Ordering Recommendations

Panel includes PCR testing to detect M. tuberculosis complex isolates and determine possible resistance to rifampin treatment. Test may be ordered for client-processed specimens. Refer to specimen requirements.

Ordering Instructions

Specimen Type New Diagnosis of MTB Suspected? Has a LAB8286 MTBRIFPCR already been ordering in the current encounter? Ordering Recommendation
Sputum Yes Yes Order LAB877 instead
Sputum Yes No Order LAB8286 instead
Sputum No NA Order LAB877 instead
Respiratory, non-sputum Yes NA Order LAB877 instead
Respiratory, non-sputum No NA Order LAB877 instead
Non-respiratory Yes NA Order LAB877 additionally
Non-respiratory No NA Order LAB877 instead

ARUP Test Code

2010775

Performed

Sun-Sat

Reported

1-3 days

Notes

Body fluids other than pleural fluid will be run with a disclaimer.

Specimen source required. To perform this test, it is essential to know whether or not the submitted specimen has been processed (digestion and decontamination procedure). If processed, smear results must be provided as a comment on the test order or requisition. Delayed turnaround time will occur if the required information is not provided.

After a positive result, repeat orders for Mycobacterium tuberculosis Complex Detection and Rifampin Resistance by PCR will continue to yield a positive result and repeat testing is not clinically indicated.

The Xpert MTB/RIF test performance has not been evaluated with samples from pediatric patients.

Interpretive Data

Mycobacterial culture is a more sensitive method than molecular testing for the diagnosis of tuberculosis and is still considered the gold standard. When possible, a culture must be performed regardless of the molecular method test result.

Referral Lab

Laboratories.

Collect

Respiratory specimens, CSF, pleural fluid, or tissue.

Minimum Collection Volume

1 mL

Specimen Preparation

Unprocessed Specimens: Transport 5-10 mL respiratory specimen, CSF or pleural fluid (Min: 1 mL) in a sterile container, or tissue large enough to be ground. Label as unprocessed.
Processed Specimens: Transport 2-5 mL digested/decontaminated respiratory specimen, CSF, pleural fluid, or tissue in a sterile container. (Min: 1 mL)
Place each specimen in an individually sealed bag.

Unacceptable Conditions

Blood, paraffin blocks, stool, swabs, and urine.

Storage/Transport Temperature

Refrigerated.

Stability (from collection to initiation)

Unprocessed: Ambient: 3 days; Refrigerated: 1 week; Frozen: 1 month
Processed: Ambient: Unacceptable; Refrigerated: 1 week; Frozen: 1 month

Remarks

Specimen source required. Processed Specimens: Identify method used for digestion and provide smear results.

Containers

Sterile Plastic Leakproof Container

Sterile Tube

Interpretive Data

Mycobacterial culture is a more sensitive method than molecular testing for the diagnosis of tuberculosis and is still considered the gold standard. When possible, a culture must be performed regardless of the molecular method test result.

CPT Disclaimer

The Current Procedural Terminology (CPT) Codes published in the M Health Fairview Test Directory are based on American Medical Association (AMA) guidelines and are provided for informational purposes only. CPT codes are provided only as guidance to assist clients with billing. CPT coding is the responsibility of the billing party. M Health Fairview Laboratories does not assume responsibility for billing errors due to reliance on the CPT codes listed in this Test Directory. Charges may vary due to reflexing, susceptibilities, specimen source, patient age, methodology requirements, etc..

Patient Price Inquiries

Requester Contact Information
Patient and UMP/FV Care Team Fairview Consumer Line at 612-672-1048
MRL Outreach Client dept-mrl-business-assessment@fairview.org
Research research@fairview.org

Billing Information

CPTQtyHC HospitalPR ClinicNote
87564130087564028756402HC M TUBERCULOSIS RIFAMPIN RESISTANCE AMB PROBE, ARUP

CPT Codes

87564

Methodology

Qualitative Polymerase Chain Reaction (PCR)

MRL Test Build

Test Name Component Required Description Type LOINC
LAB6512     MTB Complex and Resistance Orderable  
  159578 Y MTB specimen source: Prompt  
  SPT_1044 Y Specimen type: Prompt  
  1231000393   MTB Sample Source Result 31208-2
  1231000394   Mycobacterium Tuberculosis PCR Result 13956-8
  1231000395   MTB Rifampin Resistance PCR Result 48176-2
  1231000396   MTB Complex Interpretation Result 48767-8

Contact

For questions regarding the test code Interface Map, please contact DEPT-LAB-CLIENT-INTERFACE@fairview.org
Ordering

Ordering Recommendations

Panel includes PCR testing to detect M. tuberculosis complex isolates and determine possible resistance to rifampin treatment. Test may be ordered for client-processed specimens. Refer to specimen requirements.

