Billing

Confirmation and Reflex Testing

Reflex tests are ordered when a particular test result indicates that additional testing should be performed. This is a list of Reflex Tests and their CPT4 codes. Our pathologists have reviewed these reflex tests and have confirmed that they follow accepted medical practice and are done in the best interest of the patient. The trigger which causes the additional test to be ordered is also indicated.  Note: New Tests referred to a reference laboratory which include Reflex Testing will be added to this list when Applicable.

Confirmation tests are performed when a particular test result is positive. Additional testing is done to confirm the positive result or to report a titer following accepted medical practice. This is a list of tests and their billable CPT4 codes. Additional testing for cultures varies with the organisms identified.

Reflex Testing
Long Test Name Order Name Short Test code Performing Lab CPT4 code Reflex Trigger Reflex test Test Code Reflex CPT code
Alpha-1 Antitrypsin; Genotype - Reflex Phenotype ALPH 1 GEN 3811200 ARUP 82103, 81332 Protein concentration less than 90 mg/dl and one or noe all deficiency allele detected by A1A Genotyping A1A PHENOTYPE Part of original order 82104
Bordetella pertussis Antibodies; IgA and IgG by ELISA with Reflex to Immunoblot BOR AR AB 5521005 ARUP 86615X2 Bordetella pertussis Antibody; IgA by ELISA is 1.2 U/mL or greater Bordetella pertussis Antibody; IgG by ELISA is 1.2 U/mL or greater BOR P IgA BY Immunoblot and/or BOR P IgG by Immunoblot 5521045 and/or 5521020 86615 for each Immunoblot
Chromosome Analysis - Amniotic Fluid & AFP (Alpha-Fetoprotein) w/ Reflex AFP/CHRM 1003950 Saint Francis/ARUP 88269, 88235, 88280, 88291, 82106 If preliminary AFP is abnormal Acetycholinesterase Fetal Hemoglobin 3801575 82013, 83033
CPK with Troponin CK HEART T 2017925 RML 82550; 84484 CPK elevated .CKMB with Index 2018200 82553
Cryoglobulins CRYOBLOB 5500500 RML 82595 Positive Cryoglobulins Protein Electrophoresis Analyzer 5004425 84155, 84165; (80500 or 8416526) Initial testing only.
Drug Screen 9 Panel; Serum or Plasma; Reflex to Quant Confirmation Drug Screen 9 6980101 ARUP 80307 If Detail is positive it will be Quantitated Possilbe Tests: Amphetamines; Benzodiazepines; Phencyclidine (PCP); Barbiturates; Canabinoids; Cocaine Metabolite; Methadone; Opiates; Buprenorphine. 6980127; 6980151; 6980207; 6906453; 6900553; 6900757; 5613599; 4312130; 6900547 G0480, G0480, G0480, G0480, G0480, G0480, G0480, G0480, G0480
Duchenne/Becker Muscular Dystrophy (DMD) Deletion/Duplication with Reflex to Sequencing DMD Del/Dup Rflx 6904997 ARUP 81161 If no large deletions or duplications are detected DMD Sequencing 6905271 81408
Encephalitis Antibody Panel (CSF) with Reflex Encephal Ab CSF 6906027 Quest 86727x2 86765x2 86735x2 86787x2 86788 86789 86695x2 86696x2 If HSV 1 IgM positve IF HSV 2 IgM positive HSV 1 IgM Titer; HSV2 IgM Titer 6905769; 6905771 86695; 86696
