Billing

Confirmation and Reflex Testing

Reflex Testing and Confirmation 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. 

Ordered Test CPT4 code Reflex test Reflex code Reflex Trigger
Alpha-Fetoprotein (AFP) Amniotic Fluid 82106 Acetylcholinesterase 82664 Abnormal AFP MoM Amniotic Fluid
    Fetal Hemoglobin 83033 Abnormal AFP MoM Amniotic Fluid
Cardiolipin G/M 86147x2 GPI Beta 2 86146x2 Either Cardio IgG or IgM positive
CPK with Troponin 82550, 84484 CK MB 82553 CPK elevated
Cryoglobulins 82595 Protein Electrophoresis - Serum (Analyzer) 84155; 84165; 83883x2, (80500 or 8416526) Initial testing only. Positive Cryoglobulins
Fragile X PCR Screen 81243 Fragile X Southern Blot 81244 Patient Specific Genetic Banding
Hemoglobin Electrophoresis 83020 Hemoglobinopathy by HPLC 83021, 85014, 85018, 85041 % of A2 is 2.8% to 3.5%
    Sickle Cell Screen 85660 Hemoglobin A/S Present (Sickle Trait)
Human Papillomavirus High Risk 87624 HPV 16/18 Genotype 87625 To differentiate HPV 16/18 from positive high risk screen
Rapid Strep A Screen (Strep Throat) 87880 Group A Strep Culture 87081 Negative on Rapid Strep A Screen
Confirmation Testing

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 our tests and their billable CPT4 codes. Additional testing for cultures varies with the organisms identified.

Ordered Test CPT4 code Reflex test Reflex code Reflex Trigger
Antibody Screen 86850 Antibody ID 86870 If screen positive: each antibody detected
    Direct Coombs (Polyspecific) 86880
(possibly up to 3)
If screen positive.
Anti-nuclear Antibody (ANA) 86038 Titer 86039 > 1:80 adults,
> 1:20 child
Cryptococcus Antibody -
Serum or CSF
86641 Titer 86406 Screen positive
Cryptococcus Antigen 86403 Titer 86406 Screen positive
Culture, Aerobic
(Non-urine, blood or stool)
87070 Org ID, Susceptibility
(one or more of the following codes)
87077, 87186, 87184,
87181
(may be multiple)
Positive Culture
Culture, AFB 87116, 87015 Org ID, Susceptibility
(one or more of the following codes)
87118, 87186 Positive Culture
Culture, Blood 87040 Org ID, Susceptibility
(one or more of the following codes)
87077, 87184, 87186,
87181
(may be multiple)
Positive Culture
Culture, Fungus 87102 Org ID, Susceptibility
(one or more of the following codes)
87107, 87106, 87016, 877186 Positive Culture
Culture, Stool with
Campylobacter-E Coli Plates,
Shiga1 and Shiga2
87045, 87046, 87015, 87899x2 Org ID, Susceptibility
(one or more of the following codes)
87077, 87147, 87186, 87184 Positive Culture
Culture, Urine 87086 Org ID, Susceptibility
(one or more of the following codes)
87088, 87077 , 87186, 87181, 87184 Positive Culture
Culture, Virus 87252 Virus ID
(one or more of the following codes)
87260, 87267,  87273, 87274, 87275, 87276, 87279x3, 87280 Positive Respiratory Screen; Cytopathic Effect (CPE)
Dilute Russell Viper Venom (DRVVT) Profile 85613 DRVVT mix and DRVVT confirm 85613 each Positive DRVVT Screen, Positive DRVVT mix
Direct Coombs, Polyspecific 86880 Anti-C3D (complement), Anti-IgG 86880x2 Positive Polyspecific Coombs
ENA Screen (Extractable Nuclear Antigens) 86235 Antibodies to RNP; Smith; Sjogrens A & B; SCL 70; Jo-1 Ab 86235x6 Positive screen
HIV 1/O/2 Antibodies 86703 Western Blot 86689 Positive HIV 1/O/2
HTLV-I/II Antibodies 86790 Western Blot 86689 Positive HTLV-I/II
Lyme EIA 86618 Lyme Western Blot 86617x2 Positive Lyme EIA
Streptozyme Antibody Screen 86403 Streptozyme Antibody Titer 86406 Positive screen
Syphilis Antibody Screen 86780 Non-Treponemal Antibody (RPR) 86592 Positive Syphilis Antibody Screen
Urinalysis Routine
with microscopic examination if indicated
81003 Microscopic 81001
(81003 credited)
Glucose +, Protein +, Hgb +, Nitrate +, leukocyte +
Urinalysis Routine 81003 Reducing Substance 81002 Age < 1 year