January Billing and compliance. Chemistry. Help us help you. Referral testing. Additional CPT code changes announced for 2015

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Raymond Newton
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January 2015 Billing and compliance Additional CPT code changes announced for 2015 Chemistry CA 27.

1 January 2015 Billing and compliance Additional CPT code changes announced for 2015 Chemistry CA conversion to CA 15-3 nearing completion Vitamin B12 and LD, Total specimen change Timed Urine Protein reference range change RBC Folate testing to be discontinued Help us help you Lock box use and extreme temperatures Beaker sites Packing listing of referral laboratory specimens Keeping your provider list current Referral testing Dengue Fever Antibodies IgG & IgM test changes

2 BILLING AND COMPLIANCE Additional CPT code changes announced for 2015 Following the distribution of the December 2014 edition of our newsletter, three additional CPT code changes for 2015 were announced. The Allina Health Laboratory Test Catalog has been updated to reflect the changes indicated below Performing Test Name Performing Lab Test # CPT CPT lab test # LAB2837 Encainide (Enkaid) MedTox Scientific 176 LAB2955 Meconium Drug Screen G MedTox Scientific 4077 LAB1997 Mephenytoin (Mesantoin) MedTox Scientific 68 2

3 CHEMISTRY CA conversion to CA 15-3 nearing completion Allina Health Laboratory is completing the process of transitioning the tumor marker assay CA to the bio-equivalent assay CA 15-3 (LAB3551). The re-baselining period for this tumor marker testing is scheduled to be complete on January 25, Since July of 2014, all orders for CA27-29 testing have been reported along with CA 15-3 results on all patients, with the following comment: On January 25, 2015, Allina Health Laboratory will discontinue running CA and convert to essentially equivalent testing by CA Both CA and comparative CA 15-3 test results will be reported from now through 1/24/2015 to allow for re-baselining of patients currently being monitored using the CA tumor marker. The CA 15-3 test result is provided below. As of January 25, 2015, only CA 15-3 results will be reported. CA will no longer be an orderable test performed at Allina Health Laboratory. As the time available to perform re-baselining is quickly coming to a close, please recall any patients that require re-baselining for this testing in a timely manner so they can be tested for CA 27-29/CA 15.3 before the end of January For any questions please contact Client Services at (612) ; Tom Massmann, Allina Health Laboratory Chemistry Technical Specialist at (612) or Dr. Brenda Katz, Central Laboratory Medical Director at (612) Vitamin B12 and LD, Total specimen change Cellular debris from platelets, RBC s and amorphous material can occur in samples collected in Heparinized plasma (PST) tubes. This cellular debris can lead to falsely elevated Vitamin B12 and LD results. While this issue is rare, it can lead to additional unnecessary follow-up testing. Effective immediately, the specimen for Vitamin B12 (LAB272) and LD, Total (LAB909) will change to SERUM ONLY. This change is necessary in an effort to further decrease the possibility of falsely elevated results due to cellular debris. The Beaker labels have been adjusted to reflect this change and our test catalog has been updated. 3

4 Timed Urine Protein reference range change Effective immediately, Allina Health Laboratory has changed the stated reference range for Timed Urine Protein (24 Hour Urine Protein). Previous Range: NEW Range: Protein, Timed Urine (PTU) LAB361 < 300 mg/24 hr mg/24 hr This change is supported by literature from the National Kidney Foundation which suggests a reference range for Protein Timed Urine of mg/24 hours as being a more clinically relevant reference range. The Allina Health Laboratory Test Catalog has been updated to reflect this change. Collect: Container: Processing: Transport/Stability: Alternate Names: Performing Lab: Days Set Up: Expected TAT: Ref. Ranges: Processing Details: Method: Protein, Timed Urine LAB hr Urine Collection - No Preservative 10 ml Urine Aliquot Tube (preferred) or Entire 24 hour Urine Collection Submit 8 ml Mixed Aliquot or Entire 24 hr Specimen Refrigerated PTU AHL - Chemistry; C Daily 1 day mg/24 hrs Record total urine volume on request form and/or aliquot container Colorimetric (Biuret) CPT Codes: Supply Connection: 10 ml Urine Aliquot Tube 4