Ethyl Glucuronide Screen with Reflex to Quant Confirmation; Urine Ethyl Gluc Scn U 6905005 ARUP 80307 Postivie Ethyl Glucoronide Quant 6906245 80321 (G0480)
Fentanyl ; Urine Screen with Reflex to Quantitation Fentanyl Ur Scr 5613589 ARUP 80307 Positive Fentanyl Metabolite 5613591 80354 (G0480)
Fragile X (FMR1) with Reflex to Methylation Analysis FRAGILE X 0117075 ARUP 81243 Patient Specific Genetic Banding Fragile X Southern Blot Part of original order 81244
Gamma-Hydroxybutyric Acid (GHB) GHB Serum 3604705 ARUP 80304 Positive GHB Confirmation 5613651 80368
Heavy Metals Panel; Urine (24hr or Random) with Reflex to Arsenic Fractions METAL S U 3810575 ARUP 82175; 83655; 83825 Arsenic between 35-2000 ug/L Arsenic Fractionated 3709000 82175
Hemoglobin Electrophoresis HGB ELECT 5000750 RML 83020 Unusual hemoglobin variants (% of A2 is 2.8% to 3.5%). Hemoglobin A/S Present (Sickle Trait) "Hemoglobinopathy by HPLC. Sickle Cell Solubility" 0105575; 0105700 83021, 85014, 85018; 85041
HTLV I/II Antibody; EIA ( Positives Reflexed to Western Blot ) HTLV-I/II 3535875 ARUP 86790 Positive Human T-Lymphotropic Virus Types I/II Antibodies .HTLV I/II Antibodies Conf Western Blot 5355875 86689
Hu Antibody Screen with Reflex to Titer and Western Blot; CSF Hu Ab CSF 6905713 Quest 86255 Hu Antibody Screen; IFA; CSF is positive. If Hu Antibody; WB; CSF positive "Hu Antibody; WB; CSF. Hu Antibody Titer; CSF" 6905715; 6905717 84181; 86256
Gyn Pap Test, ThinPrep, Image Guided, Reflex to HPV if ASCUS PAP 2 6910143 RML 88175 HPV if ASCUS .HPV Test 6910161 87624
Gyn Pap Test, ThinPrep, Image Guided and HPV with Reflex to Genotypes 16, 18/45 PAP 4 6910147 RML 88175, 87624 Abnormal HPV Result Genotypes 16, 18/45 6910101 87625
Gyn Pap Test, ThinPrep, Image Guided, Reflex to HPV if ASCUS or AGUS PAP 5 6910175 RML 88175 HPV if ASCUS or AGUS .HPV Test 6910161 87624
Gyn Pap Test, ThinPrep, Image Guided, Reflex to HPV if ASCUS or AGUS, Reflex to Genotype 16, 18/45 PAP 6 6910177 RML 88175 HPV if ASCUS or AGUS, Reflex to Genotype 16, 18/45 .HPV Test. and/or Genotypes 16, 18/45 6910161; 6910101 87624; 87625
Gyn Pap Test, ThinPrep, Image Guided, Reflex to HPV if ASCUS, ASC-H, or AGUS PAP 7 6910179 RML 88175 HPV if ASCUS, ASC-H, or AGUS .HPV Test 6910161 87624
Gyn Pap Test, ThinPrep, Image Guided, Reflex to HPV if ASCUS, Reflex to Genotype 16, 18/45 PAP 9 6910183 RML 88175 HPV if ASCUS, Reflex to Genotype 16, 18/45 .HPV Test. and/or Genotypes 16, 18/45 6910161; 6910101 87624; 87625
Gyn Pap Test, ThinPrep, Image Guided, Reflex to HPV if ASCUS, ASC-H, or AGUS, Reflex to Genotype 16, 18/45 PAP 8 6910181 RML 88175 HPV if ASCUS, ASC-H, or AGUS, Reflex to Genotype 16, 18/45 .HPV Test 6910161 87624
Gyn Pap Test, ThinPrep, Image Guided, Reflx to HPV if ASCUS, ASC-H, AGUS, or LSIL PAP 10 6910187 RML 88175 HPV if ASCUS, ASC-H, AGUS, or LSIL .HPV Test 6910161 87624
Gyn Pap Test, ThinPrep, Image Guided, Reflx to HPV if ASCUS, ASC-H, AGUS, or LSIL,Reflex Genotype 16, 18/45 PAP 11 6910191 RML 88175 HPV if ASCUS, Reflex to Genotype 16, 18/45 .HPV Test. and/or Genotypes 16, 18/45 6910161; 6910101 87624; 87625
