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.
Sleep studies do need to be ordered in Epic under SLEEP SPECIALIST, this is the way to order on the Clinic side.
Quick reminder at this time that Tammy STILL needs the correct sleep study form to be filled out with each sleep study that is ordered. Once completed and signed these can be placed in her box.
* ALL NON INSURED PATIENTS/ CHARITY
MUST HAVE SLEEP STUDY DONE AT LUTHERAN AND THEY MUST HAVE AN ACTIVE CONTRACT TO BE REFERRED, the referral can be submitted to me with the form and I will hold on to the form until the patient does become leveled.
The cost of a sleep study is $3,000 plus $550 for interpretation
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)
Order "Graded Exercise Treadmill Test (AKA GXT)" - order number 200104
Select "Ancillary w/Auth" (w/Auth is required in order to generate a necessary referral in the background)
Resulting Agency is "SJH Stress"
A referral to "AMB Ref to Cardiology" is not required for Stress Tests.
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
Order "US Preg 1st trimester (dating)" when you scheduled the patient for dating u/s
IMPORTANT: change the resulting agency from Radiant to "External Radiology" so the order can be completed
Anatomy
Order "US OB Anatomy Complete"
IMPORTANT: change the resulting agency from Radiant to "External Radiology" so the order can be completed
Carrier/cfDNA Screening
Pap Test
First, type Pap, then Amb Pathology Orders.
For routine pap without STD screening: choose “Cytology Gynecologic”, then under Test, select your desired HPV screen
For gonorrhea and chlamydia screening: choose “Cytology Gynecologic with Age-Based HPV Screening, Plus CTNG.” CTNG = Chlamydia Trachomatis and Neisseria Gonorrheae.
For the simple option: choose “Cytology Gynecologic with Age-Based HPV/CTNG.” Samples from patients under 25 will get screened automatically for gonorrhea and chlamydia, and the correct HPV screening will also be done.
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:
Place an order in Epic for Echocardiogram - Pediatric (TTE), order # 20066
Your MA will call central scheduling to get this scheduled for the patient
If you need a cardiologist consultation as well as the echo:
Order Amb Ref to Pediatric Cardiology, and specify Echo and consultation in the comments
Currently this process is backed up at least 6 months
If you need an urgent consult or urgent echo:
Order the above referral as urgent/ STAT and talk to Tammy or Iris in person
You can also call Children's One Call (720-777-1234) and speak with the on-call cardiologist about your concern
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
BFM offers the following tests
urine GC/CT
vaginitis panel (BD Affirm VPIII kit)
Hologic-Aptima Unisex Swab/kit (gc/ct swab for oropharyngeal and rectal testing and urethral testing in males)
You can also continue to run GC/CT and vaginitis testing off of pap samples.
Follow this guideline for how to order STD testing.
HSV
Use green top culture tube
Send to SCL Health Lab
Wound Culture
Use red top swab (same as GBS swab)
Send to SCL Health Lab
Throat culture
Use red top swab (same as GBS swab)
Send to SCL Health Lab
GBS
Use red top swab
Send to SCL Health Lab
See above for sensitivity testing - must call lab to request
GC/CT Throat/rectal swab
LABEL EACH TUBE: source, time collected, your initials
Use red top tubes and call lab directly to order them. No current good order system in Epic.
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)
Make sure your test is ordered as STAT
In the Comments section, write "Hold and Call" then your name and phone or pager #
This means radiology will not send the patient out of the imaging department until they have reviewed the findings with you via phone
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:
Place the following order: XR Lumbar Puncture Diag In Radiology
Call Diagnostic Radiology at (303) 812-4865
Request approval of the order (they will connect you to the radiologist working that day)
Diagnostic Radiology will reach out to the patient to schedule the lumbar puncture.
Of note, Interventional Radiology will not do outpatient LPs.
Updated July 2022