Test ID: HBL Test ID: CHRHB - Mayo Medical Laboratories

Disorders Request Form (Supply ...

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TEST STATUS NOTIFICATION DATE: June 16, 2015 EFFECTIVE DATE: August 2, 2015

CHROMOSOME ANALYSIS, HEMATOLOGIC DISORDERS, BLOOD Test ID: HBL EXPLANATION: MML test for HBL, Chromosome Analysis, Hematologic Disorders, Blood will become obsolete. RECOMMENDED ALTERNATIVE TEST:

CHROMOSOME ANALYSIS, HEMATOLOGIC DISORDERS, BLOOD Test ID: CHRHB METHODOLOGY: Cell Culture without Mitogens* followed by Chromosome Analysis* *In addition to the cell culture without mitogens, a CpG stimulated culture will be added and 10 additional cells will be analyzed for any specimen received from a patient age 30 or older with a reason for referral of chronic lymphocytic leukemia (CLL), small lymphocytic lymphoma (SLL), lymphocytosis, Waldenstrom's macroglobulinemia, or when CLLF / Chronic Lymphocytic Leukemia (CLL), FISH is ordered concurrently. REFLEX TESTS: Test ID Reporting Name Available Separately Always Performed _CX04 Culture 04 (Bill Only No (Bill Only) No _ML20 Metaphases, 1-19 (Bill Only) No (Bill Only) No _M25 Metaphases, 20-25 (Bill Only) No (Bill Only) No _MG25 Metaphases, >25 (Bill Only) No (Bill Only) No _STAC Ag-Nor/CBL Stain (Bill Only) No (Bill Only) No TESTING ALGORITHM This test only includes a charge for professional interpretation of results and does not include charges for cell culture or analysis. Charges will be incurred for the cell culture of fresh specimens. Analysis charges will be incurred for total work performed, and generally include 2 banded karyograms and the analysis of 20 or more metaphase cells for this test. If no metaphases are available for analysis, no analysis charges will be incurred. If additional analysis work is required, additional charges may be incurred. REFERENCE VALUES: An interpretative report will be provided. Note: A PDF report will be available in MayoACCESS for this test. SPECIMEN REQUIREMENTS: Provide a reason for referral with each specimen Container/Tube: Green top (sodium heparin) Specimen Volume: 5-10 mL Collection Instructions: 1. Invert several times to mix blood.

2. Other anticoagulants are not recommended and are harmful to the viability of the cells. Additional Information: Advise Express Mail or equivalent if not on courier service. Forms: 1. Cytogenetics Hematologic FISH Panel Patient Information Sheet (Supply T603) in Special Instructions 2. If not ordering electronically, please submit a Cytogenetics Hematologic Disorders Request Form (Supply T607) with the specimen.

SPECIMEN STABILITY INFORMATION:

Specimen Type Whole Blood

Temperature Ambient (preferred) Refrigerated

Time

CPT CODE: Individual components of this assay will be individually defined and the additional bill-only FISH probe tests will no longer be used. The test will carry the interpretation CPT code:  88291-Interpretation and report The following CPT codes will be applied as appropriate based on the number of probe sets applied, culture performed, or cells analyzed as indicated in the test report:  88237-Tissue culture for neoplastic disorders; bone marrow, blood  88264 w/ modifier 52-Chromosome analysis with less than 20 cells (if appropriate)  88264-Chromosome analysis with 20 to 25 cells (if appropriate)  88264,88285- Chromosome analysis with greater than 25 cells (if appropriate)  88283-Additional specialized banding technique (if appropriate)  Please consult the MML client price portal for specific fee information: https://www.mayomedicallaboratories.com/customer-service/client-price-lookup/intro.html

DAY(S) SET UP: Monday through Sunday Reported: Monday through Friday; 8 a.m.-5 p.m.

ANALYTIC TIME: 10 days

QUESTIONS: Contact your Mayo Medical Laboratories’ Regional Manager or Michaela Erickson, MML Laboratory Technologist Resource Coordinator Telephone: 800-533-1710