University of Virginia Medical Laboratories Reflex Testing and Procedure Chart
|
Initial Requested Test |
Reflex Criterion |
Reflex Test or Procedure |
CPT Code for Reflex Billing |
|
Chemistry |
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|
*Free Phenytoin (FRPTN) |
Phenytoin > 2.5 |
Free Phenytoin |
80186 |
|
*Free Valproic Acid (FRVALP) |
Valproic Acid > 12.0 |
Free Valproic Acid |
80164 |
|
TSH Reflexive (TSHR) |
TSH <0.45 or >4.50 |
Free T4 |
84439 |
|
Qualitative HCG with reflex to Quantitative HCG (HCGQR) |
Positive qualitative result |
Quantitative HCG |
84702 |
|
*HIV-1 / HIV-2 Antibody Screen (HIV12, HIVNS, HIVNE) |
Positive |
BioRad Geenius HIV½ If Neg (first time) HIV viral load will be performed |
86703 & 87536 |
|
*Hepatitis B Surface Antigen (HBSAG) |
Positive |
Hepatitis B Confirmation (if not previously done) |
87301 |
|
*Serum Protein Electrophoresis (SPEP) |
Abnormal findings |
IG Quantitation (QUANT) Immunofixation (IMFIX)/Freelites |
82784 x3 83883 x2 |
|
*Serum Protein Electrophoresis / Urine Protein Electrophoresis (SPEP / URPEP) |
Abnormal findings not resolved by QUANTP/Freelites |
Immunofixation (IMFIX)/Band present |
86334 |
|
*Hemoglobin Electrophoresis (HGBEP) |
Abnormal Hemoglobins |
Hemoglobin Acid Electrophoresis (ACIDHB) |
83020 |
|
*Hemoglobin Electrophoresis (HGBEP) |
Abnormal findings of A2 or F |
Quantitation for A2 or F (send out) |
83021 |
|
Calcium reflex to PTH, Intact |
Calcium <8.5 or >10.5 |
PTH, Intact |
82310 & 83970 |
Note: Free Drug Test Request Includes Free and Total Drug Levels |
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|
Microbiology/Molecular |
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|
*Throat Screen for Strep (TS) |
Negative |
Culture |
87081 |
|
*Bacterial Culture |
Positive |
Identification Susceptibility |
87077 87070 83789 87185 87156 87181 87184 |
|
*Fungal Culture |
Positive |
Identification Susceptibility |
87106 83789 87186 |
|
*Cryptococcal AG CRYPG |
Cryptococcal Ag Positive |
Fungal Culture, CSF (FUNCSF) |
87102 |
|
*AFB Culture |
Positive |
Identification |
87118 83789 87149 |
|
*C diff PCR |
Positive |
C. diff. Toxin Antigen |
87493 & 87324 |
|
Genomics |
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|
*Colorectal CA Molecular Analysis |
KRAS no mutation detected |
BRAF and NRAS |
81210 & 81404 |
|
Toxicology |
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|
*Drugs of Abuse Screening |
Any positive results |
Confirmation |
80102 |
|
Buprenorphine/ Norbuprenorphine |
Positive for Fentanyl/ Norfentanyl |
Quantitative Fentanyl results will be reported to the patient’s chart. |
80348 & 80354 |
|
Immunology |
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|
*Serum Syphillis Screen (SYPIGG) |
Equivocal (0.9–1.0) or Reactive (>1.0) |
Rapid Plasma Reagin Titer (RPRT) Quantitation |
86593 |
|
*SYPIGG and RPRT |
Discordant results and no previous history |
Treponemal Pallidum Antibody Assay (TPPA) |
86780 |
|
Celiac IgA Panel |
<7 mg/dL |
Celiac IgG Panel |
83516 (X2) |
|
Cytology |
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|
Thin Prep Pap |
ACS or AGS Diagnosis |
Human Papillomavirus (HPVGEN) |
87621 |
|
Blood Bank |
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|
*Type and Hold |
Positive Antibody Screen |
Antibody Identification (ABID) |
86870 |
|
*Type and Hold |
Positive Antibody Screen |
Antigen Information (AGIO) |
