SPECIMEN COLLECTION
Experience, research and literature documentation have established the suitability of mailed specimens for most clinical laboratory analyses. Specimen requirements are listed in the alphabetical test listing. For accurate results, the collection, preservation and mailing instructions must be followed. We provide couriers for much of the area served by Pathology Services, P.C. The couriers have wet and dry ice with them for maintaining the proper temperatures of specimens while in transport.
When multiple tests are requested but the specimen is inadequate because of quantity, lipemia etc., the laboratory will process as many tests as possible.
Serum: Draw in red-top tube. Allow to clot at room temperature. Separate by centrifugation within one hour. Transfer serum into labeled plastic mailing vials. Cap tightly.
For most tests requiring serum the SST (Serum Separator Tubes) may be used---except where noted in the specimen requirements. Allow the SST tube to clot at room temperature. Centrifuge within one hour. You may transport the tube after centrifugation without transferring the serum into a separate vial.
Plasma and Whole Blood: Use the anticoagulant indicated. Mix gently but thoroughly.
Tube Color Anticoagulant
Lavender EDTA Blue Sodium Citrate Green Heparin Grey Sodium Fluoride and Potassium Oxalate
For plasma, centrifuge as soon as possible. Transfer plasma into labeled plastic vial and label with the anticoagulant used. Cap tightly.
When whole blood is requested, please be sure to draw the full amount indicated on the vacuum tube. Please refrigerate whole blood in EDTA tubes for hematology and send on cold pack. Do not freeze whole blood unless specifically requested.
Peripheral Blood Smears: Send two air-dried peripheral blood films and an EDTA tube of whole blood. Do not send slides in the same shipping container with formalin-fixed specimens. Send pertinent patient history and CBC data. Pathologist will review smears and interpret results.
Bone Marrow: Prepare 8-10 air-dried films of fresh bone marrow aspirate. Prepare two fresh, air-dried peripheral blood films. Fix the clotted aspirate and core specimen in 10% buffered formalin and package separately from the marrow and blood films. Send EDTA tube of whole blood. Include the patient’s hematology history, CBC results and clinical history. Do not send blood and marrow slides in the same shipping container with formalin-fixed specimens.
24-Hour Urine: Collection Tests that require a 24-hour urine collection are valid only if the collection includes all urine passed in the 24-hour period. For example, to start the 24-hour collection at exactly 7:00 am the patient empties their bladder at 7:00 am. Thereafter, they collect all urine passed during the next 24 hours until 7:00 am the following morning. At 7:00 am on the following morning, the patient empties their bladder to conclude the collection. Save the 7:00 am voided specimen because this urine was formed during the collection period.
Measure the 24-hour volume. Record the volume and thoroughly mix the specimen before removing an aliquot for submission to the laboratory.
Preservatives used in collecting 24-hour urine specimens must be in the container at the start of the collection. Urine collected is kept at refrigerator temperature during collection, except urine for oxalates, which must be kept at room temperature.
Fasting specimens: Most specimens require an overnight fast. However, a number of tests, particularly lipid and lipoprotein tests, require more stringent dietary regulation. For these tests, patients should eat nothing for 14 hours before the test. They should drink no alcoholic beverages for 24 hours before the test. During the night before the specimen collection, the evening meal should be eaten before 6:00 PM. The meal should contain no fatty foods.
PHLEBOTOMY
Patients may come to either the main Pathology Services, P.C. lab at 500 West Leota, Suite 200 or the Physicians Office Building Laboratory at 611 West Francis, Suite 120 for phlebotomy.
SPECIMEN LABELING
Pathology Services, P.C. seeks to establish positive identification for all specimens it receives to minimize the possibility of testing the wrong specimen. Testing will not be completed on specimens with MAJOR DISCREPANCIES, since there is a high risk that the wrong specimen may be tested. When there are major discrepancies involving patient names, the submitter will be contacted and the specimen resubmitted. The specimen will be returned to the submitter on request. If a circumstance arises when it is necessary to test a specimen with a major discrepancy which cannot be recollected (for example, body fluids or tissue), testing will be completed only after a pathologist has consulted with the requesting physician. A disclaimer will be reported with the test results.
Label specimens carefully and legibly. Print the patient’s first and last name on each container. If the requisition is completely filled out, only a patient name and date are needed on the specimen container unless they are sequential specimens like cardiac enzymes.
Exception: When requesting antibody ID or crossmatch, follow the labeling instructions in Appendix VI.
Serum vials, blood tubes and bacterial swab and viral swab containers: Use a black permanent felt tip pen to write patient name and specimen source directly on the container. Do not write ID on the culturette paper wrapper. Please do not use tape on vials or tubes, either for labeling or to “seal” the lids.
