5440 South Street Lincoln, Nebraska 68506 (402) 484-5462 – NLL (402) 465-1900 – PMS Issue #105 LOCAL LAB NEWS October 2014 In our ongoing commitment to provide our clients with reliable and accurate laboratory services, we will strive to keep you informed of the very latest developments and modifications regarding laboratory supplies, methodologies, regulations, etc. ____________________ VERIGENE MICROARRAY METHODOLOGY IMPLEMENTED FOR EARLY IDENTIFICATION OF BACTERIA FOUND IN POSITIVE BLOOD CULTURES From an infection prevention view, precautions may be implemented sooner. isolation Specimen Requirements: Positive Blood Culture Bottle Delayed administration of appropriate antibiotics is associated with a 7.6% decrease in survival rate for each hour that therapy is delayed. The MicroArray can identify organisms including: Staph aureus, Strep pneumo, Group A and B streptococcus, Streptococcus anginosus, Enterococcus faecalis, Enterococcus faecium, Acinetobacter, Citrobacter, Enterobacter, Proteus, Escherichia coli, Klebsiella, and Pseudomonas aeruginosa directly from positive blood culture vials. The MicroArray can also detect resistance markers: 1. vanA/vanB-mediated Vancomycin resistance in Enterococcus 2. mecA –mediated methicillin resistance in S. aureus and staphylococcus sp. 3. Extended Spectrum beta Lactamases and Carbepnemase resistance in Enterobacteriaceae Using the MicroArray system to test sample directly from a positive blood culture bottle provides much faster identification (within 4 hours) than the traditional method of waiting for the organism to grow on media and biochemicals. This rapid process facilitates earlier selection of organism-specific antibiotics for physicians and may also decrease patient length of stay and improve patient outcomes. Complete susceptibilities still need to be performed on organisms isolated on media. Ordering Information: NLL Order Code 54010, Identification and/or MIC on Referred Isolate For questions or additional information, contact an NLL Account Manager or Christy Saum, Bryan Laboratory Section Coordinator-Microbiology at 402-481-5062 [email protected] METHODOLOGY CHANGE FOR TOTAL VITAMIN D, 25 HYDROXY, TOTAL Test Code #29600 On October 8th, Nebraska LabLinc, LLC, will be switching its methodology for Vitamin D, 25 Hydroxy, Total (Test #29600) on our Siemens Advia Centaur platform to one that is in alignment with the reference procedure of the Vitamin D Standardization Program (VDSP), a collaboration of the National Institutes of Health Office of Dietary Supplements, National Institute of Technology and Standards, Centers for Disease Control and Ghent University. What this means for our clients is a more accurate assay that meets national standardization guidelines. (cont’d. pg. 2) Page 1 October 2014, Issue #105 Please note: Stability:  For results less than 50 ng/mL, no significant difference in patient results between methodologies was identified. Refrigerated: For results greater than 50 ng/mL, internal studies revealed that the new method does yield an average negative shift of approximately -14.0% with an average expected difference of -10.0 ng/mL for the new methodology as compared to the previous. Run Schedule:  7 days Reference Ranges: Adults: ≤13 mcmol/L Test will be performed Monday through Friday at 2pm CST/CDT with results available in 2 to 4 days. CPT Code Information: 83090 Specimen requirements, reference ranges, CPT codes and charges will remain the same for the new method. ACETAMINOPHEN Test Code #20000 HOMOCYSTEINE, TOTAL Test Code #24330 Due to low test volumes, on October 14, 2014, Nebraska LabLinc will discontinue offering Homocysteine, Total (Test Code #24330) as part of our local test menu. This test will be replaced by Homocysteine, Total, Plasma (Test Code #91970) which is performed by Mayo Medical Laboratories. The new test will be performed by Liquid ChromatographyTandem Mass Spectrometry (LC-MS/MS) Stable Isotope Dilution Analysis. Updated specimen requirements and stability, reference ranges, run schedule and CPT codes are as follows: Due to low test volumes, on October 14, 2014, Nebraska LabLinc will discontinue offering Acetaminophen (Test Code #20000) as part of our inhouse test menu. This test will be replaced by Acetaminophen (Test Code #20010) which is performed by Bryan Health. Updated specimen requirements and stability, reference ranges, run schedule and CPT codes are as follows: Specimen