REQUESTING LAB SUPPLIES

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Exciting news for our valued clients! 

We’ve rolled out a convenient new way to request lab supplies from us.

Order supplies online

As an alternative to requesting supplies over the phone, clients can now request supplies using our new supplies ordering web form.  Simply select which supplies you need on our web form, input your facility/delivery information, and submit your supplies order to us in just a few clicks. 

Join us in embracing simplicity and convenience and start using our new online ordering tool today!

Going forward, clients may choose to request lab supplies either through the online form or by calling 847-509-9779, option 3.

Reminders for all supplies orders:
  • The supplies provided by NICL Laboratories are solely to be used for the collection and preparation of specimens which are being sent to our laboratory for testing.  Type and quantity of items must correlate to the number of specimens submitted to us for testing.
  • Please allow up to 3 business days for delivery of lab supplies.
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Post PHE COVID PCR Testing

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With the Public Health Emergency (PHE) ending on May 11, 2023, there are some important changes coming that impact all COVID testing requests.  Post PHE, any COVID PCR tests requested that do not meet the requirements below and/or that are not covered by a patient’s health plan will be billed to your facility.

REQUIREMENTS FOR REQUESTING

To request any COVID testing, facilities should use NICL’s NEWLY UPDATED COVID Requisition Form.  All requests for COVID testing submitted to NICL must include the following along with the completed Requisition Form:

  • An ordering MD
  • A corresponding order for the testing in the patient medical record
  • All ICD-10 codes reflective of patient condition and symptoms present
  • Any other required documentation as may be required by the payor

PAYMENT FOR COVID TESTING

While specific guidance from CMS regarding medical necessity for testing and the CDC on appropriate circumstances to test are evolving and forthcoming, we anticipate that submitting COVID PCR testing for the following reasons will NOT BE COVERED by Medicare and other health plans:

  • Pre-operative or pre-procedure testing
  • New admissions
  • Asymptomatic exposures
  • Surveillance testing

NICL Laboratories reserves the right to reject any samples or charge the facility for any testing performed where the above requirements are not satisfied or where testing is not covered by a patient’s health plan.

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Panel Notification

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This notice contains important information regarding test panels and profiles that you may order from or through NICL.   Please be reminded that you should only order those tests which are medically necessary for the diagnosis and treatment of your patients and that ordering medically unnecessary tests that are billed to Medicare or Medicaid for reimbursement may subject you to civil penalties.  You have the option to order all tests individually.

The table below includes the panel order codes, the individual components, CPT codes[1] and names, and the 2022 Medicare reimbursement rates for currently offered Organ and Disease Panels.

Order Code
CPT Name
CPT[1]		Components Included2022 Medicare Reimbursement
20004Electrolyte Panel80051Sodium Potassium Chloride, Carbon Dioxide$7.01
20167Hepatic Function Panel80076Total Protein, Albumin, Total Bilirubin, Direct Bilirubin, Akaline Phosphatase, AST, ALT$8.17
20163Basic Metabolic Panel80048Glucose, Urea Nitrogen, Creatinine, Sodium, Potassium, Chloride, Carbon Dioxide, Calcium$8.46
20165Renal Function Panel80069Albumin, Calcium, Carbon Dioxide, Chloride, Creatinine, Glucose, Phosphorus, Potassium, Sodium, Urea Nitrogen$8.68
20164Comprehensive Metabolic Panel80053Glucose, Urea Nitrogen, Creatinine, Solium, Potassium, Chloride, Carbon Dioxide, Calcium, Total Protein, Albumin, Total Bilirubin, Alkaline, Phosphatase, AST, ALT$10.56
20062Lipid Panel20062Triglycerides, Total Cholesterol, HDL Cholesterol$13.39
129380Zonisamide (Zonegran®)80203  1
86001  2		Zonisamide
Phoma SPP IGG		$13.25
$7.82
47000Protein Elect. & Total84155  1
84165  1		Protein
Protein Elecrtroph Serum		$3.67
$10.74
71750Immunofixation Eval Serum84155  1
84165  1		Protein
Protein Elecrtroph Serum		$3.67
$10.74
7510Primidone (Mysoline®)80184  1
80188  1		Phenobarbital
Primidone		$15.30
$16.59
2310Alkaline Phosphatase ISO84075  1
84080  1		Alk Phosphatase
Alk Phosphatase, ISO		$5.18
$14.78

[1] The CPT codes and related information provided in the table are based on AMA guidelines and are for informational purposes only.  CPT coding is the sole responsibility of the billing party.  Please direct any questions regarding code to the payer being billed.

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Proper Swab Type for Testing Respiratory Viral Pathogens

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There are two different types of nasal swabs that may be used for respiratory viral pathogen testing by NICL.  Which is the correct swab type to use depends on the specific test being ordered.

