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.
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.
Glucose, Urea Nitrogen, Creatinine, Solium, Potassium, Chloride, Carbon Dioxide, Calcium, Total Protein, Albumin, Total Bilirubin, Alkaline, Phosphatase, AST, ALT
$10.56
20062
Lipid Panel
20062
Triglycerides, Total Cholesterol, HDL Cholesterol
$13.39
129380
Zonisamide (Zonegran®)
80203 1 86001 2
Zonisamide Phoma SPP IGG
$13.25 $7.82
47000
Protein Elect. & Total
84155 1 84165 1
Protein Protein Elecrtroph Serum
$3.67 $10.74
71750
Immunofixation Eval Serum
84155 1 84165 1
Protein Protein Elecrtroph Serum
$3.67 $10.74
7510
Primidone (Mysoline®)
80184 1 80188 1
Phenobarbital Primidone
$15.30 $16.59
2310
Alkaline Phosphatase ISO
84075 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.
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.
https://nicl.com/wp-content/uploads/2022/11/Swab-Types-Quick-Reference-Chart.jpg612980NICL/wp-content/uploads/2022/04/nicl-logo-300x86.pngNICL2022-11-21 10:42:222022-11-21 10:42:26Proper Swab Type for Testing Respiratory Viral Pathogens
NICL Laboratories is introducing new technology to Microbiology in May 2022. The new technology is MALDI-TOF or matrix assisted laser desorption/ionization-time of flight, and it will be performed on the Bruker Sirius ONE MALDI Biotyper® CA System.
This technology uses high mass spectrometric resolution to rapidly and accurately identify microorganisms in a matter of minutes after isolation of the organism.
RAPID IDENTIFICATION
Turnaround time for this method is equivalent to a gram stain, but unlike a gram stain it provides definitive identification (ID) of the microorganism with over 98% certainty. The accuracy of this methodology is comparable to nucleic acid sequencing, but it is more cost effective and easily accessible, as it doesn’t require nucleic acid specific testing materials or kits and a longer time to results. If the organism requires specific resistance classification the report will indicate so, and a preliminary identification will be reported, with the organism and resistance reported later.
Included in this method’s compendium are organisms such as Candida auris, a deadly yeast, which is primarily only identifiable via this method. Historically, Candida auris has been transferred to a reference laboratory for identification, adding up to 48 hours to turnaround time.
Blood Cultures and Sepsis
The MBT Sensityper® test will also be available, and when used with the Bruker MALDI Biotyper® allows for identification of the organism directly from a positive blood culture bottle. When the bottle is flagged as positive, this method will allow us to provide a sample for identification on the MALDI in 15 to 20 minutes. This will effectively reduce the turnaround time for organism ID from a blood culture by up to 48 hours.
NICL Laboratories also has a PCR method available for a small menu of organisms, to provide antimicrobial susceptibility test results within a few hours of organism isolation and identification, and it can now be performed in a more selective manner, based upon the organism identified.
Antimicrobial Stewardship
Rapid organism identification from a culture bottle or a culture plate will provide for focused antimicrobial treatment and intervention. Coupled with NICL Laboratories annual MASTR™ report, the Bruker MALDI Biotyper® will assist the Infection Surveillance personnel in appropriate antimicrobial utilization. It will also provide for early determination of contamination, reducing the use of needless treatments.
Use of Broad Spectrum Antimicrobials and intravenous (IV) antimicrobials is very expensive. The use of PIC line and Midline catheters adds to the cost. The cost of use of Daptomycin over the period of a month can cost $9-10,000 and other drugs can cost as much as $33,000 for a one-month Medicare A stay. There is also risk attached to the use of these IV methods as they relate to nosocomial infections.
Use of this technology has an added benefit in that the microtiter wells on the plates used for organism ID can now be used to add a larger menu of antimicrobials for each organism identified, and for some antimicrobials, to provide a greater range of microtiters. BRUKER MALDI Biotyper® will help us to provide you with improved antimicrobial stewardship and patient outcomes.
Sepsis impact on Reimbursement
Hospital Acquired Conditions (HAC) such as sepsis, may impact a facility’s reimbursement. Every year the worst performing 25% are penalized by losing up to 1% of their Medicare payments. Targeted treatment may assist in reducing sepsis, and early successful treatment of other nosocomial infections, which will not only improve patient care and outcome, but it can also significantly impact the financial bottom line.
https://nicl.com/wp-content/uploads/2022/05/Bruker-mbt-sirius-with-user-bruker-md-web-thumbnail.jpeg511512NICL/wp-content/uploads/2022/04/nicl-logo-300x86.pngNICL2022-05-24 11:24:002022-09-23 14:40:18Antimicrobial Stewardship and the War on Sepsis
In consideration of the increased acuity of patients now seen in our facilities and in our ongoing efforts to ensure prompt response and quality patient care, NICL Laboratories is providing the following information regarding STAT testing.
By definition, STAT laboratory tests and services are those that are needed immediately in order to manage medical emergencies. STAT test requests are given the highest priority for processing, analysis and reporting. In order to effectively apply resources to meet the needs of genuine medical emergencies, only the test listed below will be offered for STAT priority. All requests for STAT eligible tests must be substantiated by appropriate medical necessity. All results for STAT eligible tests will be called and faxed to the ordering facility. In accordance with Joint Commission requirements the laboratory requires the full name of the individual who receives the STAT test results.
Only the following tests can be ordered STAT:
Chemistry
Hematology
Basic Metabolic Panel Comprehensive Metabolic Panel Renal Function Panel BUN Creatinine Electrolytes Glucose Potassium Magnesium Amylase BNP (B-type natriuretic peptide) Troponin I
CBC w/o differential CBC w/differential Hemoglobin and Hematocrit Platelets PT/INR PTT D-dimer
Therapeutic
Other
Digoxin Dilantin Phenobarbital Valproic Acid
Blood Culture (draw only)
Tests not listed as STAT eligible may be scheduled for routine early AM collection. Please contact the laboratory to schedule these collections and have a requisition prepared and/or specimen collected for the phlebotomist’s arrival.
Be advised that facilities requiring same day collection will incur a handling charge. You will be notified of any future modifications to our procedure for STAT services. If you have any questions, please do not hesitate to contact your Customer Service Representative or contact the Laboratory.
6/1/2016 NICL Laboratories, Ltd All Rights Reserved
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.
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
Specimen collection and labeling are essential steps to assuring reliable results. The Joint Commission for Accreditation of Hospitals, CLIA, and other inspecting agencies require all specimen to have two patient identifiers. The following guidelines apply to all specimen, routine laboratory, microbiology, cytology, and anatomic pathology.
DO NOT label the specimen tubes prior to collection. 24-hour urine containers, however, should be labeled prior to giving the container to the patient for collection.
Write the patient’s full first and last name on the specimen.
Write the patient’s date of birth on the specimen.
Write the date and time of collection and your initials on either the specimen or the accompanying requisition.
Unlabeled or mislabeled specimen will not be accepted if labeling is not accurate and complete, as in the following scenarios:
First or last name or both on the specimen do not match those on the requisition.
The specimen is unlabeled, even though it arrives at the laboratory in a plastic specimen bag with the requisition.
The patient’s complete name is not on the specimen. Initials are not acceptable.
Irretrievable specimens may be an exception. These include spinal fluids and biopsy materials. In these cases, the physician or staff involved must sign the lab mislabeled/unlabeled documentation form before results can be reported.
