EFTA00282980.pdf

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