Sutter Health Sacramento-Sierra RegionEffective Date: 04/15/2016

Laboratory Service

Laboratory Compliance Program Overview - Appendix A: Clinical Laboratory Reflex Testing List

Clinical Laboratory

SECTION

/ TEST/ORDER / CPT-4 CODE / REFLEX TEST / REFLEX CPT-4 CODE / CONDITION / IS REFLEX TEST AN ADDITIONAL CHARGE? / ADDITIONAL ORDER GENERATED IN
HIS / ADDITIONAL ORDER GENERATED IN SUNQUEST
FLOW / RPR – Rapid Plasmin Reagin / 86592 / RPRD Titer / 86593 /
  • Reactive RPR Screen
/ YES / NO / YES
FLOW / RPRC – Rapid Plasmin Reagin with Confirmatory / 86592 / RPRD Titer, Treponemal antibodies / 86593
86781 /
  • Reactive RPR Screen and RPRC order
/ YES / NO / YES
FLOW / Leukemia Panel / 88184
88185x16
88189 / Cytoplasmic Markers / 88185 /
  • Increased number of blasts, absence of surface markers
  • Increased small CD10+ lymphs
/ YES / NO / NO
FLOW / Lymphoma Panel, BM / 88184
88185x12
88188 / CD38/138 / 88185
88185X2 /
  • Increased plasma cells
/ YES / NO / NO
FLOW / Lymphoma Panel, Tissue / 88184
88185x12
88188 / CD38/138 / 88185x2 /
  • Presence of plasma cells or lymphoplasma cytoid lymphs
/ YES / NO / NO
FLOW / CLL Panel / 88184
88185x13
88188 / CD103, CD22, CD11c, CD25 / 88185x4 /
  • Lymphs with hairy or villous projections
/ YES / NO / NO
CD3/16 & 56 / 88185x2 /
  • Large granular lymphs
/ YES / NO / NO
TS / Indirect Antiglobulin Test (IAT)—Reflex Testing for prenatal work only / 86850 / Antibody ID / 86870 /
  • Positive antibody screen
/ YES / NO / YES
86850 / DIGG / 86880 /
  • When needed for AB ID workup
/ YES / NO / YES
86850 / Patient Phenotype / 86905 /
  • 1st time when Clinically significant alloantibody(ies) identified
  • R/O alloantibody specificities
/ YES / NO / Yes
TS / Direct Antiglobulin Test (DAT) / 86880 / Differential DAT / 86880 /
  • Positive DAT
/ YES / NO / Yes
TS / Type & Screen or Type & Crossmatch / 86900 86901 86850 / Antibody Id / 86870 /
  • Positive antibody screen
/ YES / NO / Yes
86900 86901 86850 / Patient Phenotype / 86905 /
  • 1st time when Clinically significant alloantibody(ies) identified
  • R/O alloantibody specificities
/ YES / NO / NO
86900 86901 86850 / Absorption / 86978 /
  • When indicated for completionof AB ID workup
/ YES / NO / NO
86900 86901 86850 / DIGG / 86880 /
  • When needed for AB ID workup
  • Infant < 4 months if not done on current stay
/ YES / NO / Yes
86900 86901 86850 / Elution / 86860
86870 /
  • Positive DAT with IgG & patient transfused in past 4 weeks
  • Autoantibody workup
  • Infant < 4 months old with positive direct Coombs
/ YES / NO / NO
86900 86901 86850 / RBC units crossmatched / 86922
86920 or
86923 /
  • TS- 2 units when positive screennot due to RhIg orHistory of clinically significant antibody(ies)
  • Crossmatch- as ordered
/ YES / NO / Yes
86900 86901 86850 / Unit phenotyping / 86905 /
  • Current or history of clinically significant alloantibody(ies)
  • Unable to R/O alloantibody
/ YES / NO / NO
TS / Rh Immune Globulin / N/A / Rh type / 86901 /
  • No patient Rh type on current admission
/ Yes / No / Yes
N/A / Kleihauer-Betke /
  • Termination of pregnancy or other significant event at >26 weeks gestation
/ Yes / No / Yes
TS / Fetal Screen / N/A / Rh type / 86901 /
  • No patient Rh type on current admission, including weak D testing
/ YES / NO / YES
N/A / Kleihauer-Betke /
  • Positive fetal bleed screen, or baby Rh type unknown or mother and/or baby Weak D positive,
/ YES / NO / YES
COAG / Thrombin Time / 85670 / Protamine Corrected Thrombin Time / 85670 /
  • Thrombin Time Ratio > 1.3, when patient is not receiving direct thrombin inhibitors.
/ YES / NO / YES
COAG / Fibrinogen / 85384 85366 / D-dimer, Quant / 85378 /
  • Abnormal fibrinogen and plat. Ct. For DIC on bleeding pt.
