directory of services and laboratory test menu clw catal… · laboratory test menu revised...

Directory of Services and Laboratory Test Menu

Revised December 29, 2020

Consultants Laboratory of Wisconsin, LLC 430 East Division Street Fond du Lac, Wisconsin 54935

Phone: (920) 929-9300 or (800) 826-1580 Fax: (920) 929-9640

Table of Contents Preface: Accessing the directory on-line …………………………………………………………….. 3 Mission Statement ………………………………………………………………………………………….. 4 Accreditations and Phone Numbers ………………………………………………………………………. 5 Laboratory Site Directory ………………………………………………………………………………… 6 Services …………………………………………………………………………………………………… 8 Customer Service ………………………………………………………………………………… 8 Courier Services ………………………………………………………………………………… 8 Supplies ………………………………………………………………………………………….. 8 Consultation Services ………………………………………………………………………………… 8 Long Term Care and Assisted Living Facilities ………………………………………………………. 8 Quality Assurance …………………………………………………………………………………. 8 Compliance Policies …………………………………………………………………………………. 9 Reporting of Results …………………………………………………………………………………. 9 Acute & Communicable Disease Reporting …………………………………………………….. 10 Paternity Testing …………………………………………………………………………………. 10 Significant Exposure Testing ………………………………………………………………………… 10 Critical Values / Call Results Policy ………………………………………………………………. 11 Important Personal or Public Health Results …………………………………………………….. 14 Reflex Testing …………………………………………………………………………………………… 15 Billing and Collection Information ………………………………………………………………………… 16 Advanced Beneficiary Notice (ABN) ………………………………………………………………………… 17 Genetic Testing – Preauthorization Required ………………………………………………………………. 17 Specimen Collection …………………………………………………………………………………………… 18 Blood Bank Orders and Special Instructions ………………………………………………………………. 24 Therapeutic Drug Sampling Times ………………………………………………………………………… 25 Alphabetical Listing of Tests ………………………………………………………………………………….. 26 Alphabetical Listing of Cytology and Pathology Tests …………………………………………… 159 Consultants Laboratory Test or Phrase Abbreviation List …………………………………………… 169 Consultants Laboratory Unit of Measure List ………………………………………………………………. 174 Prioritization of Lab Tests ………………………………………………………………………………….. 175 STAT Test List ……………………………………………………………………………………………. 176 Blood Bank Component Availability and Requirements ……………………………………………. 177 Microbiology Cultures – Media and Transport Instructions ……………………………………………. 179 Microbiology Antibiograms ………………………………………………………………………………….. 182 CLW Specimen Collections Charts ………………………………………………………………………… 190

Preface

This new edition of the Directory of Services and Laboratory Test Menu contains numerous modifications, updates and revisions. Changes to our test menu and methodologies are common. To ensure the most accurate information, please refer to our on-line publication.

Internet access:

1. Go to www.agnesian.com

2. In the top banner, under "Find Care", select "Departments and Services" 3. Go to the "L" in the directory, we are the only thing listed. Click on “Laboratory Services (Consultants

Laboratory of Wisconsin) 4. The link for the Consultants Laboratory Directory of Services will be on the right side, right below the

listing of our 3 locations.

Intranet access: 1. Log on to the SSM Intranet 2. Click on “My Tools” 3. Click on “Application Launching Pad” 4. Click on “Consultants Laboratory of Wisconsin – Directory of Services (Test Catalog)”. The Laboratory

Antibiograms are listed for your convenience in the same location.

http://www.agnesian.com/

SSM Health Mission and Values

OUR MISSION

Through our exceptional health care services, we reveal the healing presence of God.

OUR VALUES

COMPASSION We reveal the healing presence of God through compassionate care focused on the fullness of the person.

RESPECT

We respect life at all stages and promote the dignity and well-being of every person. EXCELLENCE

We provide exceptional care and service through employees and physicians dedicated to our Mission.

RESPECT We use financial, human and natural resources responsibly and care for the environment.

STEWARDSHIP We use financial, human and natural resources responsibly and care for the environment.

COMMUNITY We cultivate relationships that inspire service and promote justice in our organization and throughout our communities, with special concern for the poor and marginalized.

SSM HEALTH’S QUALITY PRINCIPLES

❖ Patients and other customers are our first priority. ❖ Quality is achieved through people. ❖ All work is part of a process. ❖ Decision-making by facts. ❖ Quality requires continuous quality improvement.

OUR VISION

Through our participation in the healing ministry of Jesus Christ, communities, especially those that are economically, physically and socially marginalized, will experience improved health in mind, body, spirit and environment within the financial limits of the system

Accreditations Accreditations and Licensure College of American Pathologists (CAP) 1793501 (Central Laboratory Fond du Lac) 1786101 (Waupun Memorial Hospital Laboratory) 8033625 (Ripon Medical Center Laboratory) Center for Medicare & Medicaid Services (CMS) CLIA Certification 52D0397685 (Central Laboratory Fond du Lac) 52D0671036 (Waupun Memorial Hospital Laboratory) 52D0397949 (Ripon Medical Center Laboratory)

Telephone Directory

Central Laboratory – Fond du Lac (920)929-9300 or (800)826-1580

Central Laboratory Customer Service fax: (920)929-9640 Outpatient Laboratory fax: (920)926-8392

The following options are available through an automated phone system after calling the above numbers: Press 2 for our Customer Service Department Press 5 for our Billing Department Press 4 for Supply Orders Press 0 for an Operator

Press “1” and then the 4 digit extension for the numbers below. The numbers with the 926 prefix may be dialed directly or the last 4 digits used as an extension:

Department Direct Number or Extension

Billing Department 929-9300 ext. 3891

Laboratory Director 926-5862

Human Resources 926-5724

Vice President Laboratory, SSM Health of WI (608) 260-3516

Supply Requests 926-5842

Surgical Pathology/Cytology Reports 929-9300 ext. 3895

Manager Blood Bank, Chemistry, Hematology 926-5883

Manager Microbiology, Processing and Satellite Clinics

Laboratory Site Directory Phlebotomy services are available at all locations. Please call the specific location for hours of operation.

Site Code *

Central Laboratory - Fond du Lac Outpatient Laboratory Hours: Monday-Friday 6am to 5:30pm Saturday 7am to noon

Located on the Agnesian Healthcare Campus 430 E. Division Street Fond du Lac, WI 54935 800-826-1580 or 920-929-9300 Fax: 920-929-9640 (Customer Service) Fax: 920-926-8392 (Outpatient Laboratory)

A

Fond du Lac Regional Clinic – Brandon

601 East Clark Street Brandon, WI 53919 920-346-8300 fax: 920-346-8304

E

Fond du Lac Regional Clinic – Brownsville

900 Main Street Brownsville, WI 53006 920-926-8375 fax: 920-583-4250

B

Fond du Lac Regional Clinic – Campbellsport

350 East Sheboygan Street Campbellsport, WI 53010 920-533-3848 fax: 920-533-5598

T

Fond du Lac Regional Clinic − Convenient Care

145 N. Main Street Fond du Lac, WI 54935 920-926-6047 fax: 920-926-6050

U

Fond du Lac Regional Clinic – Fox Lake

703 West State Street Fox Lake, WI 53933 920-928-6300 fax: 920-928-6304

X

Fond du Lac Regional Clinic – Markesan

730 N. Margaret Street Markesan, WI 53946 920-398-2406 fax: 920-398-3766

N

Fond du Lac Regional Clinic – Mayville

360 South Mountin Drive Mayville, WI 53050 920-387-2111 fax: 920-387-3252

M

Fond du Lac Regional Clinic – Mt. Calvary

100 Evergreen Road Mt. Calvary, WI 53057 920-753-2311 fax: 920-753-2804

Y

Laboratory Site Directory (cont.)

Site Code *

Fond du Lac Regional Clinic – North Fond du Lac

723 Park Ridge Lane North Fond du Lac, WI 54937 920-926-8610 fax: 920-926-8679

F

Fond du Lac Regional Clinic − West

912 S. Hickory Street Fond du Lac, WI 54935 920-907-3919 fax: 920-929-7470

H

Ripon Medical Center Outpatient Laboratory Hours: Monday-Friday 6:30am to 5:30pm Saturday 8am to noon

845 Parkside Street Ripon, WI 54971 920-745-3310 fax: 920-745-7920

L

Waupun Memorial Hospital Outpatient Laboratory Hours: Monday-Friday 6:30am to 5:30pm Saturday 8am to noon

620 W. Brown Street Waupun, WI 53963 920-324-6502 fax: 920-324-0172

W

❖ The test location code will appear on the Laboratory generated report to indicate the Laboratory site where

each test is performed.

Services Consultants Laboratory offers a complete range of routine and specialty procedures in Chemistry, Hematology, Immunohematology, Microbiology, Cytopathology, and Histopathology. If you need a test that is not listed in our manual, please call to check on its availability. If we do not currently perform the test that you are requesting, we will make every effort to provide that testing procedure for you. Customer Service Customer Service is a focal point at Consultants Laboratory. The Customer Service Department has trained and qualified representatives available to respond to your inquiries. Our representatives will answer your questions or concerns regarding specimen requirements, turnaround time, patient results, add-on test requests, and miscellaneous other inquiries. Your call can also be referred to our Pathologists, Technical Associates, or any of our Laboratory Departments through the Customer Service Department. Courier Services Our dependable Courier Service provides scheduled daily pick-ups and deliveries Monday through Friday in our service area. Stops can also be set up on an as needed basis. Saturday pick-ups can be arranged with advance notification. Courier arrangements are handled through the Customer Service Department. When calling our Customer Service Department, please be sure that the specimen has been collected and is ready to be picked up. Provide the name, address and city of the facility, the patient’s name, the internal location where the specimen should be picked up and the type of specimen. Please call for a pick up as soon as possible after the specimen is obtained. This information enables our Courier Associates to efficiently handle your request. Requisitions must accompany specimens. Supplies Collection devices and transport supplies can be ordered by submitting a Supply Order Form (available upon request), or by calling our Materials Management Department at 920-926-5842. Completed Supply Order Forms can be faxed or given to your courier. Supplies will usually be delivered within 3 working days. The supplies are not to be used for any activity not connected with the collection of specimens being referred to this Laboratory. See the Appendix for a listing of available supplies. Consultation Services Pathologists are available for consultation upon request. Call our Customer Service Department to arrange for these services. Long Term Care Facilities Requests for phlebotomy services must be faxed to the laboratory within 7 days of the scheduled date of collection. The date of collection must be indicated on the requisition. Requests received beyond seven days of the collection date will not be processed and faxed back to the facility. STAT services are available for long term facilities in the Agnesian service area only. STAT services are not available for the Oshkosh area facilities. Assisted Living Facilities Requests for phlebotomy services must be faxed to the laboratory within 7 days of the scheduled date of collection. The date of collection must be indicated on the requisition. Requests received beyond seven days of the collection date will not be processed and faxed back to the facility. There is a service charge that is billed to the facility for any same day services in the Agnesian service area only. Same day services are not available for the Oshkosh area facilities. Quality Assurance Consultants Laboratory receives accreditation through the Laboratory Accreditation Program through the College of American Pathologists (CAP). Consultants Laboratory also participates in External Quality Assessment through the Inter-Laboratory Proficiency Testing Surveys & Education Case Studies with CAP.

The Internal Quality Assurance (QA) Program is implemented through the Quality Assurance Plan which monitors performance indicators such as result turnaround time, critical result notification, and canceled tests/redraws. The Plan is reviewed and monitored by the QA Committee consisting of the Management and Pathology Team. Lean/Work Smart Team projects are focused on improving the laboratory processes and reducing and/or eliminating

Services (cont.) errors and waste. Performance is measured through client surveys, associate surveys, audits, and process measures.

Compliance Policies - HIPAA Compliance Consultants Laboratory is committed to respecting the privacy of individuals by protecting patient health information and other verbal, written, and/or electronic information. Information will be shared only for legitimate reasons and as required by law, professional ethics, and accreditation requirements. Consultants Laboratory takes the steps reasonably necessary to verify the identity and legal authority of any person requesting access or disclosure of laboratory results. If results are requested verbally by telephone, the caller must identify themselves with a first and last name and their position in their facility Compliance Policies - CMS / OIG Compliance Consultants Laboratory participates in an active compliance plan which follows the outline of the Centers for Medicare & Medicaid Services, Office of the Inspector General program. All ordering providers need to be fully informed and aware of the specific activities associated with the Government Compliance Program and its requirements. These requirements include, but are not limited to, the following:

➢ As of January 1st, 1998, Medicare regulations require only tests that are medically necessary for diagnosis or treatment of a patient may be billed. Each laboratory test request requires appropriate medical necessity documentation (ICD-10 codes).

➢ Screening tests (with a few exceptions) that are billed to Medicare will be denied reimbursement. ➢ Each individual test component within the Organ and Disease Related Panels must meet the criteria

of medical necessity. ➢ If all component tests within a panel do not meet the criteria of medical necessity, a physician should

order individual tests or a more appropriate panel. ➢ A reflex test is a specific laboratory test in which an abnormal result causes one or more additional

tests to be automatically ordered, resulted, and billed. A listing of Consultants Laboratory’s reflex tests is available in this manual.

➢ Written documentation is required for all verbal orders that are received. Clients will receive a written confirmation of the verbal order which must be signed and returned to our facility.

➢ An Advance Beneficiary Notice is required for Medicare recipients when payment is not expected. Please see page 17 for further information.

Compliance Policies - Safety Precautions All specimens should be handled as if they are infectious. Every effort must be made to protect all health care workers from exposure to Human Immunodeficiency Viruses (HIV) and Hepatitis Viruses. Consultants Laboratory has safety policies that adhere to guidelines provided by the Occupational Safety and Health Administration (OSHA), the Department of Labor, and the Department of Health and Human Services. All specimens must be properly sealed prior to being transported. Leaking containers pose a health hazard. The Laboratory will not accept or transport any specimen contained in a syringe with a needle attached. Specimens should be placed in completely sealed biohazard bags for transport. Reporting of Results Testing is performed at Consultants Laboratory 24 hours a day, seven days a week. Availability of each test is indicated in the Alphabetical Listing of Tests section of this directory. Tests ordered STAT will be communicated to the ordering physician or facility as soon as available. Critical results will be communicated to the source facility as soon as they are identified. These results should be given promptly to the responsible clinician. Clients are required to “read back” results when verbal results are given. (See the Critical Values/Call Results Policy section of this manual on pages 11-13.) To expedite the reporting of test results, this information can be electronically transmitted to fax machines. In addition, reports can be mailed if requested. Results are reported in chart ready formats with reference ranges. NOTE: All pediatric reference ranges are obtained from literature; not validated in this Laboratory. Values are provided as a guide to be used in conjunction with the clinical setting.

Services (cont.) Acute & Communicable Disease Reporting Consultants Laboratory complies with the Wisconsin Department of Health & Family Services, Division of Public Health laboratory reporting requirements for reportable diseases. Qualifying reports are electronically submitted or faxed to the local public health department of the patient’s place of residence. Clients/providers shall be responsible for compliance with Wisconsin statutes concerning reportable conditions. Significant Exposure Testing Significant Exposure consultation services are available through Agnesian HealthCare’s Work and Wellness. Work and Wellness can be reached at (888) 333-6996 or (920) 926-5666. For clients using their own significant exposure protocol and needing only laboratory tests, please see the Appendix for Significant Exposure forms. Please note: Use of this specialized form prevents confidential reports from autofaxing to the primary facility fax location. If a routine requisition is used, clearly indicate specific report handling instructions (i.e.: “do not fax”, “call to”, or “mail results to”).

Critical Values / Call Results Policy

REVISED 07/18/19

The client is notified of the following Critical Values as soon as available, 24 hours per day.

Test Critical Value Department

Acetaminophen > 200 ug/mL Chemistry

Acid Fast Smear Positive (1st in 7 days) Microbiology

Alcohol ≥ 400 mg/dL (0.4%) Chemistry

Bilirubin (infant) > 15 mg/dL Chemistry

Blasts (new) All newly diagnosed patients Hematology

Calcium < 6 or > 13 mg/dL Chemistry

Calcium, Ionized < 0.75 or > 1.5 mmol/L Chemistry

Carbon monoxide > 20% Chemistry

Clostridium difficile Positive *If not inpatient or nursing home, call 8 am - 5 pm daily

Chemistry

Cryptococcal Ag Positive Blood Bank

CSF cells Verified blasts or unclassified cells (non-oncology patient)

Hematology

Culture (any) Suspected bioterrorism agent Microbiology

Culture (Fungal) All blood or CSF; or Zygomycete, dimorphic, Cryptococcus

Microbiology

Culture Dialysate or Water (from Hemodialysis) Dialysate/water > 200 CFU/mL Microbiology

Cultures: B. anthrasis Isolate Microbiology

Cultures: Beta Hemolytic Strep Isolate from deep wound or sterile body fluid

Microbiology

Cultures: Blood (including transfusion bags) Positive (first in 48 hour period) Microbiology

Cultures: Blood (including transfusion bags) All Verigene (Nanosphere) results Microbiology

Cultures: C. botulinum Isolate Microbiology

Cultures: C. diphtheriae Isolate Microbiology

Cultures: Clostridium Isolate from deep wound Microbiology

Cultures: CSF Positive Microbiology

Culture: Duodenoscope Positive for pathogen; call to GI Supervisor and Infection Control nurse

Microbiology

Culture: CRE screen Positive Microbiology

Cultures: ESBL – blood, body Fld, sterile site and IP/NH

*If not inpatient or nursing home, call 8 am - 5 pm daily

Microbiology

Cultures: Franscisella tularensis Isolate Microbiology

Cultures: H. ducreyi Isolate Microbiology

Cultures: H. influenzae Isolate from epiglottis Microbiology

Cultures: CRE – Blood, body fld, sterile site and IP/NH

*If not inpatient or nursing home, call 8 am - 5 pm daily

Microbiology

Cultures: Listeria Isolate Microbiology

Cultures: MRSA

Isolate *If not inpatient or nursing home, call 8 am - 5 pm daily

Microbiology

Cultures: N. meningitidis Isolate from sterile Microbiology

Culture: Streptococcus pneumonia IF Ceftriaxone resistant *If not inpatient or nursing home, call 8 am - 5 pm daily

