Documenting Office Procedures

Button	Purpose
Supplies	Document the supplies for office procedures.
ABN	Add advance beneficiary notice of non-coverage (ABN).
Epidural	Document epidural injections.
Add	Add office procedures.
Edit	Edit office procedures.
Remove	Remove office procedures.

NextGen® Orthopedic Suite Help 80.2.14.0

Documenting Cast and Splint Procedures

You can document the office procedures for the cast and splint applied. You can use the IORTS Castsplint Apply template to document the cast and splint details, repair, supplies, and waterproofing details. You can also use this template to document the appearance of the extremity after the cast or splint is removed, physician examination, and any additional details. IORTS Cast Splint Apply template The main grid displays the list of casts and splints and their associated details. You can configure the cast and splint application codes, supply codes, and waterproofing details on the Cast & Splint Configuration template. For more information, go to NextGen Healthcare Success Community, and download the Configuration Guide for NextGen® Orthopedic Suite. Document Cast and Splint Procedures You can document the details of the cast and splint procedures performed in the office. Remove a Submitted Cast or Splint Parent topic: Documenting Office Procedures

NextGen® Orthopedic Suite Help 80.2.14.0

Document Strapping Procedures

You can document the strapping procedures for finger, knee, ankle, foot, and toe. Open the IORTS Castsplint Apply template. Click Strapping in the left pane. The IORTSproc Strapping template opens. IORTS Procedure Strapping template Select the appropriate check box for the strapping performed, and select the applicable side from the list. If you select Finger strapping performed or Toe strapping performed, you need to select the applicable finger or toe from the list along with the selection of side. To provide additional details, click the Comments field. Select the Performed by check box. The name of the provider who performed the procedure and the date and time of the procedure are automatically filled in the corresponding fields. Click Add to Grid. A message appears stating that the procedure has been sent to the grid. Click Save & Close. Remove a Strapping Procedure Parent topic: Documenting Office Procedures Related tasks Access Office Procedure Templates

NextGen® Orthopedic Suite Help 80.2.14.0

Document Debridement Procedures

You can document the debridement, burn, and wound care procedures performed in the office. You can select only one type of procedure at a time in the Burns, Infected skin, and Ulcer/Wound sections. To add multiple procedures, you can document the treatment of each body area as a separate procedure and add it to the grid. When you document the details in the Ulcer/Wound section, the Wound Debridement - Total area of wound in sq.cm field displays the total area of debridement documented. For the initial 20 square centimeters of debridement documented, an entry is added to the Office Procedures grid on the Billable Visit template. For each increment of 20 square centimeters, separate entries are added to the grid. Open the IORTS Castsplint Apply template. Click Debridement in the left pane. The IORTSproc Debride template opens. IORTS Debridement template In the Debridement/Burn/Wound section, select the pre-procedure steps performed. In Burns, Infected skin, and Ulcer/Wound sections, do t

NextGen® Orthopedic Suite Help 80.2.14.0

Document Diabetic Foot Wound Care

You can document the office procedures for the wounds on toes, mid-foot, and hind-foot of diabetic patients. On the IORTS Castsplint Apply template, click Diabetic Foot in the left pane. The IORTSproc Diab Foot template opens. IORTS Diabetic Foot Procedures template Select Informed Consent if the patient was informed about the risks, benefits, and alternatives prior to the procedure. In the panel for the location of the wound, click the Side field, and select the side from the list. Note: When the side is selected, the Location and Direction fields display lists of locations and directions of the wound. Panels on the IORTS Diabetic Foot Procedures template Select the location and direction of the wound from the lists. Click the Depth field, and enter the depth of the wound on the Depth window. The Width and Length windows open subsequently. Enter the width and length of the wound. Click the Margins field, and select the margin of the wound from the list. Click the field for the anesthe

NextGen® Orthopedic Suite Help 80.2.14.0

Document Compartment Pressure

You can document the compartment pressure of the lower leg and thigh after the exercise, total exercise time, and time of the measurements taken. Documenting compartment pressure enables you to confirm or rule out the compartment syndrome. Open the IORTS Castsplint Apply template. Click Compartment Pressure in the left pane. The IORTSproc Comp Press template opens. IORTS Compartment Pressure template Select Trauma or Exercise to indicate the type of procedure performed. In the Lower Leg and Thigh sections, select the lower leg and thigh positions for the left and right sides. Click the applicable mm Hg field, and enter the pressure value in the Number Pad window. Note: The SSD fields are automatically filled with the difference between the pressure values entered in the mm Hg fields for the left and right side. Click the Dur of Exer field, and enter the duration of the exercise in the Number Pad window. Select the appropriate option for when the measurements are taken after the exercis

NextGen® Orthopedic Suite Help 80.2.14.0

Document Incisions and Drainage Procedures

You can document the Incisions and Drainage (I&D) procedures performed in office. Open the IORTS Castsplint Apply template. Click I & D in the left pane. The IORTSproc Ind template opens. IORTS Incisions and Drainage template Select the appropriate I&D procedure type. If you select Ndle Asp of Fluid Coll (needle aspiration) or I and D of Fluid Coll (incision and drainage), the list automatically opens for the following fields. You can select the options from the lists. Type of Fluid Side Location Instrument used If you select I and D of Abscess (abscess incision and drainage), the list automatically opens for the following fields. You can select the options from the lists. Side Location Instrument used Enter the anesthetic injection dosage as follows: Click the Lido w/o field, and select the injection dosage for Lidocaine without epinephrine. Click the Lido /Epi field, and select the injection dosage for Lidocaine with epinephrine. Click the Marc field, and select the injection dosage

Documenting Office Procedures

Recommendations

Documenting Cast and Splint Procedures

Document Strapping Procedures

Document Debridement Procedures

Document Diabetic Foot Wound Care

Document Compartment Pressure

Document Incisions and Drainage Procedures

Documenting Office Procedures

Documenting Cast and Splint Procedures

Document Strapping Procedures

Document Debridement Procedures

Document Diabetic Foot Wound Care

Document Compartment Pressure

Document Incisions and Drainage Procedures