Test Ordering Outpatients Outpatient orders may be requested by phone, fax, written on a Pathology Laboratory requisition or written on a physician prescription blank. All phoned in orders must be followed by written orders within 14 days. At the time of registration, physician orders, diagnosis, insurance, and patient demographic information must be provided. Referred Specimens Referred Specimens must be accompanied by a written request. The physician orders, diagnosis, insurance, and patient demographic information must be provided. Add-on Orders Additional orders to specimens already collected must have a written order faxed or sent to the laboratory. Required Information for Paper Requisitions 1. Patient’s Full Name Include first and last name with middle initial. Do not use nicknames. 2. Patient Location This should be the outpatient location, physician office, or sending facility. This information is used to send reports back. 3. Patient Date of Birth and Sex Reference ranges are age and sex dependent. Date of birth also is used as a unique identifier. 4. Patient Identification number Referral specimens may use social security number, date of birth and/or requisition number as a unique identifier. 5. Ordering Physician The physician ordering the test is provided with the report. 6. Date, Time, and Collector of the Specimen The date and time are used to validate certain results. 7. Tests Requested Tests that are ordered should be checked, circled or clearly handwritten. 8. Diagnosis Codes (ICD-9) Diagnosis codes must be included to bill all third party payers and to validate medical necessity for certain laboratory orders. 9. Signed ABN (if indicated) If there is reason to believe Medicare will not pay for a test, the patient must be informed. The patient must sign an Advanced Beneficiary Notice (ABN) to indicate that the patient is responsible for the cost of the test. This signed ABN must accompany the requisition. Test Priority Several test priorities are available. If no priority is assigned, the test will be assigned the status of routine. Stat – results will be available (where possible) within 1 hour of receipt. (Note: some tests analytical time exceeds one hour). This priority should only be used in medical emergencies. ASAP – results will be available (where possible) within 2 hours of receipt. Timed – this priority is used when the timing of collection is critical to the result such as in dosing of medication. Timed specimens are available within 2 hours of receipt. Routine – results will be available (where possible) the same day received. When significant delays of testing occur, clinical personnel will be notified by phone. Test Turnaround Time The service manual lists optimal turnaround times on tests. Variations in test schedules occasionally occur due to unforeseen circumstances. Unlisted Tests New tests and procedures are added throughout the year, therefore, some tests may not be included in this service manual. If you need a test that is not listed, please call Pathology Laboratory for more information. Ordering Guidelines for Medicare When ordering tests for federally funded programs such as Medicare/Medicaid, the following requirements may apply. 1) Only tests that are medically necessary for the diagnosis or treatment of patients should be ordered. Medicare does not pay for screening tests except for certain specifically approved procedures. 2) If there is reason to believe Medicare will not pay for a test, the patient must be informed. The patient must sign an Advanced Beneficiary Notice (ABN) to indicate that the patient is responsible for the cost of the test. ABN’s are available on the back page of the Pathology Laboratory requisition or from Client Services. 3) The ordering physician must supply an ICD-9 diagnosis code. 4) An organ or disease oriented panel should be ordered only when all the components of the panel are medically necessary. Pathology Laboratory does not offer custom panels. 5) Medicare National Limitation Amounts for CPT (Current Procedure Terminology) are available through CMS or its intermediaries. Questions concerning utilization of CPT codes should be addressed with your local carrier. Testing Methodology Testing methodologies are available upon request by clients or clinicians. Please contact the laboratory and a list will be provided. Please call the contact numbers listed in the front of the manual. Service Manual Testing The information in this service manual is current, however, changes to specimen requirements can occur periodically with changes in methodology. Please contact Pathology Laboratory if there are questions. Reflex Testing Reflex testing is the follow up with another procedure in the laboratory based upon the results of the original test request. Pathology Laboratory will routinely perform the following reflex tests to optimize evaluation of your patient’s specimen. Individual practitioners may make arrangements for alternative tests for individual patients by so noting on the requisition form. All such reflex test protocols are listed on the back of the Pathology Laboratory physician requisition form. 1. ANA and Crytococcus titers when the screens are positive. 2. Confirmations of drugs (where possible) when screen is positive. 3. Confirmation of Hepatitis B surface antigen when screen is positive. 4. Confirmation of HIV by Western Blot when screen is positive. 5. Confirmations of RPR’s and VDRL’s with FTA. 6. Sensitivities of cultures with significant growth of potential pathogens. 7. Gram Stains on cultures determined by clinical site. 8. Identification of abnormal antibodies found in blood bank screenings, including phenotyping, crossmatch of 2 antigen negative units of red blood cells, titration of antibodies, direct antiglobulin tests, elution, and adsorptions. 9. Smear to Pathologists as defined by criteria or significant cells found. 10. Special Stains on Bone Marrow as needed to render an interpretation. 11. Dilute Russell Viper Venom Test or Factor Assays on Circulating Anticoagulants as needed for interpretation by the pathologists. 12. In an emergency, blood products will be issued according to the massive transfusion protocol. 13. E-Coli 0157 plates on all bloody stools and on all children regardless of blood when less then 16 years old. 14. Collagen/ADP testing for PFA 100 platelet aggregation testing when Collagen/Epinephrine closure time is > 175 seconds. Cancellation of Tests Cancellations received prior to test set-up will be honored at no charge. Requests received after test set-up cannot be honored. Reports and charges will be issued to the client.
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