Y2K PREPAREDNESS.
Are you ready for Y2K? This seems to be the hot topic for the year 1999.
We would all like to have a look into the future at Jan. 1, 2000 to see
what will really happen when we start the new millennium. Some are
predicting that computer systems will fail to recognize that 00 comes
after 99 and as a result will fail to operate properly if at all. We at
Avera are working to upgrade and test our systems so that this won't
happen or will have little effect on services. We encourage you to do the
same at your facility. You should be contacting your vendors to see what
may need to be done with any equipment currently in use. All departments
within the facility should be coordinating efforts to make sure
inter-department activities continue to run smoothly. So, you've done all
you should, what if you have a computer system that fails? Have a
contingency plan ready. Decide now what you will do if a part of your
system fails. Please contact the client service department at any of the
Avera Lab Network hospitals if you have questions or need assistance with
your Y2K preparations.
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AVERA SACRED HEART COMPUTERIZED.
Avera Sacred Heart Hospital, Yankton will go live March 1, 1999 with
the new Meditech computer system version "client server".
"Client server" is the newest Meditech version, and Avera Sacred
Heart Hospital is one of the first hospitals in the Midwest to implement
it. This system will be connected to all hospital departments, thereby
improving communications within the hospital and departments and
decreasing turnaround times for ancillary services. Test ordering,
billing, and reporting will also be combined. This system allows remote
site ordering, advance beneficiary notice and comment sections. Bar-coding
will be utilized for those analyzers with that capability. This will
increase automation and make laboratory work more user friendly.
Other sites in the Avera Health System are currently using the Meditech
system.
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Avera St. Luke’s Updates.
Avera St. Luke's has upgraded to a Nova CRT 11 for Lithium analysis.
Specimen requirements are 1 ml serum refrigerated if analysis will take
place within 48 hours. If longer storage is necessary the specimen must be
frozen. Minimum sample volume is 0.5 ml.
The laboratory at Avera St. Luke’s has begun using heparinized plasma
for most chemistry testing. Please contact the client services department
for more information.
The blood bank at Avera St. Luke’s will be changing to Gel technology
soon. This system is already in place at Avera McKennan and Avera Sacred
Heart and will be added at Avera Queen of Peace in the future. This system
allows for improved productivity (less hands on time), increased
standardization, and increased automation. The Gel technology uses EDTA
plasma rather than serum. EDTA offers the benefit of decreased
interference from fibrin and increased turn around time for in-house STAT
testing.
For more information on Gel technology, see the Spring 1998 edition of
Lab News.
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Good for You.
Avera Queen of Peace has been recertified by the College of American
Pathologists.
Avera McKennan and Avera St. Luke’s have been
reaccredited by the American Association of Blood Banks.
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Question of the Quarter.
Q: Why is the measurement of intact parathyroid hormone
important for differentiation between primary hyperparathyroidism and
non-parathyroid hypercalcemia?
A: PTH (parathyroid hormone) helps control
extracellular calcium through its action on target organs, principally
calcium retention by the kidneys and release of calcium from skeletal
stores. Rising extracellular Ca levels normally suppress PTH through a
negative feedback mechanism. While fragments of the PTH molecule are
present in peripheral circulation, intact PTH has been determined to be
the major biologically active form. Primary hyperparathyroidism is
characterized by elevated Ca levels (>10.3 mg/dl) and high normal or
elevated PTH levels. Hypercalcemia of malignancy is characterized by
hypercalcemia and low PTH levels.
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Local Medical Review Policy Reminders for
Physicians.
Subject: Vitamin B12 (Cyancobalamin)
CPT Code: 82607
Description: The serum cyanocobalamin is a
quantitative analysis of serum vitamin B12 levels. It is generally
indicated in the evaluation of megaloblastic anemias whose cause is
unknown and in patients with malabsorptive states.
Inadequate intake is rarely the cause of B12
deficiency, it occurs most commonly when there is damage to the stomach,
ileum, or pancreas, or when the enterohepatic circulation of vitamin B12
is impaired.
Indications and Limitations of Coverage.
A. Vitamin B12 testing is indicated when a macrocytic
anemia is suspected using blood indices, especially when the Mean
Corpuscular Volume (MCV) is increased above 100fl.
B. Testing is indicated only for megaloblastic anemias,
and in dementias or neuropathies thought to be secondary to B12
deficiencies. Sequential testing is usually unnecessary to monitor the
effects of vitamin B12 therapy. Since cyanocobalamin is given to treat the
macrocytic anemia, tests normally used to monitor anemia such as
hemoglobin or hematocrit should be used.
Reasons for Denial.
A. Cyanocobalamin testing is usually not necessary to
monitor vitamin B12 therapy.
B. Medicare does not cover routine screening.
Non-covered ICD-9 codes.
Any diagnostic code not listed in the covered ICD-9
diagnosis section of model policy #97.12.
Documentation requirements.
Medical records should indicated signs and symptoms to
substantiate medical necessity.
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