Professional courtesy testing is prohibited as stated in the Corporate Compliance Plan of Laboratory Alliance of Central New York, LLC.
Laboratory standing orders are permitted as long as Laboratory Alliance receives a written order that includes duration, frequency, diagnosis and a physician signature. Written requests for standing orders need to be renewed by the physician every 6 months.
Reflex testing is testing that is performed as a result of initial test results which are used to further identify significant diagnostic information required for appropriate patient care. The following is a list of the tests for which Laboratory Alliance may perform reflexive testing:
- ANA with Reflex - When the result of an ANA screen is positive, an ANA Evaluation Panel will be performed. The panel is composed of the following analytes: Anti-dsDNA, Anti-SSA, Anti-SSB, Anti-Smith, Anti-SmRNP, Anti-RNP, Anti-Chromatin, Anti-Scleroderma, Anti-Centromere B, Anti-Ribosomal P and Anti-Jo-1 (IgG antibodies). Note: If reflex testing is not desired, order “ANA Screen Only”.
- Syphilis Screen - If the result of a syphilis screen is positive, additional testing will be performed.
- Protein Electrophoresis - If an abnormality is identified on a protein electrophoresis, an Immunofixation and Quantitative Immunoglobulin are performed. Note: If reflex testing is not desired, order “Protein Electrophoresis – No Reflex”.
- Lyme Antibody – When the test for Lyme IgG/IgM is positive or borderline, a confirmatory test will be performed.
- Toxoplasma IgG/IgM – When the test for Toxoplasma IgG/IgM is positive, Toxoplasma IgM will be performed.
- Lipid Panel – When the result of triglycerides is greater than 300 mg/dL, a direct LDL is performed.
- Hep C Virus Ab – When antibody screen is positive and the signal/cutoff ratio is less than 8.0, additional testing will be performed.
- PSA with Reflex to Free PSA – When the result of the Total PSA is greater than 3.9 ng/mL and less than 10.1 ng/mL, a free PSA is performed.
- Thyroid Cascade – If the TSH is abnormal, a Free Thyroxine is performed. If Free Thyroxine is normal, then a Free T3 is performed.
- Cardiac Enzymes - If CK is greater than 55 U/L, CKMB will be performed.
- Platelet Count – If an automated platelet count cannot be obtained, a manual platelet count will be performed.
- Peripheral Smears – Peripheral smears and body fluids will be reviewed by a pathologist when indicated.
- White Blood Count – A manual white blood cell count may be ordered and performed if the automated white blood count cannot be resulted.
- Hematocrit – A hematocrit may be ordered on a patient with the reticulocyte count test if the patient has not had a hematocrit or complete blood count performed within the previous eight hours. The hematocrit result is necessary to obtain a portion of the test result.
- Bone Marrow – A CBC/Diff and reticulocyte may also be performed.
- Lupus Anticoagulant – The following tests may also be performed when this test is ordered
- Dilute Russell Viper Venom – confirm and ratio
- APTT Mixing Study
- Dilute Russell Viper Venom Screen Mixing Study
- Dilute Russell Viper Venom Confirm Mixing Study
- Organism/Susceptibility Testing – If an organism is isolated, there may be additional identification and susceptibility testing done.
- Group A Strep Screen – When the results of a Group A Strep Screen are negative, a culture is done to confirm the negative.
- Viral Cultures – Additional charges for identification or screening for respiratory viruses may be added.
- Enteric Pathogen Culture with Gram Stain – Stool for fecal lactoferrin will be ordered.
- Antibody Identification – is automatically performed if the antibody screen is positive unless the clinician indicated that further testing is not desired.
- Urine Microscopic – A urine microscopic analysis is performed when an abnormality on the screening examination is detected.