HML Update. Summer 2008 Volume 14, No. 2. Keeping Our Clients Informed Questions or Comments: Call PANEL CHANGES

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1 HML Update Summer 2008 Volume 14, No. 2 Keeping Our Clients Informed Questions or Comments: Call Inside: Panel Changes New Panels...2 Rubella, IgM Testing...3 Medicare Updates...3 Consultant s Corner...4 Glucose Tolerance Scheduling...4 Human Anaplasmosis...5 Pap Smear Testing New LIS Supervisor...6 Education Word Search...8 HealthEast MEDICAL LABORATORY PANEL CHANGES Catecholamines, Plasma (CAP): This test now requires an indwelling catheter for the collection process. HML recommends ordering a Plasma Metanephrines (PMT) panel instead Panel Name: Myasthenia Gravis Evaluation, Adult. Please note there are additional reflex panels for this test. Initial assays are AChR binding, modulating and striational antibodies. Panel Code: MGA CPT Codes: ACHR Binding Aby (84238) Modulating Aby (84238) Striational Aby (83520) If the AChR modulating is % loss, the following test is performed and charged at $ AChR blocking antibody (84238). If the AChR modulating is >or = 90%, and striational antibodies are positive, the following additional tests are performed and charged at $ AChR Ganglionic Neuronal antibody (84238) $97.22 GAD65 (86341) $34.57 VGKC antibody (83519) $97.22 CRMP-5-IgG (84182) $ Submit: 2 ml serum REFRIGERATED List Price: Base Panel (without reflex) $ Panel Name: Torch Panel, IgM Panel Code: TCM CPT Codes: CMV, IgM Herpes Simplex Toxoplasma Aby Submit: 1.5 ml serum REFRIGERATED List Price: $74.50 Note: This panel no longer includes the Rubella, IgM component. See following article. HML Update Summer

2 PANEL CHANGES (continued) Panel Name: Vitamin D, 1,25-Dihydroxy Panel Code: DVD CPT Codes: Submit: 2.5 ml serum REFRIGERATED List Price: $39.46 Please note the specimen requirement change. NEW PANELS Panel Name: Beta-2-Transferrin, body fluid Panel Code: B2T CPT Code: Submit: 0.5 ml body fluid FROZEN (nasal, otic, etc.) List Price: $ Panel Name: BK Virus DNA Quantitative (PCR), plasma Panel Code: QBK CPT Code: Submit: 1 ml EDTA plasma REFRIGERATED List Price: $ Panel Name: Cortisol, Salivary Panel Code: SLC CPT Code: Submit: Saliva collected in a SARSTEDT Salivette (R), REFRIGERATED List Price: $ Panel Name: Cortisol, Serum Panel Code: CTL CPT Code: Submit: 1 ml serum REFRIGERATED Test Performed at: HealthEast Medical Laboratory List Price: $58.05 Note: This new panel replaces the Cortisol AM (CTA) and Cortisol PM (CTP) panels. The interpretive information will indicate time of day range differences. CTA and CTP are no longer orderable Panel Name: Ehrlichia/Anaplasma by PCR, blood Panel Code: EHL CPT Code: Submit: 4 ml whole blood (EDTA), REFRIGERATED List Price: $88.03 HML Update Summer