Ordering Instructions

Specimen Type New Diagnosis of MTB Suspected? Has a LAB8286 MTBRIFPCR already been ordering in the current encounter? Ordering Recommendation
Sputum Yes Yes Order LAB877 instead
Sputum Yes No Order LAB8286 instead
Sputum No NA Order LAB877 instead
Respiratory, non-sputum Yes NA Order LAB877 instead
Respiratory, non-sputum No NA Order LAB877 instead
Non-respiratory Yes NA Order LAB877 additionally
Non-respiratory No NA Order LAB877 instead

ARUP Test Code

2010775

Performed

Sun-Sat

Reported

1-3 days

Notes

Body fluids other than pleural fluid will be run with a disclaimer.

Specimen source required. To perform this test, it is essential to know whether or not the submitted specimen has been processed (digestion and decontamination procedure). If processed, smear results must be provided as a comment on the test order or requisition. Delayed turnaround time will occur if the required information is not provided.

After a positive result, repeat orders for Mycobacterium tuberculosis Complex Detection and Rifampin Resistance by PCR will continue to yield a positive result and repeat testing is not clinically indicated.

The Xpert MTB/RIF test performance has not been evaluated with samples from pediatric patients.

Interpretive Data

Mycobacterial culture is a more sensitive method than molecular testing for the diagnosis of tuberculosis and is still considered the gold standard. When possible, a culture must be performed regardless of the molecular method test result.

Referral Lab

Laboratories.
Collection & Processing

Collect

Respiratory specimens, CSF, pleural fluid, or tissue.

Minimum Collection Volume

1 mL

Specimen Preparation

Unprocessed Specimens: Transport 5-10 mL respiratory specimen, CSF or pleural fluid (Min: 1 mL) in a sterile container, or tissue large enough to be ground. Label as unprocessed.
Processed Specimens: Transport 2-5 mL digested/decontaminated respiratory specimen, CSF, pleural fluid, or tissue in a sterile container. (Min: 1 mL)
Place each specimen in an individually sealed bag.

Unacceptable Conditions

Blood, paraffin blocks, stool, swabs, and urine.

Storage/Transport Temperature

Refrigerated.

Stability (from collection to initiation)

Unprocessed: Ambient: 3 days; Refrigerated: 1 week; Frozen: 1 month
Processed: Ambient: Unacceptable; Refrigerated: 1 week; Frozen: 1 month

Remarks

Specimen source required. Processed Specimens: Identify method used for digestion and provide smear results.
Containers

Containers

Sterile Plastic Leakproof Container

Sterile Tube
Result Interpretation

Interpretive Data

Mycobacterial culture is a more sensitive method than molecular testing for the diagnosis of tuberculosis and is still considered the gold standard. When possible, a culture must be performed regardless of the molecular method test result.

Administrative

CPT Disclaimer

The Current Procedural Terminology (CPT) Codes published in the M Health Fairview Test Directory are based on American Medical Association (AMA) guidelines and are provided for informational purposes only. CPT codes are provided only as guidance to assist clients with billing. CPT coding is the responsibility of the billing party. M Health Fairview Laboratories does not assume responsibility for billing errors due to reliance on the CPT codes listed in this Test Directory. Charges may vary due to reflexing, susceptibilities, specimen source, patient age, methodology requirements, etc..

Patient Price Inquiries

Requester Contact Information
Patient and UMP/FV Care Team Fairview Consumer Line at 612-672-1048
MRL Outreach Client dept-mrl-business-assessment@fairview.org
Research research@fairview.org

Billing Information

CPTQtyHC HospitalPR ClinicNote
87564130087564028756402HC M TUBERCULOSIS RIFAMPIN RESISTANCE AMB PROBE, ARUP

CPT Codes

87564

Methodology

Qualitative Polymerase Chain Reaction (PCR)
Interface Mapping

MRL Test Build

Test Name Component Required Description Type LOINC
LAB6512     MTB Complex and Resistance Orderable  
  159578 Y MTB specimen source: Prompt  
  SPT_1044 Y Specimen type: Prompt  
  1231000393   MTB Sample Source Result 31208-2
  1231000394   Mycobacterium Tuberculosis PCR Result 13956-8
  1231000395   MTB Rifampin Resistance PCR Result 48176-2
  1231000396   MTB Complex Interpretation Result 48767-8

Contact

For questions regarding the test code Interface Map, please contact DEPT-LAB-CLIENT-INTERFACE@fairview.org
Private Details

Test Detail

Processing Key


See Processing Key "Special" Definitions document for *SPECIAL* definition.
Abbreviation
MTBRIF
Performing Lab
ARUP
Department
Reference Laboratory
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