OIG Compliance - Charges Accessed Based on Physician’s Order



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.

Platelets ABO, Rh, if indicated

Fresh Frozen Plasma ABO, Rh, if indicated

Cryoprecipitate ABO, Rh, if indicated

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

Chemistry

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

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

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

Test Order Reflexive/Associated Billable Tests

Hepatitis B Surface Antigen If positive, Hepatitis B Surface Antigen confirmation is performed at ARUP.

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.

Thyroid Panel Thyroid Panel is no longer an AMA recommended test.

TSH and FT4 will be performed in lieu of a panel.

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.

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

Test Order Reflexive/Associated Billable Tests

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.

C. difficile/Epi by PCR C. difficile by PCR and the O27/NAP1/B1 epidemic strain of C. diff by PCR.

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.

Liquid based PAP test 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

APC Resistance Profile Factor V Leiden by PCR

Arsenic Arsenic, Fractionated

Autoimmune Hepatitis Panel ANA, IFA Titer IgG

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

BCR-ABL1, Qualitative BCR-ABL1, Quantitative

Test Order Reflexive/Associated Billable Tests

Celiac Disease Reflexive Cascade tTG Antibody IgA, Endomysial 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.

F-Actin Ab, IgG w/ reflex to Smooth Muscle Ab IgG titer

ASM by IFA

Factor XIII, Qualitative Factor XIII 1:1 Mix

Fragile X Methylation Analysis

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

Fungal Culture Fungal/Mold 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.

Leukemia/Lymphoma Panel Up to 30 individual markers w/ interpretations

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

Smooth Muscle Antibody, IgG Smooth Muscle Antibody, IgG Titer

By ELISA

tTG Antibody IgA Endomysial Antibody IgA Titer

VDRL VDRL Titer

Test Order Reflexive/Associated Billable Tests

Viral Culture Virus identification

von Willebrand Panel von Willebrand Multmeric Analysis

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