Medical Necessity Documentation:
Client Notes:
Patient Preparation:
Collection Instructions:
Transport & Storage: Temperature/Stability:
30 days Ambient (transport)
Refrigerated and frozen=unacceptable
Rejection Criteria:
SurePath vials without the head of the collection device(s) in the fluid, swabs, cervical swabs in Digene HC cervical sampler, Digene vials
Reference Range:
Refer to Interpretive Report
Critical Ranges:
Test Comments:
Patients 21-25: If the Pap result is ASC-US then the HPV mRNA assay will be performed at an additional charge (CPT code(s): 87624). Chlamydia trachomatis (CT)/ Neisseria gonorrhoeae (NG) RNA, TMA (CPT code(s): 87491, 87591), and Trichomonas vaginalis ("trich" or TV), Qualitative TMA, Pap Vial (CPT code(s): 87661) will also be performed.
Patients 26-29: If the Pap result is ASC-US then the HPV mRNA assay will be performed at an additional charge (CPT code(s): 87624). CT/NG RNA, TMA (CPT code(s): 87491, 87591), and TV, Qualitative TMA, Pap Vial (CPT code(s): 87661) will also be performed.
Patients 30-65: If the Pap result is negative and the HPV mRNA screen (CPT code(s): 87624) is positive (detected), then HPV mRNA Genotypes 16, 18/45 will be performed at an additional charge (CPT code(s): 87625). CT/NG RNA, TMA (CPT code(s): 87491, 87591), and TV, Qualitative TMA, Pap Vial (CPT code(s): 87661) will also be performed.
Pap results requiring physician interpretation will be performed at an additional charge (CPT Code(s): 88141; HCPCS: G0124).
Methodology:
Hologic ThinPrep System • Transcription-Mediated Amplification
Clinical Significance:
Based on the patient's age and on ACOG Practice Guidelines for cervical cancer screening and Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), and Trichomonas vaginalis screening
Documentation:
Custom Panel:
No
PRODUCTION SCHEDULE
Turn Around Time:
5 to 7 days
Days Performed:
Monday, Tuesday, Wednesday, Thursday, Friday
Sites Performed:
Quest - Chantilly
PHL Test Code:
MSOT
EPIC Test Code:
LAB3001
Send Out Test Code:
91386
Alternate Test Names:
Image Guided Pap Age Based with CT/NG/Trich; Thin Prep
Included Tests:
Chlamydia trachomatis (CT); Neisseria gonorrhoeae (NG); and Trichomonas vaginalis
CPT Coding:
88175 (R - 87624, 87491, 87591, 87625, 87661)