University of Virginia Medical Laboratories Reflex Testing and Procedure Chart
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Initial Requested Test |
Reflex Criterion |
Reflex Test or Procedure |
CPT Code for Reflex Billing |
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Chemistry
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*Free Phenytoin (FRPTN) |
Phenytoin > 2.5 |
Free Phenytoin |
80186 |
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*Free Carbamazapine (FRCARB) |
Carbamazapine > 2.0 |
Free Carbamazapine |
80156 |
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*Free Valproic Acid (FRVALP) |
Valproic Acid > 12.0 |
Free Valproic Acid |
80164 |
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*Free Digoxin (FDIG) |
Digoxin > 2.0 |
Free Digoxin |
80162 |
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TSH Reflexive (TSHR) |
TSH < 0.45 or > 4.50 |
Free T4 |
84439 |
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Qualitative HCG with reflex to Quantitative HCG (HCGQR) |
Postive qualitative result |
Quantitative HCG |
84702 |
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Alkaline Phosphatase |
Alkp > 104 |
Fractionate Alkaline Phosphatase (heated) |
84078 |
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Note: Free Drug test request includes free and total drug levels |
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Microbiology
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*Flu Screen A and/or B (VSFLU) |
Negative |
Flu PCR |
87798 |
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*Throat Screen for Strep (TS) |
Negative |
Culture |
87081
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*Bacterial Culture
|
Positive |
Identification Susceptibility |
87077 87106 87147 87149 87181 87184 83891 83898 (performed in DNA) |
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*Fungal Culture |
Positive |
Identification Susceptibility |
87106 87186 83891 83898 (performed in DNA) |
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*AFB Culture |
Positive |
Identification |
87118 87149 83891 83898 (performed in DNA) |
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*Viral Culture |
Positive |
Identification |
87253 87254 |
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Toxicology
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*Drugs of Abuse Screening |
Any positive results |
Confirmation |
80102 |
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Immunology
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*HIV-1 / HIV-2 Antibody Screen (HIV12) |
Positive |
HIV-1 Western Blot |
86689 |
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*Rapid HIV Antibody Testing (RHIVNS) test performed in Microbiology |
Reactive |
HIV-1 Western Blot (performed in Davis Lab) |
86689 |
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*HIV-1 Western Blot (HIVWB) |
Negative or indeterminent |
HIV-2 Western Blot (send out) |
86689
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*Hepatitis B Surface Antigen (HBSAG) |
Positive |
Hepatitis B Confirmation |
87301
|
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*Serum Syphillis Screen (RPR) |
Positive |
RPRT (Quantitation)
|
86593
|
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*Serum Syphillis Screen (RPR) |
Positive (1st time) |
Treponemal Pallidum Antibody Assay |
86787 |
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*Serum Protein Electrophoresis (SPEP) |
Abnormal findings |
IG Quantitation Plus (QUANTP) Immunofixation (IMFIX) |
82784
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*Serum Protein Electrophoresis / Urine Protein Electrophoresis (SPEP / URPEP) |
Abnormal findings not resolved by QUANTP |
Immunofixation (IMFIX) |
86334 |
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*Hemoglobin Electrophoresis (HGBEP) |
Abnormal Hemoglobins |
Hemoglobin Acid Electrophoresis (ACIDHB) |
83020
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*Hemoglobin Electrophoresis (HGBEP) |
Abnormal findings not resolved by ACIDHB |
Quantitation for A2 or F (send out) |
83021 |
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*G6PD Screen |
Abnormal results |
G6PD Quantitation (send out) |
83021
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Cytology
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Thin Prep Pap |
ACS or AGS Diagnosis |
Human Papillomavirus (HPVD) |
87621 |
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Blood Bank
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*Type and Hold |
Positive Antibody Screen |
Antibody Identification (ABID) |
86870 |
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*Type and Hold |
Positive Antibody Screen |
Antigen Information (AGIO) |
86903 (per antigen per unit crossmatched) |
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*Type and Screen |
Positive Antibody Screen |
Antibody Identification (ABID) |
86870
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*Antibody Screen (ordered separately or as part of battery) |
Positive Antibody Screen |
Antibody Identification (ABID) |
86870
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*Antibody Identification |
Inconclusive Result |
Direct Antiglobulin Test |
86880
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*NewAntibody Identification |
All Patients |
Direct Antiglobulin Test, Elution, Drug-Associated Antibody Identification, Phenotype and/or RBC antigen genotype |
86880 86890 & 86870 86978
86903 |
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Direct Antiglobulin Test (polyspecific) |
Positive |
Direct Antiglobulin Test (monospecific) |
86880
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Direct Antiglobulin Test |
Positive No current antibody screen on file. |
Antibody Screen |
86850 |
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Platelet Evaluation |
Positive |
Platelet Crossmatch |
86023 |
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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 |
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Cord Blood Workup |
Positive Direct Antiglobulin Test |