Microbiology

Cultures: TB Positive (1st in 7 days if AFS is neg) Microbiology

Cultures: Vibrio cholerae Isolate Microbiology

Cultures: VISA or VRSA Isolate Microbiology

Cultures: VRE Isolate *If not inpatient or nursing home, call 8 am - 5 pm daily

Microbiology

Cultures: Yersinia pestis Isolate Microbiology

Culture/Smear, any Discrepant result from preliminary, gram, or identification

Microbiology

D Dimer (excluding ED patients effective 08.01.19)

> 230 Central Lab, RMC and Waupun Hematology

Digoxin > 2.5 ng/mL Chemistry

Dilantin (Phenytoin) > 25 ug/mL Chemistry

Fibrinogen < 80 mg/dL Hematology

Gentamicin (peak or random) > 12 ug/mL Chemistry

Gentamicin (trough) > 2 ug/mL Chemistry

Glucose (up to 1 day) < 30 or > 200 mg/dL Chemistry

Glucose (1 day – 1 year) < 40 or > 400 mg/dL Chemistry

Glucose (1 year – adult) < 50 or > 400 mg/dL Chemistry

Gram stain: CSF organisms observed on smear Microbiology

Gram stain: Joint Fluid organisms observed on smear Microbiology

Gram stain: Peritoneal Dialysis (PD) Fluid organisms observed on smear Microbiology

Gram stain: Sterile site (incl. blood transfusion bags) organisms observed on smear Microbiology

HCO3 < 10 or > 40 Chemistry

HCO3 (venous) < 10 or > 40 Chemistry

Hematocrit (adult) < 20 or > 60% Hematology

Hematocrit (infant) < 31 or > 70% Hematology

Hemoglobin (adult) < 7 g/dL or > 20 g/dL Hematology

Hemoglobin (infant) < 10.0 g/dL or > 23 g/dL Hematology

HIV (significant exposure, including intrapartum) Positive Blood Bank

Influenza Molecular Positives on Inpatients Special

Chem/Micro

KOH Wound or sinus/nasal specimen with nonseptate hypae; positive CSF; deep fungal morphology

Microbiology

Lactic acid > 3 mmol/L Chemistry

Lead (0 – 15 years) ≥ 20 ug/dL Sp Chemistry

Lead (16 years and older) ≥ 40 ug/dL Sp Chemistry

Legionella urinary antigen Positive Urinalysis

Lithium > 2.0 mEq/L Chemistry

Magnesium < 1 or > 4.7 mg/dL Chemistry

Methemoglobin > 30% Chemistry

Myoglobin (core lab & POC) ≥ 200 ng/mL Chemistry

pCO2 (arterial) < 20 or > 70 mm/Hg Chemistry

pH (arterial) < 7.2 or > 7.6 Chemistry

pH (cord) < 7.2 Chemistry

pH (venous) < 7.2 or > 7.6 Chemistry

Phenobarbital > 65 ug/mL Chemistry

Phosphorus < 1.0 mg/dL Chemistry

Platelets < 20K or > 900K Hematology

Platelets (OB patients) < 100 K/uL Hematology

Platelets (oncology) ≤ 10K Hematology

pO2 (arterial) < 45 mm/Hg Chemistry

pO2 (capillary) < 20 mm/Hg Chemistry

Potassium (0 – 1 year) < 2.8 or > 6.9 mEq/L Chemistry

Potassium ( > 1 year – adult) < 2.8 or > 6.2 mEq/L Chemistry

Procalcitonin > 2.0 ng/mL (all called if < 3 days old)

Chemistry

Prothrombin – INR ≥ 5.0 Hematology

PTT > 100 Hematology

Reference Lab Results Critical results called to CLW

Respiratory Syncytial Virus (RSV) Molecular Positive (Age < 3 months) Sp

Chemistry/Micro

Salicylate > 30 mg/dL Chemistry

Schistocytes 4+ on smear Hematology

Sickle Cells Any present Hematology

Smear, blood Any new blood parasite or intracellular bacteria or yeast.

Hematology

Sodium (< 1 year) < 125 or > 150 mEq/L Chemistry

Sodium (> 1 year) < 120 or > 160 mEq/L Chemistry

Streptococcus pneumoniae urinary antigen Positive Urinalysis

Tegretol (Carbamazepine) > 15 ug/mL Chemistry

Theophylline > 20 ug/mL Chemistry

Tobramycin (peak or random) > 12 ug/mL Chemistry

Tobramycin (trough) > 2 ug/mL Chemistry

Transfusion Reactions Acute hemolytic Blood Bank

Troponin ≥ 0.5 ng/mL Chemistry

Troponin (POC) > 0.6 mg/mL Point of Care

Urine: Ketones ≥ 80 mg/dL (if glucose ≥ 1000) Urinalysis

Urine: RBC casts Present Urinalysis

Urine: Reducing substances (≤ 2 years) Positive Urinalysis

Valproic Acid (Depakote) > 120 ug/mL Chemistry

Vancomycin (peak or random) > 45 ug/mL Chemistry

Vancomycin (trough) > 25 ug/mL Chemistry

WBC (infant) < 5K or > 30K Hematology

WBC (adult) < 2K or > 30K Hematology

WBC, Absolute Neutrophil Count < 0.5K Hematology

WBC, CSF > 10 with > 50% segs Hematology

Consultants Laboratory Call List Important Personal or Public Health Results

REVISED 01/15/19 The client is called upon completion of the test if the facility is open; otherwise the practitioner will be called during the hours of 8:00am – 5:00pm, 7 days a week.

Test Value Department

Cord blood DAT Positive Blood Bank

Giardia Specific Antigen (GSA) Cryptosporidium Specific Antigen (CSA)

Positive Microbiology

Culture, throat Positive for Strep A if rapid was negative; called only to Pediatrics on Sat/Sun

Microbiology

Culture, stool Growth of stool pathogen or Shigatoxin positive

Microbiology

Culture N. gonorrhoeae Microbiology

Outbreak isolates Positive Microbiology/other

(Test is referenced out)

Respiratory Syncytial Virus (RSV) Molecular Positive (Age > 3 months) Microbiology

MRSA screen VRE screen

Positive Microbiology or Special Chemistry

Gonorrhea (GC) or Chlamydia (by SDA) Positive Special Chemistry

Clostridium difficile (OP or discharged ED) Positive Chemistry

Hepatitis A IgM Positive Chemistry

MRSA Culture (OP.or discharged ED) Positive Microbiology

ESBL – Nonsterile site / urine (OP or discharged ED)

Positive

VRE Culture (OP or discharged ED) Positive Microbiology

Acid Fast Smear (OP. or discharged ED) Postive Microbiology

AFB Culture, if smear positive Positive Microbiology

Surgical Prosthesis Culture or Gram Stain Positive Microbiology

Environmental for CRE Positive Microbiology

Bordetella Pertussis Culture or PCR Positive Microbiology/send out

Outpatient = Not inpatient, Nursing Home resident, or currently in Emergency Department

Reflex Testing Reflex testing allows a physician to order a test that will automatically reflex to additional testing if the results of the initial test fall within certain criteria. These criteria are based on good medical practice and are standard operating procedure for all patients. The following tests have been set up by the Medical Director of Consultants Laboratory. These tests will always reflex to the tests indicated, at an additional charge, when the criteria established have been satisfied indicating that the performing of the additional testing is medically necessary.

INITIAL TEST RESULT SECOND TEST

Acid Fast Culture Growth of Acid Fast Bacillus

Mycobacteria Isolate Identification (Wisconsin State Lab of Hygiene). If ID is M. tuberculosis, then susceptibility. Other Mycobacteria, susceptibility done on request.

Acid Fast Smear Acid Fast Bacilli observed

Mycobacterium Tuberculosis PCR testing at Wisconsin State Lab of Hygiene

Antibody Screen Positive Antibody identification and 2 units of antigen typed crossmatched blood for banded patients.

