Laboratory Testing Policies
- › Medico-Legal Testing
- › No Charge for Testing
- › Reflexive Testing
- › Reporting
- › Sample Returns
- › STAT Testing
- › Supplies
- › Turnaround Times
- › Unacceptable Specimens
Billing and Insurance Information
- › Client Billing
Reference Laboratory Services
- › Esoteric Test Resource
- › Resident On-call
We ask that those submitting specimens to our laboratories become acquainted with the following policies:
Medical Necessity Information
It is our policy to provide health care providers with the ability to order only those lab tests medically necessary for the individual patient and to ensure that the convenience of ordering standard panels and custom profiles does not impact this ability. While we recognize the value of this convenience, indiscriminate use of panels and profiles can lead to ordering tests that are not medically necessary. Therefore, all tests offered in our panels and profiles can be ordered individually as well. If a component test is not listed individually on the request form, it may be written in the “OTHER REQUESTS” box. We encourage you to order individual tests or a less inclusive profile when not all of the tests included in the panel or profile are medically necessary for the individual patient.
Forensic Testing is not available through the Department of Laboratory Medicine. We refer most of these requests to each state's
Medical Examiner's office. Please consult the Laboratory Medicine resident on-call if a specimen analysis may have unusual legal implications. The Laboratory Medicine resident can be reached through the University general paging,
No Charge for Testing - Criteria
The Department of Laboratory Medicine Reference Laboratory Services Division bills appropriately for all tests performed. Any test that is not performed for any reason will be promptly and appropriately credited. Occasionally, referring providers may request that a test be performed and resulted at no charge due to errors in laboratory handling, transport or ordering. These requests will be reviewed, and may be honored, if the circumstances fit into an appropriate category. The categories are outlined below.
UW Medicine mishandles sample, results reportedSince the error is on our part, we will remove charges, include a comment about the test being run at no charge to client, why the specimen was not viable, and who was notified at the ordering location.
UW Medicine mishandles sample, test is cancelled, redraw scheduled at client's discretion.Since the error is on our part, we will remove charges. Redraw may be scheduled at the client's discretion, and replacement assay will be run at full price.
Test is cancelled per client, test is resulted before request to creditClient has ordered the test, we have run it per their request, and it is too late to cancel once any results are entered in our laboratory reporting system. The bill should be sent to the ordering location rather than the patient or their insurance.
Test is cancelled per client, test has not been resultedAs long as results have not been entered in our laboratory reporting system, we will credit the test as the client has requested.
Referral to Another Lab
Tests not performed in the Department of Laboratory Medicine can be referred to another qualified, licensed reference laboratory. We will inform the ordering location of the specimen and storage requirements. A report will be sent by the Department of Laboratory Medicine to the ordering physician.
Some of our tests can be ordered as reflex panels in which additional testing is done automatically in response to particular results from the initial testing. The tests for which users can choose reflex panels are indicated in the Online Testing Guide. When additional testing is done because the user has chosen a reflexive panel, the fees for the additional testing can be found in the Department of Laboratory Medicine's fee schedule.
Whenever there is a question about the validity of a test result, a repeat will be performed upon request at no extra cost.
As a test result becomes available, it is entered into the laboratory computer system and becomes immediately accessible for paper reports and transmission to other systems for inquiry. Reports may be printed in the laboratory or on printers located in patient care areas. Clinicians at the University Medical Center, Harborview Medical Centers, and Seattle Cancer Care Alliance can view laboratory data electronically in the following systems:
- ORCA: Inpatient and Outpatient data since July 2002
- CIS: Inpatient data only
- MINDscape: Inpatient and Outpatient data, general lab data since June 1994, and Microbiology data since May 1998
- EPICcare: UWPN Clinics and Hall Health data
Results for patients from outside UW Medicine are not available in the ORCA, CIS, MINDscape, or EPICcare systems.
Requesting laboratory values via telephone to the laboratory reduces the amount of time available for technical tasks and, therefore, hinders the ability of the laboratory staff to do the most effective job. Please familiarize yourself with the types and schedules of printed reports and utilize them whenever possible. Reports printed in the laboratory for distribution to patient service areas are summarized as follows:
- In-patient reports:
Paper laboratory reports are not generated due to the high availability of electronic laboratory results in ORCA, CIS, and MINDscape. The laboratory can, upon request, produce Interim reports for locations. Please contact the Laboratory Coordinator (206-598-6235) to initiate this service.
