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 |
| Non-Treponemal Antibody | RPR | 5500605 | RML | 86592 | Negative | Treponema pallidum Ab, Particle Agglutination (TP-PA) | 5501065 | 86780 |
| 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 |
Regional Medical Laboratory