University of Virginia Medical Laboratories Reflex Testing and Procedure                                   Chart

Initial

Requested Test

Reflex

Criterion

Reflex Test or

Procedure

CPT Code for Reflex Billing

Chemistry

 

Free Phenytoin

(FRPTN)

Phenytoin > 2.5

Free Phenytoin

80186

Free Valproic Acid

(FRVALP)

Valproic Acid

> 12.0

Free Valproic Acid

80164

TSH Reflexive

(TSHR)

TSH < 0.45 or > 4.50

Free T4

84439

Qualitative HCG with reflex to Quantitative HCG

(HCGQR)

Postive qualitative result

Quantitative HCG

84702

HIV-1 / HIV-2 Antibody Screen

(HIV12, HIVNS, HIVNE)

Positive

BioRad Geenius HIV ½

If Neg (first time)

HIV viral load will be performed

86703

87536

 

Hepatitis B Surface Antigen

(HBSAG)

Positive

Hepatitis B Confirmation (if not previously done)

87301

 

 

Hepatitis C Antibody

(HCVAB)

Positive

Hepatitis C Viral Load

(HCV)

87522

Serum Protein Electrophoresis

(SPEP)

Abnormal findings

IG Quantitation

(QUANT) Immunofixation (IMFIX)/Freelites

82784 x3

83883 x2

 

Serum Protein Electrophoresis / Urine Protein Electrophoresis

(SPEP / URPEP)

Abnormal findings not resolved by QUANTP/Freelites

Immunofixation

(IMFIX)/Band present

86334

Hemoglobin Electrophoresis

(HGBEP)

Abnormal Hemoglobins

Hemoglobin Acid Electrophoresis

(ACIDHB)

83020

 

 

Hemoglobin Electrophoresis

(HGBEP)

Abnormal findings of A2 or F

Quantitation for

A2 or F

(send out)

83021

Calcium reflex to PTH, Intact

Calcium <8.5 or > 10.5

PTH, Intact

82310

83970

Note: Free Drug test request includes free and total drug levels

             
 

 

Microbiology/Molecular

 

Throat Screen for Strep

(TS)

Negative

Culture

87081

 

 

Bacterial Culture

 

Positive

Identification

Susceptibility

87077

87070

83789

87185

87156

87181

87184

 

Fungal Culture

Positive

Identification

Susceptibility

87106

83789

87186

 

Cryptococcal AG CRYPG

Cryptococcal Ag Positive

Funcal Culture, CSF FUNCSF

87102

AFB Culture

Positive

Identification

87118

83789

87149

 

C diff PCR

Positive

C diff Toxin Antigen

87493

87324

Genomics

 

Colorectal CA Molecular Analysis

KRAS

no mutation detected

BRAF

and

NRAS

81210

 

81404

Toxicology

 

Drugs of Abuse Screening

Any positive results

Confirmation

80102

Drugs of Abuse Confirmation

Any positive result not identified by screen

Confirmation

80102

Buprenorphine/Norbuprenorphine

Positive for Fentanyl/Norfentanyl

Quantitative Fentanyl results will be reported to the patient’s chart.

80348

80354

Immunology

 

Serum Syphillis Screen (SYPTAB)

Positive

Rapid Plasma Reagin Titer (RPRT)

Quantitation

86593

SYPTAB and RPRT

Discordant results and no previous history

Treponemal Pallidum Antibody Assay

(TPPA)

86780

 

 

Celiac IgA Panel

<7 mg/dL

Celiac IgG Panel

83516 (X2)

 

 

Cytology

 

Thin Prep Pap

ACS or AGS Diagnosis

Human Papillomavirus

(HPVGEN)

87621

Blood Bank

 

Type and Hold

Positive Antibody Screen

Antibody Identification

(ABID)

86870

 

 

Type and Hold

Positive Antibody Screen

Antigen Information

(AGIO)

86903

(per antigen per unit crossmatched)

Type and Hold (on patient scheduled for surgery

Positive Antibody Screen

Crossmatch two units of blood

86920

Type and Screen

Positive Antibody Screen

Antibody Identification

(ABID)

86870

 

 

Antibody Screen

(ordered separately  or as part of battery)

Positive Antibody Screen

Antibody Identification

(ABID)

86870

 

 

Antibody Identification

Inconclusive Result

Direct Antiglobulin Test

86880

 

NewAntibody Identification

All Patients

Direct Antiglobulin Test,

Elution,

Drug-Associated Antibody Identification,

Phenotype and/or RBC antigen genotype

86880

86890 & 86870

86978

 

86903

Direct Antiglobulin Test

(polyspecific)

Positive

Direct Antiglobulin Test

(monospecific)

86880

 

 

Direct Antiglobulin Test

Positive

No current antibody screen on file.

Antibody Screen

86850

Platelet Evaluation

Positive

Platelet Crossmatch

86023

Cord Blood Workup

If the mother has a non-ABO IgG antibody or is Group O and the child is Group A or B, or no current mother’s sample is available

Direct Antiglobulin Test

86880

Cord Blood Workup

Positive Direct Antiglobulin Test

Antibody Screen if no current mother’s sample

86850

Cord Blood Workup

Positive Direct Antiglobulin Test and mother has an IgG antibody

Eluate

86860

86870

 

Fetal Bleed Screen

Positive

Fetal Hemoglobin Stain

85460

Fetal Bleed Screen

Infant with weak D

Fetal Hemoglobin Stain

85460

Transfused Red Cells

Patient with Antibody

Antigen type units

86903

(per antigen per unit crossmatched)

Type and Hold

Diagnosis of sickle cell disease

Phenotype patient’s red cells

86905

86906

Transfused Red Cells

Diagnosis of sickle cell disease

Antigen typing Rh and K compatible units

86903

 

