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April 2015 Billing and compliance ICD-10 go-live Oct. 1, 2015 Chemistry Phenytoin Free (LAB1993) referred to MedTox Scientific Thyroglobulin testing now performed in house Help us help you Viral culture, non-respiratory (LAB7635) and dermal sources Microbiology New blood culture rapid identification assay implemented 2014 Antimicrobial susceptibility cards Referral testing Neurokinin A testing changes MedTox Scientific reference range changes announced Website Test number format changing BILLING AND COMPLIANCE ICD-10 go-live Oct. 1, 2015 Allina Health, along with other health care organizations nationwide, is working to transition from ICD-9 to ICD-10 code sets to accommodate approximately 140,000 medical documentation codes for diseases and procedures, as well as for billing to payers. The Centers for Medicare & Medicaid Services (CMS) mandated date for transition is Oct. 1, 2015. Are you ready? Following is a link to a CMS website that includes a countdown, as well as links to helpful information. http://www.cms.gov/Medicare/Coding/ICD10/index.html For future reference, this link has also been included on the AHL Lab Billing page of our website. 2 CHEMISTRY Phenytoin Free (LAB1993) referred to MedTox Scientific Due to a reagent issue, Allina Health Laboratory is currently unable to perform Phenytoin, Free (LAB1993). Until further notice, all specimens received for this assay will be referred to MedTox Scientific (test # 98) for analysis. This test will be ordered as a Miscellaneous Sendout (LAB994). You can continue to order the test per your usual workflow, however, if you place electronic orders for your testing, when the specimen arrives at our Central Laboratory, you will be contacted with a request to re-order the test as a LAB994 to facilitate transfer of the orders to MedTox, and resulting of the test. Please note the following differences due to this temporary change in the performing laboratory: Specimen Requirements Allina Health Laboratory: 2.0mL (0.5mL minimum) serum (SST) or Li Heparin Plasma (PST) MedTox Scientific: 3.0mL serum (red top) or Heparinized plasma (green top) Reference Ranges Allina Health Laboratory: 1.2 - 2.5 µg/ml MedTox Scientific: 1.00 - 2.00 µg/ml Turn Around Time Allina Health Laboratory: 1 day MedTox Scientific: 2 days; Stat orders will receive a preliminary result within 4 hours of receipt at MedTox. 3 Thyroglobulin testing now performed in house On Monday, March 16, 2015 Allina Health Laboratory began performing Thyroglobulin and Anti -Thyroglobulin antibody testing in-house, using assays performed on a Beckman Unicel DxI instrument. This testing is currently referred to Mayo Medical Laboratories (MML). Both the Thyroglobulin and the Anti-thyroglobulin antibody assays, which will be performed on the Beckman Unicel DxI at the Allina Health Central Laboratory, are identical to the assays that are currently in use at MML. Note, however, that because MML converted to the Beckman Unicel DxI Anti-thyroglobulin antibody assay in October of 2014, any Anti-thyroglobulin antibody levels which had been sent to MML for testing prior to that time would not be comparable to levels obtained by the Beckman assay. The Beckman Access thyroglobulin assay is a one-step immuno-enzymatic sandwich assay. Tumor marker assay values obtained with different assay methods cannot be used interchangeably due to differences in assay methods and reagent specificity. There are no changes to test ordering, reference ranges or CPT codes associated with this performing laboratory change. Test name: Test code: Days tested: Thyroglobulin Antibody LAB1654 Mo, We, Fr Test name: Test code: Days tested: Thyroglobulin Tumor Marker LAB429 Mo, We, Fr Complete test ordering and specimen requirement information can be found in our test catalog at www.allinahealth.org/laboratory. 4 HELP US HELP YOU Viral culture, non-respiratory and dermal sources Recently we have noted a increasing number of Viral culture, non-respiratory (LAB7635) orders placed on specimens with dermal sources. When a dermal source is submitted for this assay, referred to Mayo Medical Laboratories (MML), it will be tested for Enterovirus only. In order to have a dermal specimen tested for Herpes simplex or Varicella zoster virus, you must order the appropriate PCR assay: Herpes simplex Virus (HSV) by Rapid PCR (LAB4495) Varicella zoster Virus by Rapid PCR (LAB4771) Herpes simplex Virus (HSV) + Varicella zoster Virus (VZV) Molecular Detection, PCR (LAB7898) Complete specimen requirement/specimen collection and test ordering information for each of these tests can be found in our test catalog. 