Whirl pack tissue bags: Identify patient name and specimen source on the bag. Either an adhesive label or permanent black felt tip marker is acceptable. Do not wrap the adhesive label over the folded top.
Any specimen on dry ice: Label the container with a permanent black felt tip marker only. Adhesive labels do not stick at subzero temperatures.
Cytology Slides: Label the frosted end with the patient’s name and, when appropriate, specimen source using a soft lead pencil. The ink from some “permanent” marker pens may dissolve in alcohol. For more information about Cytology, click:Cytology
Hematology Slides: Using a plain glass slide, write the patient’s name using a diamond point stylus or a permanent marker. The name can also be written in pencil in the thick end of the smear in the dried blood (not the feathered end).
USE OF DOUBLE POCKET SPECIMEN BAGS
Specimens are initially placed in an appropriate container (i. e. serum vial, urine vial, tissue whirl pack bag, etc.) and properly labeled.
Place the specimen in the ziplock side of the bag. Fold and place the corresponding requisition in the other (open-top) side of the bag. Use one bag for EACH specimen.
If there is more than one vial of the same specimen, they may be submitted together in the same bag.
If there is more than one specimen per requisition and part must be kept frozen, make a copy of the requisition and include it with the frozen specimen(s). the frozen specimen should also be transported in a double pocket bag.
Large tissue specimens must be separately “double bagged” using larger plastic bags such as trash can liners to prevent leakage. If shipped, a leakproof styrofoam outer container is required. Mailing containers and double pocket specimen bags are provided by our laboratory.
REQUEST SLIPS
Each specimen must be accompanied by a request slip. Fill out the requisition completely, including:
Patient’s proper name. Please do not use nicknames or other variations. In order to ‘retrieve” a patient from the computer files and to bill insurance companies, a correct name is necessary. Source of specimen (if tissue). Date and time of collection. Patient diagnosis or ICD-9 code. We must have this before testing can begin. Social Security number and, where appropriate, Medicare number as these are needed for billing most insurance companies. Inpatient or outpatient status. For timed urine collection record the volume.
REPORTING
Specimens are processed immediately upon receipt. Results are reported as soon as possible. Report time vary depending on the analysis requested. For most analyses, reports are issued within 24 hours of the specimen’s arrival at the laboratory. Reports of priority requests may be telephoned, teleprinted or faxed. Call lab for arrangements.
If unavoidable delays in reporting are encountered, the referring physician or institution will be notified.
Tests which are referred to an off site laboratory for analysis are indicated by a * which follows the test code.
REPEAT DETERMINATIONS
Test results that do not correlate with the clinical impression will be repeated at no charge using either the original specimen or a new specimen. Serum specimens are retained for one week after analysis.
CPT CODES
Please note that this listing contains the relevant CPT coding we use for billing most procedures. These codes are those used in our laboratories for specific instruments or methods any may not apply to another instrument or method. In addition, some insurance payors or localities may have local or area specific codes in addition to CPT codes.
ORDER CODES
Order codes are test and profile codes designed to simplify ordering of tests. Although many of these codes are currently listed beside the test name on our requisition, not all tests are on the requisition. Order codes for most tests are listed in this book.
BILLING FOR SERVICES
Account bill, selected insurance billing and direct patient billing are available. Please designate the proper billing mode on the requisition and provide the necessary information.
IMPORTANT BILLING NOTICE
Medicare will only pay for tests that meet the Medicare definition of “medical necessity.” Organ or disease related panels will only be billed when all components are medically necessary. Medicare may deny payment for a test that the physician believes is appropriate, such as a screening test. If some tests are ordered as a screen (for instance, Pap Smear, PSA or Fecal Occult Blood), and the Medicare time limits have not been met, be certain the patient has signed an Advance Beneficiary Notice (ABN) and note on the requisition that you have it on file. Pathology Services, P.C. has physician clinical consultants (pathologists) available to discuss appropriate testing and test ordering. A pathologist may be reached at 800-762-6811 or 308-532-4700.
When a third-party payer (Medicare included) denies payment due to the requesting physician’s lack of documentation of the need for testing or the signed waiver, we will bill the requesting physician for this testing.
HEALTH FAIRS
Special test combinations and profiles with volume discounts are available. Please contact Dave Glenn at least six weeks in advance to arrange for special handling and pricing.
MEDICOLEGAL SPECIMENS
Upon being informed that an analysis may be entered as evidence in a medicolegal issue, we require special handling procedures and documentation. These specimens often require correspondence and communication with clients, attorneys, and law enforcement officials. The fee for this service is determined by each situation.