Test Ordering
Outpatients
Outpatient orders may be requested by phone, fax, written on a Pathology
Laboratory requisition or written on a physician prescription blank. All phoned in
orders must be followed by written orders within 14 days. At the time of
registration, physician orders, diagnosis, insurance, and patient demographic
information must be provided.
Referred Specimens
Referred Specimens must be accompanied by a written request. The physician
orders, diagnosis, insurance, and patient demographic information must be
provided.
Add-on Orders
Additional orders to specimens already collected must have a written order faxed
or sent to the laboratory.
Required Information for Paper Requisitions
1. Patient’s Full Name
Include first and last name with middle initial. Do not use nicknames.
2. Patient Location
This should be the outpatient location, physician office, or sending facility. This
information is used to send reports back.
3. Patient Date of Birth and Sex
Reference ranges are age and sex dependent. Date of birth also is used as a
unique identifier.
4. Patient Identification number
Referral specimens may use social security number, date of birth and/or
requisition number as a unique identifier.
5. Ordering Physician
The physician ordering the test is provided with the report.
6. Date, Time, and Collector of the Specimen
The date and time are used to validate certain results.
7. Tests Requested
Tests that are ordered should be checked, circled or clearly handwritten.
8. Diagnosis Codes (ICD-9)
Diagnosis codes must be included to bill all third party payers and to validate
medical necessity for certain laboratory orders.
9. Signed ABN (if indicated)
If there is reason to believe Medicare will not pay for a test, the patient must be
informed. The patient must sign an Advanced Beneficiary Notice (ABN) to
indicate that the patient is responsible for the cost of the test. This signed ABN
must accompany the requisition.
Test Priority
Several test priorities are available. If no priority is assigned, the test will be
assigned the status of routine.
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Stat – results will be available (where possible) within 1 hour of receipt.
(Note: some tests analytical time exceeds one hour). This priority should only
be used in medical emergencies.
ASAP – results will be available (where possible) within 2 hours of receipt.
Timed – this priority is used when the timing of collection is critical to the
result such as in dosing of medication. Timed specimens are available within
2 hours of receipt.
Routine – results will be available (where possible) the same day received.
When significant delays of testing occur, clinical personnel will be notified
by phone.
Test Turnaround Time
The service manual lists optimal turnaround times on tests. Variations in test
schedules occasionally occur due to unforeseen circumstances.
Unlisted Tests
New tests and procedures are added throughout the year, therefore, some tests
may not be included in this service manual. If you need a test that is not listed,
please call Pathology Laboratory for more information.
Ordering Guidelines for Medicare
When ordering tests for federally funded programs such as Medicare/Medicaid,
the following requirements may apply.
1) Only tests that are medically necessary for the diagnosis or treatment of
patients should be ordered. Medicare does not pay for screening tests except
for certain specifically approved procedures.
2) If there is reason to believe Medicare will not pay for a test, the patient must
be informed. The patient must sign an Advanced Beneficiary Notice (ABN) to
indicate that the patient is responsible for the cost of the test. ABN’s are
available on the back page of the Pathology Laboratory requisition or from
Client Services.
3) The ordering physician must supply an ICD-9 diagnosis code.
4) An organ or disease oriented panel should be ordered only when all the
components of the panel are medically necessary. Pathology Laboratory
does not offer custom panels.
5) Medicare National Limitation Amounts for CPT (Current Procedure
Terminology) are available through CMS or its intermediaries. Questions
concerning utilization of CPT codes should be addressed with your local
carrier.
Testing Methodology
Testing methodologies are available upon request by clients or clinicians. Please
contact the laboratory and a list will be provided. Please call the contact
numbers listed in the front of the manual.
Service Manual Testing
The information in this service manual is current, however, changes to specimen
requirements can occur periodically with changes in methodology. Please
contact Pathology Laboratory if there are questions.
Reflex Testing
Reflex testing is the follow up with another procedure in the laboratory based
upon the results of the original test request. Pathology Laboratory will routinely
perform the following reflex tests to optimize evaluation of your patient’s
specimen. Individual practitioners may make arrangements for alternative tests
for individual patients by so noting on the requisition form. All such reflex test
protocols are listed on the back of the Pathology Laboratory physician requisition
form.
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8.
ANA and Crytococcus titers when the screens are positive.
Confirmations of drugs (where possible) when screen is positive.
Confirmation of Hepatitis B surface antigen when screen is positive.
Confirmation of HIV by Western Blot when screen is positive.
Confirmations of RPR’s and VDRL’s with FTA.
Sensitivities of cultures with significant growth of potential pathogens.
Gram Stains on cultures determined by clinical site.
Identification of abnormal antibodies found in blood bank screenings, including
phenotyping, crossmatch of 2 antigen negative units of red blood cells, titration
of antibodies, direct antiglobulin tests, elution, and adsorptions.
9. Smear to Pathologists as defined by criteria or significant cells found.
10. Special Stains on Bone Marrow as needed to render an interpretation.
11. Dilute Russell Viper Venom Test or Factor Assays on Circulating
Anticoagulants as needed for interpretation by the pathologists.
12. In an emergency, blood products will be issued according to the massive
transfusion protocol.
13. E-Coli 0157 plates on all bloody stools and on all children regardless of
blood when less then 16 years old.
14. Collagen/ADP testing for PFA 100 platelet aggregation testing when
Collagen/Epinephrine closure time is > 175 seconds.
Cancellation of Tests
Cancellations received prior to test set-up will be honored at no charge.
Requests received after test set-up cannot be honored. Reports and charges will
be issued to the client.