REFLEX TESTING AGREEMENT
UAMS DEPARTMENT OF PATHOLOGY & LABORATORY SERVICESContact Person: Sue Scott, Administrative Director
Facility: University Medical Center
Address: 4301 West Markham, Slot 502; Little Rock, AR 72205
Phone: 501-686-6354, Fax: 501-296-1054
E-mail: ScottGloriaS@uams.edu
Purpose. The purpose of this Reflex Testing Agreement is to ensure that the UAMS physician understand when reflex tests will be performed and how they will be billed.
Reflex Testing Policy. It is the policy of the UAMS Department of Pathology and Laboratory Services to perform reflex tests when all three of the following conditions are met:
The initial test listed in the chart below ("Initial Test");
The initial test result meets the criteria listed in the chart below for prompting a reflex test ("Reflex Criteria"); AND
This agreement has been approved by the Medical Board of the UAMS Medical Staff.
Acknowledgement and Approval. By signing this agreement, the Medical Board of the UAMS Medical Staff acknowledges and agrees that whenever initial tests ordered meet the reflex criteria, the corresponding reflex test listed in the chart below (Reflex Test) should be performed, reported, and billed.
Option of Ordering Initial Tests Only. The ordering physician has the option on the Laboratory's requisition form to order any initial test without the reflex test.
Medical Necessity. Whenever an initial test is ordered that is subject to a reflex test, the physician must consider whether that reflex test is, in their judgement, medically necessary for that particular patient. If a physician considers the reflex test unnecessary, order the initial test, without the reflex test on the requisition form. Please be advised that the Office of the Inspector General and the Centers for Medicare and Medicaid Services take the position that a physician who orders medically unnecessary tests for which Medicare reimbursement is claimed may be subject to civil penalties.
Execution of Agreement. After the agreement is signed, a copy will be made available for Medical Staff records and the orginial will
be maintained in the laboratory.
Annual Re-approval and Discontinuation. The Agreement will remain in effect for one year. Thereafter, the agreement must be re-approved at least once a year to remain in effect.
Chart.
Initial Test Reflex Criteria Reflex Test(s) CPT Code for Billing Dipstick Urine Positive Dipstick Criteria met Urine Microscopy 81001 (Replaces urine w/o microscopic CBC with Automated Diff Pertinent CBC Criteria met Manual Differential 85025 Manual Differential Pertinent Diff Criteria met Pathologist Review 80500 Peripheral Blood Smear Suspected Leukemia/Lymphoma on smear Flow Cytometry on newly diagnosed patients or as directed by Dr. 88184
88185
88188PFA (PFA-EPI) Elevated closure time PFADP (PFA-ADP) 85577
85578HIV I and II Positive Screen HIV Western Blot 86689 HTLV I and II Positive Screen HTLV Western Blot 86689 HBC Positive Screen HBC IgM 86705 HBSAG Positive Screen HBSAG Confirmation 86382 Endomysial Antibody Positive Screen Titer by IFA 86256 DNA Positive Screen DNA Titer 86256 ANA Positive Screen ANA Titer 86039 SFVDRL Positive Screen SFVDRL Titer 86593 Streptozyme Positive Screen Titer 86406 Cryptococcal Antigen Positive (Initial test only) Cryptococcal Titer 86406 Protein Electrophoresis, Serum Suspect Monoclonal Gammopathy Immunofixation Electrophoresis 86334 Protein Electrophoresis, Urine, CSF, other fluids Suspect Monoclonal Gammopathy Immunofixation Electrophoresis 86335 Culture Samples Positive for organism Identification
Please Note: and individual CPT code is billed based on the type of organism and methodology indicated.Bacterial:
87076-ana
87077-aer
Fungal:
87106-yeast
87107-mold
87797-probe
AFB:
87149-(PCR)
87561-MAI
87551 X2-MG & MK
87556-MTB
87118-sequencingCulture Samples Positive ID based on established protocol Susceptibility Studies Please note: an individual CPT code is billed based on the indicated methodology Bacti:
87186 (MIC)
87184 (KB)
87181 (E-test, each drug)
87185-BL
AFB-MTB:
87190-each drug (proportion method)
87188 (dilution method)AFB Smear Suspicious of organisms Path. Review 87206 Calcofluor Stain for Fungi Suspicious of organisms Path. Review 87206 GMS/Silver Stain ONLY Request for this stain Calcofluor Stain 87206 Total Billirubin Total Bili > 1.5 Direct Bilirubin 82248 Helper/Suppressor panel or equivalent Circulating plasma cells >10% for Myeloma Patients CIg VS. DNA Plot 88184
88185
88182
88187Bone Marrow aspirate/biopsy for morphology Increased blasts/lymphoid aggregates/or atypical cells For new diagnosis only Immunophenotyping, number of markers stained to be determined by Pathologists 88184
88185
88187
88188BMAR Aspirate Cases where CIg is not ordered for MM patients Pathologists to order for myeloma vs. reactive plasmacytosis CIg vs. DNA 88184
88185
88182
88187Serological HLA-ABC, on all new or established patients; or related donors Patient and donor apparent Class I serological match HLA Class II molecular typing on patient and donor(s) 83894,83912,83890,83898 Platelet Antibody screen in BB (PLAB) Positive Platelet Specific Antibody ID (PLID)
HLA Class I Antibody Screen886022
86807Urine Myoglobin Positive Positive Serum Myoglobin 83874 Type and Antibody Screen Positive Antibody panel GEL antibody screen
Prewarmed antibody screen
2 Units Coomb's Crossmatch Interpretation86870
86885
86885
86922
86077Antibody Panel Positive all cells Cold Autoabsorption
Warm Autoabsorption
Neutralization
Phenotype
Diagnostic Direct Coombs
Interpretation86978
86978
86977
86905
86880
86077Antibody Panel (OB patient) Positive/IgG Antibody Antibody Titer
Interpretation86886
86077IS Crossmatch IgG Antibody Antigen Type GEL
Crossmatch PEG
Crossmatch Prewarmed
Crossmatch
Interpretation86903
86922
86922
86922
86077Fetal Screen Positive Kleihauer Betke 85460 Diagnostic Direct Coombs Positive Monospecific Testing
Eluate86880
86860HBP-Hemoglobin HPLC Profile (short program) 1. Detection of Hgb S (initial test only)
2. Detection of Hemoglogin Variants (Non A)1. Hemoglobin Solubility (Hgb S) (Sickledex)
2. Send to a reference laboratory for extended time HPLC with reflex to electrophoresis and/or RBC solubility (CAP Requirement)
85660
83021 (modified)
83020
85660
RPR Positive Screen RPR Titer (QRPR)
FTA-ABS86593
86781Thin Prep Pap Smear ASC/US or ASC/H Diagnosis High Risk HPV DNA Test 87621 PSA Screen Test code - SPSA Perform Free PSA when total PSA is > 4.0 ng/ml and < 10.0 ng/ml Free PSA 84154 Pediatrics Amphetamine Urine Drug Screen Positive Screen Confirmation/Quantitation by Gas Chrom./Mass Spectrometry 82145 Pediatrics Cocaine Urine Drug Screen Positive Screen Confirmation/Quantitation by Gas Chrom./Mass Spectrometry 82520 Pediatrics Opiates Urine Drug Screen Positive Screen Confirmation/Quantitation by Tandem Mass Spectrometry 83925 Pediatrics PCP Urine Drug Screen Positive Screen Confirmation/Quantitation by Tandem Mass Spectrometry 83992 Cardiac Biomarker panel If Troponin >0.5 CKI Panel Includes CKMB and CK with a calculated index CK-82550
CKMB-82553
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