Antibody Screen (Outpatient OB patients)

Positive Antibody identification

Antibody Screen on Surgical Patient Positive Crossmatch

Antibody Screen with Crossmatch Positive Antigen typing for Crossmatches

Antinuclear Antibody Screen Positive Antinuclear Antibody Titer

Bacterial Cultures Positive for pathogens

Organism identification and/or antibiotic susceptibility per CLSI recommendations; may include reference lab referral

C. difficile by EIA (antigen and toxin) Invalid or Inconclusive

C. difficile by PCR

Cord Blood from Rh negative Mother ABO, Rh and DAT

Culture if indicated Urinalysis Positive Urine culture

Direct Coombs in recently transfused patient

Positive Elution Studies

Direct Coombs on Cord Blood Positive ABO, Rh, Ab Screen, Elution, and Bilirubin

Fetal Screen Positive Quantitative Kleihauer Betke (to Theda Clark)

Fungal Cultures Positive Fungal Identification

Hepatitis B Surface Antigen Positive Hepatitis B Surface Antigen Neutralization

Hepatitis C Antibody (unless ordered as No Reflex)

Positive Hepatitis C RNA RT-PCR

HIV Test Positive Multispot

Lipid (LPD+R) Trig > 400 Direct LDL

Lyme Positive or Equivocal

Western Blot Lyme

Malaria Smear Positive Intracellular Malarial Organism ID (sent to State)

Protein Electrophoresis, Serum & Urine Abnormal Immunofixation

Rapid Strep A Screen Negative Strep only or Throat Culture (Pediatric patients)

Reflex Urine Dipstick Positive Urine Microscopic

Rh Type Negative Du Type (on newborns only)

TSH (TSHRF) Abnormal Free T4

Billing and Collection Information Consultants Laboratory offers several choices for the billing of laboratory testing services. In order to properly bill for testing, Consultants Laboratory depends on our clients to provide us with complete billing information. If this information is not included on the original requisition, we will contact your office to request additional information. Consultants Laboratory’s Federal Tax ID number is 39-1528550. Client Account Billing Clients receive itemized statements on a monthly basis. Statements are generated within five business days following the month during which services are rendered. Statements include the date of service, patient name, physician code, CPT code, test name, and test price. Statements are considered to be correct unless the Billing Department is notified within 30 days of the statement date. Notifications of transfers/rebillings must be made to the Billing Office within this timeframe in order to ensure timely billing. Requests received after 30 days may not be processed. Payment terms are net 30 days. Acceptable payment methods are cash, check, or credit card. Client Account Billing – Nursing Homes (SNF) Skilled Nursing Facilities (SNFs) are required to submit all Medicare claims for services provided to their residents who are covered under a Part A stay. (Section 4432 (b) of the Balanced Budget Act (BBA) of 1997.) For services provided to patients covered under Medicare Part A, CLW will bill the Nursing Home. Nursing Homes are provided a weekly audit to ensure status accuracy prior to submitting claims or charges. Please notify our Billing Department with the status of your patients. Third Party Billing Consultants Laboratory will bill third party commercial insurances, Medicare, and Wisconsin Medicaid directly. An appropriate diagnosis code is required for each test ordered. To avoid incomplete or misinformation, we recommend that a copy (front and back) of the patient’s insurance card be attached to the test request form. If the billing information is incomplete, the client will be required to assume responsibility and will be billed for all charges. Consultants Laboratory does not bill Medicaid for states other than Wisconsin. The following information must appear clearly on the requisition form:

➢ Patient Legal Name (Last, First, Middle). No nicknames, please. ➢ Date of Birth (month, date, year) ➢ Sex ➢ Referring Physician Information – Please provide first and last names. ➢ Patient phone number ➢ Bill to – Check type of billing wanted. ➢ Medicare /Medicaid Number ➢ Insurance Subscriber Name ➢ Insurance Subscribers Relationship to Patient ➢ Billing Party Address ➢ Primary Insurance Company Name ➢ Insurance Company Address ➢ Insurance ID number ➢ Group number ➢ Responsible Party Employer ➢ Diagnosis Code(s) for tests ordered ➢ Date of injury and Employer name (for Workers Compensation claims) ➢ Provider signature, if no other signed order

In today’s regulated healthcare climate, diagnosis codes are mandatory. When requisitions arrive without a valid or covered diagnosis code or a signed waiver (if necessary), the laboratory may not be reimbursed for services provided. Please assist us by providing this required information at the time you order the test. If you have any questions regarding this issue, please contact our Billing/Coding Department.

Billing and Collection Information (cont.) The Balanced Budget Act of 1997 requires physicians to provide diagnostic or other medical information when ordering services furnished by another entity furnishing the services. Consultants Laboratory is not allowed to determine what code should be used for the laboratory services. Only the ordering physician or authorized provider is authorized to determine the reason that the test is ordered. Advanced Beneficiary Notice (ABN) If a test identified by Local Medical Review Policies as a limited coverage test is ordered, a Medicare recipient must be informed that Medicare may deny payment for the service and that they will be responsible for payment to Consultants Laboratory. You and the patient should complete the ABN and submit it along with the Laboratory requisition. ABN forms can be ordered from Consultants Laboratory’s Supplies Department. If the patient requests a copy of the ABN, make a copy after the patient has signed the ABN. The original ABN should be attached to the requisition. (See Appendix for a copy of the ABN Form) The ABN must be completely filled out including:

➢ Patient’s full name ➢ Date of service (Month, Day and Year) ➢ Test(s) ordered must be checked ➢ The reason why Medicare may deny payment must be checked (do not check all reasons) ➢ Patient signature with date

If a patient refuses to sign the ABN but still wants the tests performed, sign the bottom of the form indicating that the patient refused to sign. The patient will still be responsible for payment of the testing if they choose to have the service after refusing to sign the ABN. Your facility will be billed at the Medicare reimbursement rate when no ABN is obtained and there is no Medicare acceptable diagnosis. (HCFA views write-offs in these instances as an inducement.) Limited coverage tests are backlit in blue on the Laboratory requisition. Genetic Testing – Preauthorization Required A genetic test is the analysis of human DNA, RNA, chromosomes, proteins, or certain metabolites in order to detect alterations related to a heritable disorder. Genetic tests are conducted for a number of purposes including predicting disease risk, newborn screening, determining clinical management, identifying carriers and establishing prenatal or clinical diagnoses or prognosis in individuals, families, or populations. In the 2015 edition of the AMA CPT Coding Manual, genetic tests have been identified with CPT codes 812xx, 813xx, 814xxx and 815xx. Most insurers require prior authorization for genetic testing. Tests requiring preauthorization vary by insurers and change frequently. Additionally, many insurance plans have genetic counselors and require their involvement. Consultants Laboratory will initiate a prior authorization when these tests are ordered; however, your office may be contacted if additional information is needed for the prior authorization. Prior authorizations can take up to 5 days to be approved by the insurers so patients may need to wait before the sample can be collected. Providers and patients need to be aware of out of pocket costs associated with this testing should the insurer deny payment. Cost of testing can range from hundreds to thousands of dollars.

Specimen Collection The correct identification of patients and specimens are two of the most important steps in the specimen collection procedure. Proper identification helps to ensure that each patient receives the correct laboratory results and diagnosis. The need for proper identification is specified by the College of American Pathologists (CAP) and the Joint Commission (TJC). Additionally the quality of test results is dependent upon the proper collection and handling of the specimen submitted. The patient must be properly prepared and identified, the proper specimen for the tests requested must be collected by the correct method, and the specimen must be prepared for transport and stored at the correct temperature.

➢ Refer to the specific collection requirements in the Alphabetical Listing of Tests section of this manual. ➢ Check all blood collection tubes and swabs for expiration dates. ➢ Consultants Laboratory will not accept specimens collected with outdated materials. ➢ Surgical and cytology pathology specimens must be labeled and requisitions prepared in the room where the

surgical procedure is performed. ➢ For a color chart of swabs, transport containers and tube types, please refer to the CLW Specimen Collection

Chart in the Appendix. Specimen Labeling Requirements

1. Verify the patient’s identification. a. For banded patients:

➢ Scan and/or check their wristband b. For non-banded coherent patients:

➢ Have the patient spell their first and last name (do not spell it for them) ➢ Ask the patient their date of birth (do not tell them their date of birth)

c. For non-banded incoherent patients ➢ Ask the nurse to identify the patient and document their name on the requisition.

2. Label all specimens in the presence of the patient. 3. The following information is required:

a. COMPLETE first and last legal name (no nicknames or initials) b. Date of birth in the format of MM/DD/YYYY c. The date and time of collection d. SOURCE of specimen if the specimen is not blood. e. The initials of the person collecting the specimen

4. Show each of the labeled specimens to the patient and ask that they verify that they are all labeled with the correct name. (Coherent patients only)

Requisition Requirements

1. The name on the sample must match the name on the requisition EXACTLY 2. The date and time of collection 3. SOURCE of specimen if other than blood.

Anatomic Pathology Specimens Surgical and cytology pathology specimens must be labeled and requisitions prepared in the room where the surgical procedure is performed.

1. A completed Surgical Pathology requisition must accompany every specimen. 2. Containers must be labeled with:

a. Patient’ s legal first and last name b. Patient’s date of birth in MM/DD/YYYY format c. Date and time of collection d. Exact SOURCE (including laterality)

NOTE: When insufficient or inconsistent patient information is submitted, Consultants Laboratory will request that a new specimen be obtained.

Specimen Collection (cont.) Processing Careful attention to processing procedures will eliminate common errors that can compromise the integrity of the specimen and, consequently, the test results.

Submit the proper specimen tube and volume as indicated in the specific test listing. Please note: Minimum required volumes are listed for some tests. A minimum volume listing is the amount of serum or plasma required to perform an assay once, including instrument and container dead space. Submitting the minimum specimen volume makes it impossible to repeat the test, perform confirmatory, or perform reflex testing. In some situations, a minimum specimen volume may result in a QNS (quantity not sufficient) result, requiring a second specimen to be collected. Keep specimen tubes at room/ambient temperature (18-25°C or 64.4-77°F) prior to centrifugation. EXCEPTIONS: Some tests require immediate icing after collection as indicated in test listing.

Clot or serum separator tube specimens will be rejected if not spun within 2 hours of collection time. Allow SST tubes to clot at room temperature (ambient) a minimum of 30 minutes, but optimally no longer than 60 minutes before centrifuging. (CLSI Guidelines recommend no more than 2 hours.)

