February Billing and Compliance. Chemistry/Immunology. Help Us Help You. Microbiology. Referral Testing. Supplies. Website

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Mae Goodman
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1 February 2014 Billing and Compliance ICD 10 update It s coming! Chemistry/Immunology Hepatitis B Antibody reporting change Help Us Help You Completion of Allina Health Laboratory manual request forms Unscheduled Rush courier requests Microbiology Mycoplasma/Ureaplasma testing changes Referral Testing Chlamydia trachomatis & Neisseria gonorrhoea, miscellaneous sources Plasminogen Activity, Chromogenic testing changes Supplies Prevantics TM swab for blood culture collection Website CEU DVD s available for checkout Did you know?... Allina Health Laboratory accreditation documents are available online

2 BILLING AND COMPLIANCE ICD 10 Update-It s coming! On October 1st, 2014, the United States will join the rest of the world medical community and will transition from ICD 9 (International Statistical Classification of Diseases and Related Health Problems) to ICD 10. Allina Health has a comprehensive transition plan in place. For the past year Allina Health has been working with our electronic medical record (EMR) to ensure accurate documentation is present in the patient s records to meet the more specific coding options required with ICD 10. Along with that Allina Health continues to meet regularly with other health care organizations to collaborate on this major project to share knowledge gained during updates and transition planning. Allina Health is also working with the payers that we contract with to ensure that we meet and understand their deadlines and expectations. What does this mean for you, as our client? Now is the time to start working with your providers and other medical staff to ensure accurate and complete documentation is available to allow your staff to select the appropriate ICD 10 code. With the ICD 10 conversion we are seeing many new codes; most of these due to very specific needs such as: Body site Specific location left vs right/anterior vs posterior/digit/joint Where injury occurred and during what type of activity Complications of primary diagnosis Acute or chronic condition Removal of many of the unspecified codes Due to this complexity of the new coding requirements, effective October 1st, Allina Health Laboratory will no longer be accepting narrative diagnosis on requisitions. After that time, if a narrative or an incomplete ICD 10 code is received, Allina Health Laboratory Billing will initiate a fax correspondence letter back to your facility requesting the ICD 10 code. CMS updates: You can sign up for updates from CMS on their website at Once you register, you can select the updates you would like to receive. We will be sharing additional communications as the October 1st transition date nears. Please contact your Allina Health Laboratory Account Representative with any questions. 2

3 CHEMISTRY/IMMUNOLOGY Hepatitis B Antibody reporting change Effective February 7, 2014 Allina Health Laboratory changed the result format for Hepatitis B Antibody (689/AHB, LAB689). Allina Health will no longer report Hepatitis B Antibody as an Index Value and has converted to reporting results as miu/ml. This change brought Allina Health in line with the nationally recognized standard reporting units for Hepatitis B Antibody. Hepatitis Antibody results now include the following descriptive comment: Accepted criteria for immunity to HBV is anti-hbs activity 10 miu/ml (Reactive) as defined by CDC guidelines and WHO International Reference Preparation. Please direct any questions regarding this change to Tom Massmann, Allina Health Chemistry Technical Specialist at HELP US HELP YOU Completing a manual request form For both accurate patient identification and complete and accurate insurance claim submission please make sure that when you are competing an Allina Health Laboratory you include the following patient information: full legal (not preferred) name date of birth, a complete address and gender Unscheduled Rush courier requests We would like to remind our clients that costs incurred for unscheduled Rush courier requests are the responsibility of the requesting site. If you contact Allina Health Laboratory with a request for rush services for a stat specimen or by submitting a request for same day pickup after your designated 1pm or 3pm cutoff time (determined by your closing time), charges will be billed back to your facility on a tiered fee schedule basis. If you have questions regarding this, please contact your Account Representative for assistance. 3

