Reflex testing is an essential element in providing efficient, timely high-quality and timely treatment to patients. Automated follow-up tests are performed basing on the initial test results the reflex test streamlines the process of diagnosing and improves the outcomes of patients.
What is Reflex Testing?
Reflex testing is when you conduct extra tests in the laboratory following the initial test which was previously ordered and has resulted. The initial test results satisfy some pre-determined requirements for example, it is positive or outside normal parameters and needs additional testing before it can be considered conclusive. The follow-up test is carried out in a way that is completely automatic, and does not require an intervention from the doctor who ordered the test.
For instance, in the event that a patient’s initial blood test reveals the hormone thyroid-stimulating (TSH) then a reflex test can be carried out to assess levels of free T4 levels. This extra data can benefit in the identification of disorders like hypothyroidism or hyperthyroidism without needing another blood sample of the individual.
There are two types of reflex tests:
- No Lab Order Required (Reflex Testing):
Laboratory tests that, if positive, require further follow-up to be of clinical value are considered “follow-up laboratory tests”, often due to physician orders for such additional follow-up testing, reflex tests required by state, regulatory or accreditation bodies also qualify as follow-up laboratory tests.
Example: Include, but are not limited to, performing a positive urine culture and reporting its identification and susceptibility as part of an ordered test order. Please be aware that additional reports for these additional tests can be generated as they were not performed as part of an ordered set of tests.
- Lab Order Required (Reflex Testing):
Laboratory tests where initial test results could provide clinical value without additional reflex testing are also conducted, however if requested by your physician this testing can take place.
Example: If we have positive or inconsistent presumptive tests however, we will require doctor prescriptions for more conclusive (Reflex) test results.
Benefits of Reflex Testing
- Timeliness: Reflex testing ensures that necessary follow-up tests are immediately conducted after initial results have been collected, shortening wait time for critical diagnostic information and leading to quicker treatment decisions.
Example: In the event of an initial test that is positive to detect a sexually transmitted disease (STI) A reflex test is a quick way to confirm the diagnosis, which allows for a quicker start of treatment.
- Cost-Effectiveness: Reflex testing helps lower healthcare costs by eliminating additional appointments and specimen collections, and can save both time and money in terms of healthcare spending.
Example: Reflex tests for positive HIV screenings may automatically conduct confirmatory testing, eliminating the need for another visit and blood draw.
- Quality Care: Reflex testing is in line with excellent medical practices, providing detailed diagnostic data that could increase patient treatment.
Example: Reflex tests following an abnormal Pap smear may provide valuable additional information regarding high-risk human papillomavirus (HPV), supporting decision making regarding further intervention strategies
| Initial Test (CPT) |
Test Name |
Reflex Criteria |
Reflex Test | Reflex Test (CPT) |
| 85307 | Activated Protein C (APC) Resistance | Abnormal ratio or Anticoagulant interference | Factor V Leiden | 81241 |
| 86038 | ANA Screen | Positive Titer | Reflex to Titer | 86039 |
| 86063 | Anti-Streptolysin O (ASO) | Positive Titer | Reflex to Titer | 86060 |
Protocol and Communication
Each laboratory has its own standards to determine what constitutes a medically suitable reflex test, however certain reflex tests that confirm the results are required by law. It is crucial that laboratories disclose their protocols for testing reflexes to the doctors who order them as well as offer patients with the choice to not take subsequent tests.
Physician Involvement
Physicians can refuse reflex testing in the event that they do not wish to follow the prescribed protocol. The reason for this must be disclosed when the first test is scheduled. A clear communication between the laboratory and the doctor who is ordering the test will warrant that reflex testing is a part of the accurate possible care for the patient.
Compliance: Performing reflex tests is allowed by CMS but we have to check if it is medically necessary or not.
Example of Toxicology: As Medicare only reimburses one presumptive IA test result per patient per service date regardless of billing providers, performing and ordering presumptive IA testing from reference laboratories with or without reflex testing is neither reasonable nor necessary for physicians.
Conclusion
Reflex testing has quickly become an invaluable component of modern healthcare, providing timely, cost-effective diagnostic information at high quality levels. By understanding and employing reflex testing protocols appropriately, healthcare providers can improve patient outcomes while streamlining diagnostic processes.
Related Post:
