Test Bulletin. Effective November March 1, 2014

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Erick Woods
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1 Test Bulletin Effective November March 1, 2014 BD Vacutainer Tube Conversion Red, Gold, and Green Tubes On Wednesday, December 3, 2014, the final conversion from Greiner Vacuette to BD Vacutainer collection tubes will occur for: serum tubes, lithium heparin plasma tubes, and sodium heparin plasma tubes (which are the current Greiner red top and green top tubes). The Greiner red gel tubes will be replaced by BD Vacutainer gold gel tubes and Greiner green gel tubes will be replaced by BD Vacutainer light green tubes. The existing inventory of Greiner tubes may continue to be used after this date until the supply is depleted. As part of the BD Vacutainer conversion project, the tube sizes that will be available for use within ACL were also reviewed and the chosen tube sizes are listed below. A complete BD Collection Tube Conversion guide is available from your BD representative, Client Services ( ) or on-line at NEW BD Vacutainer Tube Cap/Color Additive and ACL s Available Tube sizes / volume Number of Inversions Types of Testing Previous Greiner Vacuette Cap/Color Gold Clot activator and gel for serum separation 13 x 75 / 3.5 ml 13 x 100 / 5 ml 5 Chemistry (serum) Immuno-chemistry Some TDMs Red Gel Red Silicone coated, no gel, for serum 13 x 75 / 3 ml 13 x 100 / 6 ml 5 Chemistry (serum) Some TDMs Viral Markers Red Light Green Lithium Heparin and gel for plasma separation 13 x 75 / 3 ml 13 x 100 / 4.5 ml 8 Chemistry (plasma) Immuno-chemistry Green Green Lithium Heparin (no gel) for plasma 13 x 75 / 2 ml 13 x 100 / 6 ml 8 Chemistry (plasma) Green Green Sodium Heparin (no gel) for plasma 13 x 75 / 2 ml 13 x 75 / 4 ml 13 x 100 / 6 ml 8 Flow Cytometry Cytogenetics Green

2 Additional Information Regarding the Conversion from Greiner to BD Clotting Times: Per BD, serum gel tubes (gold top) should be allowed to clot for 30 minutes and serum non-gel (red top) should be allowed to clot for 60 minutes before centrifugation. Centrifuge Tips: Red top and gold top tubes must be spun within 2 hours of collection. As with Greiner tubes, gel tubes may NOT be re-centrifuged. If re-centrifugation is needed, remove an aliquot from the primary tube and re-spin the aliquot. Hematology Lavender top tube: Difficult draws requiring lavender tubes should use the 3.0 ml lavender tube with a 1.0 ml minimum draw volume or use a lavender pediatric microtainer tube. Navy top tubes for Trace metals and White top tubes for discard collection will remain the same, Greiner Vacuette BD Vacutainer Tube Conversion Therapeutic Drug Testing In conjunction with the conversion to BD Vacutainer tubes, a change in acceptable tube type will occur for some therapeutic drug testing. The gel in the BD Vacutainer tubes is a different composition than that found in the Greiner Vacuette tubes, causing some sample requirements to change. With the conversion to BD Vacutainer tubes, plasma will no longer be an acceptable sample type for therapeutic drug (TDM) testing. Serum samples for some drugs may be collected in BD Vacutainer gel tubes (Gold), while serum samples for other drugs will require BD Vacutainer non-gel tubes (Red). Until the conversion to BD tubes is complete, both Greiner and BD Vacutainer tubes may be used with the new tube type listed in the TDM chart below. To prepare for the conversion to BD Vacutainer tubes, the sample requirements in ACL s Directory of Services (DOS) will be updated Saturday, November 29, BD Vacutainer TUBES USED FOR TDM s NEW Vacutainer Cap/Color Gold Plastic Stopper Red Plastic Stopper Additive and Tube size / volume Clot activator and gel for serum separation 13 x 75 / 3.5 ml 13 x 100 / 5 ml Silicone coated, non-gel 13 x 75 / 4 ml 13 x 100 / 6 ml 16 x 100 / 10 ml Sample Type Serum from gel tube Serum from non-gel tube

