EFTA00282980.pdf

Jul 27 2016 0127FM Huy Rsch 12129881634 page HARRY FISCH, MD (PIN #091790) 944 Park Avenue New York, NY 10028 —c— n Patient Name: _j P r 51 sip Date of Birth: lift( I WI New Patient Level II 99202 H f! New Patient Level III 99203 Established Patient Visit Level Il - 99212 Established Patient Visit Level III ------- 99213 rd.") -,--- !AlliI;I: •H '• !on lb Ipt,.. Biopsy of Testis {Needle) 54500 i Fr Biopsy of Testis {Incisiona I) 54505 Epiclidymovastostomy {Unilateral) 54900 Epld Idymovastosta my (Bilateral) 54901 Hydrocelectomy {Unilateral) 55040 Hydrocelectomy (Bilateral) 55041 TUR Ejaculatory Ducts 52402 Varkocelectomy {Unilateral) 55530 Varlcor_electomy (Bilateral) 55530{50} Vasovasostomy {Unilateral} 55400 Vasovasostomy (Bilateral) 55400(50) Vasectomy 55250 DiAil.F70' HI. II ,,I It' It ‘,.. ;41;;A!. ! ; Transrectal Prostate Son • . tarn Testicular Son . • ram Testicular Son • :ram w/Do • . ler Penile Duplex Do • 'ler Bladder Ultrasound •sco.:), 2,C(5-1S- I certify that I have rendered the above service: UpdsSatt10/27^25 EMI Slo 76 Pt ID Number:490.MM- Date of Service: III It Bladder Scan 51798 !Fs Cystoscopy 52000 Transrectal Prostate _.,,,-, [../ 76872 /3 CC Testicular (Scrotal) 76870 Testicular wiDoppler 93975 1 Ultrasound Bladder e_.---" 76856 /7OO Prostate Biopsy 55700 Ultrasound Guided 76942 .,iiiii-ki,...r, Acute Prostatkis N41.0 Azoospermla N46.01 BPH N40.0 Chronic ProstatItts L/ N41.1 Condyloma of Penis B07.9 Epldidymitis N45.1 Hematurla, Gross R31.0 Hematuria, Unspecified 831.9 Hydrocele N43.3 Infertility, Male N46.9 Orchitis N45.2 Peyronle's Disease l'148.6 Pituitary Dysfunction E23.6 ProstateCancer C61 Renal Stone P420.0 Testicular Failure E29.1 Testicular Pain R10.2 UTI N39.0 Varkocele 186,1 Voluntary Sterilization 230.2 0 _0 EFTA00282980