- Out-patient reports:
Interim Clinic Reports. This report for OUT-PATIENTS includes all results and pending requests that have not been reported on a previous interim or cumulative summary. These reports are printed on solid white paper and are delivered to the requesting clinics daily, Monday through Friday.
- Physician reports:
Interim Physician Reports. These reports include all tests requested by a specific physician for all patients since the last physician interim report. They include only those tests requested with the physician code (UWP/UPIN Number) included on the requisition. These reports can be requested and scheduled for printing by calling the Laboratory Coordinator (206-598-6235).
- The following results cannot be faxed unless the patient name is coded: Sexually Transmitted Diseases' (STD's), drugs of abuse and toxicology screens.
- STAT gram smears will be called to the physician as soon as they are available. MIC results are called as soon as completed.
- Positive cultures from blood, CSF, and body fluid will be called to the physician. Cultures positive for N. gonorrhoeae and Group A Beta
Strep will be called to the physician.
- Kirby-Bauer and Vitek sensitivity tests are available daily and are usually reported within 24 hours after pure culture of the organism has been received. Anaerobic susceptibilities are performed Monday through Friday. Due to the fastidious nature of most anaerobes, sensitivity tests may require 48 hours or longer to complete. Results of tube or agar dilution MIC, MBC, MFC, Schlichter tests, antibiotic levels and synergism studies are telephoned as soon as completed (24-72 hours).
- AFB smear positive respiratory specimen concentrates are sent out on request for nucleic acid amplification testing for direct detection of M. tuberculosis complex. This test is provided free of charge by the Washington State Public Health Department Tuberculosis Laboratory and is performed on Tuesday and Thursday, at least one day AFTER processing for AFB culture. STAT gram smears will be called to the physician as soon as they are available. MIC results are called as soon as completed.
The Department of Laboratory Medicine, Reference Laboratory Services occasionally receives requests to return specimens to clients. These requests will be reviewed and may be honored if the circumstances fit into an appropriate category. The procedure for returning samples is outlined below.
- Samples may be returned to the ordering location only. If the request comes from another entity, they will be referred to the ordering location.
- A sample may be returned only if it is in the original container, which we received it in, with client labeling intact.
- Client must cover the cost of returning a sample. If it is returned using a shipping company, the client's account number should be given as the payer. When possible, we will utilize our courier or the client's courier to return the sample.
- Date requested, date returned, name of patient, patient ID number, (indicating location), contact person, specimen type, and shipping temperature are to be recorded in our Returned Specimens ledger.
- Requests for human samples for research testing will be forwarded to Dr. Mark Wener at (206) 598-6152.
- Requests from legal entities will be forwarded to the Laboratory Medicine legal representative.
There is no STAT fee.
Many procedures are available STAT, 24 hours a day, as indicated in the Online Testing Guide of this manual. Others may be treated as STAT after consultation with a Laboratory Medicine resident on-call or a division head. The Laboratory Medicine resident can be reached through the UWMC general paging, (206) 598-6190.
These supplies are routinely provided to outside clients at no charge, please call Reference Laboratory Services office to place a request, (206) 685-6066 or (800) 713-5198.
- Blood culture collection tubes
- Chlamydia culture transport media
- Chlamydia/GC Aptima Collection kits
- Containers for timed urine or stool collections
- Laboratory requisition forms
- Mycoplasma culture transport media
- Plastic transport tubes
- Specimen bags
- Styrofoam mailing containers and blue ice packs
- Tissue transport media
- Viral culture transport media
The manual of Laboratory Services lists the days on which the test is set up and the day the test is expected to be resulted. Repeated tests take additional time.
The University of Washington observes a number of minor holidays. These include Veteran's Day, the day after Thanksgiving, Martin Luther King Jr.'s birthday, and President's Day. Reference Laboratory Services will operate normal courier service and observe usual office hours on these days. However, since these are holidays for the UW, laboratories will be on holiday staffing and test run schedules may be altered.
