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 |
Regional Medical Laboratory