Blood should be spun for 10 minutes at 1100 RCF that equates to 3200-3500 RPM on most centrifuges. (Centrifuges provided by Consultants Laboratory will have optimal speeds posted on each unit.) Please call Customer Service if you need help in computing the speed of your centrifuge.

Serum and plasma specimens drawn in gel separator tubes should be sent to the Laboratory in the original tube when specimen transport and storage instructions allow it. Use plastic transport tubes when pour off is indicated. Clearly label the transport tube PLASMA if submitting that type of specimen. If the gel separator does not cover the cells completely after centrifugation, the SST or PST tube cannot be respun. The serum/plasma needs to be pipetted off the original tube into a transport tube. That transport tube can then be spun to separate the remaining cells. The clear serum/plasma should then be placed into a new transport tube. If more than one test requires a frozen specimen, please freeze individual aliquots for each test. Storage & Transport After centrifugation, store tubes at the temperature indicated in the catalog listing, keeping in mind transport time needed before specimen will reach testing laboratory while watching specimen stability limits. Couriers will transport the specimen at the temperature the sample was stored at the time of pickup. To minimize hemolysis, all centrifuged tubes should be kept upright during storage and transport. (Use foam racks available from laboratory.) Uncentrifuged specimens may be placed in foam racks or submitted in biohazard bags. When submitting urine, stool, or body fluid specimens, make sure that specimen containers are tightly capped to prevent spillage. Needles must be removed from all syringes that are submitted. To ensure safety when transporting these specimens, samples should be submitted in completely sealed biohazard transport bags. A separate bag should be used for each requisition and the specimens related to that requisition. If a requisition has samples that have different storage requirements such as room temperature, refrigerated, and frozen, place the requisition with the refrigerated specimen and place all room temperature specimens in one bag and frozen specimens in another bag. Care must be taken to prevent specimens from experiencing extreme temperature fluctuations during winter and summer transport. To minimize the risk of hemolysis, do not place whole blood specimens in direct contact with cold packs. Call our Customer Service Department if you have specific transport questions or needs.

Specimen Collection (cont.) Lockbox Samples: Proper Packaging For sample integrity, proper packaging of lockbox samples is important. Without additional protection inside an unsheltered lockbox, a sample will reach the outside temperature in about 15 minutes! Studies were done at Consultants Laboratory on the following conditions and based on the lockbox being placed outside in the elements without shelter or shade. In extreme heat or cold, extra precautions or alternate delivery options are needed and stability will probably be shorter than what is listed. Definitions: ConstaTemp small blue cooler (brick size) with frozen or ambient packs that fit into the inside pockets. Cooler (six pack size) used as a overpack/overcooler Ambient pack- at room temperature can help soak up heat or cold If air temperature is 75-90ºF. Goal is to keep samples from getting too warm.

Refrigerated samples: ➢ ConstaTemp with ONE FROZEN Gel pack. (Two frozen packs will make the sample freeze) ➢ Cooler with ONE FROZEN Gel pack. ➢ Place in Lockbox ➢ *Sample will be stable for approximately 6 hours ➢ NOTE: if only the cooler is used with an FROZEN pack (no ConstaTemp), sample stays cold enough

for 30 minutes. Room Temp samples:

➢ ConstaTemp with ONE AMBIENT Gel Pack ➢ Cooler ➢ Place in lockbox ➢ *Sample will be stable approximately 1.5 hours

If air temperature is 46-75ºF Goal is to stabilize samples in moderate temperatures)

Refrigerated samples: ➢ ConstaTemp with ONE FROZEN Gel Pack ➢ Cooler ➢ Place in lockbox ➢ *Sample will be stable approximately 6 hours

Room Temp samples:

➢ ConstaTemp with TWO AMBIENT Gel Packs ➢ Cooler ➢ Place in lockbox ➢ *Sample will be stable approximately 2 hours

If air temperature is < 32ºF Goal is to keep samples from freezing

Refrigerated samples: ➢ ConstaTemp with TWO AMBIENT Gel Pack ➢ Cooler ➢ Place in lockbox ➢ *Sample will be stable approximately 45 minutes

Room Temp samples:

➢ ConstaTemp with TWO AMBIENT Gel Pack ➢ Cooler ➢ Place in lockbox ➢ *Sample will be stable approximately 1 hour

Specimen Collection (cont.) Specimen Retention Except for unstable specimens, Consultants Laboratory retains most specimens for 5 days. If a test must be added or a repeat is necessary, please contact our Customer Service Department as soon as possible. Due to stability and specimen requirements, not all tests can be re-ordered or added on to existing specimens.

Order of Collection When drawing multiple tubes on a patient, follow this order of draw to ensure a quality sample. Order of Draw and Fill

1. Blood cultures (if needed) 2. Blue top (Sodium Citrate) 3. Red or SST / Vacuette® 4. Green top / PST (Heparin tubes) 5. TB QuantiFERON® Gold tubes (set of three) 6. Purple top (EDTA-K3 tubes) 7. Gray (Oxalate/Fluoride tubes) 8. Black (Buffer Sodium Citrate tubes)

NOTE: if the following specialty tubes are required, please follow these collection order guidelines:

➢ Yellow ACD – draw after EDTA tube in listing above ➢ Royal blue with additive – draw in the same order as the EDTA tube in the listing above. ➢ Royal blue without additive – draw first

Indwelling Catheter Collection (PICC, Central Line) Our phlebotomists do not perform indwelling catheter draws (exception: specifically trained Laboratory Assistants for

certain hospital situations). We do offer bedside assistance to help with tube types, filling, and labeling. When a

resident/patient has an Indwelling Catheter that the blood is to be obtained from, clearly indicate this need so we

don’t draw peripherally.

Non-medication Catheter

1. Have ready, the appropriate size of syringe and the blood tubes needed for the tests ordered.

a. Plan for the volume of blood needed.

b. Order of fill is important to avoid cross contamination of tube additives. Order is Blood Cultures -

Blue - Red or SST - Green or PST - Lavender - Gray - Black

c. Blood starts to clot once removed from the body, being timely with filling the tubes is important.

2. Wipe lumen with alcohol wipe, allow to dry.

3. Flush catheter with saline.

4. Using the same flush syringe, withdraw 6 mL of waste. Discard into sharps following your facility protocol.

5. Wipe lumen with alcohol, allow to dry.

6. Connect the sample syringe and withdraw the volume of blood needed.

7. Remove syringe. Use a safe transfer device (recommended to prevent a needlestick) to transfer blood

immediately into tubes, in order of fill.

8. As you fill the tubes, immediately mix gently 8-10 times.

9. Properly dispose of syringe and transfer device.

10. Flush catheter with appropriate solution of saline or heparin.

11. Label the tubes with Last Name, First Name (legal, no nicknames), date of birth in mm/dd/yyyy format, date

and time of collection, and collector’s initials. This same information is recorded on the requisition and must

match for patient identification and safety.

12. Process and transport the specimen tubes according to the test requirements.

Indwelling Catheter Collection (PICC, Central Line) (cont.)

Medication Catheter

*If coagulation samples are ordered, such as an INR, and heparin is infusing, a peripheral blood sample is

required.

1. Stop infusion for two (2) minutes.

a. TPN requires a two minute pause followed by a saline flush for all lumens. The sample must be

collected from the non-TPN lumen.

b. Document the medication infusing on the requisition. This is important for result interpretation.

2. Follow procedure as noted in the Non-Medication Catheter

3. Restart infusion per your facility policy.

24 Hour Urine Collection – Special Instructions Suitable containers, preservatives, and Collection Instruction Pamphlets are available from our Customer Service Department (929-9300 ext. 5800). If a preservative is required (see Alphabetical Listing of Tests), it is important that the designated preservative be in the collection container at the start of collection. The patient should be cautioned that the preservative may be toxic and/or caustic and not to spill or discard the preservative. Instruction Brochures for patients are available upon request. To collect a 24-hour urine specimen, follow these instructions:

• Discard the first morning urine. Collection begins after this urine is voided.

• Collect all urine for the next 24 hours so that the morning urine voided on the second day is the final collection. The specimen should be stored as indicated in the specific test instructions.

• Mix the specimen well and measure the total 24 hour urine volume. Record the volume on the test request form, as well as the patient’s height and weight if a clearance was ordered. If a preservative was added to the urine or none was added, please indicate this on the requisition. Place the requested volume of the well mixed urine in a transport container. Record the start date and time and the end collection date and time on the label and test request form.

Clean Voided Midstream Urine Collections Urine is normally a sterile body fluid. However, unless the urine specimen is collected properly, it can become contaminated with bacteria from the perineum, prostate, urethra, or vagina. Midstream urine collections should be performed for all cultures, unless ordered to be collected by an alternate procedure. Patients should be given both verbal and written instructions on how to collect a “clean catch” urine. See instructions below. Patient instructions for Midstream Urine Collection

1. Open sterile urine container being careful not to touch inside of container or inside of cover. 2. Place lid upside down on flat surface, 3. Open packet of cleansing towelettes. 4. While continually holding the folds of skin away from the urethral opening, wipe the urethral area once with

each towelette using all three towelettes. 5. Holding the folds of skin away from the urethral opening, begin urinating into the toilet; as you continue to

urinate, bring the sterile container into the stream of urine to collect the specimen. Remove cup from urine stream just before finishing or after the container is about half full.

