PATIENT WORKSHEET 1.1: UTI - Simple

1. PATIENT WORKSHEET 1.1: UTI - Simple Scenario: A 28-year-old woman with iron deficiency anemia underwent colonoscopy which showed a large polyp not amenable to removal. Biopsy showed fragments of tubulovillous adenoma and low grade dysplasia. Laparoscopic assisted right hemicolectomy was performed. The procedure goes well but during recovery phase, patient presents symptoms of UTI. BACTERIAL INFECTION Oral antibiotics/ Observation Evaluation SURGICAL PATIENT CRITICAL CARE PATIENT MEDICAL PATIENT DISCHARGE History Physical Exam Symptomatic Presentation Blood Culture IV antibiotics Or Oral antibiotics Urine Culture BACTERIMIA Urine Culture Ultrasound of Kidneys • Oral Antibiotics: One of the following is prescribed for 10 - 14 days; • Cephalexin cap; • Levofloxacin tab • Augmentin Tab. • Urine Culture • CBC (CPT 85027)$13.08 Total Cost • Oral Antibiotics • Cephalexin cap$54 Total Cost • Levofloxacin tab$111 Total Cost • Augmentin tab$174.60 Total Cost Cost Total = $352.68

2. PATIENT WORKSHEET 1.2: UTI - Moderate Scenario: A 647-year-old man with mild deficiency anemia underwent colonoscopy which showed a large polyp not amenable to removal. Biopsy showed fragments of tubulovillous adenoma and low grade dysplasia. Laparoscopic assisted right hemicolectomy was performed. The procedure goes well but during recovery phase, Patient presents symptoms of UTI. BACTERIAL INFECTION Oral antibiotics/ Observation Evaluation SURGICAL PATIENT CRITICAL CARE PATIENT MEDICAL PATIENT DISCHARGE History Physical Exam Symptomatic Presentation Blood Culture IV antibiotics Or Oral antibiotics Urine Culture BACTERIMIA Urine Culture Ultrasound of Kidneys • Oral Antibiotics: One of the following is prescribed for 10 - 14 days; • Cephalexin cap; • Levofloxacin tab • Augmentin Tab. • Urine Culture • Complete Blood Count (85027) once a day for 4days • Blood Draw (36415) • CBC (CPT 85027)$13.08 Total Cost • CBC (CPT 85027)$13.08 Total Cost • Blood Draw (CPT 36415)$164.24 Total Cost • Oral Antibiotics • Cephalexin cap$54 Total Cost • Levofloxacin tab$111 Total Cost • Augmentin tab$174.60 Total Cost Cost Total = $530

3. PATIENT WORKSHEET 1.3: UTI – Moderate Complex Scenario: A 54-year-old woman with iron deficiency anemia underwent colonoscopy which showed a large polyp not amenable to removal. Biopsy showed fragments of tubulovillous adenoma and low grade dysplasia. Laparoscopic assisted right hemicolectomy was performed. The procedure goes well but during recovery phase, Patient present symptoms of UTI. BACTERIAL INFECTION Oral antibiotics/ Observation Evaluation SURGICAL PATIENT CRITICAL CARE PATIENT MEDICAL PATIENT DISCHARGE History Physical Exam Symptomatic Presentation Blood Culture IV antibiotics Or Oral antibiotics Urine Culture BACTERIMIA Urine Culture Ultrasound of Kidneys • Urine Culture IV antibiotics: One of the following is prescribed X 8 days (changed to oral antibiotics once the patient feels better): Levofloxacin IV; Cefazolin IV. • Complete Blood Count (85027) once a day for 4days • Blood Draw (36415) • CBC (CPT 85027)$13.08 Total Cost • CBC (CPT 85027)$13.08 Total Cost • Blood Draw (CPT 36415)$164.24 Total Cost • IV Antibiotics • Levofloxacin IV$135.28Total Cost • Cefazolin IV$262.80 Total Cost Cost Total = $588.48

4. PATIENT WORKSHEET 1.4: UTI - Complex Scenario: A 62-year-old woman with iron deficiency anemia underwent colonoscopy which showed a large polyp not amenable to removal. Biopsy showed fragments of tubulovillous adenoma and low grade dysplasia. Laparoscopic assisted right hemicolectomy was performed. The procedure goes well but during recovery phase, Patient present symptoms of UTI. BACTERIAL INFECTION Oral antibiotics/ Observation Evaluation SURGICAL PATIENT CRITICAL CARE PATIENT MEDICAL PATIENT DISCHARGE History Physical Exam Symptomatic Presentation Blood Culture IV antibiotics Or Oral antibiotics Urine Culture BACTERIMIA Urine Culture Ultrasound of Kidneys • Urine Culture IV antibiotics: One of the following is prescribed X 8 days (changed to oral antibiotics once the patient feels better): Levofloxacin IV; Cefazolin IV. • Complete Blood Count (85027) once a day for 4days • Blood Draw (36415) • Echo of kidneys (74160) • CBC (CPT 85027)$13.08 Total Cost • CBC (CPT 85027)$13.08 Total Cost • Blood Draw (CPT 36415)$164.24 Total Cost • IV Antibiotics • Levofloxacin IV$135.28Total Cost • Cefazolin IV$262.80 Total Cost • Echo of Kidney(CPT 72193$105.40 Total Cost Cost Total = $693.88