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Patient Discharge Summary

Demographic Information
Name: AHMED FATHELDIN Current Date: 14/01/2020 20:06:47
DOB: 6/10/1941 Gender: Male
Emirates ID: 784-1941-4384241-0 MRN: 10086538
Patient Address: Dubai Phone: (055)221-3469

Reason for Visit/Chief complaint


breathing difficulty,cough and fever for 1 day
Admitting diagnosis:

Medical Summary Information


Dr.Mohammed Rajaa
Physician Name: Admission Date: 01/08/2019 09:37:00
Abdulraheem
08/01/2020 12:00:00
Specialty: ICU Discharge Date:
1:Respiratory difficulty; 2:Aspiration pneumonitis; 3:Respiratory failure; 4:Bronchospasm;
5:CRP elevated; 6:Fever; 7:Laryngeal dystonia; 8:Hypotension; 9:Dehydration; Abnormal
LFTs; Agitation requiring sedation protocol; Anemia; Aspiration pneumonitis; Bedbound;
Bloating; Cachexia; Central venous line infection; Central venous catheter in place;
Cholestasis; Congested nose; Constipation; Copious oral secretions; Decreased urine
output; Dehydration; Diarrhea; Dry eyes; Dry skin; Ear infection; Eye dryness; Eye problem;
Fluid loss; Fluid overload; Gastric acidity; Gastroparesis; Head ache; High alkaline
Discharge diagnosis:
phosphatase; Hyperkalemia; Hypoalbuminemia; Hypokalemia; Hypomagnesemia;
Hypotension; Infection; Infection of chest; Insomnia; Irritable bowel; Loose stools;
Malnutrition; Metabolic alkalosis; Mouth sore; Neutropenia; Nutrition disorder; Nutritional
problems; Occluded PICC line; Pain; Pain in back; Pain in the abdomen; Pleural effusion,
bilateral; Pneumonia; Pyrexia; Respiratory difficulty; Sepsis; Septic shock; Serratia infection;
Sialorrhea; Thick sputum; Thrush, oral; Tracheostomy care; Urinary catheter
insertion/adjustment/removal; Ventilator dependent; Vomiting

Vitals/Allergies Information
Allergies No Known Allergies
Blood Pressure / 59 mmHg Temperature
Respiratory Rate 20 br/min Pulse
BMI Weight

Smoking Status
Never smoker

Laboratory or Other Results This Visit (last charted value for your 01/08/2019 visit)

Hematology
26/12/2019 5:56 PM
Name: AHMED FATHELDIN 1 of 35 14/01/2020 20:06:53
MRN: 10086538
White Blood Cell: 8.2 x10^3/uL -- Normal range between ( 3.4 and 10.8 )
Red Blood Cell: 3.15 x10^6/uL -- Normal range between ( 4.14 and 5.80 )
Neutrophil Automated Percentage: 71 %
Mean Cell Volume: 91 fL -- Normal range between ( 79 and 97 )
MCHC: 32 g/dL -- Normal range between ( 32 and 36 )
Hematocrit: 28.6 % -- Normal range between ( 37.5 and 51.0 )
Mean Cell Hemoglobin: 29 pg -- Normal range between ( 27 and 33 )
Hemoglobin: 9.1 g/dL -- Normal range between ( 12.6 and 17.7 )
Platelet Count: 257 x10^3/uL -- Normal range between ( 150 and 379 )
RDW: 15.7 % -- Normal range between ( 12.3 and 15.4 )
Lymphocyte Automated Percentage: 18 %
Monocyte Automated Percentage: 6 %
Eosinophil Automated Percentage: 5 %
Basophil Automated Percentage: 0 %
Neutrophil Automated Absolute: 5.82 x10^3/uL -- Normal range between ( 1.40 and
7.00 )
Lymphocyte Automated Absolute: 1.5 x10^3/uL -- Normal range between ( 0.7 and
3.1 )
Monocytes Automated Absolute: 0.47 x10^3/uL -- Normal range between ( 0.10 and
0.90 )
Eosinophils Automated Absolute: 0.4 x10^3/uL -- Normal range between ( 0.0 and
0.4 )
Basophils Automated Absolute: 0.0 x10^3/uL -- Normal range between ( 0.0 and 0.2 )

07/12/2019 1:08 PM
International Normalization Ratio: 1.02 -- Normal range between ( 0.80 and 1.20 )
PTT: 31.5 seconds -- Normal range between ( 24.0 and 33.0 )
Protime: 10.9 seconds -- Normal range between ( 9.5 and 12.0 )
02/11/2019 6:56 AM
Scan Review: Scan Review
08/10/2019 6:18 PM
Retic %: 1.3 % -- Normal range between ( 0.6 and 2.6 )
29/09/2019 5:34 AM
Peripheral Blood Smear: RBCs :Show moderate normocytic normochromic
anemia\.br\WBC: Marked total leukocytosis and absolute neutophilia with shift to the left(18%
band cells,2% metamyelocytes and 1% myelocytes).Mild reactive monocytosis and eosinophilia
are also seen\.br\Plate...

Urinalysis
01/08/2019 1:46 PM
UA Color: YELLOW
UA Urobilinogen: 1.0 EU/dL -- Normal range between ( 0.0 and 1.0 )
UA Bili: Negative
UA Ketones: Trace
UA Bacteria: None Seen
UA Yeast: None Seen
UA pH: 7.5 -- Normal range between ( 5.0 and 7.5 )
UA Specific Gravity: 1.015 -- Normal range between ( 1.005 and 1.030 )
UA Protein: Trace
UA Glucose: Trace
UA Nitrite: Negative
UA Blood: Negative

Name: AHMED FATHELDIN 2 of 35 14/01/2020 20:06:53


MRN: 10086538
UA RBCs: 0-1 /HPF -- Normal range between ( 0 and 3 )
UA WBCs: 2-4 /HPF -- Normal range between ( 0 and 5 )
UA Casts: None Seen
UA Crystals: Amorphous Phos
UA Epithelial Cells: 0-1 /HPF -- Normal range between ( 0 and 10 )
UA Appearance: CLEAR
UA Renal Cells: None Seen
UA Trichomonas: None Seen
WBC Esterase: Negative

Chemistry
26/12/2019 5:56 PM
Bicarbonate.: 27 mmol/L -- Normal range between ( 18 and 29 )

General Chemistry
26/12/2019 5:56 PM
BUN: 31 mg/dL -- Normal range between ( 8 and 27 )
Protein Total: 5.2 g/dL -- Normal range between ( 6.0 and 8.5 )
Gamma Glutamyl Transferase: 24 unit/L -- Normal range between ( 0 and 65 )
CRP (C-Reactive Protein): 151.17 mg/L -- Normal range between ( 0.00 and 4.90 )

Thyroid
18/09/2019 4:00 PM
T4 Free: 1.06 ng/dL -- Normal range between ( 0.82 and 1.77 )
T3 Free: 2.2 pg/mL -- Normal range between ( 2.0 and 4.4 )

Immunology
01/08/2019 3:58 PM
Influenza A Ag: Negative
Influenza B Ag: Negative

Microbiology
25/12/2019 7:24 PM
Urine Culture: Urine Culture
Lower Respiratory Culture: Lower Respiratory Culture
25/12/2019 6:25 PM
C Blood: C Blood
24/12/2019 9:03 PM
Stool Culture: Stool Culture
30/09/2019 4:44 PM
Body Fluid Culture: Body Fluid Culture
30/08/2019 6:57 AM
Wound Culture: Wound Culture
15/08/2019 2:54 PM
C MRSA: C MRSA

Transfusion Medicine
02/11/2019 2:46 PM
Product Ready: Done
22/09/2019 7:49 AM
TRANSFUSED: TRANSFUSED

Name: AHMED FATHELDIN 3 of 35 14/01/2020 20:06:53


MRN: 10086538
Misc Send Outs
24/12/2019 9:03 PM
Miscellaneous Test: Miscellaneous Test

Biochemistry
26/12/2019 5:56 PM
Creatinine: 0.34 mg/dL -- Normal range between ( 0.76 and 1.27 )
Potassium: 3.7 mmol/L -- Normal range between ( 3.5 and 5.2 )
Sodium: 141 mmol/L -- Normal range between ( 134 and 144 )
Calcium: 8.4 mg/dL -- Normal range between ( 8.6 and 10.2 )
Phosphorus: 4.1 mg/dL -- Normal range between ( 2.5 and 4.5 )
Albumin: 2.9 g/dL -- Normal range between ( 3.5 and 4.8 )
Chloride: 99 mmol/L -- Normal range between ( 97 and 108 )
eGFR: 122 mL/min/1.73 mE2
Globulin: 2.3 g/dL -- Normal range between ( 2.3 and 3.5 )
A/G Ratio: 1.3 -- Normal range between ( 1.1 and 2.5 )
Alk Phos: 82 IntlUnit/L -- Normal range between ( 39 and 117 )
ALT (Alanine Aminotransferase): 10 IntlUnit/L -- Normal range between ( 0 and 44 )
AST (Aspartate Aminotransferase ): 12 IntlUnit/L -- Normal range between ( 0 and 40
)
Indirect Bilirubin: 0.1 mg/dL -- Normal range between ( 0.1 and 0.8 )
BUN/Creat Ratio: 91 -- Normal range between ( 10 and 22 )
Glucose, Fasting: 107 mg/dL -- Normal range between ( 65 and 99 )
Bilirubin Dir: 0.16 mg/dL -- Normal range between ( 0.00 and 0.40 )
Bilirubin Tot: 0.28 mg/dL -- Normal range between ( 0.00 and 1.20 )
18/12/2019 11:00 PM
CK-MB: 1.7 ng/mL -- Normal range between ( 0.0 and 10.4 )
26/11/2019 10:36 AM
Lipase: 37 U/L -- Normal range between ( 0 and 59 )
Amylase Total: 187 unit/L -- Normal range between ( 31 and 124 )
11/11/2019 6:17 AM
Magnesium: 1.8 mg/dL -- Normal range between ( 1.6 and 2.3 )

