GASTROINTESTINAL (GI) PANEL BY PCR NOTE: LOCAL COVERAGE DETERMINATIONS (LCD)APPLY TO THIS TEST
Test Code: LAB8729
CPT Code: 87507
Interface Code
PCRGIP
Synonym
STOOL, FECES, GI PANEL PCR, GASTROINTESTINAL
Specimen Type
Stool
Specimen Container
Culture and Sensitivity vial (C&S) (orange lid) - contains Cary-Blair media
or
ETM vial (red lid) – contains modified Cary-Blair media
or
ETM vial (red lid) – contains modified Cary-Blair media
Specimen Handling
PLEASE NOTE: COVERAGE LIMITATIONS APPLY FOR THIS TEST
DETAILS OF CMS LOCAL COVERAGE LOCATED IN CMS ARTICLE ID: A58720
1. Collect stool sample in a clean, dry container such as a plastic bag, plastic plate, or bedpan. Note: If the specimen needs to be collected in a diaper, line the diaper with plastic wrap or turn the diaper inside out to avoid the stool from being absorbed into the diaper.
2. Do not mix urine or toilet water in the stool sample.
3. Unscrew the cap of the vial. Be careful to keep upright (vial may contain a fluid). A plastic scoop is attached to the vial lid.
4. Using the scoop, select stool from areas which appear bloody, slimy or watery and place 1-4 scoops of stool into the vial (total volume of stool needed is approximately the size of a walnut). If stool is solid, then take a scoop from each side and the middle. DO NOT FILL the vial above the FILL LINE. Overfilled vials cannot be tested.
5. Mix the contents with the scoop and screw the vial cap back on ensuring it is tight. Shake the vial vigorously to guarantee all contents are mixed.
6. Write your name, date of birth, time and date of collection on each vial.
7. Wash hands thoroughly.
8. Place vials in the Ziploc biohazard bag provided and keep at room temperature.
9. Deliver to a PDL Patient Service Center location within 24 hours.
4. Label container with patient’s name (first and last), date of birth, date and actual time of collection, and type of specimen.
5. Refrigerate specimen and submit to the lab.
DETAILS OF CMS LOCAL COVERAGE LOCATED IN CMS ARTICLE ID: A58720
1. Collect stool sample in a clean, dry container such as a plastic bag, plastic plate, or bedpan. Note: If the specimen needs to be collected in a diaper, line the diaper with plastic wrap or turn the diaper inside out to avoid the stool from being absorbed into the diaper.
2. Do not mix urine or toilet water in the stool sample.
3. Unscrew the cap of the vial. Be careful to keep upright (vial may contain a fluid). A plastic scoop is attached to the vial lid.
4. Using the scoop, select stool from areas which appear bloody, slimy or watery and place 1-4 scoops of stool into the vial (total volume of stool needed is approximately the size of a walnut). If stool is solid, then take a scoop from each side and the middle. DO NOT FILL the vial above the FILL LINE. Overfilled vials cannot be tested.
5. Mix the contents with the scoop and screw the vial cap back on ensuring it is tight. Shake the vial vigorously to guarantee all contents are mixed.
6. Write your name, date of birth, time and date of collection on each vial.
7. Wash hands thoroughly.
8. Place vials in the Ziploc biohazard bag provided and keep at room temperature.
9. Deliver to a PDL Patient Service Center location within 24 hours.
4. Label container with patient’s name (first and last), date of birth, date and actual time of collection, and type of specimen.
5. Refrigerate specimen and submit to the lab.
Volume
Sufficient stool to raise fluid volume to the red FILL LINE on the vial.
Temperature
Room Temperature
Unacceptable Conditions
Stool contamined with urine or water. Specimens filled above the FILL LINE on the container will be rejected.
Fresh stool not transferred into preservative within 1 hour after being collected.
Fresh stool not transferred into preservative within 1 hour after being collected.
Methodology
Polymerase Chain Reaction (PCR)
Additional Information
If FRESH STOOL is submitted, it must be transferred into the stool transport vials within 1 hour of collection to be suitable for testing.
Due to test method limitation, confirmatory testing may be performed. If confirmation testing is performed, additional charges/CPT code(s) will apply.