3 TDM Sample Requirement Changes: ACL Test Name Acetaminophen Amikacin Carbamazepine Gentamicin Lidocaine Phenobarbital Phenytoin Phenytoin, Free and Total Primidone Theophylline Tobramycin Valproic Acid Vancomycin ACL Test Code ACTM AMIKP, AMIKR, AMIKT TEG GENP, GENR, GENT LIDO PHENB DIL DILF PRIMPH THEO TOBP, TOBR, TOBT VALP VANCP, VANCR, VANCT, VANPE Current Sample Type, Greiner Vacuette Serum, gel or non-gel Serum, gel or non-gel Serum, gel or non-gel Serum, gel or non-gel NEW Sample Type, BD Vacutainer (Red or Gold) Serum, Serum, Serum, Serum, Serum, Serum, Serum,

4 BD Vacutainer Tube Conversion HLA Testing With the conversion to BD Vacutainer tubes, a change in acceptable tube type will occur for some HLA testing. The chart below reflects those changes. Always refer to ACL s Directory of Services for the most accurate test collection information, ACL Test Name HLA Crossmatch HLA B27 HLA Transplant Workup HLA Antibody Analysis HLA Disease Association HLA Donor Specific Antibody ACL Test Code HLAX HLAB27 HLARH HLABS HLADAS HLADSA New Sample Requirements for BD Vacutainer Collect: One plain red 6.0 ml (non-gel) Transport: 6.0 ml serum ambient or refrigerated. Must send primary tube. Do not send an aliquot. Gold gel is not an acceptable alternative Collect: One ACD yellow tube Transport: 8.5 ml whole blood ambient Sodium heparin tube is not an acceptable alternative. Collect: One plain red 6.0 ml (non-gel) and two ACD yellow tubes Gold gel and sodium heparin tubes are not acceptable alternatives Collect: One plain red 6.0 ml (non-gel) Must send Primary Tube. Do not aliquot. Gold gel is not an acceptable alternative Collect: One ACD yellow tube Sodium Heparin is not an acceptable alternative Collect: One plain red 3.0 ml (non-gel) Gold gel is not an acceptable alternative

5 ICD-10 and ICD-9 What s the Difference? ICD-10-CM is much more clinically relevant than ICD-9-CM. It better reflects details that describe clinical severity and complexity. Because of the greater detail in ICD-10, we can better represent medical necessity of services. Physicians and other providers can help to validate their evaluation and management codes because of the specificity in the new diagnosis codes. In addition, ICD-10 codes permit the documentation to be translated into a more clear and accurate clinical picture. The table below outlines the differences. ICD-9-CM (Volume 1 & 2) ICD-10-CM 3-5 characters in length 3-7 characters in length Approximately 14,000 codes First digit may be alpha (E or V) or numeric; digits 2-5 are numeric Limited space for adding new codes Lacks detail Lacks laterality Approximately 68,000 codes Digit 1 is alpha (to indicate the category); Digit 2 is numeric (in the future, alpha characters may be used if code expansion is needed); Digits 3-7 can be alpha or numeric Flexibility to add new codes Very specific Includes laterality (i.e., codes identifying right vs. left) Anatomy of the ICD-10-CM: First digit is always alpha; digits 2 and 3 are always numeric Digits 4 through 7 can be either alpha or numeric Alpha (every letter except U) Numeric Numeric or Alpha (every letter except U) category category, anatomic site, severity extension