Endocrinology
18/09/2019 4:00 PM
Cortisol: 4.87 ug/dL
TSH (Thyroid Stimulating Hormone): 5.840 uIU/mL -- Normal range between ( 0.450
and 4.500 )
18/09/2019 5:45 AM
SHBG: 67.6 nmol/L -- Normal range between ( 19.3 and 76.4 )
Testosterone: 174 ng/dL -- Normal range between ( 348 and 1197 )
FSH: 6.9 mIU/mL -- Normal range between ( 1.5 and 12.4 )
LH ( Lutenising Hormone ): 17.4 mIU/mL -- Normal range between ( 1.7 and 8.6 )

Cytopathology
29/12/2019 2:14 PM
Report: Report

Reference Lab Reports


19/12/2019 5:17 AM
Potassium Level: 3.4
31/10/2019 1:12 PM

Name: AHMED FATHELDIN 4 of 35 14/01/2020 20:06:53


MRN: 10086538
Clostridium Difficile Toxin.: see attached

Blood Bank
02/11/2019 3:54 PM
ABO/Rh: AB Rh(D) Negative
Antibody Screen: Negative ABSC
06/09/2019 1:58 PM
Save Sample: Yes
29/08/2019 6:25 PM
ABORh Retype: AB Rh(D) Negative
ABO/Rh Retype: ABO/Rh Retype

LCA
18/09/2019 4:00 PM
Free Testosterone(Direct): 2.5 pg/mL -- Normal range between ( 6.6 and 18.1 )

Micro GL
26/12/2019 5:00 AM
ST Color: Yellowish Brown
ST Consistency: Loose
ST WBC (Pus Cells): Few
ST RBCs: Nil
ST Comments: No ova, cysts, or parasites seen.
ST Mucus: Nil
Interpretative Data: See Comment
24/12/2019 9:03 PM
Clos. difficile: NOT DETECTED
30/08/2019 9:19 PM
Ova: None seen
Cyst: None seen
ST Trophozoites: None seen
Occult Blood: Positive
Larvae: None seen

NRL ORDERS
26/12/2019 5:00 AM
Stool Routine & Microscopy.: Stool Routine & Microscopy.
24/12/2019 9:03 PM
Clostridium Difficile Toxin A & B (Stool: Clostridium Difficile Toxin A & B (Stool
26/11/2019 10:36 AM
Lipase (Serum): Lipase (Serum)
11/11/2019 6:17 AM
Magnesium: Magnesium
08/10/2019 6:18 PM
Reticulocyte %, Blood: Reticulocyte %, Blood
18/09/2019 4:00 PM
Free T4 (Free Thyroxine): Free T4 (Free Thyroxine)
Free T3 (Free Triiodothyronine): Free T3 (Free Triiodothyronine)
TSH (Thyroid Stimulating Hormone): TSH (Thyroid Stimulating Hormone)
Free Testosterone: Free Testosterone
18/09/2019 5:45 AM
LH (Luteinising Hormone): LH (Luteinising Hormone)

Name: AHMED FATHELDIN 5 of 35 14/01/2020 20:06:53


MRN: 10086538
30/08/2019 9:19 PM
Stool Occult Blood: Stool Occult Blood

Diagnostic Radiology
25/12/2019 10:13 PM
XR Abdomen Portable: XR Abdomen Portable
03/11/2019 9:44 AM
XR Chest Portable: XR Chest Portable

Ultrasound
26/11/2019 3:52 PM
US Abdomen Complete: US Abdomen Complete

Procedures
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); each
additional hour (List separately in addition to code for primary procedure) (10/09/2019)
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); each
additional hour (List separately in addition to code for primary procedure) (10/09/2019)
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); each
additional hour (List separately in addition to code for primary procedure) (10/09/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous
or intramuscular (09/09/2019)
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); each
additional hour (List separately in addition to code for primary procedure) (09/09/2019)
Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) and
automated differential WBC count (28/08/2019)
Electrolyte panel This panel must include the following: Carbon dioxide (bicarbonate)
(82374) Chloride (82435) Potassium (84132) Sodium (84295) (28/08/2019)
Hepatic function panel This panel must include the following: Albumin (82040) Bilirubin, total
(82247) Bilirubin, direct (82248) Phosphatase, alkaline (84075) Protein, total (84155)
Transferase, alanine amino (ALT) (SGPT) (84460) Transferase, aspartate am (28/08/2019)
Calcium; total (28/08/2019)
C-reactive protein; (28/08/2019)
Phosphorus inorganic (phosphate); (28/08/2019)
Glucose; quantitative, blood (except reagent strip) (28/08/2019)
Urea nitrogen; quantitative (28/08/2019)
Glutamyltransferase, gamma (GGT) (28/08/2019)
Creatinine; blood (28/08/2019)
Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) and
automated differential WBC count (27/08/2019)
Electrolyte panel This panel must include the following: Carbon dioxide (bicarbonate)
(82374) Chloride (82435) Potassium (84132) Sodium (84295) (27/08/2019)
Hepatic function panel This panel must include the following: Albumin (82040) Bilirubin, total
(82247) Bilirubin, direct (82248) Phosphatase, alkaline (84075) Protein, total (84155)
Transferase, alanine amino (ALT) (SGPT) (84460) Transferase, aspartate am (27/08/2019)
Calcium; total (27/08/2019)
C-reactive protein; (27/08/2019)
Phosphorus inorganic (phosphate); (27/08/2019)
Glucose; quantitative, blood (except reagent strip) (27/08/2019)
Urea nitrogen; quantitative (27/08/2019)
Glutamyltransferase, gamma (GGT) (27/08/2019)

Name: AHMED FATHELDIN 6 of 35 14/01/2020 20:06:53


MRN: 10086538
Creatinine; blood (27/08/2019)
Electrolyte panel This panel must include the following: Carbon dioxide (bicarbonate)
(82374) Chloride (82435) Potassium (84132) Sodium (84295) (26/08/2019)
Hepatic function panel This panel must include the following: Albumin (82040) Bilirubin, total
(82247) Bilirubin, direct (82248) Phosphatase, alkaline (84075) Protein, total (84155)
Transferase, alanine amino (ALT) (SGPT) (84460) Transferase, aspartate am (26/08/2019)
Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) and
automated differential WBC count (26/08/2019)
Calcium; total (26/08/2019)
C-reactive protein; (26/08/2019)
Phosphorus inorganic (phosphate); (26/08/2019)
Glucose; quantitative, blood (except reagent strip) (26/08/2019)
Urea nitrogen; quantitative (26/08/2019)
Glutamyltransferase, gamma (GGT) (26/08/2019)
Creatinine; blood (26/08/2019)
Electrolyte panel This panel must include the following: Carbon dioxide (bicarbonate)
(82374) Chloride (82435) Potassium (84132) Sodium (84295) (25/08/2019)
Hepatic function panel This panel must include the following: Albumin (82040) Bilirubin, total
(82247) Bilirubin, direct (82248) Phosphatase, alkaline (84075) Protein, total (84155)
Transferase, alanine amino (ALT) (SGPT) (84460) Transferase, aspartate am (25/08/2019)
Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) and
automated differential WBC count (25/08/2019)
Calcium; total (25/08/2019)
C-reactive protein; (25/08/2019)
Phosphorus inorganic (phosphate); (25/08/2019)
Glucose; quantitative, blood (except reagent strip) (25/08/2019)
Urea nitrogen; quantitative (25/08/2019)
Glutamyltransferase, gamma (GGT) (25/08/2019)
Creatinine; blood (25/08/2019)
Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop
strength and endurance, range of motion and flexibility (24/08/2019)
Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop
strength and endurance, range of motion and flexibility (24/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (24/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (24/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (24/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (24/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous
or intramuscular (24/08/2019)
Culture, bacterial; any other source except urine, blood or stool, aerobic, with isolation and
presumptive identification of isolates (24/08/2019)
Culture, bacterial; any source, except blood, anaerobic with isolation and presumptive
identification of isolates (24/08/2019)
Electrolyte panel This panel must include the following: Carbon dioxide (bicarbonate)
(82374) Chloride (82435) Potassium (84132) Sodium (84295) (24/08/2019)

Name: AHMED FATHELDIN 7 of 35 14/01/2020 20:06:53


MRN: 10086538
Hepatic function panel This panel must include the following: Albumin (82040) Bilirubin, total
(82247) Bilirubin, direct (82248) Phosphatase, alkaline (84075) Protein, total (84155)
Transferase, alanine amino (ALT) (SGPT) (84460) Transferase, aspartate am (24/08/2019)
Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) and
automated differential WBC count (24/08/2019)
Calcium; total (24/08/2019)
Creatinine; blood (24/08/2019)
Phosphorus inorganic (phosphate); (24/08/2019)
Glucose; quantitative, blood (except reagent strip) (24/08/2019)
Urea nitrogen; quantitative (24/08/2019)
Glutamyltransferase, gamma (GGT) (24/08/2019)
C-reactive protein; (24/08/2019)
Therapeutic procedure, 1 or more areas, each 15 minutes; massage, including effleurage,
petrissage and/or tapotement (stroking, compression, percussion) (24/08/2019)
Ventilation assist and management, initiation of pressure or volume preset ventilators for
assisted or controlled breathing; hospital inpatient/observation, each subsequent day
(24/08/2019)
Ventilation assist and management, initiation of pressure or volume preset ventilators for
assisted or controlled breathing; hospital inpatient/observation, each subsequent day
(23/08/2019)
Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop
strength and endurance, range of motion and flexibility (23/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (23/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (23/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (23/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (23/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous
or intramuscular (23/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (23/08/2019)
Electrolyte panel This panel must include the following: Carbon dioxide (bicarbonate)
(82374) Chloride (82435) Potassium (84132) Sodium (84295) (23/08/2019)
Hepatic function panel This panel must include the following: Albumin (82040) Bilirubin, total
(82247) Bilirubin, direct (82248) Phosphatase, alkaline (84075) Protein, total (84155)
Transferase, alanine amino (ALT) (SGPT) (84460) Transferase, aspartate am (23/08/2019)
Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) and
automated differential WBC count (23/08/2019)
Calcium; total (23/08/2019)
Creatinine; blood (23/08/2019)
Phosphorus inorganic (phosphate); (23/08/2019)
Glucose; quantitative, blood (except reagent strip) (23/08/2019)
Urea nitrogen; quantitative (23/08/2019)
Glutamyltransferase, gamma (GGT) (23/08/2019)