6. Screw lid back on container, again being careful not to touch inside of lid or container. 7. Label container with patient name, date of birth, and collection date and time.

Microbiology Cultures – Special Instructions The date and time of the specimen collection must be indicated on the requisition. A specific anatomic source must be indicated on the requisition (i.e. “right leg wound”). It is also important to list any antibiotics that the patient is currently taking. List the antibiotics administered, any known antibiotic allergies, any suspected organism(s), and the patient diagnosis or history. The specimen source must be clearly indicated. The specimen (container, culturette, or other transport media) submitted must be properly identified with the patient’s name (first and last, legibly printed) and a date of birth as a second identifier. Person specific identifiers may include accession number, medical record number, or birth date. Labeling only the outside of the biohazard bag is NOT ACCEPTABLE. See Appendix for a quick reference guide for stool and culture collection and transport and the CLW Specimen Collection Chart.

Specimen Rejection

Proper collection and handling of specimens is essential so as not to compromise the accuracy of results from Consultants Laboratory. If a specimen is unacceptable, the Laboratory will contact the client to request a new specimen or to explain the limitations on testing. When a new specimen is requested, a credit will be issued to the account and the test will be billed when a new specimen accompanied by a new requisition is received. The following guidelines are used for rejection of a specimen:

➢ Quantity not sufficient (QNS) for accurate test results. ➢ Clots in EDTA or Citrate specimens will yield unacceptable results. ➢ The correct ratio of blood to anticoagulant is essential for accurate results. ➢ Uncentrifuged serum specimens received more than 2 hours after collection. Certain constituents change

when left in contact with red blood cells for extended periods of time. ➢ Improper storage of specimens may result in rejection. The Alphabetical Listing of Tests includes storage

requirements. Please follow these instructions carefully. The stability of a specimen is dependent on temperature and time of storage.

➢ Proper labeling and identification is very important. All specimens must be labeled and accompanied by a Laboratory requisition. Information on the requisition and the specimen must be consistent. Use legal names only, no nicknames, for proper patient identification. A second identifier, such as a birthdate, should also be on the requisition and specimen. In exceptional instances, and with written authorization, the Laboratory will provide testing and final results on unlabeled or mislabeled specimens. Such exceptions apply only when the specimen would be difficult or impossible to obtain again such as body fluids, tissue samples, or timed blood collection specimens. Laboratory associates will contact the client to obtain necessary information.

➢ Lipemic (turbid) serum or plasma may cause interference with test results. For certain tests, it is recommended that patients fast for 10-12 hours before specimen collection, as a recent meal may cause lipemia (see Alphabetical Listing of Tests for affected tests). Lipemic specimens may be rejected or the Laboratory will ultracentrifuge the specimen and evaluate the lipemia. If a specimen is lipemic, submit as much serum or plasma as possible as ultracentrifugation requires more specimen.

➢ Grossly contaminated specimen containers. Standard precautions require prompt cleanup and disinfection of potentially infectious spills. Likewise, do not submit specimens with needles attached.

➢ Hemolysis occurs when the membrane surrounding red blood cells is disrupted and hemoglobin and other intracellular components escape into the serum or plasma. Hemolyzed serum or plasma varies in color from faint pink to bright red, rather than the normal straw color. Grossly or moderately hemolyzed specimens may be rejected and even slight hemolysis may alter certain test results.

Blood Bank Orders and Special Instructions Patients with orders for Blood, FFP, or Cryoprecipitate transfusion must be banded using the Consultants Laboratory identification system. DO NOT REMOVE the Blood Bank bracelet unless you notify the Blood Bank. Removing the band could result in the need to re-crossmatch blood, causing transfusion delays and additional costs to the patient. Pre-Admission Testing (PAT) Patient samples may be drawn, banded, and crossmatched (or type & screened) up to 5 days before the surgery date provided the following conditions are met:

1. The patient has not been challenged (pregnant or transfused within the past 3 months). 2. There is an adequate supply of blood of that patient’s type available to keep it tagged for up to 5 days. 3. The patient’s Blood Bank ID band is intact upon admission.

Inpatient Blood Bank Samples Samples properly labeled for compatibility testing may be used for 3 days. Autologous Units for Inpatient Procedures Autologous blood must be crossmatched for the recipient to confirm compatibility. The Type & Screen is performed in the event that additional blood is required. To order an autologous crossmatch, follow normal crossmatch ordering. In the comment field, enter in “Autologous Blood”. Autologous donations are coordinated by the Blood Center of Wisconsin. For information about autologous donations or to schedule a patient donation, please call the Blood Center of Wisconsin at: (800)245-3117, extension 6188. Product Availability See Appendix for a list of the blood components that are available and the ordering requirements for those patients. Blood Center Donations For general information regarding blood donations and public blood drives conducted by the Blood Center of Wisconsin, please call 1-800-BeA-Hero (1-800-232-4376).

Therapeutic Drug Sampling Times

Drug

Optimal Sampling Time

Route

Peak

Trough

Carbamazepine (Tegretol)

Close to Trough* Oral Within 30 min. before next dose

Digoxin Close to Trough* Oral > 8 hrs. post dose

Gentamicin

Peak & Trough IV 30 min. post completion of IV transfusion

Within 30 min. before next dose

Peak IM 60 minutes after IM

dose

NOTE: Dialysis patients must have trough drawn after dialysis

Lithium Close to Trough* Oral 12 hrs. post dose

Phenobarbital Close to Trough* Oral Within 30 min. before next dose

Phenytoin (Dilantin)


Theophylline Close to Trough* Oral Within 30 min. before next dose

Tobramycin

Peak & Trough IV 30 min. post completion of IV infusion

Within 30 min. before next dose

Peak IM 60 minutes

after IM dose

NOTE: Dialysis patients must have trough drawn after dialysis

Valproic Acid (Depakote, Depakene)


Vancomycin Peak & Trough(1) IV (60 min. infusion)

1 or 2 hrs. post completion of 60 minute IV infusion

Within 30 minutes before next dose

TDM Dose Information Form should be used to provide Laboratory with dosage information. (See Appendix for form)

* These drugs are presumed to be in steady state concentrations and therefore sampling times are not that crucial. However, levels drawn closer to the trough time will monitor the attainment of therapeutic ranges more effectively. If toxicity is clinically suspected, draw the level closer to the peak.

(1) Vancomycin peak levels can be drawn 1 or 2 hours after the infusion is complete.

NOTE: For information regarding therapeutic drugs not listed on this table, please call Consultants Laboratory’s Customer Service Department.

Alphabetical Listing of Tests

ABO & Rh Type

COMPUTER ORDER ENTRY BLOOD TYPE ABO+RH PANEL—LAB03144

SYNONYMS Blood Grouping and Rh (D) Typing; Blood Type; Group & Rh; Part of Type and Screen order. Tests may be ordered separately as ABO Type or as Rh Type.

AVAILABILITY Test performed daily; all shifts; available STAT.

TEST INCLUDES ABO (forward and reverse), and Rh type (two CPT codes). Weak D determination performed (in most cases) if Rh (D) is negative.

SPECIAL INSTRUCTIONS If this test is requested in anticipation of a possible transfusion, the patient must be banded with a unique Blood Bank band, a procedure performed solely by the Laboratory. (Other previously determined groups may also draw and band. Contact the Laboratory). Include the patient's date of birth on all tubes.

SPECIMEN REQUIREMENT Draw blood in one 6 mL or two 3 mL lavender top (EDTA) tubes (unless otherwise directed by the patient label). ACD, CPD, CPDA-1 or heparin anticoagulated blood is acceptable but renders the specimen unacceptable for Antibody Screen or Crossmatch.

STORAGE INSTRUCTIONS Refrigerate (2-8°C). Heparinized plasma stable for 48 hours, EDTA stable for 7 days, whole blood stable for 14 days. Fresh specimen is preferred.

CAUSES FOR REJECTION Specimens that are hemolyzed, contaminated with bacteria or other

contaminants; specimens that are not properly labeled or have discrepant demographics with requisition.

DEPARTMENT Blood Bank

ABGs (Arterial Blood Gases)

COMPUTER ORDER ENTRY EPOC BLOOD GAS ART ROOM AIR, EPOC BLOOD GAS ART CO2, EPOC BLOOD GAS ART RESPIRATOR—LAB013334

SYNONYMS ABGS; ABG


TEST INCLUDES pH, pCO2, pO2, HCO3, tCO2, O2 Sat, and Base Excess.

SPECIAL INSTRUCTIONS The syringe should contain at least 1 mL of blood. The patient must have acceptable Allen test if drawn arterially.

SPECIMEN REQUIREMENT Draw blood from an arterial puncture using a blood gas syringe.

STORAGE INSTRUCTIONS Send immediately to Lab at room temperature. Specimen should be analyzed within 30 minutes of collection.

Ripon Medical Center: Test within 10 minutes

CAUSES FOR REJECTION Improper collection, handling, or storage.