/ YES / NO / YES
COAG / PTT / 85730 / Hepzyme PTT / 85525 /
  • Abnl PTT on line-draw sample contaminated with heparin
/ YES / NO / YES
COAG / PT / 85610 / Hepzyme PT / 85525 /
  • Abnl PT on line draw sample contaminated with heparin
/ YES / NO / YES
COAG / PTT / 85730 / Fibrinogen / 85384 /
  • Abnl PTT on bleeding OB pt. – added only after consult with RN/MD
/ YES / YES / YES
COAG / PT / 85610 / Pathologist review of report /
  • Abnl INR > 4.0 (except Coumadin patients)
/ NO / NO / YES
COAG / PTT / 85730 / Pathologist review of report /
  • Abnl PTT > 40 sec (unexplained)
/ NO / NO / YES
COAG / Factor VIII Assay / 85240 / Pathologist review of report /
  • Factor VIII value <60%
/ NO / NO / YES
UA / Urinalysis / Reflex to Microscopic / 81003 / Urinalysis w / Microscopic Exam / 81001 /
  • Blood = Positive
  • Leukocyte Esterase = Positive
  • Protein ≥ 1+
  • Nitrite = Positive
/ NO / NO / YES
UA / Urinalysis / Reflex to Microscopic and Culture if Indicated / 81003 / Urinalysis w/ Microscopic Exam
And
Urine Culture / 81001
87070 /
  • Blood = Positive
  • Protein ≥ 1+
  • Nitrite = Positive
  • WBC >5 or Leukocyte Esterase = Positive
/ NO – UMIC
YES – culture / NO / YES
UA / UA/Synovial Fluid Crystals / 89060 / Pathologist Review of report /
  • Positive crystal exam
/ NO / NO / YES
UA / Influenza A & B Antigen, Rapid Test w/ Reflex / 87400
87400 / Flu A & B by PCR / 87502
87503 /
  • Influenza A & B Antigens = Negative
/ YES / YES / YES
UA / Strep A Antigen, bacterial identification / 87077 / Culture, Strep A Throat / 87081 /
  • Strep A antigen = Negative
/ YES / NO / NO
UA / Body Fluid Cell Count / 89051 / Pathologist review of report /
  • Suspect malignant cells or crystals
/ NO / NO / YES
CHEM / Hepatitis A Total Antibody / 86708 / Hepatitis A IgM Antibody / 86709 /
  • Positive Screen
/ YES / NO / YES
CHEM / Hepatitis B Surface Antigen / 87340 / HBSAg Confirmation / 87340 /
  • Repeatedly Positive Screen
/ YES / NO / YES
CHEM / Hepatitis C Antibody / 86803 / Hepatitis C Total / 86804 /
  • Results in gray zone of positivity
/ YES / NO / YES
CHEM / HIV 1/2 Antibody / 86703 / Western Blot, HIV 1/2 / 86689 /
  • Repeatedly Positive Screen
/ YES / NO / YES
CHEM / Hemoglobin A1C / 83036 / Glycohemoglobin – by immunoturbido-metry / 83036 /
  • Abnormal peaks or unable to obtain valid % A1c hemoglobin
/ YES MISC Quest 496x / NO / YES
HEME / CBC with Auto Diff / 85025 / Slide Review / 85008 /
  • Blast Flag, Platelet Flag and first time count <50, Abnormal Lymph Flag, nucleated RBC
  • IG flag
/ NO / NO / YES
HEME / CBC (Complete Blood Ct) / 85025 / Slide Review / 85008 /
  • Platelet Flag and first time count,<50, nucleated RBC
  • Blast and Atypical Lymph flag
/ NO / NO / YES
HEME / CBC with Auto Diff / 85025 / Manual DIff / 85007 /
  • Differential invalid flag
  • Reflexed slide review indicates inaccurate autodiff
/ NO / NO / YES
HEME / CBC / 85025 / Pathologist review of report /
  • WBC, Total <1,000 or >40,000, or Neutrophilia, Neutropenia, Lymphocytosis, Monocytosis, Eosinophilia, Basophilia, Atypical Lymphocytes or significant morphologic abnormalities including Plasma Cells, immature cells and blasts
  • Hemoglobin <4 g/dl or >21 g/dl
  • MCV <65 fl or >105 fl or abnormal high (<12 years old)
  • RBC – Nucleated RBCs or significant abnormality of morphology (Newborns <10 days old are excluded from nRBC review criteria)
  • Platelet count <30,000 or > 900,000 or significant abnormality of morphology
  • Presence of any organisms
/ NO / NO / YES

KEY:

  • FLOW = Flow Cytometry
  • TS = Transfusion Services
  • COAG = Coagulation
  • UA = Urinalysis/Microscopy
  • CHEM = Chemistry
  • HEME = Hematology

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