4 MICROBIOLOGY Effective February 1, 2014, Allina Health Laboratory discontinued the Mycoplasma/Ureaplasma Culture (MU/6592) which tested for Mycoplasma hominis and Ureaplasma. This test was replaced by the following PCR assays which are sensitive and specific and offer a wider range of acceptable specimens. Each of these assays is performed by Mayo Medical Laboratories (MML). If both the Mycoplasma hominis and Ureaplasma PCR assays are ordered, two swabs are required. Test Name: Test Number: Collect: Container: Processing: Transport/ Stability: Alternate Names: Performing Lab: Days Set Up: Expected TAT: Ref. Ranges: Collection/ Processing Details: Method: CPT Codes: List Price: $ Mycoplasma hominis, Molecular Detection, PCR 994/MSO Cervix, urethra, urogenital, vaginal, 10 ml urine, kidney stones Fluid (1-2 ml): pelvic, amniotic, prostatic secretion, semen, reproductive drainage, lower respiratory, synovial Tissue (5mm): placenta, products of conception, genitourinary Mayo - Culturette BBL Swab for PCR (White cap) Fluids, tissue: Sterile screw cap container Submit entire specimen Refrigerated (preferred) or frozen within 7 days Mycoplasma hominis PCR Mayo Medical Labs (MHRP/60756) Mon-Fri 3-4 days Negative for DNA Rapid, sensitive, and specific identification of Mycoplasma hominis from synovial fluid, genitourinary, reproductive, and lower respiratory sources. A separate swab must be collected if also ordering Ureaplasma species, Molecular Detection, PCR. Also acceptable: Specimens in M4, M5, or UTM transport media. Unacceptable specimens: ESwab, cotton or calcium alginatetipped swab, wooden shaft swab, transport swab containing gel or charcoal, Port-A-Cul tube, anaerobic fluid vials, dry swab, formalin-fixed and/or paraffin-embedded tissues. Real-Time Polymerase Chain Reaction (PCR) and Fluorescent Resonance Energy Transfer (FRET) 4

5 Test Name: Test Number: Collect: Container: Processing: Transport/ Stability: Alternate Names: Performing Lab: Days Set Up: Expected TAT: Ref. Ranges: Collection/ Processing Details: Method: CPT Codes: x 2 List Price: $ Ureaplasma species, Molecular Detection, PCR 994/MSO Cervix, urethra, urogenital, vaginal, 10 ml urine, kidney stones Fluid (1-2 ml): pelvic, amniotic, prostatic secretion, semen, reproductive drainage/fluid, lower respiratory Tissue (5mm): placenta, products of conception, genitourinary Mayo - Culturette BBL Swab for PCR (White cap) Fluids, tissue: Sterile screw cap container Submit entire specimen Refrigerated (preferred) or frozen within 7 days Ureaplasma urealyticum; Ureaplasma parvum Mayo Medical Labs (URRP/60758) Mon-Fri 3-4 days Negative for DNA A separate swab must be collected if also ordering Mycoplasma hominis, Molecular Detection, PCR. Also acceptable: Specimens in M4, M5, or UTM transport media. Unacceptable specimens: ESwab, cotton or calcium alginatetipped swab, wooden shaft swab, transport swab containing gel or charcoal, Port-A-Cul tube, anaerobic fluid vials, dry swab, formalin-fixed and/or paraffin-embedded tissues. Real-Time Polymerase Chain Reaction (PCR) and Fluorescent Resonance Energy Transfer (FRET) The preferred collection of the specimens for these assays is the Mayo - Culturette BBL Swab for PCR (White cap). If a specimen for Mycoplasma or Ureaplasma is received collected with an Eswab, the specimen will be sent to the U of MN for culture. 5

6 REFERRAL TESTING Chlamydia trachomatis & Neisseria gonorrhoea, miscellaneous sources We are pleased to share that effective immediately, Chlamydia trachomatis, Miscellaneous sources and Neisseria gonorrhoea, Miscellaneous Sources can be ordered as a single test; Chlamydia trachomatis & Neisseria gonorrhoea, Miscellaneous Sources (9009/GCM or LAB9009 for Excellian users). Each test also remains orderable individually; Chlamydia trachomatis Miscellaneous Sources (8270/CTO) or Neisseria gonorrhoea, Miscellaneous Sources (8949/NGM). Test Name: Chlamydia trachomatis & Neisseria gonorrhoea, Miscellaneous Sources Test Number: 9009/GCM Collect: APTIMA Unisex Swab Container: MAYO Aptima Unisex Swab Processing: Submit Entire Specimen Transport/Stability: Refrigerated Preferred, Ambient or Frozen OK Performing Lab: Mayo Medical Labs - (PR841) Collection/ Processing Details: This is a combined test - the Chlamydia trachomatis (MCRNA) & the Neisseria gonorrhoea (MGRNA) may still be ordered as individual tests. This test is used for specimens that are not FDA approved for this assay. Acceptable non-fda-approved specimen types are ocular, oral/ throat, anal or rectal swabs, and peritoneal fluid. Specimens sent with no swab, two swabs, or non Gen-Probe swabs will be rejected. NAT collection devices will be rejected. Method: Transcription Mediated Amplification CPT Codes: (Chlamydia) (Neisseria) If we receive orders for both individual tests (8949/NGM and 8270/CTO) on a single source, the tests will be cancelled and re-ordered as a Chlamydia trachomatis & Neisseria gonorrhoea, Miscellaneous Sources (9009/GCM). 6