Name: AHMED FATHELDIN 8 of 35 14/01/2020 20:06:53


MRN: 10086538
C-reactive protein; (23/08/2019)
Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop
strength and endurance, range of motion and flexibility (23/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (23/08/2019)
Ventilation assist and management, initiation of pressure or volume preset ventilators for
assisted or controlled breathing; hospital inpatient/observation, each subsequent day
(22/08/2019)
Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop
strength and endurance, range of motion and flexibility (22/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (22/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (22/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (22/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (22/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous
or intramuscular (22/08/2019)
Electrolyte panel This panel must include the following: Carbon dioxide (bicarbonate)
(82374) Chloride (82435) Potassium (84132) Sodium (84295) (22/08/2019)
Hepatic function panel This panel must include the following: Albumin (82040) Bilirubin, total
(82247) Bilirubin, direct (82248) Phosphatase, alkaline (84075) Protein, total (84155)
Transferase, alanine amino (ALT) (SGPT) (84460) Transferase, aspartate am (22/08/2019)
Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) and
automated differential WBC count (22/08/2019)
Creatinine; blood (22/08/2019)
Urea nitrogen; quantitative (22/08/2019)
Glutamyltransferase, gamma (GGT) (22/08/2019)
C-reactive protein; (22/08/2019)
Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop
strength and endurance, range of motion and flexibility (22/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (22/08/2019)
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); each
additional hour (List separately in addition to code for primary procedure) (21/08/2019)
Prothrombin time; (21/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (21/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (21/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately

Name: AHMED FATHELDIN 9 of 35 14/01/2020 20:06:53


MRN: 10086538
in addition to code for primary procedure) (21/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous
or intramuscular (21/08/2019)
Transfusion, blood or blood components (21/08/2019)
Radiologic examination, chest; single view, frontal (21/08/2019)
Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop
strength and endurance, range of motion and flexibility (21/08/2019)
Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop
strength and endurance, range of motion and flexibility (21/08/2019)
Electrolyte panel This panel must include the following: Carbon dioxide (bicarbonate)
(82374) Chloride (82435) Potassium (84132) Sodium (84295) (21/08/2019)
Calcium; total (21/08/2019)
Creatinine; blood (21/08/2019)
Phosphorus inorganic (phosphate); (21/08/2019)
Glucose; quantitative, blood (except reagent strip) (21/08/2019)
Urea nitrogen; quantitative (21/08/2019)
Glutamyltransferase, gamma (GGT) (21/08/2019)
C-reactive protein; (21/08/2019)
Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop
strength and endurance, range of motion and flexibility (21/08/2019)
Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop
strength and endurance, range of motion and flexibility (21/08/2019)
Ventilation assist and management, initiation of pressure or volume preset ventilators for
assisted or controlled breathing; hospital inpatient/observation, each subsequent day
(21/08/2019)
Gases, blood, any combination of pH, pCO2, pO2, CO2, HCO3 (including calculated O2
saturation); with O2 saturation, by direct measurement, except pulse oximetry (21/08/2019)
Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) and
automated differential WBC count (21/08/2019)
Hepatic function panel This panel must include the following: Albumin (82040) Bilirubin, total
(82247) Bilirubin, direct (82248) Phosphatase, alkaline (84075) Protein, total (84155)
Transferase, alanine amino (ALT) (SGPT) (84460) Transferase, aspartate am (21/08/2019)
Blood bank physician services; difficult cross match and/or evaluation of irregular
antibody(s), interpretation and written report (21/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (21/08/2019)
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug);
additional sequential infusion of a new drug/substance, up to 1 hour (List separately in addition
to code for primary procedure) (20/08/2019)
Antibody screen, RBC, each serum technique (20/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (20/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (20/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (20/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous
or intramuscular (20/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional

Name: AHMED FATHELDIN 10 of 35 14/01/2020 20:06:53


MRN: 10086538
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (20/08/2019)
Tracheostomy, planned (separate procedure); (20/08/2019)
Radiologic examination, chest; single view, frontal (20/08/2019)
Radiologic examination, chest; single view, frontal (20/08/2019)
Ventilation assist and management, initiation of pressure or volume preset ventilators for
assisted or controlled breathing; hospital inpatient/observation, each subsequent day
(20/08/2019)
Gases, blood, any combination of pH, pCO2, pO2, CO2, HCO3 (including calculated O2
saturation); with O2 saturation, by direct measurement, except pulse oximetry (20/08/2019)
Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) and
automated differential WBC count (20/08/2019)
Hepatic function panel This panel must include the following: Albumin (82040) Bilirubin, total
(82247) Bilirubin, direct (82248) Phosphatase, alkaline (84075) Protein, total (84155)
Transferase, alanine amino (ALT) (SGPT) (84460) Transferase, aspartate am (20/08/2019)
Electrolyte panel This panel must include the following: Carbon dioxide (bicarbonate)
(82374) Chloride (82435) Potassium (84132) Sodium (84295) (20/08/2019)
Blood smear, peripheral, interpretation by physician with written report (20/08/2019)
Calcium; total (20/08/2019)
Creatinine; blood (20/08/2019)
Phosphorus inorganic (phosphate); (20/08/2019)
Glucose; quantitative, blood (except reagent strip) (20/08/2019)
Urea nitrogen; quantitative (20/08/2019)
Glutamyltransferase, gamma (GGT) (20/08/2019)
C-reactive protein; (20/08/2019)
Blood typing, serologic; ABO (20/08/2019)
Blood typing, serologic; Rh (D) (20/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (20/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure)

(19/08/2019)
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); each
additional hour (List separately in addition to code for primary procedure) (19/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (19/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (19/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous
or intramuscular (19/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (19/08/2019)
Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop
strength and endurance, range of motion and flexibility (19/08/2019)
Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop
strength and endurance, range of motion and flexibility (19/08/2019)
Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop

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MRN: 10086538
strength and endurance, range of motion and flexibility (19/08/2019)
Radiologic examination, chest; single view, frontal (19/08/2019)
Ventilation assist and management, initiation of pressure or volume preset ventilators for
assisted or controlled breathing; hospital inpatient/observation, each subsequent day
(19/08/2019)
Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) and
automated differential WBC count (19/08/2019)
Hepatic function panel This panel must include the following: Albumin (82040) Bilirubin, total
(82247) Bilirubin, direct (82248) Phosphatase, alkaline (84075) Protein, total (84155)
Transferase, alanine amino (ALT) (SGPT) (84460) Transferase, aspartate am (19/08/2019)
Electrolyte panel This panel must include the following: Carbon dioxide (bicarbonate)
(82374) Chloride (82435) Potassium (84132) Sodium (84295) (19/08/2019)
Calcium; total (19/08/2019)
Creatinine; blood (19/08/2019)
Phosphorus inorganic (phosphate); (19/08/2019)
Urea nitrogen; quantitative (19/08/2019)
Glutamyltransferase, gamma (GGT) (19/08/2019)
C-reactive protein; (19/08/2019)
Glucose; quantitative, blood (except reagent strip) (19/08/2019)
Blood smear, peripheral, interpretation by physician with written report (19/08/2019)
Prothrombin time; (19/08/2019)
Thromboplastin time, partial (PTT); plasma or whole blood (19/08/2019)
Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop
strength and endurance, range of motion and flexibility (19/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (19/08/2019)
Culture, bacterial; blood, aerobic, with isolation and presumptive identification of isolates
(includes anaerobic culture, if appropriate) (18/08/2019)
Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop
strength and endurance, range of motion and flexibility (18/08/2019)
Ventilation assist and management, initiation of pressure or volume preset ventilators for
assisted or controlled breathing; hospital inpatient/observation, each subsequent day
(18/08/2019)
Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) and
automated differential WBC count (18/08/2019)
Hepatic function panel This panel must include the following: Albumin (82040) Bilirubin, total
(82247) Bilirubin, direct (82248) Phosphatase, alkaline (84075) Protein, total (84155)
Transferase, alanine amino (ALT) (SGPT) (84460) Transferase, aspartate am (18/08/2019)
Electrolyte panel This panel must include the following: Carbon dioxide (bicarbonate)
(82374) Chloride (82435) Potassium (84132) Sodium (84295) (18/08/2019)
Calcium; total (18/08/2019)
Creatinine; blood (18/08/2019)
Phosphorus inorganic (phosphate); (18/08/2019)
Urea nitrogen; quantitative (18/08/2019)
Glutamyltransferase, gamma (GGT) (18/08/2019)
C-reactive protein; (18/08/2019)
Glucose; quantitative, blood (except reagent strip) (18/08/2019)
Blood smear, peripheral, interpretation by physician with written report (18/08/2019)
Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop
strength and endurance, range of motion and flexibility (18/08/2019)
Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop
strength and endurance, range of motion and flexibility (18/08/2019)