86903 (per antigen per unit crossmatched) |
|
*Type and Hold (on patient scheduled for surgery |
Positive Antibody Screen |
Crossmatch two units of blood |
86920 |
|
*Type and Screen |
Positive Antibody Screen |
Antibody Identification (ABID) |
86870 |
|
*Antibody Screen (ordered separately or as part of battery) |
Positive Antibody Screen |
Antibody Identification (ABID) |
86870 |
|
*Antibody Identification |
Inconclusive Result |
Direct Antiglobulin Test |
86880 |
|
*NewAntibody Identification |
All Patients |
Direct Antiglobulin Test, Elution, Drug-Associated Antibody Identification, Phenotype and/or RBC antigen genotype |
86880 86890 86870 86978 86903 |
|
Direct Antiglobulin Test (polyspecific) |
Positive |
Direct Antiglobulin Test (monospecific) |
86880 |
|
Direct Antiglobulin Test |
Positive No current antibody screen on file |
Antibody Screen |
86850 |
|
Platelet Evaluation |
Positive |
Platelet Crossmatch |
86023 |
|
Cord Blood Workup |
If the mother has a non-ABO IgG antibody or is Group O and the child is Group A or B, or no current mother’s sample is available |
Direct Antiglobulin Test |
86880 |
|
Cord Blood Workup |
Positive Direct Antiglobulin Test |
Antibody Screen if no current mother’s sample |
86850 |
|
Cord Blood Workup |
Positive Direct Antiglobulin Test and mother has an IgG antibody |
Eluate |
86860 & 86870 |
|
*Fetal Bleed Screen |
Positive |
Fetal Hemoglobin Stain |
85460 |
|
*Fetal Bleed Screen |
Infant with weak D |
Fetal Hemoglobin Stain |
85460 |
|
*Transfused Red Cells |
Patient with Antibody |
Antigen type units |
86903 (per antigen per unit cross-matched) |
|
Type and Hold |
Diagnosis of sickle cell disease |
Phenotype patient’s red cells |
86905 & 86906 |
|
Transfused Red Cells |
Diagnosis of sickle cell disease |
Antigen typing Rh and K compatible units |
86903 |
|
Transfused Red Cells |
Diagnosis of Thalassemia or patient with warm autoantibody that has not been recently transfused |
Phenotype patient’s red cells |
86905 & 86906 |
|
Transfused Red Cells |
Chronically transfused patient |
Phenotype patients red cells |
86905 & 86906 |
|
Transfuse Red Cells |
Previously transfused patient with auto-antibody |
Auto- or differential absorptions |
86978 |
|
*Transfusion Reaction Workup |
Positive Direct Coombs in which new antibody is discovered |
Elution and antigen typing of all transfused units |
86860 86870 86903 |
|
*HLA or cross-matched platelets |
None |
Irradiate |
86945 |
|
*Transfuse cellular products |
All red cell and platelet products |
Irradiate |
86945 |
|
Reference Lab |
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|
*Borrelia burgdorferi antibody (Lyme’s Disease) |
Positive or equivocal |
Western Blot |
86617 (x2) |
|
Paraneoplastic Autoantibody Screen |
Dependent upon initial results |
Varies |
Variable depending upon Ab found |
|
*Mycoplasma pnuemoniae Antibodies, IgG and IgM, Serum |
If IgM is positive or equivocal |
IgM by indirect immunofluorescence assay (IFA) |
86738 |
|
Cytogenetics |
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|
Amniotic Fluid Study (CTGAFS) |
Suspicious or abnormal standard chromosome finding |
Fluorescent in situ hybridization |
88271 and one of the following: 88272 88273 88274 88275 |
|
Chorionic Villus Sample (CTGCVS) |
Suspicious or abnormal standard chromosome finding |
Fluorescent in situ hybridization |
88271 and one of the following: 88272 88273 88274 88275 |
