Surgery+referral+grid

Proper surgery referral grid
This table was submitted by Kim Haglund, surgical registrar, September 2008. Please notify both of us of any errors noted.

Mediastinal tumors Esophageal disease, esophageal and airway stent placement || Thoracic surgery. CCHP patients got to East By Cardiovascular and Thoracic Associates at JMMC Concord (925) 689-3100. T-codes (TO etc), and A-codes such as AP (Basic Health that has applied for disability) or people who are clearly disabled and //should// apply for disability need to be referred to Doctors, Highland, or UCSF or Davis (whoever's on call for emergencies). ||
 * Gallstone disease || General surgery ||
 * GI cancer: gastric, small bowel, colon, rectal, anal || General surgery ||
 * GI cancer: pancreas, esophageal, liver || Usually UCSF or tertiary center ||
 * Other GI disease (diverticulitis, Meckel’s, peptic ulcer disease, hiatal hernia, GERD needing lap Nissen, colostomy takedown) || General surgery ||
 * Bariatric surgery || NOT general surgery! These all get referred out. See the [|bariatric surgery referral info section] for details. ||
 * Renal or bladder cancer || Urology if confined to kidney; refer to UCSF if evidence of neurovascular invasion on CT ||
 * Breast disease (benign or cancer) || General surgery ||
 * Breast reconstruction or reduction || Plastic surgery. For reduction, first document 20 lb weight loss without reduction in bra size and symptoms (eg back or neck pain, intertrigo) ||
 * Thyroid or parathyroid disease || ENT or General surgery (Weiss, Miller, Gynn or Rafael, not Berguer -- per Dave MacDonald, September 2008) ||
 * Varicose vein stripping || General surgery—Dr. Weiss or Gynn or Berguer ||
 * Venous stasis ulcers || General surgery, or chart check to wound clinic for review ||
 * Lipomas || Big can go to general surgery, small to minor procedures ||
 * Diabetic foot ulcers || General surgery or podiatry ||
 * Decubitus ulcers, Stage 3 or 4 || General surgery, or chart check to wound clinic if complicated ||
 * Peripheral vascular disease || Vascular surgery (NOT general). T-codes (TO etc), and A-codes such as AP (Basic Health that has applied for disability) or people who are clearly disabled and //should// apply for disability need to be referred to Doctors (Dr. Sharon Drager), or UCSF or Davis (whoever's on call for emergencies). CCHP pts can go to John Muir ||
 * Lung—for biopsy, VATS, pleurodesis, resection
 * Foreign body removal || Minor procedures if palpable, in subQ; General surgery if in deep structures of abdomen/limb; Ortho if for hardware removal; ENT or plastics if in face/neck ||
 * Portacath placement/removal, Groshong placement removal || Both placed in OR or IR with Dr. Howard Young (Dr. Young here on Mondays only) Tunneled lines can be removed in minor procedures; Portacaths usually in OR--send to General surgery to schedule. ||
 * Hidradenitis suppurativa || General surgery ||
 * Melanoma || Plastic surgery for wide excision, sentinel node dissection. For initial diagnosis, biopsy can be done by FP, derm, minor procedure, general surgery, or ENT if on head/neck ||
 * Anal condylomata || General surgery ||
 * Staple/stitch removal || Minor procedure (nurse can do) or FPC ||
 * Facial trauma/reconstruction || ENT and/or plastics ||
 * Eyelids, orbits, facial skin lesions || ENT, plastics, and ophthalmology ||
 * Eyeball problems || Ophthalmology ||
 * Ear issues || Unless problem is clearly external (eg foreign body in canal, lesion on auricle, otitis externa after water exposure), order audiogram as well as ENT referral. ||
 * Hearing loss in elderly || Order an audiogram first. If the audiogram shows symmetric hearing loss and the audiologist does not make a specific recommendation for an ENT referral then they DO NOT need to see ENT. Any MD can fill out the MediCal hearing aid clearance forms. If they are health plan and covered for a hearing aid the audiologist can take care of it without an MD. ||