HPV (Human Papillomavirus), High Risk w/ Reflex to HPV 16/18 (SurePath) HPV 16RFLX 1516355 RML 87624 Abnormal HPV Result Genotypes 16, 18/45 6910101 87625
HPV Only, Reflex to HPV Genotypes 16,18,45 (ThinPrep Pap Collection) HPV Gentype Rflx 6910105 RML 87624 Abnormal HPV Result Genotypes 16, 18/45 6910101 87625
LSD (Lysergic Acid Diethyl) Screen; Reflex Confirmation; Urine LSD QL UR 4310925 ARUP 80307 Screen positive LSD Confirmation Urine 4310926 80323 (G0480)
Meningoencephalitis (Encephalitis) Panel (CSF) with Reflex Meningoen CSF 6906065 Quest 86735x2, 83727x2, 83352x2, 86651x2, 86653x2, 86654x2, 86789, 86788, 86695x2, 86696x2 HSV 1 IgM positve and/or HSV 2 IgM positive HSV 1 IgM Titer; HSV2 IgM Titer 6905769; 6905771 86695, 86696
Rapid Strep A Screen (Strep Throat) C RAP A SCR 6001700 RML 87880 Negative on Rapid Strep A Screen Group A Strep Culture 6000250 87081
Confirmation Testing
Order Name Long Order Name Short Test code Performing Lab CPT4 code Confirmation Trigger Confirmation Test Confirmation Test Code Confrimation CPT code
Actin (F_Actin) Smooth Muscle Antibody ACTIN AB 5700200 ARUP 83516 Postive Rflx Sm Muscl Titer 5577080 86526
Antibody Screen ABSC 7301170 RML 86850 If screen positive: each antibody detected Antibody ID; Direct Coombs (Polyspecific) 7302000; 7301350 86870, 86880
Anti-nuclear Antibody (ANA) ANA SCR 5500050 RML 86038 > 1:80 adults, > 1:20 child Titer ANA 5512450 86039
Blastomyces dermatitidis Ab Blasto Ab 5501505 ARUP 86612 Antibodies equivical or positive .Reflex Blasto AbID 5501506 86612
Cardiolipin IgG/IgM Antibodies CARDIO G/M 5564450 RML 86147x2 Either Cardio IgG or IgM positive GPI BETA 2 5565975 86146x2
CMV AB IgM (Immunoassay) CMV AB IGM 5503326 RML 86645 Positive CMV M IFA (IFA Assay) 5567800 86645
Cryptococcus Antigen CRYPTO AG 6002175 RML 87899 Screen positive Titer Crypt 6002300 86406
Cryptococcus Antigen Spinal Fluid CSF CRYPTO 6002150 RML 87899 Screen positve and no culture previoulsy performed Titer Crypt; Fungus Culture 6002300; 6000300 86406, 87102
Culture, Aerobic (Non-urine, blood or stool) C WOUN RTS 6000153 RML 87070 Positive Culture Org ID, Susceptibility (one or more of the following codes) n/a 87077, 87186, 87184, 87181 (may be multiple)
Culture, AFB C AFB 6000100 RML 87116, 87015 Positive Culture Org ID, Susceptibility (one or more of the following codes) n/a 87118, 87186
Culture, Blood C BLD 1ST 6000200 RML 87040 Positive Culture Org ID, Susceptibility (one or more of the following codes) n/a 87077, 87184, 87186, 87181 (may be multiple)
Culture, Fungus C FUNGUS 6000300 RML 87102 Positive Culture Org ID, Susceptibility (one or more of the following codes) n/a 87107, 87106, 87016, 877186
Culture, Stool with Campylobacter-E Coli Plates, Shiga1 and Shiga2 C STOOL RT 6001075 RML 87045 87046 87015 87899X2 Positive Culture Org ID, Susceptibility (one or more of the following codes) n/a 87077, 87147, 87186, 87184
