Order Exam : Home Health / Hospice

    Order Exam : Home Health / Hospice

    Patient Information
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    Reason Portable X-Ray is needed
    Diagnosis Code: Select applicable CPT Code(s) Other: Please Specify

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    Chest
    Abdominal
    Spine
    Head
    Upper Extremity 73030 Shoulder (2 views) 73000 Clavicle (2 views) 73090 Forearm (2 views) 73080 Elbow (3 views) 73110 Wrist (3 views) 73130 Hand (3 views) 73140 Fingers (2-3 views) 73060 Humerus (2 views)
    Lower Extremity 72170 Pelvis (1 view) 73502 Hip (2-3 views) 73522 Hip Bilat (4 views) 73552 Femur (2 views) 73562 Knee Complete (3 views) 73590 Tibia Fibula (2 views) 73610 Ankle (3 views) 73630 Foot (3 views) 73650 Calcaneus (2 views)
    Electrocardiogram

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