6 All ICD-10 codes will begin with one of the following letters of the alphabet; the alpha characters are not case sensitive. A & B: Infectious and Parasitic Diseases C: Neoplasms D: Neoplasms, Blood, Blood-forming Organs E: Endocrine, Nutritional, Metabolic F: Mental and Behavioral Disorders G: Nervous System H: Eye and Adnexa, Ear and Mastoid Process I: Circulatory System J: Respiratory System K: Digestive System L: Skin and Subcutaneous Tissue M: Musculoskeletal and Connective Tissue N: Genitourinary System O: Pregnancy, Childbirth and the Puerperium P: Certain Conditions Originating in the Perinatal Period Q: Congenital Malformations, Deformations and Chromosomal Abnormalities R: Symptoms, Signs and Abnormal Clinical and Lab Findings S: Injuries Related to Single Body Regions T: Injuries Involving Multiple or Unspecified Body Regions, Poisoning, Certain other Consequences of External Causes U: no codes listed, will be used for emergency code additions V, W, External Causes of Morbidity (homecare will only have to code how patient was hurt; X, Y: other settings will also code where injury occurred, what activity patient was doing) Z: Factors Influencing Health Status and Contact with Health Services (similar to current V-codes )

7 ICD-9 translation to ICD-10 Example: ICD-9 Code Translation ICD-10 Code Translation Unspecified Vitamin D deficiency E55.9 Vitamin D deficiency, unspecified Heart failure, unspecified I50.9 Heart failure, unspecified Wheezing R06.2 Wheezing ACL is working with all vendors and payers to upgrade its systems to receive, maintain and transmit ICD-10 codes by the deadline date of October 1, ACL will continue to communicate its ICD-10 progress with clients as we are ready to accept and test the ICD-10 process. Where do I find out more about the change to ICD-10? CMS (Centers for Medicare & Medicaid Services) AHIMA (The American Health Information Management Association) SS&G Healthcare, LL Cleveland Clinic Test Codes Old Test Code(s) New Test Code Test Name Old Test Panel New Test Panel Specimen Type CCL Required Volume (ml) Collection Tube Type Temperature to Transport HYDROR 21OHAB 21-Hydroxylase Antibody Not Applicable Not Applicable Serum 1.0 Red Refrigerated ALMONR/ ALMND ALMOND Allergen, Food, Almond IgE, BZNUTR/ BRAZIL BZNUT Allergen, Food, Brazil Nut IgE, CASHER/ CASHEW CASHW Allergen, Food, Cashew Nut IgE, HAZNTR/ HAZEL HAZNUT Allergen, Food, Hazelnut IgE, MIXNUR NUTPNL Allergen, Food, Nut Panel Group IgE, Peanut, Hazelnut, Cashew, Almond, Walnut, Pecan, Brazil Nut Peanut, Hazelnut, Cashew, Almond, Walnut, Pecan, Brazil Nut, Macadamia Nut, Pistachio Serum 2.0 Gold Gel Refrigerated PECANR/ PECAN PECANS Allergen, Food, Pecan Nut IgE, PISTAR/PISTAH PISTAC Allergen, Food, Pistachio IgE, JUBLUR/ JUNKYG JUNEGR Allergen, Grass, June IgE, ORCHR/ ORCHG ORCHRD Allergen, Grass, Orchard IgE, BREDTR/ BENTGS REDTOP Allergen, Grass, Redtop IgE,

