Billing Policies

Professional Courtesy

Professional courtesy testing is prohibited as stated in the Corporate Compliance Plan of Laboratory Alliance of Central New York, LLC.

Standing Orders

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

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:

Chemistry/Immunology

• 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”.
• Endomysial Antibodies (EDAB) – If Tissue transglutaminase IgA is positive, EDA by IFA will be added.
• Lyme Antibody – When the screening test for Lyme IgG/IgM is positive or equivocal, individual confirmatory tests for Lyme IgG and Lyme IgM will be performed.
• Lipid Panel – When the result of triglycerides is greater than 300 mg/dL, a direct LDL is performed.
• Hepatitis B Surface Antigen – If HBsAg is positive, confirmatory testing by neutralization may be added.
• Hepatitis C Virus Antibody – When antibody screen is positive or equivocal, viral load 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.
• 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”.
• Syphilis Screen - If result of syphilis screen is positive or equivocal, additional testing will be performed.
• Thyroid Testing – Reflex testing from abnormal TSH values is available when ordered as Thyroid Cascade or TSH with Reflex to Free T4.  Additional tests added depend on initial order and results of component reflexed testing. 

Hematology

• Platelet Count – If an automated platelet count cannot be obtained, a manual platelet count will be performed. An Immature Platelet Fraction may be performed if indicated.
• 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 cell count cannot be resulted.
• 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

Microbiology

• Organism/Susceptibility Testing – If an organism is isolated, there may be additional identification and susceptibility testing done. 
• Wound cultures from sources where anaerobes are a potential pathogen will have an anaerobe culture added on if not already requested.

Transfusion Services

• Antibody Identification – is automatically performed if the antibody screen is positive unless the clinician indicated that further testing is not desired

Urinalysis

• Urine Microscopic – A urine microscopic analysis is performed when an abnormality on the screening examination is detected.
• Urinalysis (Reflex) – A urine culture will be performed if either the Leukocyte Esterase or Nitrite is positive.