Summary of Services and Availability (by location) Each location has sufficient space, equipment, staffing and financial resources in place or available in sufficient time as required to support each requested privilege. On an ongoing basis, the organization consistently determines the resources necessary for each requested privilege related to the facility's scope of service. Please review the following Summary of Services and Availability by Location prior to making your selections. If a facility is specifically identified below as NOT having a privilege/service available, you will NOT be considered for that privilege at that individual facility. Any request made that is identified as not available at an individual site will be considered Not Applicable for that site(s), and will be identified as such on your final approved Delineation of Privileges form. Key x means Privilege is Available at that location. C means contractual arrangement restricts granting this privilege. means Privilege Not Available at that location. Facility Codes: = UPMC Mercy Privilege Core Privileges Consultation Privileges ALLERGY / IMMUNOLOGY Allergy Disease Management CARDIOLOGY Cardiac Disease Management *Cardiac Catheterization Diagnostic *Cardiac Catheterization Angioplasty *Cardiac Catheterization Right Heart Myocardial Biopsy Echo Interpretation Echo Transesophageal *Electrophysiological Studies *Electrophysiology Ablation Tilt table testing Holter Monitor Interpretation 30 Day Event Monitor Interpretation ICD Implant including Biventricular & CS Lead Implant *Pacemaker Insertion Permanent (includes Biventricular & CS Lead Implant) *Pacemaker Insertion - Temporary Pericardiocentesis
Page 2 of 5 Nuclear Stress Testing Stress Echocardiography Stress EKG CVP line placement Intra-aortic Balloon Insertion Swan-Ganz Insertion Intracoronary stent-transcatheter Placement Carotid Doppler studies Peripheral Doppler studies Muga Interpretation Aortic Valvuloplasty *PFO Closures *ASD Closures Femoral Artery Closure Devices Intracardiac Echo *Atrial Tansseptal Puncture Cardiac/Coronary CT Scans Interpret Nuclear Studies Perform and interpret Cardiac MRI Placement of Transvenous Pacemaker Defibrillation/Cardioversion Transthoracic Echocardiography (limited) Excimer Laser Telecardiology CRITICAL CARE Medical supervision of intensive care unit patients, emergency transport, critical illness, and multisystem organ failure Arterial catheter insertion Central venous and percutaneous dialysis catheter insertion Pulmonary artery catheter insertion Pericardiocentesis Placement of transvenous pacemaker Intra-aortic balloon insertion Interpretation and management of hemodynamic data Cannulation and Institution of ECMO Management of extracorporeal membrane oxygenation/life support (ECMO/ECLS) Transthoracic echocardiography (limited) Cricothyrotomy Percutaneous tracheostomy Bronchoscopy Thoracostomy tube insertion/ management Intercostal nerve block
Page 3 of 5 Cardiopulmonary resuscitation Abdominal paracentesis Diagnostic ultrasonography *Fluoroscopy Administration of intermittent and continuous sedation, analgesia, and intravenous anesthetics for management of critically ill patients, as well as for moderate and deep sedation DERMATOLOGY Dermatology Disease Management Teledermatology ENDOCRINE / METABOLISM Endocrinology Disease Management DEA (Certificate Required) Thyroid biopsy Tele-endocrinology GASTROENTEROLOGY (GI) GI Disease Management Anoscopy Procedures Endoscopy Esophagoscopy Colonoscopy Flexible Sigmoidoscopy *ERCP Extracorpeal Shock Wave Lithotripsy PEG Tube Placement Endoscopic Ultrasound Liver Biopsy Paracentesis Esophageal Sclerotherapy Small Bowel Capsule Endoscopy (SBCE) Small Bowel Enteroscopy Motility Studies Esophageal Bougie (except pneumatic dilation) Pneumatic dilation of strictures GI tract stenting Halo Ablation Waived testing including ph testing and stool blood testing HEMATOLOGY/ONCOLOGY Hematology/Oncology Disease Management
Page 4 of 5 Chemotherapy Bone Marrow Aspiration Needle Biopsy of Soft Tissue Mass Bone Marrow Biopsy Bone Marrow Transplantation HOSPITALIST General Internal Medicine Disease Management Arterial line placement Arthrocentesis CVP line placement Endotracheal Intubation Lumbar puncture Paracentesis PICC line placement Skin biopsy Thoracentesis Tracheostomy INFECTIOUS DISEASE Infectious Disease Management NEUROLOGY Neurological Disorders and Disease Management Botox injections EEG Interpretation EMG/NCV with Interpretation Sleep Study PULMONARY Pulmonary Disease Management Bronchoscopy Lung Biopsy *Transbronchial Biopsy Pleural Biopsy PFT Interpretation Ventilator Management Thoracentesis Sleep Study Endotracheal Intubation Endobronchial Ultrasound Whole Lung Lavage (performed in OR with general anesthesia and intubation) Under Sedation-Pleurodesis
NEPHROLOGY Renal Disease Management Renal Biopsy Temp Dialysis Catheter Placement Aquaphoresis Therapeutic Apheresis Administration of Cytotoxic Agents Renal Replacement Therapy Hemodialysis Peritoneal Dialysis Continuous Veno-Veno Hemofiltration Continuous Veno-Veno Hemofiltration with Hemodialysis RHEUMATOLOGY Rheumatology Disease Management Joint/Soft Tissue Injections PSYCHIATRY Psychiatric Disease Management Buprenorphine Page 5 of 5 PART B - INTERVENTIONAL VASCULAR PROCEDURES Privilege Peripheral Diagnostic Angiography Peripheral Interventions Aortoiliac & Brachiocephalic Vessels Renal & Abdominal Visceral Vessels Infra-inguinal Vessels Intracerebral Interventions Carotid Arteriography Carotid Interventions Revised: 2/26/15