3 RUBELLA, IGM TESTING Please note the discontinuation of Rubella, IgM testing in the following information from Mayo Medical Laboratories. The determination of immune status to rubella by serologic testing for IgG-class antibodies to this virus is very useful information, particularly for women of childbearing ages. However, IgM testing for the laboratory assessment of acute phase rubella infection is currently of limited clinical value. In 2005, the Centers for Disease Control and Prevention (CDC) announced the absence of endemic transmission of rubella in the United States, largely due to successful vaccination programs. Fewer than 10 cases of rubella were reported in 2004, and the majority of these cases occurred in individuals born outside the United States. The incidence of congenital rubella syndrome (CRS) has also been significantly reduced, with a total of 4 cases of CRS being reported to the CDC during Given the low prevalence of rubella in the United States, routine serologic testing for IgM-class antibodies to this virus may yield false positive results, which can negatively impact patient care. This is especially problematic when rubella IgM testing is included in the routine screening of asymptomatic, pregnant women. Beginning July 1, 2008, Mayo Medical Laboratories will no longer offer testing for rubella IgM-class antibody testing, due to the low prevalence of disease and the potential negative impact of a false-positive result. If acute rubella or CRS is suspected, it is recommended to communicate with your state health laboratory or the CDC to arrange appropriate testing. In addition, the rubella IgM component of the TORCH profile IgM will also be discontinued. However, the other components of this profile (Toxoplasma Ab, IgM, Cytomegalovirus Ab, IgM, and HSV Ab, IgM) will continue to be available. MEDICARE UPDATES CMS has implemented a new version of the Advanced Beneficiary Notice of Noncoverage (ABN) (CMS-R-131). This form replaces any and all previous versions of the ABN. Some key features of the new form are that it: Has a new official title, the Advance Beneficiary Notice of Noncoverage (ABN), in order to more clearly convey the purpose of the notice; Replaces both the existing ABN-G and ABN-L; May also be used for voluntary notifications, in place of the Notice of Exclusion from Medicare Benefits (NEMB); Has a mandatory field for cost estimates of the items/services at issue; and Includes a new beneficiary option, under which an individual may choose to receive an item / service, and pay for it out-ofpocket, rather than have a claim submitted to Medicare. All providers and suppliers must begin using the new ABN (CMS-R-131) no later than September 1, Questions about the new ABN may be sent to RevisedABN_ODF@cms.hhs.gov A cost estimate must be included on the ABN form for it to be valid. HML has provided a listing of the laboratory tests that might be considered for an ABN along with the patient cost for this purpose. The beneficiary or representative must sign the notice, with his or her own name. The signature indicates that he or she has received the notice and understands its contents. The beneficiary or representative must enter the date he or she signed the ABN. HML is in the process of distributing the new ABN for our clients. Please contact us at (use option 5) for any questions. All older versions of the ABN form should be discarded. HealthEast MEDICAL LABORATORY HML Update Summer

4 CONSULTANT S CORNER Specimens, Specimens, and More Specimens For several years we have been requiring two forms of ID to identify patient specimens. The most commonly used identifiers are the patients full (legal) name and date of birth. Active Patient Identification involves action on the patient s part. Please ask the patient to state their name and date of birth, prior to collecting their specimen. This must always occur, no matter how many times they visit your clinic. The patient will be impressed that you care enough to verify the information. Patients today are encouraged to be their own healthcare consumer advocates. Many patients are aware and watching to make sure their phlebotomist is wearing gloves and labeling their specimens in front of them. Doing so helps to ease their minds. If your lab uses computer-generated labels, please attach the label lengthwise to the tube with the patient s last name at the top. When affixing HML generated labels (Lab Works or Ultra), again, last name at the top (stopper end) and keep the barcode aligned with the length of the tube. This will improve the turnaround time of your result reporting. When the labels are at an angle or upside down, the testing instruments will reject the tube, causing a delay in resulting the test. A critical step when labeling tubes with HMLgenerated labels is to affix the proper label to the proper specimen. For example, please do not place a serum label on an EDTA specimen or a frozen label on a refrigerated specimen or vice versa. When sending urine specimens to HML, please use the sterile blue covered containers provided by HML. If the cover is not straight and tight, the specimen may leak in transit and this is a great pet peeve of the processing department. Tissue specimens for Histology have additional labeling requirements. Along with the two patient identifiers, please add the specimen type or source to both the specimen itself and to the accompanying paperwork. This is extremely important when sending more than one specimen. The source listed on the specimen must match the source listed on the paperwork. If your lab uses a computer-generated label for the path slip, please attach a label to all copies of the path slip. If you need path slips, please order them through specimen processing. Blank slips are not advised. Please fill out Histology path slips completely as these are required for proper billing and correct clinical information is required for the diagnosis. For example, please do not use R/O for the reason for the procedure or for clinical information. Information required includes: Pertinent History: Information that dictates the diagnosis Reason for the Procedure: What physician believes is the diagnosis Examples of correct history and reason are: Pertinent History: Family history of stomach CA Reason for the Procedure: Gastric polyp GLUCOSE TOLERANCE SCHEDULING Effective August 4, 2008, HealthEast Medical Laboratory at St. Joseph s Hospital will be implementing a new scheduling process for Glucose Tolerance testing. To better serve our patients, we are asking that you, or your patient, call our Customer Service Center at , option 5, to set up an appointment prior to testing. Please have your patients bring their physician s written order with them to the appointment or you can fax it to We offer glucose tolerance testing Monday through Friday. Since this test takes approximately four hours to complete we will schedule early morning appointments for the patients comfort. In addition, a hospital meal ticket is provided to the patient so that they can have something to eat at the end of the test. HML Update Summer