Antibody Screen if no current mother's sample available |
86850 |
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Cord Blood Workup |
Positive Direct Antiglobulin Test and mother has an IgG antibody |
Eluate |
86860 86870
|
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*Fetal Bleed Screen |
Positive |
Fetal Hemoglobin Stain |
85460 |
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*Fetal Bleed Screen |
Infant with weak D |
Fetal Hemoglobin Stain |
85460 |
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*Transfused Red Cells |
Patient with Antibody |
Antigen type units |
86903 (per antigen per unit crossmatched) |
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Type and Hold |
Diagnosis of sickle cell disease |
Phenotype patient's red cells |
86905 86906 |
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Transfused Red Cells |
Diagnosis of sickle cell disease |
Antigen typing Rh and K compatible units |
86903
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Transfused Red Cells |
Diagnosis of Thalassemia or patient with warm autoantibody that has not been recently transfused |
Phenotype patient's red cells |
86905 86906 |
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Transfused Red Cells |
Chronically transfused patient |
Phenotype patients red cells |
86905 86906 |
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Transfuse Red Cells |
Previously transfused patient with auto-antibody |
Auto- or differential absorptions |
86978 |
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*Transfusion Reaction Workup |
Positive Direct Coombs in which new antibody is discovered |
Elution and antigen typing of all transfused units |
86860 86870 86903 |
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*HLA or cross-matched platelets |
None |
Irradiate |
86945
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*Transfuse cellular products |
Diagnosis of stem cell or bone marrow transplant recipient |
Irradiate |
86945 |
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*Transfuse red cells |
Intrauterine transfusion |
Irradiate |
86945 |
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*Transfuse cellular products |
Neonate < 4 Months |
Irradiate |
86945 |
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*Transfuse granulocytes |
None |
Irradiate |
86945 |
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*Transfuse patient designated unit |
None |
Irradiate |
86945 |
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*Transfuse cellular product |
Diagnosis of neuroblastoma |
Irradiate |
86945
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*Transfuse cellular products |
Diag. of congenital T-cell deficiency |
Irradiate |
86945
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Reference Lab
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*Insulin Antibody with reflex |
Positive |
Insulin Antibody Titer |
86337 |
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*Striated Muscle Antibody, Serum |
Positive screen |
Titer |
86256 |
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*Borrelia burgdorferi antibody (Lyme's Disease) |
Positive or equivocal |
Western Blot |
86617 (x2)
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*Islet Cell Antibody with Reflex to Titer |
Positive screen |
Antibody titer |
86256 each Antibody |
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*Adrenal Antibodies with Reflex |
Positive |
Adrenal Antibodies Titer |
86256
|
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*Bartonella henselae &Bartonella quintana (Cat Scratch Disease Antibodies) IgG, IgM screen with reflex |
Positive |
Bartonella henselae (IgG, IgM) & Bartonella quintana (IgG, IgM) titer |
86611 (x4)
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*Liver Kidney Microsomal Antibody Screen with reflex |
Positive |
Liver Kidney Microsomal Antibody Titer |
86376
|
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*Rickettsia rickettsii (Rocky Mountain Spotted Fever) Antibodies (IgG, IgM) with reflex to Titers |
Positive |
Rickettsia rickettsii (Rocky Mountain Spottd Fever) Antibodies (IgG, IgM) Titers |
86757 (x2)
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Cytogenetics
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Amniotic Fluid Study (CTGAFS) |
Suspicious or abnormal standard chromosome finding |
Fluorescent in situ hybridization |
88271 and one of the following: 88272 88273 88274 88275 |
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Chorionic Villus Sample (CTGCVS) |
Suspicious or abnormal standard chromosome finding |
Fluorescent in situ hybridization |
88271 and one of the following: 88272 88273 88274 88275 |
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Lymphocyte Study (CTGLS) |
Suspicious or abnormal standard chromosome finding |
Fluorescent in situ hybridization |
88271 and one of the following: 88272 88273 88274 88275 |
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*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
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Fibroblast Study (CTGFBS) |
Suspicious or abnormal standard chromosome finding |
Fluorescent in situ hybridization |
88271 and one of the following: 88272 88273 88274 88275 |
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Tumor Study (CTGSTS) |
Suspicious or abnormal standard chromosome finding |
Fluorescent in situ hybridization |
88271 and one of the following: 88272 88273 88274 88275 |
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Urinalysis
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Urinalysis with reflex culture (UACUL) |
positive leukocyte esterase, or positive nitrite, or >5 white blood cells/HPF, or any bacteria present |
Urine Culture |
87086 |
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Student Health (only)
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CBC |
Any lymph generated flag, or absolute lymphocyte count > absolute granulocyte count, or absolute lymphocyte count >2.1, or platelet count < 150 |
Monospot |
86308 |
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* Denotes Mandatory Reflex Testing