Requirements: 0.5 mL of plasma from a green-top (heparin) tube is preferred. Plasma collected in plasma gel tube (PST) or serum collected in a plain red-top tube is also acceptable. Specimen Requirements: Stability: 0.4 mL of plasma from an EDTA (lavender-top) tube is preferred. Plasma collected in sodium heparin (greentop), lithium heparin (green-top), sodium citrate (light blue-top) or sodium fluoride (grey-top) tube is also acceptable. Ambient: 5 days Refrigerated: 7 days Reference Ranges: Therapeutic: 10-20 mg/L Toxic: ≥50 mg/L Collection Instructions: 1. Fasting (12 hours, preferred but not required) 2. Immediately place specimen on wet ice. 3. Spin down and separate plasma from cells within 4 hours of draw. A refrigerated centrifuge is not required if 1-hour time restraint is met. 4. Alternatively, if blood is not immediately placed on ice, plasma must be removed from cells within 1 hour of draw. A refrigerated centrifuge is not required if 1-hour time restraint is met. Run Schedule: Test will be performed Monday through Sunday. CPT Code Information: 82003 Page 2 October 2014, Issue #105 Test Directory Revisions: October 2014 Test # Revised CPTs Previous CPTs Description 99090 83520x11 99581 87798 Enterovirus RNA Qual RT PCR (M91312) 82491 Gamma Hydroxybutyric Acid (MT1365) CPT Change Effective 8-1-2014 83516 Musk Antibody (M91445) Fee Change Effective 10-1-2014 99599 80101 98200 Co-Sensorimotor Neuropathy Profile (M91449) Comment Fee Change Effective 10-1-2014 Obsolete Effective 9-23-2014 99019 86671 83520 S Cerevisiae Ab IgA (M83022) CPT Change Effective 9-1-2014 99052 86671 83520 S Cerevisiae Ab IgG (M83023) CPT Change Effective 9-1-2014 90051 81479 SCA 6 DNA (M91588-FSCA6) Fee Change Effective 10-1-2014 96850 83520x2 Sulfatide Autoantibody Test (M90072) Fee Change Effective 10-1-2014 99830 83516 Tysabri Antibodies (M91855) Obsolete Effective 10-20-2014 CPT codes provided are for informational purposes only. CPT coding is the responsibility of the billing party. For further reference consult the CPT Coding Manual or your local Medicare carrier. FREQUENTLY CALLED PHONE / FAX NUMBERS NLL: Sales Manager (Steve DeLay) . . . . . . 402-465-1990 Account Manager (Toni Goldenstein) . . 402-465-1985 Account Manager (Sharon Pfeiffer) . . . 402-465-1997 Account Manager (Natalie Wolf) . . . . 402-465-1815 Call Center (Tina, Trish, Miriam, Wanda, Tammy) . . . . . . . . . . . 402-484-5462 Call Center fax . . . . . . . . . . . . 402-484-5463 Client Billing Questions (Vickie, Dee Dee, Shelley). . . . . . . . . . . 402-465-1966 Courier Dispatch . . . . . . . . . . . . . 402-465-1967 IT Support . . . . . . . . . . . . . . . . . 402-465-1976 Logistics Manager (Andy Davis) . . . . 402-465-1983 Patient Service Centers 5340 South Street . . . . . . . . . . 402-465-1982 Fax . . . . . . . . . . . . . . . . 402-465-1998 Bryan Plaza, Suite 414 . . . . . . . . 402-489-6466 Fax . . . . . . . . . . . . . . . . 402-489-6459 Supplies (Steve Thomas) . . . . . . . . . 402-465-1965 Supplies fax . . . . . . . . . . . . . . 402-484-5463 Technical Manager (Ryan Storz) . . . . 402-465-1813 PMS: Cytology Dept. (main) . . . . . . . . . . 402-465-1924 Requests/questions related to PAP and HPV testing . . . . . . . . 402-465-1924 Cytology fax . . . . . . . . . . . . . . . . Cytology Supervisor (Cathy Pudenz) . . Customer Service . . . . . . . . . . . . Main fax . . . . . . . . . . . . . . . . . . 402-465-1930 402-465-1922 402-465-1900 402-465-1940 MISCELLANEOUS Newsletter: This issue of our newsletter can be viewed online by accessing our website at www.lablinc.com and clicking on the Client tab. An archive of all past issues and an index of topics published in the newsletters are also available at this site. If you would like to receive the newsletter via e-mail, contact Vivian at [email protected]. Communiqué: You can now view this Mayo bimonthly publication by clicking on: http://www.mayomedicallaboratories.com/articles/re sources/communique.html. To link to specific issues of Communiqué scroll down to the bottom of the page, and in the right hand corner click on View all Communiqué Articles… Page 3 October 2014, Issue #105 PATIENT SERVICE CENTERS HOURS NEBRASKA LABLINC 5340 South Street NEBRASKA LABLINC BRYAN PLAZA PSC 1600 S. 48th St., Ste. 414 Monday thru Friday 7:00 a.m. – 6:00 p.m. Monday thru Thursday 8:00 a.m. – 5:00 p.m. Saturday pg 7:00 a.m. – Noon Friday 8:00 a.m. – 2:00 p.m. Page 4 October 2014, Issue #105