|
Lymphocyte Study (CTGLS) |
Suspicious or abnormal standard chromosome finding |
Fluorescent in situ hybridization |
88271 and one of the following: 88272 88273 88274 88275 |
|
*Bone Marrow / Unstim. Blood (CTGBMS) |
Suspicious or abnormal standard chromosome finding |
Fluorescent in situ hybridization |
88271 and one of the following: 88272 88273 88274 88275 |
|
Fibroblast Study (CTGFBS) |
Suspicious or abnormal standard chromosome finding |
Fluorescent in situ hybridization |
88271 and one of the following: 88272 88273 88274 88275 |
|
Tumor Study (CTGSTS) |
Suspicious or abnormal standard chromosome finding |
Fluorescent in situ hybridization |
88271 and one of the following: 88272 88273 88274 88275 |
|
Chromosome Microarray (CMA) |
Abnormal screen |
Fluorescent in situ hybridization |
88271 and one of the following: 88272 88273 88274 88275 |
|
Urinalysis |
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|
*Urinalysis with reflex culture (UACUL) |
positive leukocyte esterase, or positive nitrite, or >10 white blood cells/HPF, or any bacteria present |
Urine Culture |
87086 |
|
Hematology |
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*CBC with Reflex to Ferritin |
1st or 3rd trimester and HGB <11.0 g/dL 2nd trimester and HGB <10.5 g/dL and no ferritin in the last 60 days |
Ferritin |
85027 & 82728 |
|
*Heparin Induced Platelet Antibody |
Positive |
Serotonin Release Assay (SRA) |
86022 |
|
Surgical Pathology |
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Biopsy or Consult Request |
Diagnosis of: 1. Glioglastoma (Astrocytoma WHO grade IV) Or 2. Anaplastic Astrocytoma (Astrocytoma WHO grade III) Or 3. Anaplastic Oligoastrocytoma (WHO grade III) Or 4. Anaplastic Olidendroglioma (WHO grade III) Or 5. Anaplastic Ependymoma (WHO grade III) |
MGMT (O6-Methylguanine-DNA Methytransferase) Gene Methylation Assay |
83891 83896 (x2) 83898 (x2) 83907 83912 |
IHC Reflex Testing:
|
Specimen type
|
If the diagnosis is… |
Then order… |
|
Breast (biopsy, lump, mastectomy)
|
DCIS |
ER 88360 |
|
Breast (biopsy, lump, mastectomy or metastasis) |
Invasive carcinoma (ductal or lobular) |
ER 88360 PR 88360 HER2 ISH 88377 |
|
Non-skin head/neck biopsy or resection (Order if base of tongue, oropharynx, tonsil, neck lymph node; ask attending if other site) |
Squamous cell carcinoma |
p16 88342 |
|
Stomach, esophagus, or metastasis |
Gastric or esophageal Adenocarcinoma |
HER2 4B5 IHC 88342 |
|
Colon: biopsy; do on resection if not done on bx.
|
Colon: any carcinoma
|
PMS2 88342 MLH1 88341 MSH2 88341 MSH6 88341 HER2 4B5 IHC 88342 |
|
Uterus: hysterectomy; do on previous biopsy if no tumor in hysterectomy
|
Uterus: any carcinoma |
PMS2 88342 MLH1 88341 MSH2 88341 MSH6 88341 |
|
Uterus: hysterectomy |
Serous carcinoma |
HER2 4B5 IHC 88342 |
|
Ovary |
Ovary: endometrioid or clear cell types only |
PMS2 88342 MLH1 88341 MSH2 88341 MSH6 88341 |
|
Renal pelvis/ureter resection |
Upper Tract urothelial carcinoma |
PMS2 88342 MLH1 88341 MSH2 88341 MSH6 88341 |
|
Skin or metastasis |
Melanomas over 1.0 mm or metastasis to any site |
PD-L1 (SP263) 88342 |
|
Lung or metastasis |
Pulmonary Squamous Cell Carcinoma or Small Cell Carcinoma |
PD-L1 (SP142) 88342 |
|
Lung or metastasis |
Pulmonary Adenocarcinoma |
RET and ROS1 FISH 88365 x 2 TruSight Next Gen. Sequencing 81455 ALK (D5F3) 88342 PD-L1 (SP142) 88341 |
* Denotes Mandatory Reflex Testing