5 MICROBIOLOGY New blood culture rapid identification assay implemented On April 1, 2015 the Allina Health Laboratory Central Microbiology Lab implemented a new assay for the rapid identification of organisms from positive blood culture bottles. The FilmArray BCID Panel is a multiplexed nucleic acid test for the identification of the 24 most common bacteria and yeasts in positive blood culture samples. In addition, the assay can detect three antibiotic resistance genes, mecA of MRSA, vanA/vanB of VRE, and the KPC gene found in some gram negative bacilli. While the normal process of growing the isolates for 18-24 hours before they can be identified, this assay takes one hour for detection and identification. The assay will be performed on a patient’s first positive blood culture. For the cultures incubating at the Central Lab, the blood culture gram stain will not be called if the assay is being performed. When the assay is completed in an hour, the identification and any resistance gene detection will be called to the provider. On subsequent blood cultures, the gram stain will be called upon detection and the assay will not be performed. The FilmArray assay will not be performed on blood cultures showing gram positive bacilli. Advantages: Rapid identification and early detection of mechanisms of resistance will allow for more effective and appropriate antibiotic therapy. Changes for Providers: The gram stain on the first positive culture will not be called until the assay is complete and the full identification can be reported. Should the assay not yield an identification, the gram stain will be called. Gram stains on subsequent positive blood cultures will be called as usual. No order is required for the FilmArray assay. CPT: 87150 If you have questions regarding this new assay, please contact Mary Colson-Burns, Allina Health Laboratory Microbiology Technical Specialist [email protected] 6 2014 Antimicrobial susceptibility cards Enclosed with this newsletter is a card with the summary of the antimicrobial susceptibilities of the major pathogens isolated from outpatients tested at Allina Health Laboratory during the year of 2014. This information, along with information regarding pathogens isolated from Abbott Northwestern, Mercy, United and Unity Hospitals, is also available on our website Antimicrobial Susceptibility page. The intent of this card is to provide a preliminary guide to susceptibilities. This information should be used together with the specific susceptibility results of the isolated organism and guidelines from current publications. For further information, contact Mary Colson-Burns, Microbiology Technical Specialist, [email protected] or Brenda Katz, M.D., Medical Director of the Microbiology Laboratories, [email protected]. If you would like additional copies of the outpatient card, contact either the Allina Health Laboratory Client Services at (612) 863-4678 option 1, or your account representative. 7 REFERRAL TESTING Neurokinin A testing changes Mayo Medical Laboratories (MML) has issued a notification that, effective immediately, the Neurokinin A (Substance K) assay (LAB8737) is being referred to Inter Science Institute rather than Cambridge Biomedical. Due to this, there changes in specimen collection, processing and transport requirements. Our test catalog has been updated to reflect these changes, which are also detailed below. The new special collection tube for this assay (Inter Science Institute Z-Tube) has been added to our supply catalog under Blood Collection Specialty Tubes. Please note that there is a limit of 2 tubes per order. Test Name: Neurokinin A Test Number: LAB8737 Collect: 3.0 ml Plasma from Inter Science Institute Z-Tube Mayo supply T701 Peds Collect: 1.0 mL Plasma from Inter Science Institute Z-Tube Mayo supply T701 Alternate Collect: NONE Container: Mayo - Screw Cap Transfer Vial Processing: Collect 10 mL of blood in special Z-tube (MML supply number T701). Spin, separate and freeze 3.0 mL plasma as soon as possible Transport/Stability: Frozen – 2 months Refrigerated - NO Alternate Names: Substance K, NKA Performing Lab: Inter Science Institute via Mayo (ZW71); R-MM Days Set Up: Not specified Expected TAT: Not specified Ref. Ranges: < 40 pg/ml 1) Patient should be fasting 10-12 hours prior to collection. Collection/ Processing Details: 2) Patient should not be on any antacid medication or medications that affect gastroentero-intestinal function, if possible, for at least 48 hours prior to collection. CPT: 83519 List price: $315.50 8 MedTox Scientific reference range changes announced MedTox Scientific has announced reference ranges changes to multiple tests which went into effect on April 13th. Following are details regarding the announced changes. Test Name: Test Code: Previous Reference Range: New Reference Range: Carbamazepine, Free LAB1958 0.4 - 3.6 µg/ml 0.6 - 4.2 µg/ml Test Name: Test Code: Previous Reference Range: New Reference Range: Hydromorphone LAB2087 10 - 30 ng/mL 1 - 30 ng/mL Test Name: Test Code: Previous Reference Range: New Reference Range: Meprobamate LAB2309 5.0 - 20.0 µg/mL 6.0 -12.0 µg/mL Test Name: Test Code: Previous Reference Range: New Reference Range: Oxycodone LAB1443 10 - 40 ng/mL 10 - 100 ng/mL Test Name: Test Code: Previous Reference Range: New Reference Range: Propoxyphene LAB1458 200 - 800 ng/mL 100 - 400 ng/mL 9 WEBSITE Test number format changing Over the next several months, the test number format will be changing in our test catalog. The test number will be changing to a strictly numeric code which will correlate with the codes on our updated manual request forms. The Excellian ordering codes (LABXXXX or CPT.X), along with the Beaker test abbreviation/synonyms will appear in either the test name or the alternate name field which are both searchable. If you have any questions regarding these pending changes, please contact your account representative. Thank you for choosing Allina Health Laboratory We value your business! 10