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MRN: 10086538
Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop
strength and endurance, range of motion and flexibility (18/08/2019)
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); each
additional hour (List separately in addition to code for primary procedure) (18/08/2019)
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); each
additional hour (List separately in addition to code for primary procedure) (18/08/2019)
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); each
additional hour (List separately in addition to code for primary procedure) (18/08/2019)
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); each
additional hour (List separately in addition to code for primary procedure) (18/08/2019)
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); each
additional hour (List separately in addition to code for primary procedure) (18/08/2019)
Insertion of non-tunneled centrally inserted central venous catheter; age 5 years or older
(18/08/2019)
Radiologic examination, chest; single view, frontal (18/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous
or intramuscular (17/08/2019)
Blood smear, peripheral, interpretation by physician with written report (17/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (17/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (17/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (17/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (17/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (17/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (17/08/2019)
Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) and
automated differential WBC count (17/08/2019)
Hepatic function panel This panel must include the following: Albumin (82040) Bilirubin, total
(82247) Bilirubin, direct (82248) Phosphatase, alkaline (84075) Protein, total (84155)
Transferase, alanine amino (ALT) (SGPT) (84460) Transferase, aspartate am (17/08/2019)
Electrolyte panel This panel must include the following: Carbon dioxide (bicarbonate)
(82374) Chloride (82435) Potassium (84132) Sodium (84295) (17/08/2019)
Calcium; total (17/08/2019)
Creatinine; blood (17/08/2019)
Phosphorus inorganic (phosphate); (17/08/2019)
Glucose; quantitative, blood (except reagent strip) (17/08/2019)
Urea nitrogen; quantitative (17/08/2019)
Glutamyltransferase, gamma (GGT) (17/08/2019)
C-reactive protein; (17/08/2019)
Ventilation assist and management, initiation of pressure or volume preset ventilators for
assisted or controlled breathing; hospital inpatient/observation, each subsequent day
(17/08/2019)

Name: AHMED FATHELDIN 13 of 35 14/01/2020 20:06:53


MRN: 10086538
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (16/08/2019)
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); each
additional hour (List separately in addition to code for primary procedure) (16/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (16/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure)

(16/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (16/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (16/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (16/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous
or intramuscular (16/08/2019)
Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) and
automated differential WBC count (16/08/2019)
Hepatic function panel This panel must include the following: Albumin (82040) Bilirubin, total
(82247) Bilirubin, direct (82248) Phosphatase, alkaline (84075) Protein, total (84155)
Transferase, alanine amino (ALT) (SGPT) (84460) Transferase, aspartate am (16/08/2019)
Electrolyte panel This panel must include the following: Carbon dioxide (bicarbonate)
(82374) Chloride (82435) Potassium (84132) Sodium (84295) (16/08/2019)
Calcium; total (16/08/2019)
Creatinine; blood (16/08/2019)
Phosphorus inorganic (phosphate); (16/08/2019)
Urea nitrogen; quantitative (16/08/2019)
Glutamyltransferase, gamma (GGT) (16/08/2019)
C-reactive protein; (16/08/2019)
Ventilation assist and management, initiation of pressure or volume preset ventilators for
assisted or controlled breathing; hospital inpatient/observation, each subsequent day
(16/08/2019)
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); each
additional hour (List separately in addition to code for primary procedure) (16/08/2019)
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); each
additional hour (List separately in addition to code for primary procedure) (16/08/2019)
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); each
additional hour (List separately in addition to code for primary procedure) (16/08/2019)
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); each
additional hour (List separately in addition to code for primary procedure) (16/08/2019)
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); each
additional hour (List separately in addition to code for primary procedure) (16/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (16/08/2019)

Name: AHMED FATHELDIN 14 of 35 14/01/2020 20:06:53


MRN: 10086538
Culture, bacterial; quantitative colony count, urine (15/08/2019)
Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop
strength and endurance, range of motion and flexibility (15/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (15/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (15/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (15/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (15/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (15/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (15/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (15/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (15/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (15/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous
or intramuscular (15/08/2019)
Creatinine; blood (15/08/2019)
Phosphorus inorganic (phosphate); (15/08/2019)
Urea nitrogen; quantitative (15/08/2019)
Glutamyltransferase, gamma (GGT) (15/08/2019)
Glucose; quantitative, blood (except reagent strip) (15/08/2019)
Culture, presumptive, pathogenic organisms, screening only; (15/08/2019)
Culture, presumptive, pathogenic organisms, screening only; (15/08/2019)
Infectious agent antigen detection by enzyme immunoassay technique, qualitative or
semiquantitative, multiple-step method; Clostridium difficile toxin(s) (15/08/2019)
Ventilation assist and management, initiation of pressure or volume preset ventilators for
assisted or controlled breathing; hospital inpatient/observation, each subsequent day
(15/08/2019)
Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) and
automated differential WBC count (15/08/2019)
Hepatic function panel This panel must include the following: Albumin (82040) Bilirubin, total
(82247) Bilirubin, direct (82248) Phosphatase, alkaline (84075) Protein, total (84155)
Transferase, alanine amino (ALT) (SGPT) (84460) Transferase, aspartate am (15/08/2019)
Electrolyte panel This panel must include the following: Carbon dioxide (bicarbonate)
(82374) Chloride (82435) Potassium (84132) Sodium (84295) (15/08/2019)
Calcium; total (15/08/2019)
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); each

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MRN: 10086538
additional hour (List separately in addition to code for primary procedure) (15/08/2019)
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); each
additional hour (List separately in addition to code for primary procedure) (15/08/2019)
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); each
additional hour (List separately in addition to code for primary procedure) (15/08/2019)
Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop
strength and endurance, range of motion and flexibility (15/08/2019)
Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop
strength and endurance, range of motion and flexibility (15/08/2019)
Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop
strength and endurance, range of motion and flexibility (15/08/2019)
Culture, bacterial; any other source except urine, blood or stool, aerobic, with isolation and
presumptive identification of isolates (15/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (14/08/2019)
Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop
strength and endurance, range of motion and flexibility (14/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (14/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (14/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (14/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (14/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous
or intramuscular (14/08/2019)
C-reactive protein; (14/08/2019)
Electrolyte panel This panel must include the following: Carbon dioxide (bicarbonate)
(82374) Chloride (82435) Potassium (84132) Sodium (84295)

(14/08/2019)
Hepatic function panel This panel must include the following: Albumin (82040) Bilirubin, total
(82247) Bilirubin, direct (82248) Phosphatase, alkaline (84075) Protein, total (84155)
Transferase, alanine amino (ALT) (SGPT) (84460) Transferase, aspartate am (14/08/2019)
Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) and
automated differential WBC count (14/08/2019)
Calcium; total (14/08/2019)
Creatinine; blood (14/08/2019)
Phosphorus inorganic (phosphate); (14/08/2019)
Urea nitrogen; quantitative (14/08/2019)
Glutamyltransferase, gamma (GGT) (14/08/2019)
Ventilation assist and management, initiation of pressure or volume preset ventilators for
assisted or controlled breathing; hospital inpatient/observation, each subsequent day
(14/08/2019)
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); each
additional hour (List separately in addition to code for primary procedure) (14/08/2019)
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); each

Name: AHMED FATHELDIN 16 of 35 14/01/2020 20:06:53


MRN: 10086538
additional hour (List separately in addition to code for primary procedure) (14/08/2019)
Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop
strength and endurance, range of motion and flexibility (14/08/2019)
Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop
strength and endurance, range of motion and flexibility (14/08/2019)
Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop
strength and endurance, range of motion and flexibility (14/08/2019)
Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop
strength and endurance, range of motion and flexibility (14/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (14/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (13/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (13/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous
or intramuscular (13/08/2019)
Magnesium (13/08/2019)
Glucose; quantitative, blood (except reagent strip) (13/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (13/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (13/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (13/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (13/08/2019)
Electrolyte panel This panel must include the following: Carbon dioxide (bicarbonate)
(82374) Chloride (82435) Potassium (84132) Sodium (84295) (13/08/2019)
Hepatic function panel This panel must include the following: Albumin (82040) Bilirubin, total
(82247) Bilirubin, direct (82248) Phosphatase, alkaline (84075) Protein, total (84155)
Transferase, alanine amino (ALT) (SGPT) (84460) Transferase, aspartate am (13/08/2019)
Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) and
automated differential WBC count (13/08/2019)
Calcium; total (13/08/2019)
Creatinine; blood (13/08/2019)
Phosphorus inorganic (phosphate); (13/08/2019)
Urea nitrogen; quantitative (13/08/2019)
Glutamyltransferase, gamma (GGT) (13/08/2019)
C-reactive protein; (13/08/2019)
Blood smear, peripheral, interpretation by physician with written report (13/08/2019)
Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop
strength and endurance, range of motion and flexibility (13/08/2019)
Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop
strength and endurance, range of motion and flexibility (13/08/2019)
Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop

Name: AHMED FATHELDIN 17 of 35 14/01/2020 20:06:53


MRN: 10086538
strength and endurance, range of motion and flexibility (13/08/2019)
Ventilation assist and management, initiation of pressure or volume preset ventilators for
assisted or controlled breathing; hospital inpatient/observation, each subsequent day
(13/08/2019)
Culture, bacterial; any other source except urine, blood or stool, aerobic, with isolation and
presumptive identification of isolates (12/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (12/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (12/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (12/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (12/08/2019)
Glucose; quantitative, blood (except reagent strip) (12/08/2019)
C-reactive protein; (12/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (12/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (12/08/2019)
Glutamyltransferase, gamma (GGT) (12/08/2019)
Urea nitrogen; quantitative (12/08/2019)
Therapeutic procedure, 1 or more areas, each 15 minutes; massage, including effleurage,
petrissage and/or tapotement (stroking, compression, percussion) (12/08/2019)
Phosphorus inorganic (phosphate); (12/08/2019)
Ventilation assist and management, initiation of pressure or volume preset ventilators for
assisted or controlled breathing; hospital inpatient/observation, each subsequent day
(12/08/2019)
Creatinine; blood (12/08/2019)
Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop
strength and endurance, range of motion and flexibility (12/08/2019)
Calcium; total (12/08/2019)
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); each
additional hour (List separately in addition to code for primary procedure) (12/08/2019)
Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) and
automated differential WBC count (12/08/2019)
Hepatic function panel This panel must include the following: Albumin (82040) Bilirubin, total
(82247) Bilirubin, direct (82248) Phosphatase, alkaline (84075) Protein, total (84155)
Transferase, alanine amino (ALT) (SGPT) (84460) Transferase, aspartate am (12/08/2019)
Blood smear, peripheral, interpretation by physician with written report (12/08/2019)
Electrolyte panel This panel must include the following: Carbon dioxide (bicarbonate)
(82374) Chloride (82435) Potassium (84132) Sodium (84295) (12/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous
or intramuscular (12/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (12/08/2019)

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MRN: 10086538
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (12/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (11/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (11/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure)

(11/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (11/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (11/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (11/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (11/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (11/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (11/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (11/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (11/08/2019)
Therapeutic procedure, 1 or more areas, each 15 minutes; massage, including effleurage,
petrissage and/or tapotement (stroking, compression, percussion) (11/08/2019)
Ventilation assist and management, initiation of pressure or volume preset ventilators for
assisted or controlled breathing; hospital inpatient/observation, each subsequent day
(11/08/2019)
Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop
strength and endurance, range of motion and flexibility (11/08/2019)
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); each
additional hour (List separately in addition to code for primary procedure) (11/08/2019)
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); each
additional hour (List separately in addition to code for primary procedure) (11/08/2019)
Blood smear, peripheral, interpretation by physician with written report (11/08/2019)
Glutamyltransferase, gamma (GGT) (11/08/2019)
Urea nitrogen; quantitative (11/08/2019)
Phosphorus inorganic (phosphate); (11/08/2019)

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MRN: 10086538
Creatinine; blood (11/08/2019)
Calcium; total (11/08/2019)
Electrolyte panel This panel must include the following: Carbon dioxide (bicarbonate)
(82374) Chloride (82435) Potassium (84132) Sodium (84295) (11/08/2019)
Hepatic function panel This panel must include the following: Albumin (82040) Bilirubin, total
(82247) Bilirubin, direct (82248) Phosphatase, alkaline (84075) Protein, total (84155)
Transferase, alanine amino (ALT) (SGPT) (84460) Transferase, aspartate am (11/08/2019)
Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) and
automated differential WBC count (11/08/2019)
Glucose; quantitative, blood (except reagent strip) (11/08/2019)
C-reactive protein; (11/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous
or intramuscular (11/08/2019)
Infectious agent antigen detection by enzyme immunoassay technique, qualitative or
semiquantitative, multiple-step method; Clostridium difficile toxin(s) (11/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of a new substance/drug (List separately in addition to code for
primary procedure) (11/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (11/08/2019)
Infectious agent antigen detection by enzyme immunoassay technique, qualitative or
semiquantitative, multiple-step method; Clostridium difficile toxin(s) (11/08/2019)
Radiologic examination, chest; single view, frontal (11/08/2019)
Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) and
automated differential WBC count (10/08/2019)
Hepatic function panel This panel must include the following: Albumin (82040) Bilirubin, total
(82247) Bilirubin, direct (82248) Phosphatase, alkaline (84075) Protein, total (84155)
Transferase, alanine amino (ALT) (SGPT) (84460) Transferase, aspartate am (10/08/2019)
Electrolyte panel This panel must include the following: Carbon dioxide (bicarbonate)
(82374) Chloride (82435) Potassium (84132) Sodium (84295) (10/08/2019)
Calcium; total (10/08/2019)
Creatinine; blood (10/08/2019)
Phosphorus inorganic (phosphate); (10/08/2019)
Urea nitrogen; quantitative (10/08/2019)
Glutamyltransferase, gamma (GGT) (10/08/2019)
C-reactive protein; (10/08/2019)
Blood smear, peripheral, interpretation by physician with written report (10/08/2019)
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); each
additional hour (List separately in addition to code for primary procedure) (10/08/2019)
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); each
additional hour (List separately in addition to code for primary procedure) (10/08/2019)
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); each
additional hour (List separately in addition to code for primary procedure) (10/08/2019)
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); each
additional hour (List separately in addition to code for primary procedure) (10/08/2019)
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); each
additional hour (List separately in addition to code for primary procedure) (10/08/2019)
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); each
additional hour (List separately in addition to code for primary procedure) (10/08/2019)
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); each
additional hour (List separately in addition to code for primary procedure) (10/08/2019)
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); each

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MRN: 10086538
additional hour (List separately in addition to code for primary procedure) (10/08/2019)
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); each
additional hour (List separately in addition to code for primary procedure) (10/08/2019)
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); each
additional hour (List separately in addition to code for primary procedure) (10/08/2019)
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); each
additional hour (List separately in addition to code for primary procedure) (10/08/2019)
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); each
additional hour (List separately in addition to code for primary procedure) (10/08/2019)
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); each
additional hour (List separately in addition to code for primary procedure) (10/08/2019)
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); each
additional hour (List separately in addition to code for primary procedure) (10/08/2019)
Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop
strength and endurance, range of motion and flexibility (10/08/2019)
Ventilation assist and management, initiation of pressure or volume preset ventilators for
assisted or controlled breathing; hospital inpatient/observation, each subsequent day
(10/08/2019)
Therapeutic procedure, 1 or more areas, each 15 minutes; massage, including effleurage,
petrissage and/or tapotement (stroking, compression, percussion) (10/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (10/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (10/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (10/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (10/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure)

(10/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (10/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (10/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (10/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous
or intramuscular (10/08/2019)
Glucose; quantitative, blood (except reagent strip) (10/08/2019)
Culture, bacterial; stool, aerobic, with isolation and preliminary examination (eg, KIA, LIA),
Salmonella and Shigella species (10/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of a new substance/drug (List separately in addition to code for

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MRN: 10086538
primary procedure) (10/08/2019)
Intravenous infusion, hydration; each additional hour (List separately in addition to code for
primary procedure) (10/08/2019)
Intravenous infusion, hydration; each additional hour (List separately in addition to code for
primary procedure) (10/08/2019)
Intravenous infusion, hydration; each additional hour (List separately in addition to code for
primary procedure) (10/08/2019)
Intravenous infusion, hydration; each additional hour (List separately in addition to code for
primary procedure) (10/08/2019)
Intravenous infusion, hydration; each additional hour (List separately in addition to code for
primary procedure) (10/08/2019)
Intravenous infusion, hydration; each additional hour (List separately in addition to code for
primary procedure) (10/08/2019)
Intravenous infusion, hydration; each additional hour (List separately in addition to code for
primary procedure) (10/08/2019)
Intravenous infusion, hydration; each additional hour (List separately in addition to code for
primary procedure) (10/08/2019)
Intravenous infusion, hydration; each additional hour (List separately in addition to code for
primary procedure) (10/08/2019)
Intravenous infusion, hydration; each additional hour (List separately in addition to code for
primary procedure) (10/08/2019)
Pressurized or nonpressurized inhalation treatment for acute airway obstruction or for
sputum induction for diagnostic purposes (eg, with an aerosol generator, nebulizer, metered
dose inhaler or intermittent positive pressure breathing [IPPB] device) (10/08/2019)
Pressurized or nonpressurized inhalation treatment for acute airway obstruction or for
sputum induction for diagnostic purposes (eg, with an aerosol generator, nebulizer, metered
dose inhaler or intermittent positive pressure breathing [IPPB] device) (10/08/2019)
Pressurized or nonpressurized inhalation treatment for acute airway obstruction or for
sputum induction for diagnostic purposes (eg, with an aerosol generator, nebulizer, metered
dose inhaler or intermittent positive pressure breathing [IPPB] device) (10/08/2019)
Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) and
automated differential WBC count (09/08/2019)
Pressurized or nonpressurized inhalation treatment for acute airway obstruction or for
sputum induction for diagnostic purposes (eg, with an aerosol generator, nebulizer, metered
dose inhaler or intermittent positive pressure breathing [IPPB] device) (09/08/2019)
Electrolyte panel This panel must include the following: Carbon dioxide (bicarbonate)
(82374) Chloride (82435) Potassium (84132) Sodium (84295) (09/08/2019)
Calcium; total (09/08/2019)
Creatinine; blood (09/08/2019)
Phosphorus inorganic (phosphate); (09/08/2019)
Urea nitrogen; quantitative (09/08/2019)
Glutamyltransferase, gamma (GGT) (09/08/2019)
C-reactive protein; (09/08/2019)
Glucose; quantitative, blood (except reagent strip) (09/08/2019)
Blood smear, peripheral, interpretation by physician with written report (09/08/2019)
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug);
additional sequential infusion of a new drug/substance, up to 1 hour (List separately in addition
to code for primary procedure) (09/08/2019)
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); each
additional hour (List separately in addition to code for primary procedure) (09/08/2019)
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); each
additional hour (List separately in addition to code for primary procedure) (09/08/2019)
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); each