5 RBC Folate testing to be discontinued Due to lack of clinical utility, effective February 1, 2015, RBC Folate (LAB165) testing will be discontinued. When indicated, serum folate (Folic Acid, LAB103) should be ordered instead. Any orders for the RBC Folate assay received after 2/1/15 will be cancelled and, due to differing specimen requirements, the patient may need to be re-drawn for serum folate testing. Upon cancellation of the RBC Folate assay our Client Services will contact the ordering facility to notify you of the cancellation. If the Folic Acid test is desired, you must place a new order and a new specimen collected and submitted for testing. RBC folate testing has become obsolete because (1) serum folate testing provides equivalent information and requires much less labor to perform, and (2) true folate deficiency is very rare after FDA-mandated folate supplementation. Nationally, labs have moved away from testing and most manufacturers have stopped making reagents for the test. Mayo Clinic discontinued RBC folate testing in 2013 after performing a study and concluded: True folate deficiency in the current era of FDA-mandated folic acid supplementation is exceedingly rare. There is no evidence to support routine ordering of RBC or serum folate, but serum folate concentrations provide equivalent clinical information to RBC folate in the assessment and diagnosis of folate deficiency. Furthermore, investigation of megaloblastic anemia should preferentially be initiated with vitamin B12 testing instead of folate due to the low incidence of modern folate deficiency. In the absence of B12 deficiency, it is more cost effective to simply supplement with folic acid rather than routinely test and monitor a patient's folate status, similar to other nutritional deficiencies such as vitamin D. accessed on 1/5/15. Collect: Container: Processing: Transport/Stability: Days Set Up: Expected TAT: Ref. Ranges: Processing Details: Folic Acid LAB ml Serum - SST Serum Separator Tube (SST) or Plasma Separator Tube (PST) Spin Refrigerated - 7 days Daily 1-2 Days >5.4 ng/ml Specimen must not be hemolyzed. Serum or plasma specimens should be collected from fasting individuals. Recent food intake may appreciably increase the folate concentration, however, non-fasting specimens will be accepted. 5

6 HELP US HELP YOU Lock box use and extreme temperatures If your site utilizes a lockbox to store specimens prior to transport to Allina Health Laboratory, please note that when a lockbox is exposed to the elements, the insulation is not sufficient to protect specimens during extreme weather conditions. If your lockbox is located outside of your building, in order to protect specimen integrity, the lockbox should not be used if the temperatures are below zero (0 F). If the temperatures are below zero (0 F), rather than place the specimens in your lockbox, they must be given directly to a courier to be placed in the appropriate temperature for transport. If you are unable to wait for the driver, and the specimens can not be held until your next direct courier pickup, an unscheduled courier pickup should be arranged. This message does not apply to lockboxes that are located within a building, protected from outdoor temperatures. Beaker sites Packing listing of referral laboratory specimens When sites using Beaker are processing specimens that are destined for performing laboratories other than Allina Health Laboratory (i.e. MedTox or Mayo Medical Laboratories) clients must packing list the specimens to Central lab, and not directly to the performing laboratory. When staff at the Central laboratory receives the specimens, they will packing list them to the performing lab. If this workflow isn t followed the testing doesn t get submitted through the interface and causes interface failures. Note: This does not apply to PKU specimens sent to the MN Department of Health for which the Central Laboratory serves as a pass through. The PKU specimens must be placed on a generic packing list directed to the Minnesota Department of Health Keeping Your Provider List Current To ensure accurate reports, and accurate billing insurance claims, please review your Allina Health Laboratory request forms on a regular basis to make sure that we are maintaining a complete and accurate physician listing for your clinic. If any updates (removals or additions) are needed, please contact your Account Representative. 6

7 REFERRAL TESTING Dengue Fever Antibodies IgG & IgM test changes On January 22, 2015, Mayo Medical Laboratories will begin performing the Dengue fever IgG & IgM antibody assay in house rather than forwarding the testing to Focus Laboratories. Due to this change in performing lab, there are slight changes in the specimen requirements as detailed below. A Beaker change request has been submitted, and the Allina Health Laboratory test catalog will be updated with these changes at the appropriate time. Collect Current: Collect NEW: Container Current: Container NEW: Processing Current: Processing NEW: Transport/Stability Current: Transport/Stability NEW: Performing Lab Current: Performing Lab NEW: Days Set Up Current: Days Set Up NEW: Expected TAT Current: Expected TAT NEW: Ref. Ranges Current: Reg. Ranges NEW: Processing Details Current: Processing Details NEW: Dengue Fever Antibodies IgG + IgM LAB ml Serum - Plain Red 0.5 ml Serum - SST MAYO - Screw Cap Transfer Vial SST Tube Spin and separate Spin Refrigerated (preferred) -14 days Frozen (OK) - 30 days Ambient (OK) - 7 days Refrigerated (preferred) 14 days Frozen (OK) 14 days Mayo to Focus (FDFA); R-MM Mayo Medical Laboratories (DENGM): R-MM Mo Fr Mo, We, Fr; 9am 3-5 days 1-3 days IgG & IgM: <0.90 units (Negative) IgG: Negative IgM: Negative Reference values apply to all ages. FOR RESEARCH ONLY * If SST is drawn, transfer serum to a Mayo - screw cap transfer vial before transport. FOR RESEARCH ONLY 7

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