Laboratory Medicine Update - November 19, 2007
University of Virginia Health System
"Quality You Expect, Service You Deserve"
LABORATORY MEDICINE UPDATE
November 19, 2007
National Patient Safety Goals - Update!
A revision to Goal 1 of the National Patient Safety Goals from the Joint Commission - Improve the accuracy of patient identification - has been published and is relevant to laboratory testing.
Requirement 1A has been expanded. Not only must two patient identifiers be used when collecting blood samples and other specimens for testing, but the container must be labeled in the presence of the patient.
Revised Reference Interval for CSF Protein
The reference intervals for CSF protein levels have been revised. The revised values are:
Lumbar: 15 - 40 mg/dL
Ventricular: 5 - 15 mg/dL
Cisternal: 15 - 25 mg/dL
Pinworm Testing Now Referred to Mayo Medical Laboratories
Due to the extremely low volume for testing, perianal swab samples for pinworm identification will now be sent to Mayo Medical Laboratories. Results will be available within 3 to 4 days. Collection devices are available by calling Medical Laboratories Customer Service at
Fecal Fat Analysis
Reminder: To assess fat malabsorption due to pancreatic or intestinal disease, the optimum specimen is a timed (24 or 72 hour) fecal collection. However, our referral laboratory will accept a random collection for pediatric patients.
Fluconazole Susceptibility Testing
Fluconazole susceptibility testing on Candida species includes both the MIC and its interpretation. The susceptibility test is automatically performed on all Candida glabrata isolated from sterile body fluids. Susceptibility testing of Candida species isolated from all other sources will be done at the request of the physician.
Itraconazole susceptibility testing is no longer offered.
Required Information for Serotonin Release Assay Requests
The Serotonin Release Assay (SRA) is considered the gold standard for detection of antibodies in Heparin-Induced Thrombocytopenia (HIT) and can often help confirm questionable results obtained by other serologic assays for detection of heparin-dependent antibodies. In this assay, platelets labeled with radioactive serotonin are used to detect platelet activation and release of granules in the presence of heparin and HIT antibodies in the patient's serum.
Therefore, to perform this assay, the laboratory must know two key pieces of information.
(1) The exact type(s) of heparin to which the patient has been exposed. This same type will be added back during the assay. On the formulary at UVa are porcine-derived unfractionated heparin and Lovenox/Enoxaparin. The SRA is available for the heparanoids Lovenox/Enoxaparin and unfractionated heparin.
(2) When the last heparin exposure was (less than or greater than 12 hours prior to the sample draw for SRA). Sample processing is modified based on the time of last heparin exposure.
This test is currently a non-orderable sendout to the BloodCenter of Wisconsin (via Mayo) and requires approval (PIC 1267). Turn around time is approximately one week.
ICD-9 Coding For Human Papillomavirus (HPV) Primary Screening in Conjunction with Pap Test for Cervical Cancer Screening
Human papillomavirus (HPV) SCREENING is performed on Pap tests of the uterine CERVIX only. The ICD-9 code V73.81 (HPV screening) is used IN ADDITION TO the routine screening code for the Pap test V72.31 (general gynecologic exam with Pap test). The HPV screening code CANNOT be used in conjunction with the routine cervical Pap test code of V76.2, which applies to the Pap test only.
The HPV screening code is not used for reflex HPV testing or as follow-up HPV testing post therapy for cervical lesions. The ICD-9 code used in these circumstances would be related to the patient's abnormal findings (e.g. ASC, SIL).
HPV screening is not performed on vaginal Pap tests. However, HPV testing may be used as part of the workup of or follow-up for abnormal conditions. In those circumstances the ICD-9 code used for the HPV test would be related to the patient's abnormal condition.
Add-On HPV Testing with the ThinPrep Pap Test
To add HPV testing to a ThinPrep Pap test previously submitted to the Cytology Laboratory or to change the HPV test order for a previously submitted ThinPrep Pap, FAX A WRITTEN ORDER to the Cytology Laboratory at 924-0217 or send a written order by the pneumatic tube system to station 831 (8:00 am to 4:00 pm). Be sure to indicate the type of HPV testing desired: reflex testing (ASC/AG results), HPV regardless of results (even if interpretation is negative) or HPV primary screening for women 30 years of age and older. Please include an appropriate ICD-9 code for the HPV test.
ThinPrep Pap test vials are retained for three weeks after receipt in the laboratory. Written orders for add-on tests or changes in test orders must be received in the Cytology Laboratory within that timeframe. Questions concerning HPV tests should be directed to the Cytology Laboratory staff 924-2770.