7 Plasminogen Activity, Chromogenic testing changes Because the Plasminogen Activity, Chromogenic assay is no longer available from the Blood Center of Wisconsin, effective immediately, any specimens received with a request for this assay will be cancelled, re-ordered as an MSO (Miscellaneous Send Out) and forwarded to Mayo Medical Laboratories for testing. Test Name: Plasminogen Activity, Chromogenic NEW Test Number: 994/MSO Collect: 1.0 ml Frozen Plasma - Citrate (blue) Top Tube Container: Plastic Transfer Vial Processing: Spin, Separate & Freeze Plasma within 4 hours of collection Transport/Stability: Frozen Alternate Names: Plasminogen Functional Assay NEW Performing Lab: Mayo Medical Labs (PSGN) NEW Days Set Up: M - F NEW Expected TAT: 2-3 Days NEW Ref. Ranges: % Collection/ Processing Details: DO NOT OVER FILL OR UNDER FILL TUBE. Recommended consultation with pathologist before ordering. Specimens must be frozen within 4 hours of collection. Plasminogen results are potentially affected by elevated levels of fibrinogen, Heparin (unfractionated or low-molecular-weight) >4 U/mL, Fibrin degradation products (FDP) >30 mg/dl, Hemoglobin >200 mg/ dl, Bilirubin >20 mg/dl or Triglycerides >1,000 mg/dl NEW Method: Amidolysis of Chromogenic Substrate CPT Codes:

SUPPLIES Prevantics TM swab for blood culture collection As shared last fall, Allina Health Infection Prevention championed a change in products used for disinfection of the skin prior to blood

At this time, the Allina Health Laboratory supply of ChloraPrepp SEPP applicators has been depleted, and the item has been removed from our Supply Catalog, replaced by the Prevantics TM Swab; all

8 SUPPLIES Prevantics TM swab for blood culture collection As shared last fall, Allina Health Infection Prevention championed a change in products used for disinfection of the skin prior to blood culture collection. At this time, the Allina Health Laboratory supply of ChloraPrepp SEPP applicators has been depleted, and the item has been removed from our Supply Catalog, replaced by the Prevantics TM Swab; all Allina Health hospital sites should order this item via Lawson. The Prevantics TM Swab has a higher percentage of chlorhexidine for improved disinfection. Please continue to use any unexpired ChloraPrep SEPP product that you have in stock. Preparation of the blood culture venipuncture site: 1. Tear open the Prevantics TM Swab packet and remove the swab; Do not unfold the swab. 2. Apply the swab to the skin using repeated back-and-forth strokes for 15 seconds. 3. Allow the prepped area to air dry for 30 seconds; will be tacky. Note: Do not blot or wipe the solution away, or fan or blow on the site, as this may result in contamination of the blood culture. 4. Discard the swab after a single use. The Allina Health Laboratory Blood Culture Collection procedure has been updated to reflect the change in disinfection product, and is available on our website under Specimen Collection Instructions. 8

9 WEBSITE CEU DVD s available for checkout Allina Health Laboratory sponsors quarterly continuing education presentations in the Twin Cities area. For those unable to attend, we record each presentation and make the DVD s available for viewing. The DVD s are loaned at no charge to Allina Health facilities, and at a nominal fee to cover postage, to outside facilities. Upcoming CEU event information as well as a listing of available presentations and a DVD Request Form can be found under the Continuing Education heading on our website homepage at allinahealth.org/laboratory. Did you know?...allina Health Laboratory accreditation documents are available online Have you ever scrambled to obtain referral laboratory accreditation documents while preparing for an upcoming inspection? To help our clients meet this documentation requirement, we make accreditation documents (CAP and CLIA) available on our website for each of our testing locations. If you are in need of a document, from our homepage, click on Accreditation Documents in the left hand nav bar to link to a PDF and print a current CAP or CLIA certificate for any of our sites. Thank you for choosing Allina Health Laboratory We value your business! 9

March Molecular diagnostics. Update distribution changes. Billing and compliance. Hematology. Immunology. Referral testing

March Molecular diagnostics. Update distribution changes. Billing and compliance. Hematology. Immunology. Referral testing March 2016 Update distribution changes Billing and compliance Compliance Drug Analysis CPT change Hematology Hemoglobin A1c, Screening Reference Range Change Immunology Testing schedule changes Vitamin