  • The only time when an ANTERIOR NASAL SWAB may be used is for SARS CoV-2 testing.  This type of swab cannot be used for Influenza, RSV, or other Respiratory Viral Pathogen testing.
  • A NASOPHARYNGEAL SWAB must be used for all other respiratory viral pathogens, including influenza, RSV, and others.
Please use the above guide for easy reference.   For collection instructions for each type of swab, please see related NICL Lab Notes:  Respiratory Viral Pathogens Collection.
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Vancomycin Resistant Enterococci

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Enterococci

  • Enterococci are part of normal gastrointestinal and genital tract flora.
  • Enterococci are gram positive cocci included in the Streptococci group D species; they are widely distributed in nature, animals and humans.
  • Among the 17 species currently recognized, E. faecalis and E. faecium are the most prominent in humans.
  • Infections that can be caused by enterococci include: UTI, bacteremia, wound, abdominal-pelvic infections and endocarditis.
  • Vancomycin is an important antibiotic used alone or in combination with other antibiotics for the treatment of serious infections caused by enterococci.

Resistance to Vancomycin

  • Vancomycin resistant enterococci (VRE) are multidrug resistant strains which present a serious difficulty in treating patients.
  • The resistance to vancomycin is induced by a genetic mechanism; the “VAN A gene” confers high-level resistance to vancomycin; it is plasmid mediated and can be transferred to other microorganisms such as Staphylococcus aureus. This may increase a possible emergence of VRSA (vancomycin resistant Staphylococcus aureus).
  • The patients can be “colonized” (carrying VRE without symptoms of infection), or “infected” (the presence of the VRE accompanied by clinical symptoms). They are both sources for nosocomial infection.
  • The most frequent sites for colonization are: stool, perineal, anus, axilla, umbilicus, wounds, foley catheter, and colostomy sites.

Epidemiology

  • Most infections and colonizations with VRE are attributed to the patient’s endogenous flora.
  • VRE can be spread by direct patient to patient contact or indirectly via hands of personnel, contaminated environmental surface or patient care equipment.

Prevention

  • Since vancomycin use has been reported consistently as a risk factor for colonization and infection with VRE, a restriction in the use of vancomycin should be imposed (see Hospital Infection Control Practices Advisory Committee recommendations).
  • It is strongly recommended for each facility to develop its own policies regarding the prevention and control of nosocomial transmission of VRE (isolation, culture survey, education program) according to the Hospital Infection Control Practices Advisory Committee (a copy is available from NICL).
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Outbreak Protocols

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Outbreaks can happen in any facility, at any time.  We all know that, but when it’s your facility, it can be very stressful.  These are guidelines to help you when you have been told that there is an outbreak in your facility.

(1) Don’t panic!

(2) Give NICL Laboratories a call at (847) 509-9779.  Speak to the Microbiology Supervisor, the Laboratory Technical Operations Manager, or your Customer Service Representative, or send them an email.  NICL Laboratories is experienced with handling outbreaks and can help you and the Public Health Departments to gather the required information.

(3) Have the following information ready:

  • If IDPH (Illinois Department of Public Health) or your local health department has contacted the facility about an outbreak scenario, please provide the Contact Individual’s name to NICL so that we can secure the instructions for the particular outbreak.
  • Patient names and dates of birth
  • Case number assigned

(4) The Health Department may ask you to screen the other patients on the floor where there is an outbreak and/or to screen the employees that take care of the patients on that floor or unit.

(5) As soon as you let us know, we can create our Plan of Action, which may include:

  • Delivering more collection kits
  • Ordering more test kits/materials
  • Change of testing frequency
  • Add testing personnel
  • Coordinate specimens that need to be sent to IDPH, CCPH (Cook County Public Health), other health departments, or even the CDC (Centers for Disease Control)
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HIV Antigen & Antibody COMBO Screen

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The HIV Ag/Ab Combo, 4th generation assay is an in vitro diagnostic immunoassay for the simultaneous qualitative detection of human immunodeficiency virus p24 antigen and antibodies to human immunodeficiency viruses type 1 (including group “O”) and type 2, in serum.  This assay is intended to be used as an aid in the diagnosis of HIV infection in pediatric and adult populations, including pregnant women.  This new assay replaces the current HIV 1/O/2 antibody assay. The current HIV Antibody screen reported by NICL Laboratories reports all of the above except the p24 antigen.   Adding p24 antigen to the screen allows for earlier detection of infection.

Human immunodeficiency virus type 1 has been identified as the primary cause of acquired immunodeficiency syndrome.  This retrovirus, a member of the lentivirinae subfamily, is spread by sexual contact, exposure to infected blood or blood products, and perinatal transmission.  In 1986, human immunodeficiency virus type 2 was isolated from AIDS patients in West Africa.  These viruses share epitopes of the core proteins, but exhibit little or no cross-reactivity between the envelope glycoproteins.