Culture, Urine C URINE 6002002 RML 87086 Positive Culture Org ID, Susceptibility (one or more of the following codes) n/a 87088, 87077 , 87186, 87181, 87184
Culture, Virus C VIRUS 6000450 RML 87252 Positive Respiratory Screen; Cytopathic Effect (CPE) Virus ID (one or more of the following codes) n/a 87260, 87267,  87273, 87274, 87275, 87276, 87279x3, 87280
Dilute Russell Viper Venom (DRVVT) Profile DRVVT PROFF 1505975 RML 85613 Positive DRVVT Screen, Positive DRVVT mix DRVVT mix and DRVVT confirm Bill Only Orderables 85613 each
Direct Coombs, Polyspecific Dir Coombs 7301350 RML 86880 Positive Polyspecific Coombs Anti-C3D (complement), Anti-IgG 7301370, 7301360 86880x2
EBV VCA IgM (Immunoassay) EBV VCA AB IGM 5580927 RML 86665 Positive .EBVirus IgM IFA 4004269 86665
ENA Screen (Extractible Nuclear Antigen) ENA SCR 5570050 RML 86235 Positive screen Antibodies to RNP; Smith; Sjogrens(La,Ro52,Ro60); SCL 70; Jo-1 Ab "5572100, 5510450, 5599900, 5564053, 3805378" 86235x7
HIV AG/AB (4th Gen) HIV AG/AB 3609705 RML 87389 Reactive HIV-1/2 Antibody Differentiation 3609707 86701; 86702
HIV-1/2 Antibody Differentiation HIV 1/2DIF 3609707 RML 86701; 86702 Indeterminate or Negative HIV-1 RNA, Qualitative 3609719 87535
HTLV-I/II Antibodies HTLV-I/II Ab 3535875 ARUP 86790 Positive HTLV-I/II Western Blot Part of original order 86689
Lyme Antibody IgG and IgM Lyme Ab G/M 5570801 RML 86618 Positive or Equivocal Lyme EIA Lyme Western Blot 5586925 86617x2
Leucine-Rich, Glioma-Inactivated Protein 1 Antibody, IgG with Reflex to Titer LGI1 IGG 6905063 ARUP 86255 LGI1 antibody IgG is positive Reflex LGI1 antibody IgG titer 6995941 86256
Neuromyelitis Optica/AQP4-IgG CSF Reflex to Titer CSF NMO IgG 3488474 ARUP 86225 AQP4 antibody IgG is positive Rflx NMO/AQP4-IgG Titer, CSF 3488477 86256
Ovarian Antibody Screen with reflex to Titer OVARIAN AB 5005750 ARUP 86255 Ovarian Ab positive Ovarian Antibody Titer Part of original order 86256
Paraneoplastic Antibodies IgG, CSF Paraneo IgG CSF 6906719 ARUP 86255 PCCA/ANNA IgG AB by IFA. IFA screen is indeter. Neuronal Nuclear Abs IgG ImmunoBlot 6906733 86513
Phospholipase A2 Receptor (PLA2R) Antibody, IgG with Reflex to Titer PLA2R IgG 6904839 ARUP 86225 Positive Phospholipase A2 Receptor Ab PLA2R Titer 6904841 86256
Q Fever Antibody IgG, Phase I and II with Reflex to Titer Q FEVER 1/2 5558886 ARUP 86638x2 Q Fever Phase I positive Q Fever Phase II positive Q Fever Phase I Titer Q Fever Phase II Titer 5558883 5558884 86638 86638
Syphilis Antibody Screen SYP AB 5500607 RML 86780 Positive Syphilis Antibody Screen Non-Treponemal Antibody (RPR) 5500605 86592
Toxoplasma Antibodies IgG and IgM Toxo Ab G/M 5505626 RML 86778 Positive IgM .Toxo IgM IFA 5591800 86778
Urinalysis Routine, with microscopic examination if indicated UA ROUTINE 1003000 RML 81003 Glucose +, Protein +, Hgb +, Nitrate +, leukocyte + UA with Microscopic 1003050 81001 (81003 credited)
VDRL CSF (referred to ARUP) VDRL CSF 3703925 ARUP 86592 Positive VDRL Titer CSF Part of original order 86593