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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