Office procedures.

Established patients of this practice with indications appropriate to office-based procedural care. The procedure list as of v2026.02:

• Dermatologic. Punch and shave biopsies, cyst excision, lipoma excision (< 4 cm), cryotherapy of common warts and seborrheic keratoses, electrodessication of small benign lesions, ingrown toenail (matrixectomy with phenol).
• Musculoskeletal. Joint injections (knee, shoulder, subacromial bursa, lateral epicondyle, trochanteric bursa) per AAOS osteoarthritis of the knee guidance; trigger-point injections; aspiration of effusions for diagnostic and therapeutic indications.
• Reproductive. IUC (Mirena, Liletta, Skyla, Kyleena, Paragard) placement and removal; Nexplanon placement and removal; endometrial biopsy. ACOG guidance applies.
• Wound care. Suturing of clean lacerations < 6 hours, < 5 cm, not involving complex anatomy; tissue adhesive for amenable wounds; suture and staple removal; complex wound dressing changes.
• ENT. Cerumen removal by lavage and curettage; foreign-body removal from the external auditory canal in cooperative patients.
• Point-of-care ultrasound (POC US). Bedside US for indicated questions: pregnancy dating ≤ 14 weeks, IUC string visualization, abscess vs cellulitis, knee effusion, DVT screening (limited); we do not perform diagnostic abdominal, vascular, or echocardiographic ultrasound.

Office procedures are performed by Tessa Voorhies, DO as the primary procedural clinician and by Maren Vanderlyn, MD, Otis Thackeray, MD, and Helena Rey, FNP-BC as scope-allowed. The procedure list is open Tuesdays and Thursdays; same-day or next-business-day for established patients with prior consult. We do not accept procedure-only patients.

Every procedure is performed using the WHO Surgical Safety Checklist (adapted for office-based use): time-out, side/site verification, allergy and anticoagulant review, signed consent, post-procedure debrief. Each procedure has a documented complication denominator audited annually.^[01]

Established patients of CCH-001, CCH-002, or CCH-004. We do not accept procedure-only consults. Procedural care for non-established patients is referred to the appropriate specialty (dermatology, orthopedics, gynecology). Insurance: same in-network list as CCH-001; procedure CPT codes are billed separately from visit E&M codes.

• Procedural visit (CCH-005-PV) — 30–60 min depending on procedure. Wound checks at 7–14 days are billed as separate visits when indicated.
• Same-day urgent procedures (CCH-005-UR) — laceration repair, abscess I&D, foreign-body removal — through the CCH-006 same-day pathway.
• POC US (CCH-005-US) — billed as either a procedure or a focused-imaging visit per the indication; see Cost for the membership treatment.

Numerators include any documented unscheduled return for the same indication within 30 days. Denominators are CY 2025 procedural visits (n = 1,166 total).

• Excisions > 4 cm or in cosmetically sensitive areas. Referred to dermatology or plastic surgery (Hudson Valley Dermatology; Albany Med Plastic Surgery).
• Mole or skin-lesion screening with concerning features. Total-body skin examinations are part of CCH-001 prevention; suspected melanoma referred urgently.
• Diagnostic ultrasound. We do not perform diagnostic radiology-grade ultrasound; we refer to Quest Diagnostics imaging or to the hospital radiology service.

1. Procedural patients on therapeutic anticoagulation without prior plan — we do not stop anticoagulation for office procedures unless a written plan from the prescribing clinician is in hand.
2. Lacerations > 6 hours old, contaminated wounds, animal bites, full-thickness or complex anatomy lacerations — referred to ED.
3. IUC placement in confirmed pregnancy or active uterine infection (per US MEC).
4. Patients without an established CCH-001 / CCH-002 / CCH-004 relationship. We do not accept procedure-only walk-ins.

For most procedures: take any usual medications unless you have been told otherwise; eat normally; bring a friend or family member if you are nervous about needles. For IUC: take 600–800 mg of ibuprofen one hour before the appointment unless contraindicated. For Nexplanon: nothing special. For cyst excision and suturing: plan for a shower restriction of 24 hours and a wound check at 7–14 days.

Pathology results from biopsies typically return in 5–7 business days. We will call you with any clinically significant result; you will be sent the result regardless via the patient portal within 7 business days.

Insurance: most procedures are covered as standard primary-care procedures; copays and coinsurance apply. We do not bill facility fees on top of professional fees.

Membership: $95/month adult covers all CCH-005 visits with the exception of POC US (billed as $40 cash) and IUC/Nexplanon devices (billed to insurance or cash at the device cost; common-device cash range $80–$900).

Cash transparent pricing for the most common procedures is published on the membership page.

• Mohs surgery. Hudson Valley Dermatology, the dermatology services at Albany Med, or MSK.
• Cosmetic procedures. Out of scope. American Board of Cosmetic Surgery directory.
• Vasectomy. Hudson Valley Urology in-office.

This monograph is owned by Tessa Voorhies, DO with contributions from Helena Rey, FNP-BC for the device-placement procedural sections and from Maren Vanderlyn, MD for the dermatologic sections.

v2026.02.28 — supersedes v2025.10.30. Significant changes: § Outcomes table refreshed with full CY 2025 numbers; § Indications updated to include Skyla and Kyleena alongside Mirena and Liletta; § Patient counseling now explicitly recommends pre-procedure ibuprofen for IUC. Diff on the errata page.