8 Old Test Code(s) New Test Code Test Name Old Test Panel New Test Panel Specimen Type CCL Required Volume (ml) Collection Tube Type Temperature to Transport HDUSTR/ HOUSES DUSTS Allergen, House Dust IgE, AINH13 INHALE/ REGR Allergen, Inhalants Profile IgE, A. Alternata, English Plantain, Cat Epithelium, Cat Dander, D. Farinae, Hormodendrum, June Grass/ Kentucky Bluegrass, Birch Tree, Short Ragweed, Dog Dander, House Dust Stier, Oak Tree, Timothy Grass, Dog Epithelium Timothy Grass, Penicillium chrysogenum, June Grass, Short Ragweed, English Plantain, Cat Dander, Dog Dander, Hormodendrum, A. fumigatus, Lamb's Quarters, Box Elder, A. tenuis, House Dust Stier, Box Elder, D. farinae, Oak Tree Serum 1.5 Gold Gel Refrigerated AR7PR/ RG7PNL RESPR7 Allergen, Respiratory Panel Region 7 IgE, A. Alternta, Maple/ Boxelder Tree, Elm Tree, D. Farinae, Birch Tree, Dog Dander, A. fumigatus, Cow's Milk, Russian Thistle, Bermuda Grass, Penicillium Notatum, Nettle Weed, Mouse Epithelium, Marsh Elder, Oak Tree, Cockroach, Short Ragweed, Cat Epithelium, Cat Dander, D. Pteronyssinus, Hormodendrum, Cottonwood Tree, Peanut, Timothy Grass, White Ash Tree, Mucor Racemosus, Mountain Cedar, White Mulberry Tree, Immunoglobulin E Elm Tree, Box Elder, Short Ragweed, Orchard Grass, Cat Dander, Hormodendrum, Birch Tree, Retop Grass, D. farinae, A. tenuis, A. fumigatus, Oak Tree, Rough Marshelder, Dog Dander, D. pteronyssinus Serum 2.0 Gold Gel Refrigerated BIRCHR/BIRCH BIRCHT Allergen, Tree, Birch IgE, ENGRR/ ENGPLN ENGPLT Allergen, Weed, English Plantain IgE, No Code FIRBSH Allergen, Weed, Firebush, Kochia IgE,

9 Old Test Code(s) New Test Code Test Name Old Test Panel New Test Panel Specimen Type CCL Required Volume (ml) Collection Tube Type Temperature to Transport LAMBR/ LAMBQ LAMBQU Allergen, Weed, Lamb's Quarters IgE, MUGWTR/ MUGWOT MUGWRT Allergen, Weed, Mugwort IgE, NETLER/ NETLE NETTLE Allergen, Weed, Nettle IgE, SHEEPR/ SHEEPS SORREL Allergen, Weed, Sheep Sorrel IgE, WEEDSR WEEDS Allergen, Weeds Group IgE, Short Ragweed, English Plantain, Giant Ragweed, Lamb's Quarters, Mugwort, Russian Thistle, Western Ragweed, Dandelion, False Ragweed, Kochia/ Firebush, Marsh Elder, Pigweed, Sagebrush English Plantain, Kochia/Firebush, Marsh Elder, Pigweed, Sheep Sorrel Serum 0.5 Gold Gel Refrigerated No Code CLORPR Chlorpromazine Not Applicable Not Applicable Serum or Plasma 2.0 Red or Lavender Frozen

10 Home Delivery Sample Testing Testing for Rh Immune Globulin (Test Code RhIG) eligibility is required for all obstetrical patients. To determine RhIG eligibility following a home delivery, midwives must collect samples from the baby and the mother, complete a paper requisition for both, and select the desired testing. At a minimum, an ABO/RH Group and Type (Test Code ABRH) must be ordered on the baby s sample, and a Save for Post Childbirth Tests (Test Code SRHW) must be ordered on the mother s sample. If the mother is a candidate for RhIG, a Fetal Screen (Test Code FMS) is performed. If the FMS is negative, the mother requires administration of 1 vial of RhIG. If the FMS is positive, a Fetal Maternal Hemorrhage Stain (Test Code FMST), also known as the Kleihauer-Betke Stain, is performed to determine the number of vials of RhIG required. In conclusion, an FMST will only be performed when indicated by the FMS.

Allergy IgE Allergy Test Sensitivity and Specificity 6/23/17

Allergy IgE Allergy Test Sensitivity and Specificity 6/23/17 1 Sensitivity and Specificity Benchmarking Goal Test pooled human sera with known positive and negative reactivity to determine Allergy sensitivity