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Laboratory Reflex Testing The SFMC Laboratory recognizes that in some instances it is medically appropriate to perform reflex testing based on an initial lab result and in other instances reflex testing should be at the discretion of the ordering practitioner. The criteria for Reflex Testing will be annually reviewed and approved by the Medical Executive Committee.Reflex testing protocols:Required Reflex Tests: Lab tests which, if positive, require additional separate follow-up testing in order to have clinical value. The need for the follow-up testing is implicit in the physician order. Reflex test required by state, regulatory, or accreditation standards are also considered to be of this type. Example: a positive antibody screen reflexes an antibody identification.Optional Reflex Tests: Lab tests where the initial test result may have clinical value without the additional reflex testing. In situations where the MEC has approved this optional reflex protocol, the hospital and lab is required to offer the initial test without the reflex, if the physician so orders.The following is St. Francis Medical Center Laboratory’s list of Reflex Tests and order codes. These tests/order codes will always reflex for confirmation if criteria are met indicating the medical necessity for performance of the additional testing. All of the following reflex tests will be performed at an additional charge.Test OrderCPT CodeReflex ActionOptionAntibody Screen86850If positive, Antibody ID will be reflexed (CPT 86870) possibly followed by: Pre-warmed Antibody Screen, Antigen Typing, Cold Screen, DAT, and Elution Adsorption.None, always reflexedBlood Culture87040If patient is in-patient or ER patient and If the first blood culture in aerobic or pediatric bottle is positive but not a gram-positive rod, reflex molecular Blood Panel (CPT 87150). None, always reflexedClostridium difficile -or- GI Panel 8749387507If molecular test is positive, C diff toxin AB test will be reflexed (CPT 87324 )None, always reflexedCryptococcal Ag(Spinal Fluid)87327If positive, Cryptococcal titer will be reflexed (CPT 86403).If INITIAL test is positive, CSF Culture will be reflexed (CPT 87070).None, always reflexedCord Blood Workup(ABO/Rh type &? Direct Coombs) ?If mother is RH Negative antibody, reflex Cord Blood Workup.None, always reflexedCulture, AFB 87116If positive, ID will be referred to the reference lab.None, always reflexedCulture, AFB 87118If positive for Mycobacterium tuberculosis,Mycobacterium avium complex, or Mycobacterium kansasii, reference lab susceptibility testing will be reflexed. (CPT codes may include 87181, 87184, 87186, and 87188)None, always reflexedCulture, stool87045If positive, ID will be referred to the state lab for confirmation at no charge.None, always reflexedTest OrderCPT CodeReflex ActionOptionCulture, Others 8710287040870708708687045If unable to ID or if susceptibilities are invalid, organism will be referred to a reference lab.None, always reflexedFetal Maternal Bleed Screen83033If positive, Fetal Maternal Bleed Quantitative will be reflexed.(CPT 85460)None, always reflexedHepatitis B Surface Ag87340If result is reactive, a Hepatitis B Surface Ag Confirmation test will be reflexed. (CPT 87340)None, always reflexedHepatitis C antibody screen86803If result is reactive, a confirmatory HCV RNA Quant Test will be reflexed. (CPT 87522)None, always reflexedHIV-AG/AB Combo86703If positive, confirmatory HIV-1/2 Differentiation Test will be reflexed. (CPT 86701, 86702)None, always reflexedPlatelet Function Screen85576If abnormal, PLT Function Followup will be reflexed (CPT 85576).None, always reflexedRPR86592If positive, HATTS will be reflexed. None, always reflexedSickle diagnosis naIf patient is sickle positive and blood is ordered, reflex Sickle Screen on units of blood. None, always reflexedStrep A Screen (with reflex culture)87430If negative, Strep (only) Culture will be reflexed.None, always reflexedUrinalysis 81001If any of the following occur, Urine Microscopic will be reflexed (CPT 81003):Source other than VOID or Clean Catch.Clarity other than clearAbnormal results on the urine dipstick or confirmatory tests.Specific gravity <1.005 or >1.030None, always reflexed if indicatedUrinalysis with C&S if needed81001If the following occur, a Urine Culture will be reflexed (CPT 87086):Void or Clean Catch specimen: > 5 WBC/HPF + Leukocytes Test + Nitrate Test > Small BacteriaCatheterized Specimen: Any bacteria Any WBC’s + Leukocyte Test + Nitrate TestNone, always reflexed if indicatedNOTES: EXPLANATION OF CBC ORDERABLES:Test NameCPTCBC w/o diff or Hemogram85027No differential is includedCBC with diff85025 (CBC, auto diff)CBC includes an auto diff, unless instrument limits or flags indicate that a manual diff is necessary.CBC manual diff85027,85007(CBC,manl diff)CBC with manual diffEXPLANATION OF FLUID ORDERABLES:Test NameCPTFluid Cell Counts: CSF Cell Count Synovial Cell Count BAL Cell Count89051 (fluid WBC, diff)89050 (fluid RBC)89060 (fluid crystal)Fluid cell count orderables include WBC and RBC cell counts, color and appearance.Synovial fluid cell counts also include a crystal exam.Explanation of blood products at SFMC:The St. Francis Medical Center Blood Bank provides only leukoreduced red blood cells and plateletpheresis units, which alleviates the necessity of ordering these types of units. (Leukoreduction is used in place of CMV negative red blood cells and CMV negative plateletpheresis units.) Definition of Reflex Testing, Federal Register / Vol. 63, No. 163 / Monday, August 24, 1998 / Notices 45081 Reflex testing: Reflex testing occurs when initial test results are positive or outside normal parameters and indicate that a second related test is medically appropriate. In order to avoid performing unnecessary reflex tests, labs may want to design their requisition form in such a way which would only allow for the reflex test when necessary. Therefore, the condition under which the reflex test will be performed should be clearly indicated on the requisition form. Laboratories may wish to adopt a similar policy for confirmation testing which may be mandatory. ................
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