ISCTOIY HARRY FISCH, MD (PIN #D91790) ID Number: 944 Park Avenue (212) 879-0800 New York, NY 10028 Patient Names joke Rey Ep STSinv Date of Service:__/0 lA] | LS _ Date of Birth: : Unit Number: OFFICE VISIT New Patient Level I! New Patient Level {II Established Patient Visit Level || Established Patient Visit Level iI! Ul ladder Scan ystoscopy =< FEE 687 ~ uw e ss wo N co Testicular w/Doppler Ultrasound Bladder wo w wo ~ uw aisjo|2 wu io cia a4 Cla Sle ¢} 2 ojo 58 —le ° 76856 SURGICAL PROCEDURES DIAGNOSIS Biopsy of Testis (Needle) | lAcute Prostatitis || 601.0 | Biopsy of Testis {incisional} | lAzoospermia__ |_| 606.0 | PH TC 600,00 | Epididymovastostomy {Bilateral} | __ [54901 |_| [Chronic Prostatitis | | 601.1 | [Condyloma of Penis || 078.10 | Hematuria || 599.7 | Hydrocele || 603.9 | Varicocelectomy (Unilateral) [|| 55530_ |_| [infertility Male ——=«|_—=«tY-~ 606.9 | lOrchitis/Epididymitis [| 604.9 | Vasovasostomy {Unilateral} | Peyronie's Disease || 607.85 | [Pituitary Dysfunction [| 253.8 | Vasectomy | ST 55250 | [Prostate Cancer || 185.0 | [RenalStone | 592.0_| DIAGNOSTIC TEST TO BE SCHEDULED [TesticularFailure —~(| >< | 257.2 | [Transrectal Prostate Sonogram |_| [TesticularPain | |-608.9 [Testicular Sonogram | Cs ee Varicocele || 456.4 | [Penile Duplex Doppler | Voluntary Sterilization _[ __[_v25.2 | Bladder Ukrasound S| Cystoscopy |< | CHARGE PYMT CHECK RECEIVED ° | i certify that | have rendered the above service: EFTA00304570