Unlabeled or Mislabeled Specimen
In order to meet the patient safety goals of the Joint Commission for Accreditation of Health Organizations (JCAHO), Laboratory Medicine requires our users and clients to place at least two patient identifiers on every specimen’s label. The most common and appropriate patient identifiers are: Name, Birth date, Assigned Patient ID Number and Assigned Specimen ID Number. The patient’s floor, clinic, hospital or provider, or the specimen’s collection date are not valid identifiers.
The identifiers used must appear on both the specimen and on the requisition paperwork. The laboratory cannot accept responsibility for identification of unlabeled/mislabeled specimens. If a specimen is unlabeled/mislabeled:
- The ordering location will be notified.
- For specimens originating in UWMC and associated facilities, the requested lab work will be cancelled, except in rare cases where recollection of the specimen would place the patient in danger, and the specimen is reasonably identifiable. In those rare instances, the originating person(s) must receive authorization from the chief medical office, chief nursing officer or stat nurse on call for UWMC. If authorization is given, the originating person must then identify the specimen(s) and sign the original requisition indicating acceptance of responsibility for the identification of the specimen. In this rare event, the specimen will be processed and the laboratory will complete an “Unusual Incident Report” documenting the event.
- For specimens originating in Harborview Medical Center (HMC) and associated facilities, the requested lab work will be cancelled, except in rare cases where recollection of the specimen would place the patient in danger, and the specimen is reasonably identifiable. In those rare instances, the originating person(s) must receive authorization from the chief medical office, chief nursing officer or stat nurse on call for HMC. If authorization is given, the originating person must then identify the specimen(s) and sign the original requisition indicating acceptance of responsibility for the identification of the specimen. In this rare event, the specimen will be processed and the laboratory will complete an “Unusual Incident Report” documenting the event.
- For specimens originating at location outside the University system (i.e.
an outreach client location), the requested work will be cancelled and the
ordering location will be notified. The only exception are those rare cases
where recollection of the specimen would place the patient in danger, and
the specimen is reasonably identifiable. In those rare instances, the
originating person(s) must receive authorization from the medical director
of the outreach program or their designee. If authorization is given, the
originating person must then identify the specimen(s) and sign the
requisition indicating acceptance of responsibility for the identification
of the specimen. In this rare event, the specimen will be processed and the
laboratory will complete an “Unusual Incident Report” documenting the
Discrepancy between specimen label and requisition form
A requisition form must accompany specimen(s) sent to the laboratory. The patient's name and hospital number on the requisition form must match name and number on specimen container.
When a discrepancy exists, specimens are unacceptable and the policy that is followed is the same as that described above for unlabeled/mislabeled specimens.
All specimens sent to the laboratory must be collected according to the department specifications.
1. Examples of sample collection errors include:
- Improper patient preparation
- Improper specimen handling in transport to the lab
- Incorrect specimen container type
- Incorrect container used in urine and stool collection
- Incorrect preservative used in specimen collection
- Insufficient quantity of specimen
- Contaminated or damaged specimen
- Needle left on syringe
2. If a specimen is judged to be unacceptable for testing, the ordering location will be notified. No specimen will be discarded without notifying the ordering location.
Billing and Insurance Information
Clients will be billed monthly by an itemized invoice that includes the date, patient's name, specimen identification number, test performed, and the fee for each specimen completed during the month. Please note that our terms are payable upon receipt. If you have any questions pertaining to your account, please notify us immediately so that we may resolve them in a timely manner. Any adjustments will appear on the following month's statements.
Out of state Client Billing: Reference Laboratory Services is not able to provide third party billing for out of state clients. All laboratory work that is ordered from out of state locations will be billed directly to the ordering location.
Reference Laboratory Services is enrolled with a large number of private insurance companies and managed care organizations. As a service to your patients, and in compliance with agreements established with insurance and managed care companies, Reference Laboratory Services is able to bill your patient's primary insurance or managed care organization. Third-party billing must be prearranged and Reference Laboratory Services must be provided with complete and accurate billing information.
The following information must be provided in order to process a claim, if any of the information is missing or inaccurate, Reference Laboratory Services will bill the ordering location.
