Difficult-to-Order Tests

This section will list a selection of the most common difficult-to-order tests and/or recent changes on how to correctly order common tests.

Touchstone Imaging

For patients with private insurance, Medicare, and/or Medicaid - CT, MRI, US (including transvaginal), and plain films may be ordered from Touchstone Imaging. 

When placing order: 1) change "Class" to "Ancillary Performed" or "Ancillary Performed w/ Authorization" [authorization is required for CT, MRI, US] and 2) change "Resulting Agency" to "Touchstone."  

You do not need to complete any additional paperwork or forms. Touchstone Imaging will reach out to the patient directly in order to coordinate scheduling. 

For plain films, patients may go directly to Touchstone Imaging. The closes facility is located at  1007 E Colfax Ave, Denver CO 80218 (corner of Colfax & Ogden).

The forms available in our clinic our only to be used for the map. 

Echocardiogram (adult) 

1) Place referral to "AMB Ref to Cardiology." In the Provider Comments you need to state what you are wanting and/or ordering.  

2) Place order for Echo - "Echocardiogram Adult, W or WO Contrast" (200065).

Colonoscopy

Order "Amb Ref to General Surgery" and write Colonoscopy in the comments

Sleep Study

All patients need both an order in Epic and completion of a paper form which can be found in the bullpen.

For insurance related reasons, if you are not certain where someone can go, it is reasonable to refer them to Lutheran

Lung Cancer Screening

If you have a patient you feel is appropriate for lung cancer screening (USPTF recommendation statement), send a staff message to Bridgette Yeboah-Spaun with your patient's chart attached. You do not need to place an order; this will occur through the process with Bridgette. 

EKGs

Here is the workflow for EKG ordering, resulting, and billing.

Cardiology

Review with Tammy prior to placing cardiology referrals.

Exercise Stress Tests (Treadmill)

Physical Therapy

Please write indication for PT in comments section (ex: low back pain, shoulder pain, etc)

GBS 

Order number 516622 

 Penicillin-allergic patient

The SCL lab does NOT have an available order to automatically test sensitivities for PCN-allergic patients who are GBS positive. You must call the lab directly and request that they run sensitivities at the time that you send the sample. The Epic order that pops up for GBS sensitivities does not go to our lab.

Hip ultrasound for newborns (pediatric ultrasound)

The provider needs to place the desired order in Epic, and change the resulting agency to "External." Then, fill out the Children's Hospital Diagnostic Imaging Fax Form - this can be found in each MA station. Then ask the MA to print the order and fax it along with the TCH Diagnostic Imaging Form.

Holter/Event Monitor

Order Amb Ref Cardiology, then type in the comment box “Needs Holter for ____.” Note: Holter monitoring is for up to 48 hours and is continuous. Event monitoring is for up to 30 days and monitors when the patient pushes a button that they are having an event, i.e. syncopal episode. If you also need a cardiologist consult, you need to also specify that separately.

OB

Ultrasound

Dating

Anatomy

Carrier/cfDNA Screening

OB Info 

Pap Test

First, type Pap, then Amb Pathology Orders.

If you use any of the above techniques, the correct resulting agency (Ameripath) will already be selected.

Pediatric Imaging (Ultrasounds, XRays)

The provider needs to place the desired order in Epic, and change the resulting agency to "External." Then, fill out the Children's Hospital Diagnostic Imaging Fax Form - this can be found in each nurse's station as well as on the wall near the bullpen Keurig machine. Then ask the MA to print the order and fax it along with the TCH Diagnostic Imaging Form.

Pediatric Echocardiogram (TTE)

If you only need an echo and not a cardiology consultation:

If you need a cardiologist consultation as well as the echo: 

If you need an urgent consult or urgent echo:

PFTs (formal)

1. Place referral as Amb Ref Other, then specify Formal PFTs in the comments.

2. Place the order in Epic using order # 200008, Complete PFT.

If you need spirometry, our MAs can do this in the office. Just let them know and order POCT Spirometry.

Provider-collected cultures

STI Testing

HSV

Wound Culture

Throat culture

GBS

GC/CT Throat/rectal swab

Semen analysis

Next to the water cooler in the bullpen, there is a stack of prescription pads labeled "Colorado Center for Reproductive Medicine." They do semen analysis for our patients. Fill out the information listed, check Semen Analysis and give this paper prescription to your patient. They will pay out of pocket, ~$175-200, if they are uninsured or their insurace does not cover the cost.

You should receive a faxed sheet with the results.

Stat imaging orders (hold and call)

Testicular Ultrasound

Select "US Testicular/Scrotum with Doppler" - order # 303156.

Transvaginal/ pelvic ultrasounds performed at the hospital

Select “US Pelvic Transvaginal Complete with Doppler” - order # 303158. We are doing Dopplers with all ultrasounds now.

Do NOT use “US Transvaginal.”

Wet preps/wet mounts – How to Enter Result

Once you have ordered the wet prep, go to More at the bottom of the left hand Activities panel, choose Enter/Edit Results (protip: you can star this to Favorite it), then click the funnel icon at the top that says Filter. Scroll up and click “All” – this will show you the wet prep order. Select the order and click Edit. Choose today’s date for the date performed, fill in each section (i.e. Clue cells None, Bacteria Many, Trichomonas Present etc), then click Final Result.

Don’t forget to charge capture!

Outpatient Lumbar Puncture (LP)

To schedule an outpatient LP:

Of note, Interventional Radiology will not do outpatient LPs. 

Updated July 2022