Revised March 2013

Tift Regional Medical Center Clinical Laboratory

Reflex testing and Order Interpretations

TRMC Laboratory recognizes that in some instances it is medically appropriate to perform reflex testing based on initial laboratory results. It is also recognized that physicians may have certain ordering practices that include nomenclature that does not reflect current methods. In accordance with OIG compliance, the following reflex testing activity and order interpretations will apply for the following in-house testing:

Test Order Reflexive/Associated Billable Tests

Blood Bank

Crossmatch ABO, Rh, Antibody Screen, Antibody ID, Antigen Typing, Absorption, Elution, DAT, and Compatibility testing. Sickle cell Category I patients must be phenotypically matched for C, E, c, e, and K antigens. Sickle cell Category II patients must be phenotypically matched for C, E, c, e, K, Fy(a), Jk(a), and Jk(b) antigens. Both categories must also be matched for any antigens to which the patient has antibodies.

Fresh Frozen Plasma ABO, Rh,

Cryoprecipitate ABO, Rh,

Cord Blood ABO, Rh, elution, antibody ID, and Direct Antiglobulin Test.

Type & Screen ABO, Rh, Antibody ID, Antigen Typing, DAT, absorptions, elutions, and compatibility testing if indicated. Type & Screen expires after 72 hours and must be repeated.

RhoGam/RhIG ABO, Rh, Antibody Screen, Antibody ID, Kleihauer-Betke (acid elution).

Chemistry

HIV If positive, HIV ELISA verification of positive result and Western Blot confirmation if indicated.

Test Order Reflexive/Associated Billable Tests

Drug Screen (UDS) Each individual drug class, i.e. amphetamines, barbiturates, benzodiazepine, cocaine, phencyclidine, opiates,

cannabinoids, tricyclics, oxycodone, methadone, methaqualone, ecstacy, etc. Drug screens referred to the reference lab may be sent for confirmation on any or all positive results.

SMA SMA is an instrument, not a test. These orders may be interpreted as a Comprehensive Metabolic Panel, Basic Metabolic Panel, Liver Profile, Lipid Profile, Electrolytes, or any combination thereof.

% Iron Saturation TIBC (see below)

TIBC Iron, and Transferrin. TIBC is a calculation.

Hematology / Coagulation / Urinalysis

CBC w/diff Manual differential if indicated; automated diff will be credited.

Bone Marrow CBC w/diff, retic count, peripheral smear by pathologist, Aspirate smear by pathologist, cytogenetic analysis, flow cytometry, appropriate Pathology Level Code (I-VI)

UA (Urinalysis) Automated microscopic exam will be performed.

UA/Culture if indicated “Indicated” is defined as any bacteria seen, and/or more than 5 WBC seen. See “Cultures”.

INR Protime. INR is a calculation and not billed.

Test Order Reflexive/Associated Billable Tests

Microbiology / Serology

Cultures Bacterial ID and Sensitivity on all pathogens. Kirby-Bauer sensitivity, Shiga toxin testing, if required. Reference lab testing if indicated.

GBS GBS (Group B Strep) is an organism, not a test. The order will be interpreted as an Anogenital Culture See “Cultures”.

RPR If positive, sent for confirmation by FTA-ABS

Respiratory Panel PCR testing for Adenovirus, Coronavirus’ HKU1, NL63, 229E, and OC43. Influenzas A, AH1, H1 2009, AH3, and B, Metapneumovirus, Parainfluenza 1 – 4, RSV, and Rhinovirus/Enterovirus, B. pertussis, Chlamydia pneumoniae, Mycoplasma pneumoniae.

Pathology

Pathology Specimens Appropriate Pathology Level Code (I-VI), special stains, immunohistochemistry (IHC) stains, flow cytometry, FISH testing, ISH testing, gene typing, molecular testing, computer assisted quantitative IHC, and external consultations.

PAP Smear DNA probe testing for HPV if indicated by prior physician agreement, and immunocytochemistry.

Reference testing:

Reference Testing - Any tests sent out to a reference laboratory are subject to additional charges for any confirmation or reflex testing that may be necessary. Specifics include but are not limited to:

Acetylcholine Receptor Abs Acetylcholine Receptor Modulating Antibody

ANA, IgG by ELISA ANA, IgG by IFA

Arsenic Arsenic, Fractionated

Test Order Reflexive/Associated Billable Tests

Autoimmune Hepatitis Panel ANA, IFA Titer IgG

B. pertussis Antibody(s) B. pertussis Antibody(s), Immunoblot

Celiac Disease Reflexive Panel tTG Antibody IgA, tTG Antibody IgG, DGT Antibody IgA

DGT Antibody IgG.

Cortisol Stimulation Test ACTH baseline, ACTH 30 minutes, ACTH 60 minutes.

dsDNA Antibody, IgG by ELISA dsDNA (Crithidia luciliae) Antibody, IgG by IFA

Drugs of Abuse Panel Individual drug class confirmation/quantitation.

Factor XIII, Qualitative Factor XIII 1:1 Mix

FTA-ABS, IgG by IFA FTA by TP-PA

Fungal Culture Fungal/Mould Identification

H. pylori H. pylori IgA and IgG if not otherwise specified.

HIV Antibody(s) HIV Antibody(s) Confirmation by Western Blot

Heavy Metals Panel Arsenic, Fractionated

Hemoglobin Electrophoresis Acid HGB Electrophoresis, Alkaline HGB Electrophoresis,

Sickle Cell Solubility.

Hepatitis B Surface Antigen Hepatitis B Surface Antigen, Confirmation

Lupus Anticoagulant Reflex Panel Confirmation of any components

Lyme Disease Acute Reflex Panel B. burgdorferi Antibody(s) by Western Blot

ANA Panel ANA titer by IFA

O&P O&P Identification

Smooth Muscle Antibody, IgG Smooth Muscle Antibody, IgG Titer

By ELISA

Test Order Reflexive/Associated Billable Tests

tTG Antibody IgA Endomysial Antibody IgA Titer

VDRL VDRL Titer

Viral Culture Virus identification

von Willibrand, Multimeric Panel von Willibrand Factor Multimers

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