- Patient's complete name & date of birth
- Patient's telephone number
- Responsibility party's/insured's name if other than patient
- Patient's complete mailing address or responsible party's/insured's name if indicated above
- Referring physician's name - last, first, middle initial
- Referring physician's UPIN or provider number that corresponds to Medicare, Medicaid, or the applicable insurance/managed care (HMO) code/company
- List all applicable ICD-9 diagnosis codes to their highest level of specificity
- Complete name of the insurance company and address.
- Medicare, Medicaid, or insurance/managed care (HMO) insured ID member number as it appears on the insurance card
- Group/policy number as it appears on the insurance card
- Employer's name
Analyte Specific Reagents (ASR) are used in many laboratory tests necessary for standard medical care and generally do not require U.S. Food and Drug Administration approval. The University of Washington Medical Centers are authorized under Clinical Laboratory Improvement Amendments (CLIA) to perform high-complexity testing.
Compliance Statement A -
(This test should not be regarded as investigational or for research use) This test was developed and its performance characteristics determined by UW Medicine, Department of Laboratory Medicine. It has not been approved by the Food & Drug Administration.
Compliance Statement B -
(This test should not be regarded as investigational or for research use) The performance characteristics of this test were determined by the UW Medicine, Department of Laboratory Medicine. It has not been approved by the Food & Drug Administration.
Reference Laboratory Services
Esoteric Test Resource
Reference Laboratory Services maintains a resource/referral service for unusual laboratory procedures. We are happy to identify research or commercial laboratories around the U.S. and Canada, which perform exotic procedures you might need.
Information on licensure or accreditation is not always available for research or service laboratories providing such unusual tests. We encourage those taking advantage of this referral service to satisfy themselves in this regard before forwarding specimens to a laboratory we have identified for you. However, the Department of Laboratory Medicine will attempt to locate an accredited clinical source for the desired procedure whenever possible. Should a particular procedure prove unobtainable, you are invited to consult with appropriate faculty members to determine alternate test possibilities.
Physicians anticipating the need to refer particularly unusual procedures are advised to seek consultation and/or referral assistance prior to actual specimen collection. Although we try to provide rapid response to all inquiries, the research process involved in locating unusual test resources occasionally takes more time than anticipated.
Procedures of particular interest to the medical community, performed by Laboratory Medicine, are listed in the Alpha Test Listing section of this manual. The development, investigation, and clinical application of new procedures is an ongoing process in the Department of Laboratory Medicine; if the desired procedure is not found in the manual, inquiry may be directed to the Reference Laboratory Services office at (206) 685-6066 or (800) 713-5189. Emergent needs during nights and weekends may be directed to the Laboratory Medicine resident on-call, available through the University of Washington Medical Center paging operator at (206) 598-6190.
Laboratory Support / Lab Medicine Resident on-call
Technical and clinical inquiries on those assays you would like to have developed in your laboratory or on "problem" procedures are welcome. We will draw expertise from the Department and the School of Medicine, as well as from cooperating community laboratories. Special arrangement can be made to provide blind controls, back-up services and troubleshooting.
The primary service function of the Laboratory Medicine Resident on-call is to assist other health care professionals with selection and interpretation of laboratory tests.
Laboratory tests which are NEEDED ACUTELY and ARE NOT in BOLD FACE TYPE on the request forms need approval by the Laboratory Medicine Resident on-call at (206) 598-6190 (UWMC paging operator). If difficulty is encountered in locating the On-Call Resident, the Chief Resident has a back-up pager and should be called at the above number.
The Laboratory Medicine Resident serves as an intermediary between those professionals involved in direct patient care and the laboratory staff. Efficient operation of the laboratory is facilitated by communication with the RESIDENT ON-CALL. Documentation is maintained on each request for service or information, and changes in laboratory services are determined, in part, by suggestions in this record.
The Department of Laboratory Medicine and the Department of Pathology are two distinct departments within UW Medicine. Questions regarding neuropathological, renopathological, or anatomical procedures may be directed to (206) 598-6400; for cytogenetics, call (206) 598-4488.
The established protocols used throughout the Department of Laboratory Medicine are available for discussion and dissemination. Inquiries should be directed to Daniel Bankson, PhD, MBA, 206-598-6131.
Last updated: 5/17/11