5 HUMAN ANAPLASMOSIS TEST ORDER GUIDELINES The Minnesota Department of Health has received increased numbers of Laboratory reports with positive serology for Ehrlichia chaffeensis, the tick-borne agent of human monocytic ehrlichiosis (HME) carried by the Lone Star tick (Amblyoma americanum) which is rarely found in Minnesota over the last few years. The laboratory reports for positive HME are suspect of actually being a false-positive result due to cross-reactivity with Anaplasma phagocytophilum, a similar disease endemic in Minnesota, caused by deer tick (Ixodes scapularis), which is also the main vector for both Lyme s Disease and Babesiosis in Minnesota. Even though the treatment for Ehrlichia chaffeensis and Anaplasma phagocytophilum is the same, if testing is only done for Ehrlichia chaffeensis those samples that do not cross-react will be reported as negative and the patient will go undiagnosed and untreated. MDH offers the following test ordering practice guidelines for diagnosis of Anaplasma phagocytophilum to optimize successful patient diagnosis and treatment. HML send panel EH and EHL to Mayo Medical Lab for testing and panel HER is performed in the Microbiology Laboratory at St. Joseph s. Order at least two of three tests for definitive results. 1. Panel EH. A serum IgG antibody test for both Ehrlichia. chaffeensis and Anaplasma phagocytotophilum. 2. Panel EHL. An EDTA whole blood PCR test for Ehrlichia chaffeensis, Anaplasma phagocytophilum, and Ehrlichia ewingii - the causative agent of canine Ehrlichiosis that can sometimes occur in humans. 3. Panel EHR. Buffy coat smear examination of PMN s for the presence of morulae, which are diagnostic of infection with Human Anaplasmosis. Information from MLS Lab Update #25437, May 19 th, PAP SMEAR TESTING HealthEast Medical Laboratory (HML) is pleased to announce we will be converting from Cytyc ThinPrep Pap test to the BD SurePath liquid-based Pap test for cervical cytology screening. We anticipate beginning on August 18. HML has chosen to invest in the BD SurePath Cell Enrichment process to bring the advantages of 100% sampled cell collection, high HSIL+ detection, that has been shown to detect 64.4% more HSIL+ abnormalities versus conventional Pap smears, and low Unsat performance to you and your patients. With the BD SurePath Cell Enrichment process, the collection process is easily standardized. With BD SurePath devices, the head of the collection device is simply dropped into the preservative vial, capturing 100% of the collected cervical cells. An independent study found that, on average, 37% of the cellular material may be lost using a "Swish and Swirl" rinsing or smear technique for sample collection and cellular transfer. This means the diagnostically important cells are not discarded, as can happen with other liquid-based methods of sample transfer. At HML, the vial is processed using the BD SurePath Cell Enrichment process, removing obscuring materials such as blood, lubricants, inflammatory cells and mucus, to produce a slide with a uniform thin-layer of diagnostic cells clearly presented for the cytologist and pathologist. The BD SurePath patented Cell Enrichment process demonstrated a statistically significant improvement in specimen quality resulting in fewer unsatisfactory results. By improving sample adequacy, there is the potential to reduce the costs associated with unnecessary repeat visits and testing. Our HealthEast Medical Laboratory consultants and BD-SurePath Physician representatives will contact your clinic s (continued) HML Update Summer