Transfused Red Cells

Diagnosis of Thalassemia or patient with warm autoantibody that has not been recently transfused

Phenotype patient’s red cells

86905

86906

Transfused Red Cells

Chronically transfused patient

Phenotype patients red cells

86905

86906

Transfuse Red Cells

Previously transfused patient with auto-antibody

Auto- or differential absorptions

86978

Transfusion Reaction Workup

Positive Direct Coombs in which new antibody is discovered

Elution and antigen typing of all transfused units

86860

86870

86903

HLA or cross-matched platelets

None

Irradiate

86945

 

Transfuse cellular products

All red cell and platelet products

Irradiate

86945

Reference Lab

 

Borrelia burgdorferi antibody (Lyme’s Disease)

Positive or equivocal

Western Blot

86617 (x2)

 

 

Paraneoplastic Autoantibody Screen

Dependent upon initial results

Varies

Variable depending upon Ab found

Mycoplasma pnuemoniae Antibodies, IgG and IgM, Serum

If IgM is positive or equivocal

IgM by indirect immunofluorescence  assay (IFA)

86738

 

 

Cytogenetics

 

Amniotic Fluid Study

(CTGAFS)

Suspicious or abnormal standard chromosome finding

Fluorescent in situ hybridization

88271

and one of the following:

88272

88273

88274

88275

Chorionic Villus Sample

(CTGCVS)

Suspicious or abnormal standard chromosome finding

Fluorescent in situ hybridization

88271

and one of the following:

88272

88273

88274

88275

Lymphocyte Study

(CTGLS)

Suspicious or abnormal standard chromosome finding

Fluorescent in situ hybridization

88271

and one of the following:

88272

88273

88274

88275

Bone Marrow / Unstim. Blood

(CTGBMS)

Suspicious or abnormal standard chromosome finding

Fluorescent in situ hybridization

88271

and one of the following:

88272

88273

88274

88275

Fibroblast Study

(CTGFBS)

Suspicious or abnormal standard chromosome finding

Fluorescent in situ hybridization

88271

and one of the following:

88272

88273

88274

88275

Tumor Study

(CTGSTS)

Suspicious or abnormal standard chromosome finding

Fluorescent in situ hybridization

88271

and one of the following:

88272

88273

88274

88275

 

Chromosome Microarray

(CMA)

Abnormal screen

Fluorescent in situ hybridization

88271

and one of the following:

88272

88273

88274

88275

Urinalysis

 

Urinalysis with reflex culture

(UACUL)

positive leukocyte esterase, or

positive nitrite, or

>10 white blood cells/HPF, or

any bacteria present

Urine Culture

87086

Hematology

 

CBC with Reflex to Ferritin

1st or 3rd trimester and HGB <11.0 g/dL

2nd trimester and HGB <10.5 g/dL

And no ferritin in the last 60 days

Ferritin

85027

82728

Heparin Induced Platelet Antibody

Positive

Serotonin Release Assay (SRA)

86022

 

             
 

 

Surgical Pathology

 

 

Biopsy or Consult Request

Diagnosis of:

1. Glioglastoma (Astrocytoma WHO grade IV)

or

2. Anaplastic Astrocytoma (Astrocytoma WHO grade III)

or

3. Anaplastic Oligoastrocytoma (WHO grade III)

or

4. Anaplastic Olidendroglioma (WHO grade III)

or

5. Anaplastic Ependymoma (WHO grade III)

MGMT (O6-Methylguanine-DNA Methytransferase) Gene Methylation Assay

83891

83896 (x2)

83898 (x2)

83907

83912

         

 

IHC Reflex Testing:

 

Specimen type

If the diagnosis is…

Then order…

Breast

(biopsy, lump, mastectomy)

 

DCIS

ER 88360

 

Breast

(biopsy, lump, mastectomy or metastasis)

Invasive carcinoma (ductal or lobular)

ER 88360

PR 88360

HER2 ISH 88377

Non-skin head/neck biopsy or resection (Order if base of tongue, oropharynx, tonsil, neck lymph node; ask attending if other site)

Squamous cell carcinoma

p16 88342

 

Stomach, esophagus, or metastasis

Gastric or esophageal Adenocarcinoma

HER2 4B5 IHC 88342

 

Colon: biopsy; do on resection if not done on bx.

 

 

Colon: any carcinoma

 

 

 

 

 

 

 

 

PMS2 88342          MLH1 88341

MSH2 88341         MSH6 88341

 

HER2 4B5 IHC 88342

 

Uterus: hysterectomy; do on previous biopsy if no tumor in hysterectomy

 

Uterus: any carcinoma

PMS2 88342          MLH1 88341

MSH2 88341         MSH6 88341

Uterus: hysterectomy

Serous carcinoma

HER2 4B5 IHC 88342

 

Ovary

Ovary: endometrioid or clear cell types only

 

PMS2 88342          MLH1 88341

MSH2 88341         MSH6 88341

 

Renal pelvis/ureter resection

Upper Tract urothelial carcinoma

PMS2 88342          MLH1 88341

MSH2 88341         MSH6 88341

 

Skin or metastasis

 

Melanomas over 1.0 mm or metastasis to any site

PD-L1 (SP263) 88342

 

Lung or metastasis

Pulmonary Squamous Cell Carcinoma OR

Small Cell Carcinoma

PD-L1 (SP142) 88342

 

Lung or metastasis

Pulmonary Adenocarcinoma

RET and ROS1 FISH 88365 x 2

TruSight Next Gen. Sequencing 81455

ALK (D5F3) 88342

PD-L1 (SP142) 88341