DEPARTMENT Chemistry

ABGs (Arterial Blood Gases) – Rapid Point Panel (POC)

COMPUTER ORDER ENTRY BLOOD GASES ART=LYTES GLUC CA PNL—LAB04377

SYNONYMS ABGS; ABG

AVAILABILITY Test performed daily; all shifts; available STAT. PERFORMED ONLY IN SAH OR.

TEST INCLUDES pH, pCO2, pO2, HCO3, tCO2, O2 Sat, Base Excess, Hgb, Hct, CarboxyHb, OxyHb, MetHb, DeoxyHb, Sodium, Potassium, Chloride, Ionized Calcium and Glucose.

SPECIAL INSTRUCTIONS The syringe should contain at least 0.5 mL of blood. The patient must have acceptable Allen test if drawn arterially.

SPECIMEN REQUIREMENT Draw blood from an arterial puncture using a blood gas syringe or from an arterial line.

SPECIMEN MINIMUM VOLUME 0.5 mL of whole blood

STORAGE INSTRUCTIONS Specimen should be analyzed immediately after collection.


DEPARTMENT Point of Care

ABGs (Arterial Blood Gases) – Rapid Point Panel plus Lactate (POC)

COMPUTER ORDER ENTRY BLOOD GASES ART=LYTES CLUC CA LA PNL—LAB12767

SYNONYMS ABGS; ABG

AVAILABILITY Test performed daily; all shifts; available STAT. PERFORMED ONLY IN SAH ICU.

TEST INCLUDES pH, pCO2, pO2, HCO3, tCO2, O2 Sat, Base Excess, Hgb, Hct, CarboxyHb, OxyHb, MetHb, DeoxyHb, Sodium, Potassium, Chloride, Ionized Calcium, Glucose and Lactate.







ABG Blood Gas/Chemistry Panel (POC) – ED EPOC Panel

COMPUTER ORDER ENTRY BLOOD GAS EPOC ART ROOM AIR POCT—LAB12628, BLOOD GAS EPOC ART O2 POCT—LAB12627, BLOOD GAS EPOC ART RESPIRATOR POCT-- LAB12626

SYNONYMS ABGS; ABG

AVAILABILITY Test performed daily; all shifts; available STAT. PERFORMED ONLY IN ST. AGNES HOSPITAL EMERGENCY DEPARTMENT

TEST INCLUDES pH, pCO2, pO2, HCO3, tCO2, O2 Sat, Base Excess, Hgb, Hct, Sodium, Potassium, Ionized Calcium, Glucose and Lactate.







ABG Blood Gas/Chemistry Panel (POC - Capillary) – Nursery EPOC Panel

COMPUTER ORDER ENTRY CAP BLOOD GAS CHEM PANEL-- LAB13335

SYNONYMS Capillary ABG

AVAILABILITY Test performed daily; all shifts; available STAT. PERFORMED ONLY IN ST. AGNES HOSPITAL NURSERY

TEST INCLUDES pH, pCO2, pO2, HCO3, tCO2, O2 Sat, Base Excess, Hgb, Hct, Sodium, Potassium, Ionized Calcium, Glucose and Lactate.


SPECIMEN REQUIREMENT Draw blood from a heal stick puncture using an EPOC Care-Fill Capillary tube.

SPECIMEN MINIMUM VOLUME 92 uL of whole blood




Acetaminophen Level

COMPUTER ORDER ENTRY ACETAMINOPHEN LEVEL—LAB01000

SYNONYMS Tylenol

AVAILABILITY All shifts; available STAT RESULTS EXPECTED STAT (if performed at same location): 1 hour

ROUTINE: 2 hours from receipt of sample at performing lab

INTERFERENCES HAMA or Heterophile antibodies may interfere with this test. Possible clinical discrepancies may be resolved by ordering HAMA or Heterophile antibody detection.

Interpretation of results should be done in the context of the overall clinical presentation of the patient, including symptoms, clinical history, data from additional tests and other appropriate information.

SPECIMEN REQUIREMENT Draw blood in a SST. Centrifuge and send specimen in the original tube.

Stability: Room Temp (unspun): up to 2 hours Room Temp (spun): up to 4 hours Refrigerate (2-8°C) (spun): up to 48 hours SPECIMEN MINIMUM VOLUME 0.3 mL serum

STORAGE INSTRUCTIONS See above.


Acetone (Qualitative)

COMPUTER ORDER ENTRY HYDROXYBUTRATE BETA—LAB06339

SYNONYMS See Beta-Hydroxybutyrate


ACT (Point of Care)

COMPUTER ORDER ENTRY ACT—LAB07983

AVAILABILITY Test performed daily; all shifts; available STAT. PERFORMED ONLY IN SAH ICU, CATH LAB AND OR.

SPECIAL INSTRUCTIONS If blood is obtained by venipuncture, the venipuncture should be clean and the first several mL of blood discarded to avoid contamination of the sample with tissue thromboplastin. Blood should not be taken from heparinized indwelling catheters or other anticoagulant lines without thoroughly flushing the line. Withdraw and discard at least 7 mL of waste before obtaining the testing samples.

If testing fresh whole blood, samples should be run as quickly as possible after being drawn. Baseline samples, which contain no anticoagulant, should be run within one minute. Heparinized samples should be run within two minutes.

SPECIMEN REQUIREMENT Fresh whole blood samples. Draw in appropriate syringe.





ACTH (Adrenocorticotropic Hormone)

COMPUTER ORDER ENTRY ACTH—LAB06716

AVAILABILITY Test performed at a Reference Laboratory.

SPECIMEN REQUIREMENT Test Link: https://ltd.aruplab.com/Tests/Pub/0070010

ACTH (Adrenocorticotropic Hormone) STIMULATION

COMPUTER ORDER ENTRY CORTISOL BLOOD--LAB01045 (random cortisols are ordered per provider instructions)

SYNONYMS Cosyntropin Stimulation, Cortrosyn Stimulation



TEST INCLUDES Baseline cortisol and an additional timed cortisol, typically drawn 30 and/or 60 minutes post cosyntropin dose, depending on the provider order.

SPECIAL INSTRUCTIONS Testing is most often performed in Ambulatory Infusion. Draw blood for baseline cortisol. Patient is given an injection of Cosyntropin IV or IM. Additional timed cortisol specimens are drawn according to provider instructions. (If no protocol is directed, the second specimen should be drawn at 30 minutes after administering Cosyntropin.)

SPECIMEN REQUIREMENT Draw blood in a green (Lithium heparin) PST (full tube) or a SST. Centrifuge

and send specimen in the original tube. Stability: Room Temp (unspun): optimally up to 1 hour

Room Temp (spun): up to 8 hours Refrigerate (2-8°C) (spun): up to 48 hours

SPECIMEN MINIMUM VOLUME 0.3 mL serum or plasma


CAUSES FOR REJECTION Sever hemolysis

DEPARTMENT Chemistry (Central Laboratory Fond du Lac)

https://ltd.aruplab.com/Tests/Pub/0070010

AFB Smear (TB)

COMPUTER ORDER ENTRY AFB SMEAR—LAB04075

SYNONYMS AFS smear, Acid Fast smear; TB Smear

AVAILABILITY Test performed daily.

TEST INCLUDES Acid fast stain (order acid fast culture separately). If acid fast bacilli are identified on a respiratory specimen and a culture is ordered, the specimen will be sent to the WI State Lab of Hygiene for Mycobacterium tuberculosis complex PCR.

SPECIAL INSTRUCTIONS Send to the Laboratory promptly.

SPECIMEN REQUIREMENT Sputum: First morning specimen. Saline induction is acceptable. Collect three specimens. Each of the three consecutive sputum (not saliva) specimens should be collected in 8-24 hour intervals, with at least one being an early morning specimen. Urine: At least 40 mL of the first morning urine collected on three consecutive days. Swab specimens: Amies or Stuart are undesirable due to low yield, aspirate if possible. Induced sputa: Use sterile hypertonic saline (avoid nebulizer reservoir and tap water). Blood: Collect in SPS yellow cap tube available from the Laboratory. Tissue: Submit 1g Fluid: Submit 5 mL minimum CSF: 2 mL

STORAGE INSTRUCTIONS Refrigerate (2-8°C), transport to the Laboratory promptly.

CAUSES FOR REJECTION 24 hour pooled specimen or saliva specimen; frozen specimen; desiccated specimen; specimen received in fixative; swabs in gel medium.

DEPARTMENT Microbiology

AFP (Alpha-Fetoprotein) Tumor Marker

COMPUTER ORDER ENTRY ALPHA FETOPROTEIN BLOOD TUMOR—LAB06025

AVAILABILITY Test performed at a Reference Laboratory.


Albumin

COMPUTER ORDER ENTRY ALBUMIN BLOOD—LAB01210



SPECIMEN REQUIREMENT Central Laboratory Fond du Lac, Waupun Memorial Hospital, Dialysis Centers, and Convenient Care: Draw blood in a green (Lithium heparin) PST (full tube). Centrifuge and send specimen in the original tube.

Stability: Room Temp (unspun): up to 2 hours Room Temp (spun): up to 8 hours Refrigerate (2-8°C) (spun): up to 4 days

Alternative tube type or Ripon Medical Center and all other sites: Draw blood in a SST. Centrifuge and send specimen in the original tube.

