETELLA, PCR [RVPBPCR]
ONCE For 1 Occurrences, Routine, The Respiratory
Virus Panel with Bordetella test includes detection of
the following: Influenza A, Influenza A subtype H1,
Influenza A subtype H3, Influenza B, RSV A, RSV B,
Parainfluenza 1, Parainfluenza 2, Parainfluenza 3,
Parainfluenza 4, Human Metapneumovirus,(hMPV),
Human Rhinovirus, Adenovirus, Bordetella pertussis,
Bordetella parapertussis/bronchiseptica, and
Bordetella holmesii.
This test is most appropriate for transplant and
select other immunocompromised patients. All
others should consider 'Influenza A, Influenza B, and
RSV by PCR'- [HCFLURSV].
During peak influenza season consider ordering
'Influenza A, Influenza B, and RSV by PCR'-
[HCFLURSV].
If testing for only Bordetella species is desired, order
'Bordetella species by PCR ' - [BORDPCR]
Collect Nasopharyngeal Minitip swab (flocked swab)
and place in UTM. BAL is also acceptable. Room
temperature M4 (M4RT) is not acceptable.
If add on test, what should lab do if unable to add
test to previous specimen?
If Conditional, What Condition?
Contact/Droplet Isolation - Respiratory Virus
[ISO0342]
What is the Reason for Isolation?
Isolation Cart Contact/Enhanced Contact
[EQP0016]
CONTINUOUS, Routine
HERPES SIMPLEX VIRUS BY PCR
[HCHSVPCR]
STAT, Starting today For 1 Occurrences, Routine
Indicate specimen source if other:
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
IntraOp
CULTURE, LEGIONELLA [LEGCX] STAT, 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?
IntraOp
CULTURE, NOCARDIA [HCNCULT] STAT, Starting today For 1 Occurrences, Routine
Indicate source if other:
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
IntraOp
Page 3 of 6
Printed by WILLIAMS, HEATHER R [HRS0] at 1/31/2018 1:28:18 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

CYTOLOGY, NON-GYN, LIPID-LADEN
MACROPHAGES [HCPATHM]
STAT, Starting today For 1 Occurrences, For any
questions please refer to U-Connect Test Directory or
contact UWHC Cytology at (608)263-3205.
Specimen Source Description/Laterality:
Please indicate laterality if appropriate:
Method of Collection - Urine specimens only:
Other cytology tests not related to malignancy:
Evaluate for Lipid-laden Macrophages
Clinical History:
IntraOp
GALACTOMANNAN, BAL [HCGLACTB] STAT For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
SURGICAL PATHOLOGY [HCPATHS] ONCE For 1 Occurrences, Routine, This order is to be
used for fresh or formalin-fixed (for gross and micro
evaluation) tissues.
Slides and/or paraffin-embedded blocks coming from
outside institutions needing second opinion pathology
review should be ordered as Surgical Pathology
Consult [HCPATHSP].
Specimen Source Description:
Number of containers:
Clinical Diagnosis/Reason for Procedure:
Other pertinent information:
Frozen section call back number:
Type of Procedure:
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
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/Return to Work [90509]
Activity [NURACT0008] Routine
Discharge Activity:
May return to work/school in ***.
No bike riding, climbing, driving, or other sports for
today., Phase II Discharge
When to Call the Doctor or Nurse [90510]
Page 4 of 6
Printed by WILLIAMS, HEATHER R [HRS0] at 1/31/2018 1:28:18 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

Notify Doctor or Nurse [NURCOM0001] Routine, If your child has rapid, hard, or noisy
breathing, take your child to the nearest emergency
room. Call if significant coughing or wheezing. Notify
doctor or nurse for any bleeding the day after surgery;
nausea or vomiting that lasts more than 2 hours; fever
over 101 degrees F by mouth, ear or rectum, or over
100 degrees F under the arm; pain not controlled by
Tylenol.
Phone number for the Pediatric Pulmonology Service
is 608-263-6420, Monday though Friday, 8am-4:30
pm. After hours this number will be answered by the
paging operator. Ask for the pediatric pulmonary
doctor on-call. Leave your name and phone number
with the area code. The doctor will call you back.
Follow-Up Appointments [90511]
Patient to Schedule Appointment at Pediatric
Pulmonology Clinic [NURCOM0056]
Routine
Purpose: Postop evaluation
With whom: Pediatric Pulmonology Service
For when: 1-2 Weeks after procedure
Number to call: (608) 263-6420
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]
Page 5 of 6
Printed by WILLIAMS, HEATHER R [HRS0] at 1/31/2018 1:28:18 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

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 6 of 6
Printed by WILLIAMS, HEATHER R [HRS0] at 1/31/2018 1:28:18 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org