Broad Range Microbiology PCR
| PATIENT INFO |
| Patient Name: |
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| BD: / / Sex: F M |
| PHYSICIAN INFO |
| Physician Name : |
| Address: |
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| Additional Report to: |
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| TESTS REQUESTED | |
| Test Name: | ICD9 Code: (required) |
| 1. Broad Range Microbiology PCR | |
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| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
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Test ID :
BROPC
Test Workstation :
WASH
Specimen Type:
Fresh Frozen tissue, body fluid (non-bloody), paraffin embedded tissue. Eswab is acceptable.
Tube Type:
Sterile container
Collection Volume:
Fresh frozen tissue, paraffin embedded tissue, or non-bloody body fluid accepted.
Cause for Rejection:
Blood, serum, plasma, stool, formalin tissue not acceptable. Reject if collected in swabs other than Eswabs
Storage:
Tissue, body fluid-Frozen, paraffin embedded tissue- Room temp
Availability:
Sent to Reference Laboratory
Methodology:
Polymerase Chain Reaction (PCR)
Special Instructions:
Specify Broad Range PCR:
Bacterial PCR (reflex to Next Generation Sequencing for polymicrobial specimens)
Fungal PCR
AFB PCR (including nontuberculous Mycobacteria)
Lab/Phone:
330-543-8412
Additional Info:
Bacterial PCR -respiratory and genitourinary samples may also be submitted and will include reflexed testing to Next Generation sequencing. Eswab is the only validated swab specimen that is acceptable.
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Fungal PCR- BAL or skin scrapings also acceptable.
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AFB PCR- sputum tested for MTB Complex and/or M. avium complex only.
CPT Code:
Bacterial PCR or Fungal PCR CPT code 87801; MTB PCR -87556, Non Tuberculosis PCR- 87551; Next Gen. Bacterial Sequencing -87801
Synonyms:
Bacterial PCR, Fungal PCR, Mycobacterial PCR, AFB PCR