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MRN: 10086538
additional hour (List separately in addition to code for primary procedure) (09/08/2019)
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); each
additional hour (List separately in addition to code for primary procedure) (09/08/2019)
Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop
strength and endurance, range of motion and flexibility (09/08/2019)
Ventilation assist and management, initiation of pressure or volume preset ventilators for
assisted or controlled breathing; hospital inpatient/observation, each subsequent day
(09/08/2019)
Radiologic examination, chest; single view, frontal (09/08/2019)
Radiologic examination, chest; single view, frontal (09/08/2019)
Therapeutic procedure, 1 or more areas, each 15 minutes; massage, including effleurage,
petrissage and/or tapotement (stroking, compression, percussion) (09/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (09/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (09/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (09/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (09/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (09/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (09/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (09/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (09/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (09/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous
or intramuscular (09/08/2019)
Radiologic examination, chest; single view, frontal (09/08/2019)
Culture, bacterial; blood, aerobic, with isolation and presumptive identification of isolates
(includes anaerobic culture, if appropriate) (09/08/2019)
Culture, bacterial; quantitative colony count, urine (09/08/2019)
Radiologic examination, chest; single view, frontal (09/08/2019)
Radiologic examination, chest; single view, frontal (09/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of a new substance/drug (List separately in addition to code for
primary procedure) (09/08/2019)
Pressurized or nonpressurized inhalation treatment for acute airway obstruction or for
sputum induction for diagnostic purposes (eg, with an aerosol generator, nebulizer, metered
dose inhaler or intermittent positive pressure breathing [IPPB] device) (09/08/2019)

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MRN: 10086538
Pressurized or nonpressurized inhalation treatment for acute airway obstruction or for
sputum induction for diagnostic purposes (eg, with an aerosol generator, nebulizer, metered
dose inhaler or intermittent positive pressure breathing [IPPB] device) (09/08/2019)
Hepatic function panel This panel must include the following: Albumin (82040) Bilirubin, total
(82247) Bilirubin, direct (82248) Phosphatase, alkaline (84075) Protein, total (84155)
Transferase, alanine amino (ALT) (SGPT) (84460) Transferase, aspartate am (09/08/2019)
Pressurized or nonpressurized inhalation treatment for acute airway obstruction or for
sputum induction for diagnostic purposes (eg, with an aerosol generator, nebulizer, metered
dose inhaler or intermittent positive pressure breathing [IPPB] device)

(08/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (08/08/2019)
Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop
strength and endurance, range of motion and flexibility (08/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (08/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (08/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (08/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous
or intramuscular (08/08/2019)
Pressurized or nonpressurized inhalation treatment for acute airway obstruction or for
sputum induction for diagnostic purposes (eg, with an aerosol generator, nebulizer, metered
dose inhaler or intermittent positive pressure breathing [IPPB] device) (08/08/2019)
Ventilation assist and management, initiation of pressure or volume preset ventilators for
assisted or controlled breathing; hospital inpatient/observation, each subsequent day
(08/08/2019)
Radiologic examination, chest; single view, frontal (08/08/2019)
Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) and
automated differential WBC count (08/08/2019)
Hepatic function panel This panel must include the following: Albumin (82040) Bilirubin, total
(82247) Bilirubin, direct (82248) Phosphatase, alkaline (84075) Protein, total (84155)
Transferase, alanine amino (ALT) (SGPT) (84460) Transferase, aspartate am (08/08/2019)
Electrolyte panel This panel must include the following: Carbon dioxide (bicarbonate)
(82374) Chloride (82435) Potassium (84132) Sodium (84295) (08/08/2019)
Calcium; total (08/08/2019)
Creatinine; blood (08/08/2019)
Phosphorus inorganic (phosphate); (08/08/2019)
Glucose; quantitative, blood (except reagent strip) (08/08/2019)
Urea nitrogen; quantitative (08/08/2019)
Glutamyltransferase, gamma (GGT) (08/08/2019)
C-reactive protein; (08/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (08/08/2019)
Arterial catheterization or cannulation for sampling, monitoring or transfusion (separate
procedure); percutaneous (08/08/2019)

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MRN: 10086538
Therapeutic procedure, 1 or more areas, each 15 minutes; massage, including effleurage,
petrissage and/or tapotement (stroking, compression, percussion) (07/08/2019)
C-reactive protein; (07/08/2019)
Ventilation assist and management, initiation of pressure or volume preset ventilators for
assisted or controlled breathing; hospital inpatient/observation, each subsequent day
(07/08/2019)
Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop
strength and endurance, range of motion and flexibility (07/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (07/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (07/08/2019)
Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop
strength and endurance, range of motion and flexibility (07/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (07/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (07/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (07/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous
or intramuscular (07/08/2019)
Pressurized or nonpressurized inhalation treatment for acute airway obstruction or for
sputum induction for diagnostic purposes (eg, with an aerosol generator, nebulizer, metered
dose inhaler or intermittent positive pressure breathing [IPPB] device) (07/08/2019)
Pressurized or nonpressurized inhalation treatment for acute airway obstruction or for
sputum induction for diagnostic purposes (eg, with an aerosol generator, nebulizer, metered
dose inhaler or intermittent positive pressure breathing [IPPB] device) (07/08/2019)
Pressurized or nonpressurized inhalation treatment for acute airway obstruction or for
sputum induction for diagnostic purposes (eg, with an aerosol generator, nebulizer, metered
dose inhaler or intermittent positive pressure breathing [IPPB] device) (07/08/2019)
Pressurized or nonpressurized inhalation treatment for acute airway obstruction or for
sputum induction for diagnostic purposes (eg, with an aerosol generator, nebulizer, metered
dose inhaler or intermittent positive pressure breathing [IPPB] device) (07/08/2019)
Pressurized or nonpressurized inhalation treatment for acute airway obstruction or for
sputum induction for diagnostic purposes (eg, with an aerosol generator, nebulizer, metered
dose inhaler or intermittent positive pressure breathing [IPPB] device) (07/08/2019)
Electrolyte panel This panel must include the following: Carbon dioxide (bicarbonate)
(82374) Chloride (82435) Potassium (84132) Sodium (84295) (07/08/2019)
Hepatic function panel This panel must include the following: Albumin (82040) Bilirubin, total
(82247) Bilirubin, direct (82248) Phosphatase, alkaline (84075) Protein, total (84155)
Transferase, alanine amino (ALT) (SGPT) (84460) Transferase, aspartate am (07/08/2019)
Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) and
automated differential WBC count (07/08/2019)
Calcium; total (07/08/2019)
Creatinine; blood (07/08/2019)
Phosphorus inorganic (phosphate); (07/08/2019)
Glucose; quantitative, blood (except reagent strip) (07/08/2019)

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MRN: 10086538
Urea nitrogen; quantitative (07/08/2019)
Glutamyltransferase, gamma (GGT) (07/08/2019)
Therapeutic procedure, 1 or more areas, each 15 minutes; massage, including effleurage,
petrissage and/or tapotement (stroking, compression, percussion) (07/08/2019)
Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop
strength and endurance, range of motion and flexibility (06/08/2019)
Therapeutic procedure, 1 or more areas, each 15 minutes; massage, including effleurage,
petrissage and/or tapotement (stroking, compression, percussion) (06/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (06/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (06/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (06/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (06/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (06/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous
or intramuscular (06/08/2019)
Intravenous infusion, hydration; each additional hour (List separately in addition to code for
primary procedure) (06/08/2019)
Intravenous infusion, hydration; each additional hour (List separately in addition to code for
primary procedure) (06/08/2019)
Intravenous infusion, hydration; each additional hour (List separately in addition to code for
primary procedure) (06/08/2019)
Intravenous infusion, hydration; each additional hour (List separately in addition to code for
primary procedure) (06/08/2019)
Intravenous infusion, hydration; each additional hour (List separately in addition to code for
primary procedure) (06/08/2019)
Intravenous infusion, hydration; each additional hour (List separately in addition to code for
primary procedure)

(06/08/2019)
Intravenous infusion, hydration; each additional hour (List separately in addition to code for
primary procedure) (06/08/2019)
Intravenous infusion, hydration; each additional hour (List separately in addition to code for
primary procedure) (06/08/2019)
Intravenous infusion, hydration; each additional hour (List separately in addition to code for
primary procedure) (06/08/2019)
Intravenous infusion, hydration; each additional hour (List separately in addition to code for
primary procedure) (06/08/2019)
Intravenous infusion, hydration; each additional hour (List separately in addition to code for
primary procedure) (06/08/2019)
Intravenous infusion, hydration; each additional hour (List separately in addition to code for
primary procedure) (06/08/2019)
Intravenous infusion, hydration; each additional hour (List separately in addition to code for
primary procedure) (06/08/2019)

