Laboratory Medicine Update - June 18, 2007

University of Virginia Health System

Medical Laboratories

"Quality You Expect, Service You Deserve"

LABORATORY MEDICINE UPDATE

June 18, 2007

Antimicrobial Susceptibility Profiles for 2006 are now available

Profiles of antimicrobial susceptibility for both inpatients and outpatients are now available from the Microbiology Lab for the year 2006.  Also included for 2006 are yeast susceptibilities.

Please call 434-924-8059 (4-8059) to request copies of the profiles.

Hepatitis Profiles

This notice is intended as a reminder regarding current ordering practices for hepatitis testing.  The Centers for Medicare & Medicaid Services (CMS) require separate fee schedules for each test ordered as part of a "profile."  One of the high volume tests affected by this policy is hepatitis screening.  In order to ensure compliance with this policy, each test that was previously part of a hepatitis profile must be ordered separately.  It is the ordering provider's responsibility to ensure the correct tests are selected.  In the case of hepatitis screening, the following test codes are available:

If the hepatitis work-up is being requested for occupational exposure (needle-stick work-up), then the hepatitis exposure profile should be ordered. This profile should NOT be ordered for routine hepatitis testing.  In the case of occupational exposure, the following test should be ordered:

Mycobacterium tuberculosis complex susceptibilities

Susceptibility testing for M. tuberculosis complex is now performed by the Bureau of Microbiological Services at Virginia's Division of Consolidated Laboratory Services.  The critical concentration of each drug is reported rather than the actual concentration of the drug in the test system.

The critical concentrations of the antituberculosis drugs were determined by clinical and bacteriological studies.  They are the lowest concentrations that inhibit 99% of the bacilli in wild-strains of M. tuberculosis while allowing growth of resistant strains.  They are considered the concentrations that best predict treatment success.

Drugs of Abuse Testing (urine)

Effective June 7, 2007, all testing for Drugs of Abuse (test code DOAF) will include the following screening tests using the indicated detection limits.  Any screen-positive results will reflex to confirmatory testing at no additional charge.  Sample integrity will be assessed through urine pH, specific gravity, and creatinine tests.

• Amphetamines - 1000 ng/mL
• Barbiturates - 300 ng/mL
• Benzodiazepines - 300 ng/mL
• Cannabinoids - 20 ng/mL
• Cocaine (reported as benzoylecgonine) - 300 ng/mL
• Ethanol - 20 mg/dL
• Opiates - 300 ng/mL
• Oxycodone - 300 ng/mL
• Phencyclidine - 25 ng/mL
• Methadone - 150 ng/mL
• EDDP (methadone metabolite) - 100 ng/mL
• Propoxyphene - 300 ng/mL

A modified panel (test code DOAM) for use primarily in pre-employment situations includes everything indicated above except ethanol.