Stability: Room Temp (unspun): up to 2 hours Room Temp (spun): up to 8 hours Refrigerate (2-8°C) (spun): up to 4 days SPECIMEN MINIMUM VOLUME 0.4 mL serum or plasma

https://ltd.aruplab.com/Tests/Pub/0080428


CAUSES FOR REJECTION Sodium Fluoride/Potassium Oxalate anticoagulant.


Alcohol

COMPUTER ORDER ENTRY ALCOHOL ETHYL BLOOD—LAB01215

SYNONYMS See Ethanol


Alcohol, Urine

COMPUTER ORDER ENTRY ALCOHOL ETHYL URINE QUALITATIVE—LAB07710

SYNONYMS See Ethanol, Urine


Aldolase

COMPUTER ORDER ENTRY ALDOLASE—LAB06005

AVAILABILITY Test performed Sunday-Saturday at a Reference Laboratory.


Aldosterone

COMPUTER ORDER ENTRY ALDOSTERONE BLOOD—LAB06010

AVAILABILITY Test performed Sunday-Saturday at a Reference Laboratory.


Alkaline Phos (Alkaline Phosphatase)

COMPUTER ORDER ENTRY ALKALINE PHOSPHATASE BLOOD—LAB01220

SYNONYMS Alk P'tase; Alk Phos



SPECIAL INSTRUCTIONS Fasting for 8 hours is recommended.




Stability: Room Temp (unspun): up to 2 hours Room Temp (spun): up to 8 hours Refrigerate (2-8°C) (spun): up to 4 days SPECIMEN MINIMUM VOLUME 0.4 mL serum or plasma


CAUSES FOR REJECTION EDTA anticoagulant.

https://ltd.aruplab.com/Tests/Pub/0020012https://ltd.aruplab.com/Tests/Pub/0070015


ALT (SGPT)

COMPUTER ORDER ENTRY ALT—LAB01665

SYNONYMS SGPT; GPT; Alanine Aminotransferase




Stability: Room Temp (unspun): up to 2 hours Room Temp (spun): up to 8 hours Refrigerate (2-8°C) (spun): up to 4 days Alternative tube type or Ripon Medical Center and all other sites: Draw

blood in a SST. Centrifuge and send specimen in the original tube. Stability: Room Temp (unspun): up to 2 hours Room Temp (spun): up to 8 hours Refrigerate (2-8°C) (spun): up to 4 days SPECIMEN MINIMUM VOLUME 0.4 mL serum or plasma


CAUSES FOR REJECTION Hemolysis. Potassium Oxalate/Sodium Fluoride anticoagulant.


Ammonia

COMPUTER ORDER ENTRY AMMONIA—LAB01225

SYNONYMS NH3



SPECIAL INSTRUCTIONS Due to limited stability send the specimen promptly to the Laboratory. The tube should be filled completely and kept stoppered. Place the tube ON ICE. Centrifuge, separate plasma from cells within 15 minutes of collection. Pipette off plasma into aliquot tube and freeze immediately. Ammonia concentrations increase rapidly upon standing. Patient should not smoke after midnight before the AM draw. Heavy smokers should shower before the draw.

SPECIMEN REQUIREMENT Draw blood in a green (Lithium heparin) PST (full tube) or plain green Lithium heparin (full tube). Place the tube ON ICE.

NO FINGERSTICKS.

Stability: Centrifuge, pipette off plasma into an aliquot tube within 15 minutes of collection and freeze immediately. Frozen plasma stable up to 8 hours.

STORAGE INSTRUCTIONS FREEZE plasma immediately. See above.

CAUSES FOR REJECTION Hemolysis; excessive time lapse in processing (> 15 minutes); non-frozen specimen; use of other anticoagulants.


Amylase

COMPUTER ORDER ENTRY AMYLASE BLOOD—LAB01230; AMYLASE FLUID—LAB01235



SPECIAL INSTRUCTIONS If body fluid, indicate type on the requisition.





Fluids: 1 mL body fluid in a green top (Lithium heparin) tube or with no anticoagulant added. Indicate type of fluid on the requisition and the tube.

SPECIMEN MINIMUM VOLUME 0.4 mL serum or plasma STORAGE INSTRUCTIONS See above. CAUSES FOR REJECTION EDTA, Sodium Citrate, Potassium Oxalate/Na Fluoride anticoagulants


Amylase, Urine

COMPUTER ORDER ENTRY AMYLASE URINE RANDOM—LAB01240; AMYLASE URINE TIMED—LAB01295



TEST INCLUDES Amylase on a random or timed refrigerated urine collection.

SPECIAL INSTRUCTIONS Indicate the total urine volume and collection time period on the requisition.

SPECIMEN REQUIREMENT 10 mL aliquot from a well-mixed random or timed urine specimen.

SPECIMEN MINIMUM VOLUME 1.0 mL urine

STORAGE INSTRUCTIONS Refrigerate (2-8°C) during and after collection.

CAUSES FOR REJECTION Presence of acid preservative.


ANA Screen & Titer if Positive

COMPUTER ORDER ENTRY ANA BLOOD SCREEN W/ REFLEX TITER—LAB07000

SYNONYMS ANA; Antinuclear Antibodies; FANA; Antibodies against Nuclear Antigens

AVAILABILITY Test performed Monday through Friday on the AM shift.

TEST INCLUDES ANA screen by Immunoflourescence and pattern interpretation if positive. Titer is performed if ANA is positive.

SPECIMEN REQUIREMENT Draw blood in a SST. Centrifuge and send specimen in the original tube. Stability: Refrigerate (2-8°C) (spun): up to 3 days Frozen (-10 to -20°C): up to 5 days

SPECIMEN MINIMUM VOLUME 0.075 mL of serum


CAUSES FOR REJECTION Gross hemolysis; lipemia; bacterial contamination.

DEPARTMENT Special Chemistry (Central Laboratory Fond du Lac)

Antibody Identification

COMPUTER ORDER ENTRY ANTIBODY ID—LAB03003

SYNONYMS Antibody ID (Cell Panel); Antibody Identification, RBC

AVAILABILITY Test performed on all shifts. Ripon Medical Center sends all Antibody Identifications to the Community Blood Center in Appleton.

TEST INCLUDES RBC Antibody Identification. Test reflexes following a positive Blood Bank Antibody Screen. RBC Antigen testing as indicated.

SPECIAL INSTRUCTIONS Include the patient's transfusion, pregnancy, and/or current medication history.

SPECIMEN REQUIREMENT Draw blood in two 6 mL lavender top (EDTA) tubes. Special labeling instructions may apply. See ABO & Rh.

STORAGE INSTRUCTIONS Room temperature up to 24 hours. Refrigerate (2-8°C) up to 72 hours.

CAUSES FOR REJECTION Specimen not properly labeled; gross hemolysis; SST specimen.


Antibody Screen (Red Cell)

COMPUTER ORDER ENTRY ANTIBODY SCREEN—LAB03001

SYNONYMS Indirect Antiglobulin Test; Antibody Detection Test; Indirect Coombs; Erythrocyte Antibody Screen


TEST INCLUDES Erythrocyte Antibody detection. Positive Antibody Screen reflexes to Antibody Identification (added charge).

SPECIAL INSTRUCTIONS See ABO & Rh special instructions. Include the patient's date of birth on all tubes. Include the patient’s pregnancy and/or transfusion history, if appropriate.

SPECIMEN REQUIREMENT Draw blood in one 6 mL or two 3 mL lavender top (EDTA) tubes (unless otherwise instructed by the patient label).

STORAGE INSTRUCTIONS Room temperature up to 24 hours. Refrigerate (2-8°C) up to 72 hours (screen is good for 3 days after draw).

CAUSES FOR REJECTION Specimen not properly labeled; gross hemolysis; SST specimen.


Antibody Titer

COMPUTER ORDER ENTRY ANTIBODY TITER—LAB03006

SYNONYMS See OB Blood Bank Antibody Titer


Antithyroglobulin Antibodies (Anti-TG)

COMPUTER ORDER ENTRY THYHROGLOBULIN AB—LAB06670

SYNONYMS ATG; Thyroglobulin Antibody. NOTE: This is NOT an equivalent test to Thyroglobulin.

AVAILABILITY All shifts RESULTS EXPECTED 2 hours from receipt of sample at performing lab




Stability: Room Temp (unspun): up to 2 hours Room Temp (spun): up to 8 hours Refrigerate (2-8°C) (spun): up to 48 hours Alternative tube type or Ripon Medical Center and all other sites: Draw

blood in a SST. Centrifuge and send specimen in the original tube. Stability: Room Temp (unspun): up to 2 hours Room Temp (spun): up to 8 hours Refrigerate (2-8°C) (spun): up to 48 hours

SPECIMEN MINIMUM VOLUME 0.3 mL serum or plasma



Antithyroid Peroxidase Antibodies (Anti-TPO)

COMPUTER ORDER ENTRY THYROID PEROXIDASE ANTIBODY—LAB06675

SYNONYMS Antimicrosomal Antibodies

AVAILABILITY All shifts RESULTS EXPECTED 2 hours from receipt of sample at performing lab



TEST INCLUDES Microsomal Antibodies.


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