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ORDERS
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Open ORDERS
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ORDERS
• • •
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DOCTOR'S ORDERS free text
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MEDICAL NECESSITY
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MED NEC PROC/TEST NAME
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MEDICAL NECESSITY comments
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PRIOR AUTH REQUIRED?
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ORDER Durable Med Equip
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Open DME
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DME text
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CPAP/BiPAP
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Open CPAP/BiPAP
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>>> CPAP/BiPAP Vendor
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Vendor
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>>> CPAP/BiPAP Machine
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CPAP / BiPAP Machine
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>>> CPAP/BiPAP Mask
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Mask
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>>> CPAP/BiPAP Parts
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CPAP/BiPAP Parts
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Wheelchair, Power
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LABS
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Open LABS
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>>> In-House Labs
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Open In-House Labs
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A1c
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A1c Value
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GLUCOSE, Quantitative
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GLUCOSE Value
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GLUCOSE, Post-Glucose Dose
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GLUCOSE Value
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HEMOGLOBIN
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HEMOGLOBIN Value
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ALBUMIN; Urine (eg, microalbumin), Quantitative
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ALBUMIN Value
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H PYLORI
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URINALYSIS
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STREP A
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STREP POSITIVE?
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URINE TOX SCREEN
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PPD TB Test
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PPD TB Read: POSITIVE?
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PREGNANCY, Urine
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Pregnancy POSITIVE?
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>>> Outsourced Labs
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Open Outsourced Labs
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INSURANCE
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All Insurance, NO GEMCare
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QUEST LABS
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GEMCare ONLY
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PAL / WESTPAC LABS
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FEMALE ONLY
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Labs
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In-House TESTS / ECG
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Open TESTS
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TESTS
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WHEN?
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PRIOR AUTH REQUIRED?
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ECG
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Open ECG
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WHEN?
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PRIOR AUTH REQUIRED?
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Sleep Test, Home
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Open SLEEP TEST
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WHEN?
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PRIOR AUTH REQUIRED?
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Urodynamics
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Open URODYNAMICS
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WHEN?
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PRIOR AUTH REQUIRED?
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PROCEDURES
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Open PROCEDURES
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PROCEDURE
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WHEN?
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MED NEC
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MED NEC TEXT
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PRIOR AUTH REQUIRED?
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Audiometry
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Open AUDIOMETRY
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WHEN?
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PRIOR AUTH REQUIRED?
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Cerumen removal w/instrument
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Open CERUMEN
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WHEN?
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PRIOR AUTH REQUIRED?
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IMMUNIZATIONS
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IMMUNIZATIONS
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RADIOLOGY / IMAGING
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Open RADIOLOGY
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Send RAD to
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CPT + Location of Test
• • •
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Body Part
• • •
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RAD location specific...
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Radiology Comments
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HMO? PRIOR AUTH is REQUIRED
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PATIENT EDUCATION
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Open PATIENT EDUCATION
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EDUCATION >50% of ENCOUNTER
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Counseled on
• • •
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Education Comments
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GENERAL INSTRUCTIONS
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General Instructions Comments
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DIET
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Diet Comments
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Use ONLY when patient is being treated by Bariatrics
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Medically Supervised Weight Loss Program?
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Smoking Cessation
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Counseled on Smoking?
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Choose a Diagnosis
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F17.200 Nic Dep, Unspec, Uncomplicated
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F17.201 Nic Dep, Unspec, In Remission
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F17.210 Nic Dep, Cigarettes, Uncomplicated
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Z89.891 Personal Hx of Nicotine Dependence
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CT Lung Cancer Screen Criteria
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CT Lung CANCER SCREEN?
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Opioid Counseling
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Open OPIOID
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REFERRALS
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Open REFERRALS
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REFERRAL 1
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Referral Comments
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HMO? PRIOR AUTH is REQUIRED?
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STAT?
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REFERRAL 2
• • •
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Referral Comments
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HMO? PRIOR AUTH is REQUIRED?
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STAT?
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REFERRAL 3
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Referral Comments
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HMO? PRIOR AUTH is REQUIRED?
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STAT?
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HOME HEALTH
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Open HOME HEALTH
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HOME HEALTH
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Home Health Comments
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HMO? PRIOR AUTH is REQUIRED
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PHYSICAL THERAPY
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Open PHYSICAL THERAPY
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Refer to
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PHYSICAL THERAPY Recommendations
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PT Recommendation Comments
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PRIOR AUTH REQUIRED?
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RETURN FOR FOLLOW-UP
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Open RETURN
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RETURN FOR FOLLOW-UP
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FOLLOW-UP with ALQAISI?
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CODING
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MACRA
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Open MACRA
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Advanced Planning
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Advance Care Planning
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Colon Screening
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Colon Screen
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Related Diagnosis
• • •
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DEXA Scan Ordered
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DEXA Scan Ordered?
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Diabetic Foot Exam
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Diabetic Foot Exam?
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Mammogram, Screening
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Mammogram?
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PAP
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PAP?
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STD
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STD?
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CPT CODES
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ESTABLISHED 99213
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ESTABLISHED 99214
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NEW 99205
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