6 medical staff over the next few weeks to arrange for training on collection procedures. In the meantime, if you have any questions or concerns about this switch in cervical cytology screening methodologies, please free to contact the HML Cytology Section at Please note: This transition to SurePath Pap Smears is primarily a collection system change for our clients and does not impact our existing pap smear report formats, CPT Coding, or pricing. NEW LIS SUPERVISOR I am pleased to announce that we have hired LuAnn Schwickerath, MT (ASCP) as Supervisor for the Laboratory Information System department. LuAnn started on Monday, June 23, 2008 with HealthEast orientation. LuAnn has 17 years of experience in providing leadership in project management, process improvement, team building, and training. LuAnn started her career as a Medical Technologist (Clinical Laboratory Scientist) and migrated from the Laboratory to Information Technology with positions at Dynacor (Project Manager / Clinical Consultant), and Cerner Corporation (Project Architect / Sr. Integration Consultant / Sr. Application Consultant). She returned to the laboratory at Park Nicollet Health Services (Clinical Laboratory Manager) for 3 years before joining McKesson Corporation (Business Analyst). Please welcome LuAnn to the HealthEast Care System! EDUCATION Sept. 10, 2008 UA Microscopic and Wet Preps Betty Hoeschen, MT(ASCP) 8:30 AM - Vaginal wet preps are one of the most Janean Thielman MT(ASCP) 12:30 PM frequently performed laboratory procedures. HealthEast Medical Laboratory St. Joseph s Hospital Results of this simple, rapid test are used for diagnosis and treatment. The UA microscopic procedure will be reviewed, along with a discussion of the disease states that prompt this test. There will be material available for a hands-on wet workshop. Sept. 16, 2008 Wonderful World of Wet Preps Betty Hoeschen, MT(ASCP) Scheffer Center Vaginal wet preps are one of the most HealthEast Medical Laboratory St. Joseph s frequently-performed laboratory procedures. Hospital Results of this simple, rapid test are used for 9-11 AM diagnosis and treatment. The microscopic procedure will be reviewed along with a discussion of the disease states that prompt this test. There will be material available for a hands-on wet workshop. HealthEast MEDICAL LABORATORY HML Update Summer

7 Registration Form Name: Name(s) of Seminar: UA Microscopic and Wet Preps - September 10 Wonderful World of Wet Preps - September 16 CMA LPN MLT MT RN Other: Place of Employment and Address: Daytime Phone (include area code): address (for registration confirmation): No charge to current HML Clients $20.00 Non-Client (UA Microscopic and Wet Preps - September 10) $35.00 Non-Client (The Wonderful World of Wet Preps - September 16) Make check payable to HealthEast Medical Laboratory. Register online at or return to: Linda Phillips, HealthEast Medical Laboratory, 69 West Exchange Street, St. Paul, MN Please contact Linda Phillips at or lphillips@healtheast.org if you have questions. HML Update Summer

8 Word Search: SAFETY HML Update Summer

HML Update. Summer 2009 Volume 15, No. 3. Keeping Our Clients Informed Questions or Comments: Call

HML Update. Summer 2009 Volume 15, No. 3. Keeping Our Clients Informed Questions or Comments: Call HML Update Summer 2009 Volume 15, No. 3 Keeping Our Clients Informed Questions or Comments: Call 651-232-3500 Inside: Panel Changes...1-2 New Panels...2-3 H1N1... 3 Note of Appreciation... 3 BD Vacutainer