Laboratory Medicine Updates - September 9, 2003

 

University of Virginia Health System

Medical Laboratories

“Quality You Expect, Service You Deserve”

LABORATORY MEDICINE UPDATE

September 9, 2003

 

  New Plastic Blood Culture Bottles

 

Beginning this week, plastic blood culture bottles will be distributed by the Hospital Storeroom.  The bottle color is unchanged (blue – aerobic and purple – anaerobic), as are the volume required for inoculation, handling of the bottles, and recommendations for sample collection.  The major difference is a smaller neck and cap on these plastic collection devices.

  

Complete Diagnosis Codes Required For Laboratory Testing

 

The Centers of Medicare and Medicaid Services (CMS), under Section 4317 of the Balanced Budget Act of 1997, require physicians to provide diagnostic information to the laboratory at the time testing is ordered. 

 In accordance with CMS’s requirements, the University of Virginia Health System Medical Laboratories requires that health care providers submit valid ICD-9 codes for all laboratory testing requested for out-patients.

 Laboratory tests must be coded to the highest degree of specificity and using the correct number of digits.  The highest degree of specificity refers to assigning the most precise ICD-9 code that fully explains the narrative description of the symptom or diagnosis.  ICD-9 codes contain 3, 4, or 5 digits.  Failure to provide the complete information may delay testing.

 For laboratory testing that requires interpretation of results by a Pathologist, such as coagulation studies, flow cytometry, and molecular diagnostics, further clinical information may be required.  Submission of a consult sheet with the diagnosis at the time the specimen is collected is requested.

 

Requests for Data on Patients

 

All requests for large amounts of data from the laboratory information system should be directed to Dr. Dede Haverstick at 924-9202.  A copy of HIC approval or HIC waiver will be required prior to data sharing to assure that relevant federal regulations are met.  In general, the Laboratory Information System is not designed to be a searchable database; the Clinical Data Repository is the preferred venue for such data searches.

  

Comprehensive Drug Screening No Longer Available

 

The Comprehensive Drug Screen on urine or gastric contents is no longer available from the Toxicology Laboratory.  In conjunction with the Clinical Toxicology service, recommendations are for careful evaluation of clinical symptoms and requests for specific drugs or drug classes where absolutely necessary, although treatment of symptoms should always be the primary clinical pathway.

 

Genetic Testing for Mutations Associated with Cystic Fibrosis

 

Responding to developing new technology and standards of practice, including the recommendations of the American College of Obstetricians and Gynecologists and American College of Medical Genetics for carrier screening for Cystic Fibrosis ("Preconception and Prenatal Carrier Screening for Cystic Fibrosis", ACOG, 2001), the Molecular Diagnostics Laboratory offers an Extended Cystic Fibrosis Mutation Panel that includes 25 common mutations found in CF patients of northern European extraction.  The test is performed at UVA under the direction of the directors of the lab, Dr. Larry Silverman and Dr. Mani Mahadevan, both experts in the area of human genetics.  Dr. Silverman in particular, is an international authority on Cystic Fibrosis molecular diagnostics.  Of note, an informative interpretive report will be included with each result.       

  The test method is based on three processes: polymerase chain reaction (PCR), hybridization of amplified products to bound oligonucleotides, and colorimetric detection.  For individuals of Ashkenazi Jewish origin, D1152H analysis will also be performed and individuals carrying the I148T polymorphism will be tested for the 3199 DEL6 mutation. 

 The test code is CFPNL. The preferred specimen is 5 mL of peripheral blood collected in EDTA (purple top) or ACD (yellow top).  Relevant clinical information, including patient’s ethnicity, relevant family history, clinical history and pregnancy status, should be included on the requisition. The charge for this panel will be $320.  For questions, please contact Dr. Larry Silverman at 434-243-2957 or the Molecular Diagnostics Laboratory at 434-982-3310.

 

Arbovirus Requests

 

Samples submitted to the Division of Consolidated Laboratory Services (State Lab) will be tested for West Nile virus, St. Louis Encephalitis virus, Eastern Equine Encephalomyelitis virus, and LaCrosse virus.  Requests for testing should be directed to the Clinical Pathology resident on the Chemistry service (pic 1267). 

Both acute (3 to 10 days after development of symptoms) and convalescent (2-3 weeks after the acute phase sample) specimens should be submitted for definitive diagnostic testing.  Serum (at least 0.5 ml) is the recommended specimen type for antibody detection; if antibody is detected then PCR analysis will also be performed on the specimen.  CSF (at least 1.0 ml) may be submitted in addition to serum; submission of only CSF is not recommended.  Do not freeze samples if serology testing is requested.

Disease reporting regulations require that all specimens have an encephalitis/initial case report form completed by the requesting physician and submitted with the specimen.  This form is available from the Referral Lab Services area of the Medical Labs (982-4051).  Additionally, all positive results must be reported to Epidemiology.