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Test Bulletin

ACL Client Services | 800-877-7016 | www.acllaboratories.com

Complete Blood CountsTo ensure compliance with Medicare and other payor regulations, effective May 1, 2010, ACL Laboratories performs and bills test code CBCNO when CBC orders are received without a request for a differential.

ACL Laboratories offers three ordering choices for Complete Blood Counts (CBC). These ordering choices follow the American Medical Association definitions as described below.

As a reminder, the hemogram parameters of WBC, RBC, Hgb, Hct and platelet count may also be ordered individually when a Complete Blood Count is not required, and an order for CBC with diff may reflex to a CBC with manual diff if automated diff parameters cannot be reported.

AMA CPT AMA Descriptor ACL Test Code

85027 Blood count; complete (CBC), automated (Hgb, Hct,

RBC, WBC and platelet count)

CBCNO

85025 Blood count; complete (CBC), automated (Hgb,

Hct, RBC, WBC and platelet count) and automated

differential WBC count

CBCA

85027

85007

Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count)

Blood count; blood smear, microscopic examination

with manual differential WBC count

CBCDF

Effective Wednesday, July 21, 2010

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CKMB Relative IndexTest Order Code: RCK CPT Code: 82550

ACL Laboratories is committed to maintaining a test menu that is consistent with current clinical guidelines. Tests which have been shown through evidence-based studies to be inferior in their sensitivity and/or specificity are removed from our menu of available laboratory tests. For this reason, changes will be made in the cardiac test menu.

Many reports have identified the superiority of Troponin in the diagnosis of coronary injury (1), (2) and the CK-MB Index has been shown to be associated with poor sensitivity. Testing efficiency is also adversely affected by the fact that the CK-MB Index is actually a two test panel, requiring both total CK and CK-MB assay, in addition to the calculation itself. Because the cited clinical guidelines recommend reliance on cardiac Troponin for diagnosis of coronary injury, ACL will discontinue offering the “CK-MB Index” panel.

Total CK and CK-MB will continue to be orderable tests, as they appear to have use in some clinical situations(3). In such circumstances, the individual tests should be ordered and the calculation performed manually. For evaluation of chest pain and suspected MI, however, the Troponin-I assay should be the test of choice.

(1) Apple, F.S., Jesse, R.L., et al., National Academy of Clinical Biochemistry and IFCC Committee for Standardization of Markers of Cardiac Damage Laboratory Medicine Practice Guidelines: Analytical issues for Biochemical Markers of Acute Coronary Syndromes, Circulation, March 23, 2007 (online).

(2) Schreiber, D., and Miller S.M., Use of Cardiac Markers in the Emergency Room, emedicine.medscape.com, July 8, 2009 (online).

(3) Fransen, E.J., Diris, J.HJ., et al., Evaluation of “New” Cardiac Markers for Ruling Out Myocardial Infarction After Coronary Artery Bypass Grafting, Chest 122: 1316-1321 (2002).

CSF Viral Panel by PCRTest Order Code: EMVPCPT Codes: 87529, 87496, 87498, 87798

ACL Laboratories Molecular Pathology Department now offers PCR-based assays for the detection of several herpes viruses (HSV1, HSV2, VZV and CMV) and Enterovirus. These assays are based on a real-time PCR format in which viral DNA/RNA is amplified by PCR and detected by fluorescently-labeled hybridization.

PCR-based testing is the preferred method for diagnosis of these Central Nervous System (CNS) viral infections. Benefits of rapid diagnosis of viral encephalitis/meningitis include early withdrawal of antibiotics, early discharge and/or changing the diagnosis and prognosis of the disease.

The CSF Viral Panel by PCR will make it easier for physicians to order multiple viral PCR tests for Encephalitis/Meningitis on CSF specimen. In addition, the panel only requires collection of one aliquot of CSF sample, which can be shared with all four assays.

This panel is equal to individual viral assays but is more convenient to order and provides faster TAT. Collection will be easier since all four tests can be run from one mL frozen sample rather than splitting into separate samples.

Uric Acid, Rasburicase Test Order Code: URICRB (uric acid, rasburicase)CPT Code: 84550

Samples from patients who have been administered the drug Rasburicase (Elitek) must have special handling to ensure accuracy of uric acid measurements. Rasburicase is administered via IV for the initial management of plasma uric acid levels in patients with leukemia, lymphoma and solid tumor malignancies who are receiving anti-cancer therapy resulting in tumor lysis (and subsequent elevation of plasma uric acid). This drug will cause enzymatic degradation of the uric acid not only in vivo, but also within blood samples, thus causing falsely lower uric acid levels. Physicians must order uric acid – rasburicase so special drawing and handling techniques are used to ensure accurate uric acid test results. Please contact ACL Laboratories prior to patient draw so special arrangements can be made.