Comparison of the nucleic acid sequences for HIV-1 and HIV-2 shows approximately 60% homology in the conserved genes, such as gag and pol (encoding core proteins), and 30 to 40% homology in less conserved regions (encoding envelope proteins).  HIV-1 has been subdivided into group M (subtypes A-H) and group O.

The route of transmission of HIV-1 and HIV-2 are the same; however, the transmission and the viral replication rate are much lower in HIV-2 infections.  Clinical studies have shown that in HIV-2 infections there is a slower disease progression than in HIV-1 infections.  In HIV-2 infections there is a slower rate in the decline of CD4 T cells and reduced viremia.  Individuals infected with HIV-2 generally have a better clinical outcome.

A reactive result using the Siemens Atellica CHIV assay does not distinguish HIV-1 p24 antigen, HIV-1 antibody, HIV-2 antibody, and HIV-1 group O antibody.  Specimens that are initially reactive should be retested in duplicate.  Repeat reactivity is highly predictive of the presence of antibody to HIV-1 and HIV-2 in specimens from people at risk for HIV infection.  Specimen that show a repeat positive will be followed-up with appropriate supplemental tests for HIV-1 and HIV-2 antibody and/or p24 antigen testing.   NICL Laboratories will reflex a confirmatory test which will also differentiate between HIV-1 and HIV-2.

Reference: Siemens Atellica CHIV instructions for use

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Blood Culture Collection Guidelines

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This procedure will guide you through indications, timing, number of sets, volume of draw per set, and PICC line collection.

INDICATION

Routine blood cultures should be performed on patients with suspected bacteremia or candidemia. 

TIMING

Blood cultures should be drawn prior to the administration of antibiotics whenever possible, or as soon as possible after administration begins.  There is no data to support that timing in relationship to febrile state or chills will improve yield or detection.

VOLUME

Literature suggests that the volume of specimen collected is directly proportional to the positivity rate.  It also shows that low volume collections contain a higher number of contaminants.   Two to three (2-3) sets of cultures should be used to rule out bacteremia or candidemia.

COLLECTION

PICC line collection (should be performed only when absolutely necessary):

  • 1. Make sure you are wearing proper personal protection equipment (PPE), including gown and gloves.
  • 2. Gather the required equipment:
    • Blood culture bottles
    • 4 alcohol preps
    • 1 3-5 cc  syringe
    • 10 cc syringes with a sterile needle
  • 3. It is essential to AVOID DRAWING FROM LINES WITHIN AN HOUR OF COMPLETION OF ANTIMICROBIAL AGENT ADMINISTRATION, as the antimicrobial agent may be passed into the blood culture bottles and prohibit growth.
  • 4. Using two separate alcohol preps wipes (70% alcohol), scrub catheter hub connection for 15 seconds with each wipe.  Let it air dry.
  • 5. Using the last two alcohol preps carefully wipe the tops of the blood culture bottles for 15 seconds each.
  • 6. Disconnect the tubing from the cap of the catheter and attach the small syringe to collect discard blood.  The suggested amounts for adults are 3 ml and 0.2 ml for pediatric patients.  This blood is used to wash the line, and it is not used for culture.  The entire syringe and contents can be discarded into a biohazard container.
  • 7. Using a new syringe, collect blood for culture through the hub. 2-4 ml is required for each of two blood culture vials.  When enough blood has been obtained for the two vials, detach the syringe from the catheter and reconnect the tubing to the cap of the catheter. 
  • 8. Place a sterile needle on the syringe, and transfer the blood, using sterile technique into the blood culture vials.   Sterile technique requires that you DO NOT touch the top of the alcohol cleaned vials with anything but the tip of a sterile needle, and that you do not touch the syringe head with anything but the sterile needle.
  • 9. Gently mix the blood culture vials thoroughly to prevent clotting. 
  • 10. Label each specimen with the patient’s name, date of birth, date and time of collection, and collection site, and place them with a completed requisition at room temperature for pickup by laboratory personnel.

J Clin Microbiol. 2009 Nov;47(11):3482-5. doi: 10.1128/JCM.02107-08. Epub 2009 Sep 30. Effects of volume and site of blood draw on blood culture results. Gonsalves WI, Cornish N, Moore M, Chen A, Varman M.

Clin Microbiol. 2007 September; 45(9): 2765–2769.  Published online 2007 June 13. doi:  10.1128/JCM.00140-07 PMCID: PMC2045273. Is the Volume of Blood Cultured Still a Significant Factor in the Diagnosis of Bloodstream Infections? Emilio Bouza,1,*Dolores Sousa,2Marta Rodríguez-Créixems,1Juan García Lechuz,1 and Patricia Muñoz1

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