This broadcast details pathology policies and practices regarding additional/reflex testing that may be performed on certain pathology tests.  A link to this policy will be accessible in Epic in a hyperlink associated with every laboratory test starting on Tuesday, December 4, 2012.  This policy has been reviewed and approved by the Diagnostic Services Subcommittee.

All laboratory testing requires a written or electronic order signed by a Licensed Independent Practitioner (LIP).  Some laboratory tests or procedures may yield results which require additional testing for optimal clinical care.  The Department of Pathology has well-defined policies and practices for initiating additional/reflex testing but recognizes that clinical situations may arise in which such testing might not be desired.  The purpose of this announcement is to provide a basic description of current policies and practices and to remind all LIPs that they may contact the Pathology Department at any time in regard to additional/reflex testing for any patient(s).  The standard policies and practices are listed below.

Section Specific Policies and Practices Concerning Additional/Reflex testing in the Department of Pathology: 

Anatomic Pathology

• Performs additional testing per established procedures as deemed medically necessary unless prohibited by the ordering provider.  Examples include special stains, immunohistochemical (IHC) stains, fluorescence in situ hybridization (FISH), and molecular studies. 
• Performs reflex Human Papilloma Virus (HPV) testing as requested if the patient is at least 21 years old and has an ASC-US pap result or a postmenopausal status and a LSIL pap result.

Core Laboratories

• Performs confirmatory testing per established procedures as deemed medically necessary.  Examples: Positive initial tests for HIV (antigen/antibody combo assay) and Lyme disease (ELISA).  HIV positive screens are automatically reflexed to Western blot analysis by reference laboratory.  Lyme disease reactive or equivocal tests are reflexed to reference laboratory for Western blot analysis.

DeGowin Blood Center

• Performs additional testing per established procedures as deemed medically necessary.
• Performs reflex testing when the initial test results are positive and indicated related tests are appropriate and when the ordering provider has not prohibited it.
• Performs antibody identification and related testing necessary to provide compatible blood products, to investigate reports of adverse transfusion reactions, and to complete pre-natal testing. 

Microbiology and Molecular Pathology

• Performs additional testing per established procedures as deemed medically necessary unless prohibited by the ordering provider.  Examples:  susceptibility testing on clinically relevant pathogens when isolated from a specimen;  probe testing for M. tuberculosis and M. avium complexes when growth in mycobacterial cultures is detected.
• Performs confirmatory testing per established procedures as deemed medically necessary.  Example: Incomplete identification of organisms by biochemical testing may be supplemented with ribosomal DNA sequencing. 
• HPV16 and HPV18 test results are reflexively reported for women ages 30-65 years old with a normal cytology or Pap test who have a positive high risk HPV PCR result. 

Point of Service:  Critical Care Laboratory/Special Care Nursery/Iowa River Landing Laboratory

• Does not perform additional testing without a signed physician order.

Point of Service:  Mailout Services

• Transmits orders to accredited referral laboratories for testing on UIHC patients on behalf of UI Healthcare.  Referral laboratories will have individual reflex testing activities based on their established procedures and medical necessity.
• Performs additional testing per established procedures as deemed medically necessary unless prohibited by the ordering provider.

Questions may be directed to Dr. Matthew Krasowski, Director of Laboratories (384-9380, e-mail: matthew-krasowski@uiowa.edu).