Name: AHMED FATHELDIN 26 of 35 14/01/2020 20:06:53


MRN: 10086538
Intravenous infusion, hydration; each additional hour (List separately in addition to code for
primary procedure) (06/08/2019)
Intravenous infusion, hydration; each additional hour (List separately in addition to code for
primary procedure) (06/08/2019)
Intravenous infusion, hydration; each additional hour (List separately in addition to code for
primary procedure) (06/08/2019)
Intravenous infusion, hydration; each additional hour (List separately in addition to code for
primary procedure) (06/08/2019)
Intravenous infusion, hydration; each additional hour (List separately in addition to code for
primary procedure) (06/08/2019)
Intravenous infusion, hydration; each additional hour (List separately in addition to code for
primary procedure) (06/08/2019)
Intravenous infusion, hydration; each additional hour (List separately in addition to code for
primary procedure) (06/08/2019)
Intravenous infusion, hydration; each additional hour (List separately in addition to code for
primary procedure) (06/08/2019)
Intravenous infusion, hydration; each additional hour (List separately in addition to code for
primary procedure) (06/08/2019)
Pressurized or nonpressurized inhalation treatment for acute airway obstruction or for
sputum induction for diagnostic purposes (eg, with an aerosol generator, nebulizer, metered
dose inhaler or intermittent positive pressure breathing [IPPB] device) (06/08/2019)
Pressurized or nonpressurized inhalation treatment for acute airway obstruction or for
sputum induction for diagnostic purposes (eg, with an aerosol generator, nebulizer, metered
dose inhaler or intermittent positive pressure breathing [IPPB] device) (06/08/2019)
Pressurized or nonpressurized inhalation treatment for acute airway obstruction or for
sputum induction for diagnostic purposes (eg, with an aerosol generator, nebulizer, metered
dose inhaler or intermittent positive pressure breathing [IPPB] device) (06/08/2019)
Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) and
automated differential WBC count (06/08/2019)
Calcium; total (06/08/2019)
Creatinine; blood (06/08/2019)
Phosphorus inorganic (phosphate); (06/08/2019)
Glucose; quantitative, blood (except reagent strip) (06/08/2019)
Urea nitrogen; quantitative (06/08/2019)
Glutamyltransferase, gamma (GGT) (06/08/2019)
C-reactive protein; (06/08/2019)
Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop
strength and endurance, range of motion and flexibility (06/08/2019)
Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop
strength and endurance, range of motion and flexibility (06/08/2019)
Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop
strength and endurance, range of motion and flexibility (06/08/2019)
Ventilation assist and management, initiation of pressure or volume preset ventilators for
assisted or controlled breathing; hospital inpatient/observation, each subsequent day
(06/08/2019)
Electrolyte panel This panel must include the following: Carbon dioxide (bicarbonate)
(82374) Chloride (82435) Potassium (84132) Sodium (84295) (06/08/2019)
Hepatic function panel This panel must include the following: Albumin (82040) Bilirubin, total
(82247) Bilirubin, direct (82248) Phosphatase, alkaline (84075) Protein, total (84155)
Transferase, alanine amino (ALT) (SGPT) (84460) Transferase, aspartate am (06/08/2019)
Therapeutic procedure, 1 or more areas, each 15 minutes; massage, including effleurage,
petrissage and/or tapotement (stroking, compression, percussion) (05/08/2019)
C-reactive protein; (05/08/2019)

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MRN: 10086538
Therapeutic procedure, 1 or more areas, each 15 minutes; massage, including effleurage,
petrissage and/or tapotement (stroking, compression, percussion) (05/08/2019)
Pressurized or nonpressurized inhalation treatment for acute airway obstruction or for
sputum induction for diagnostic purposes (eg, with an aerosol generator, nebulizer, metered
dose inhaler or intermittent positive pressure breathing [IPPB] device) (05/08/2019)
Pressurized or nonpressurized inhalation treatment for acute airway obstruction or for
sputum induction for diagnostic purposes (eg, with an aerosol generator, nebulizer, metered
dose inhaler or intermittent positive pressure breathing [IPPB] device) (05/08/2019)
Pressurized or nonpressurized inhalation treatment for acute airway obstruction or for
sputum induction for diagnostic purposes (eg, with an aerosol generator, nebulizer, metered
dose inhaler or intermittent positive pressure breathing [IPPB] device) (05/08/2019)
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug);
additional sequential infusion of a new drug/substance, up to 1 hour (List separately in addition
to code for primary procedure) (05/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of a new substance/drug (List separately in addition to code for
primary procedure) (05/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (05/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (05/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (05/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (05/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous
or intramuscular (05/08/2019)
Intravenous infusion, hydration; each additional hour (List separately in addition to code for
primary procedure) (05/08/2019)
Intravenous infusion, hydration; each additional hour (List separately in addition to code for
primary procedure) (05/08/2019)
Intravenous infusion, hydration; each additional hour (List separately in addition to code for
primary procedure) (05/08/2019)
Intravenous infusion, hydration; each additional hour (List separately in addition to code for
primary procedure) (05/08/2019)
Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop
strength and endurance, range of motion and flexibility (05/08/2019)
Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop
strength and endurance, range of motion and flexibility (05/08/2019)
Ventilation assist and management, initiation of pressure or volume preset ventilators for
assisted or controlled breathing; hospital inpatient/observation, each subsequent day
(05/08/2019)
Hepatic function panel This panel must include the following: Albumin (82040) Bilirubin, total
(82247) Bilirubin, direct (82248) Phosphatase, alkaline (84075) Protein, total (84155)
Transferase, alanine amino (ALT) (SGPT) (84460) Transferase, aspartate am (05/08/2019)
Electrolyte panel This panel must include the following: Carbon dioxide (bicarbonate)
(82374) Chloride (82435) Potassium (84132) Sodium (84295) (05/08/2019)
Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) and
automated differential WBC count (05/08/2019)

Name: AHMED FATHELDIN 28 of 35 14/01/2020 20:06:53


MRN: 10086538
Prothrombin time; (05/08/2019)
Thromboplastin time, partial (PTT); plasma or whole blood (05/08/2019)
Calcium; total (05/08/2019)
Creatinine; blood (05/08/2019)
Phosphorus inorganic (phosphate); (05/08/2019)
Glucose; quantitative, blood (except reagent strip) (05/08/2019)
Urea nitrogen; quantitative (05/08/2019)
Glutamyltransferase, gamma (GGT) (05/08/2019)
Therapeutic procedure, 1 or more areas, each 15 minutes; massage, including effleurage,
petrissage and/or tapotement (stroking, compression, percussion) (05/08/2019)
Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with
bronchial alveolar lavage (04/08/2019)
Potassium; serum, plasma or whole blood (04/08/2019)
Radiologic examination, chest; single view, frontal (04/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of a new substance/drug (List separately in addition to code for
primary procedure) (04/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of a new substance/drug (List separately in addition to code for
primary procedure)

(04/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of a new substance/drug (List separately in addition to code for
primary procedure) (04/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of a new substance/drug (List separately in addition to code for
primary procedure) (04/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of a new substance/drug (List separately in addition to code for
primary procedure) (04/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (04/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (04/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (04/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (04/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (04/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (04/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (04/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional

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MRN: 10086538
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (04/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous
or intramuscular (04/08/2019)
Pressurized or nonpressurized inhalation treatment for acute airway obstruction or for
sputum induction for diagnostic purposes (eg, with an aerosol generator, nebulizer, metered
dose inhaler or intermittent positive pressure breathing [IPPB] device) (04/08/2019)
Pressurized or nonpressurized inhalation treatment for acute airway obstruction or for
sputum induction for diagnostic purposes (eg, with an aerosol generator, nebulizer, metered
dose inhaler or intermittent positive pressure breathing [IPPB] device) (04/08/2019)
Radiologic examination, chest; single view, frontal (04/08/2019)
Intubation, endotracheal, emergency procedure (04/08/2019)
Ventilation assist and management, initiation of pressure or volume preset ventilators for
assisted or controlled breathing; hospital inpatient/observation, initial day (04/08/2019)
Hepatic function panel This panel must include the following: Albumin (82040) Bilirubin, total
(82247) Bilirubin, direct (82248) Phosphatase, alkaline (84075) Protein, total (84155)
Transferase, alanine amino (ALT) (SGPT) (84460) Transferase, aspartate am (04/08/2019)
Electrolyte panel This panel must include the following: Carbon dioxide (bicarbonate)
(82374) Chloride (82435) Potassium (84132) Sodium (84295) (04/08/2019)
Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) and
automated differential WBC count (04/08/2019)
Calcium; total (04/08/2019)
Creatinine; blood (04/08/2019)
Phosphorus inorganic (phosphate); (04/08/2019)
Glucose; quantitative, blood (except reagent strip) (04/08/2019)
Magnesium (04/08/2019)
Urea nitrogen; quantitative (04/08/2019)
Glutamyltransferase, gamma (GGT) (04/08/2019)
C-reactive protein; (04/08/2019)
Culture, bacterial; quantitative colony count, urine (04/08/2019)
Culture, bacterial; blood, aerobic, with isolation and presumptive identification of isolates
(includes anaerobic culture, if appropriate) (04/08/2019)
Culture, bacterial; any other source except urine, blood or stool, aerobic, with isolation and
presumptive identification of isolates (04/08/2019)
Culture, bacterial; any other source except urine, blood or stool, aerobic, with isolation and
presumptive identification of isolates (04/08/2019)
Potassium; serum, plasma or whole blood (04/08/2019)
Insertion of non-tunneled centrally inserted central venous catheter; age 5 years or older
(04/08/2019)
Therapeutic procedure, 1 or more areas, each 15 minutes; massage, including effleurage,
petrissage and/or tapotement (stroking, compression, percussion) (03/08/2019)
Electrolyte panel This panel must include the following: Carbon dioxide (bicarbonate)
(82374) Chloride (82435) Potassium (84132) Sodium (84295) (03/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (03/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (03/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (03/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous

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MRN: 10086538
or intramuscular (03/08/2019)
Intravenous infusion, hydration; each additional hour (List separately in addition to code for
primary procedure) (03/08/2019)
Intravenous infusion, hydration; each additional hour (List separately in addition to code for
primary procedure) (03/08/2019)
Intravenous infusion, hydration; each additional hour (List separately in addition to code for
primary procedure) (03/08/2019)
Intravenous infusion, hydration; each additional hour (List separately in addition to code for
primary procedure) (03/08/2019)
Intravenous infusion, hydration; each additional hour (List separately in addition to code for
primary procedure) (03/08/2019)
Intravenous infusion, hydration; each additional hour (List separately in addition to code for
primary procedure) (03/08/2019)
Intravenous infusion, hydration; each additional hour (List separately in addition to code for
primary procedure) (03/08/2019)
Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop
strength and endurance, range of motion and flexibility (03/08/2019)
Radiologic examination, chest; single view, frontal (03/08/2019)
Continuous positive airway pressure ventilation (CPAP), initiation and management
(03/08/2019)
Calcium; total (03/08/2019)
Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) and
automated differential WBC count (03/08/2019)
Hepatic function panel This panel must include the following: Albumin (82040) Bilirubin, total
(82247) Bilirubin, direct (82248) Phosphatase, alkaline (84075) Protein, total (84155)
Transferase, alanine amino (ALT) (SGPT) (84460) Transferase, aspartate am (03/08/2019)
Phosphorus inorganic (phosphate); (03/08/2019)
Magnesium (03/08/2019)
Calcium; total (03/08/2019)
Creatinine; blood (03/08/2019)
Glucose; quantitative, blood (except reagent strip) (03/08/2019)
Urea nitrogen; quantitative (03/08/2019)
Glutamyltransferase, gamma (GGT) (03/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (03/08/2019)
Therapeutic procedure, 1 or more areas, each 15 minutes; massage, including effleurage,
petrissage and/or tapotement (stroking, compression, percussion) (02/08/2019)
Magnesium (02/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (02/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (02/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (02/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (02/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately

Name: AHMED FATHELDIN 31 of 35 14/01/2020 20:06:53


MRN: 10086538
in addition to code for primary procedure)

(02/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (02/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous
or intramuscular (02/08/2019)
Physical therapy evaluation (02/08/2019)
Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop
strength and endurance, range of motion and flexibility (02/08/2019)
Continuous positive airway pressure ventilation (CPAP), initiation and management
(02/08/2019)
Creatinine; blood (02/08/2019)
C-reactive protein; (02/08/2019)
Urea nitrogen; quantitative (02/08/2019)
Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) and
automated differential WBC count (02/08/2019)
Hepatic function panel This panel must include the following: Albumin (82040) Bilirubin, total
(82247) Bilirubin, direct (82248) Phosphatase, alkaline (84075) Protein, total (84155)
Transferase, alanine amino (ALT) (SGPT) (84460) Transferase, aspartate am (02/08/2019)
Therapeutic procedure, 1 or more areas, each 15 minutes; massage, including effleurage,
petrissage and/or tapotement (stroking, compression, percussion) (02/08/2019)
Radiologic examination, chest; single view, frontal (01/08/2019)
Arterial catheterization or cannulation for sampling, monitoring or transfusion (separate
procedure); percutaneous (01/08/2019)
Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones,
leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents;
automated, with microscopy (01/08/2019)
Calcium; total (01/08/2019)
Creatinine; blood (01/08/2019)
Magnesium (01/08/2019)
Phosphorus inorganic (phosphate); (01/08/2019)
Transferase; aspartate amino (AST) (SGOT) (01/08/2019)
Transferase; alanine amino (ALT) (SGPT) (01/08/2019)
Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) and
automated differential WBC count (01/08/2019)
Prothrombin time; (01/08/2019)
Thromboplastin time, partial (PTT); plasma or whole blood (01/08/2019)
C-reactive protein; (01/08/2019)
Culture, bacterial; blood, aerobic, with isolation and presumptive identification of isolates
(includes anaerobic culture, if appropriate) (01/08/2019)
Culture, bacterial; quantitative colony count, urine (01/08/2019)
Infectious agent antigen detection by immunoassay with direct optical observation; Influenza
(01/08/2019)
Infectious agent antigen detection by immunoassay with direct optical observation; Influenza
(01/08/2019)
Gases, blood, any combination of pH, pCO2, pO2, CO2, HCO3 (including calculated O2
saturation); (01/08/2019)
Gases, blood, any combination of pH, pCO2, pO2, CO2, HCO3 (including calculated O2
saturation); (01/08/2019)
Continuous positive airway pressure ventilation (CPAP), initiation and management
(01/08/2019)

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MRN: 10086538
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug);
initial, up to 1 hour (01/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of a new substance/drug (List separately in addition to code for
primary procedure) (01/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of a new substance/drug (List separately in addition to code for
primary procedure) (01/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional
sequential intravenous push of the same substance/drug provided in a facility (List separately
in addition to code for primary procedure) (01/08/2019)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous
or intramuscular (01/08/2019)
Intravenous infusion, hydration; each additional hour (List separately in addition to code for
primary procedure) (01/08/2019)
Intravenous infusion, hydration; each additional hour (List separately in addition to code for
primary procedure) (01/08/2019)
Intravenous infusion, hydration; each additional hour (List separately in addition to code for
primary procedure) (01/08/2019)
Intravenous infusion, hydration; each additional hour (List separately in addition to code for
primary procedure) (01/08/2019)
Intravenous infusion, hydration; each additional hour (List separately in addition to code for
primary procedure) (01/08/2019)
Electrolyte panel This panel must include the following: Carbon dioxide (bicarbonate)
(82374) Chloride (82435) Potassium (84132) Sodium (84295) (01/08/2019)

Final Active Medications


cosmetic (CETAPHIL MOISTURIZING LOTION 200ml) Topical as directed as needed dry skin.

enoxaparin (enoxaparin 60 mg/0.6 mL,) 60 Milligrams SubCutaneous daily (morning) for 28 Days. Refills: 0.

enoxaparin (enoxaparin 60 mg/0.6 mL,) SubCutaneous daily (evening).

esomeprazole (esomeprazole 10mg Oral Powder Sachets ,(28's),) 1 Each Gastrostomy Tube/PE TWICE a day for 120
Days. Refills: 0.

esomeprazole (esomeprazole 10mg Oral Powder Sachets ,(28's),) Gastrostomy Tube/PE TWICE a day.

glycerin (Artificial Tears Naturale eye drops,) 1 Drops Both eyes FOUR times a day for 28 Days. Refills: 0.

glycopyrrolate (glycopyrrolate 0.2 mg/mL injectable solution,) 0.5 Milliliters SubCutaneous TWICE a day.

hyoscine butylbromide (Hyoscine butylbromide 10 mg Tab,,) Gastrostomy Tube/PE as directed as needed irritable
bowel symptoms.

hyoscine butylbromide (Hyoscine butylbromide 10 mg Tab,,) 10 Milligrams Gastrostomy Tube/PE as directed as


needed spasm for 28 Days. 10mg tds prn. Refills: 0.

lactobacillus (Lactobacillus (Enterogermina) Susp Oral Vials,) Gastrostomy Tube/PE TWICE a day.

lactobacillus (Lactobacillus (Enterogermina) Susp Oral Vials,) 5 Milliliters Oral daily for 30 Days. Refills: 0.

lactulose (Lactulose 667mg/mL Syrup 15mL sachets,) 15 mls Gastrostomy Tube/PE TWICE a day for 30 Days.
Refills: 0.

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MRN: 10086538
lactulose (Lactulose 667mg/mL Syrup 15mL sachets,) Gastrostomy Tube/PE TWICE a day as needed irritable bowel
symptoms.

metoclopramide (Metoclopramide 10 mg Tab,) Gastrostomy Tube/PE THREE times a day.

metoclopramide (Metoclopramide 10 mg Tab,) 10 Milligrams Gastrostomy Tube/PE THREE times a day for 30 Days.
Refills: 0.

mouth wash (Chlorhexidine-Digluconate 0.20% Mouth Wash (Curasept 200mL),) Swish and Spit as directed as
needed mouth sore pain.

mouth wash (Chlorhexidine-Digluconate 0.20% Mouth Wash (Curasept 200mL),) Oral mouth care. Swish and spit..
Refills: 0.

nutritional supplement (Nestle Modulen IBD Powder (Modulen 400g),) Gastrostomy Tube/PE daily.

nutritional supplement (Nestle Modulen IBD Powder (Modulen 400g),) 300 Gram Gastrostomy Tube/PE daily for 4
weeks. Refills: 0.

ocular lubricant (Artificial Tears)

paracetamol (Paracetamol 120mg/5ml Syrup, Fruit Falvor,) Oral Gastric Tube every 6 hours as needed fever, temp
greater than 37.6 C.

paracetamol (Paracetamol 500mg Tab, Panadol Advance,) 2 tabs Gastrostomy Tube/PE as directed as needed pain,
breakthrough for 10 Days. prn 2 tablets 6 hourly. Refills: 0.

rifaximin (Rifaximin 200 mg oral tablet,) 1 tabs Gastrostomy Tube/PE every 8 hours.

rifaximin (Rifaximin 200 mg oral tablet,) 2 tabs Oral THREE times a day for 10 Days. Refills: 0.

Topical Lotion (Cetaphil Moisturizing Lotion 200ml,) Topical prn as directed for dry skin; as needed dry skin. Refills:
0.

ursodiol (Ursodeoxycholic Acid 250 mg Cap,) Gastrostomy Tube/PE TWICE a day.

ursodiol (Ursodeoxycholic Acid 250 mg Cap,) 250 Milligrams Oral TWICE a day for 30 Days. Refills: 0.

zopiclone (zopiclone 7.5 mg oral tablet,) 1 tabs Gastrostomy Tube/PE daily (bedtime).

zopiclone (zopiclone 7.5 mg oral tablet,) 1 tab Gastrostomy Tube/PE as directed as needed insomnia for 4 weeks. 1
tablet at 20:00 prn. Refills: 0.

Take only the medications listed above. Contact your doctor prior to taking any medications not on
this list.
Discharge Instructions:

Current Addendums

Follow-up Instructions

I, AHMED FATHELDIN, have received the required patient education materials/instructions and have

Name: AHMED FATHELDIN 34 of 35 14/01/2020 20:06:53


MRN: 10086538
verbalized understanding.

____________________________ ____________________________
Patient/Guardian Name Patient/Guardian Signature

Name: AHMED FATHELDIN 35 of 35 14/01/2020 20:06:53


MRN: 10086538

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