PANEL INCLUDES:
BACTERIA:
• Campylobacter (jejuni, coli, and upsaliensis)
• Plesiomonas shigelloides
• Salmonella
• Yersinia enterocolitica
• Vibrio (parahaemolyticus, vulnificus, and cholerae)
• Vibrio cholerae
DIARRHEAGENIC E. COLI/SHIGELLA:
• Enteroaggregative E. coli (EAEC)
• Enteropathogenic E. coli (EPEC)
• Enterotoxigenic E. coli (ETEC) lt/st
• Shiga-like toxin-producing E. coli (STEC) stx1/stx2
◦ E. coli O157
• Shigella/Enteroinvasive E. coli (EIEC)
PARASITES:
• Cryptosporidium
• Cyclospora cayetanensis
• Entamoeba histolytica
• Giardia lamblia
VIRUSES:
• Adenovirus F40/41
• Astrovirus
• Norovirus GI/GII
• Rotavirus A
• Sapovirus (I, II, IV, and V)
REFLEX TESTS FOR CONFIRMATION if the following organisms are DETECTED on the GI Panel by PCR (Note: Additional CPT codes/charges will be applied)
• Plesiomonas shigelloides reflexes Stool culture
• Shigella/Enteroinvasive E. coli (EIEC) reflexes Stool culture
• Salmonella reflexes Stool culture if isolated send to Public Health
• Shiga-like E. coli (STEC) stx1/stx2 reflexes Send to Public Health
• Shiga-like E. coli (STEC) stx1/stx2 and E. coli 0157 reflexes Send to Public Health
• Vibrio cholerae detected another Vibrio sp., not V. cholera, may also be present Vibrio culture
• Vibrio species (not V. cholerae) reflexes Vibrio culture
• Yersinia enterocolitica reflexes Yersinia culture
Due to test method limitation, confirmatory testing may be performed. If confirmation testing is performed, additional charges/CPT code(s) will apply.
PANEL INCLUDES:
BACTERIA:
• Campylobacter (jejuni, coli, and upsaliensis)
• Plesiomonas shigelloides
• Salmonella
• Yersinia enterocolitica
• Vibrio (parahaemolyticus, vulnificus, and cholerae)
• Vibrio cholerae
DIARRHEAGENIC E. COLI/SHIGELLA:
• Enteroaggregative E. coli (EAEC)
• Enteropathogenic E. coli (EPEC)
• Enterotoxigenic E. coli (ETEC) lt/st
• Shiga-like toxin-producing E. coli (STEC) stx1/stx2
◦ E. coli O157
• Shigella/Enteroinvasive E. coli (EIEC)
PARASITES:
• Cryptosporidium
• Cyclospora cayetanensis
• Entamoeba histolytica
• Giardia lamblia
VIRUSES:
• Adenovirus F40/41
• Astrovirus
• Norovirus GI/GII
• Rotavirus A
• Sapovirus (I, II, IV, and V)
REFLEX TESTS FOR CONFIRMATION if the following organisms are DETECTED on the GI Panel by PCR (Note: Additional CPT codes/charges will be applied)
• Plesiomonas shigelloides reflexes Stool culture
• Shigella/Enteroinvasive E. coli (EIEC) reflexes Stool culture
• Salmonella reflexes Stool culture if isolated send to Public Health
• Shiga-like E. coli (STEC) stx1/stx2 reflexes Send to Public Health
• Shiga-like E. coli (STEC) stx1/stx2 and E. coli 0157 reflexes Send to Public Health
• Vibrio cholerae detected another Vibrio sp., not V. cholera, may also be present Vibrio culture
• Vibrio species (not V. cholerae) reflexes Vibrio culture
• Yersinia enterocolitica reflexes Yersinia culture
Stability
Room Temperature: 4 days
Reference Range Information
Reference values are dependent upon methodology/instrumentation, check final report for current reference values
Turn Around Time
24 hours
Performing Site
Pacific Diagnostic Laboratories
| Result Code | Result Name | Result Loinc |
|---|---|---|
| 1230000428 | Adenovirus F 40/41 | 82209-8 |
| 1230000429 | Astrovirus | 82210-6 |
| 1230000430 | Campylobacter species | 82196-7 |
| 1230000431 | Cryptosporidium | 82205-6 |
| 1230000432 | Cyclospora cayetanensis | 82206-4 |
| 1230000433 | Enteroaggregative E. coli (EAEC) | 80349-4 |
| 1230000434 | Entamoeba histolytica | 82207-2 |
| 1230000435 | Shigella/Enteroinvasive E.coli (EIEC) | 80350-2 |
| 1230000436 | Enteropathogenic E.coli (EPEC) | 80348-6 |
| 1230000437 | Giardia lamblia | 82208-0 |
| 1230000438 | Norovirus GI/GII | 82211-4 |
| 1230000439 | Escherichia coli O157 serotype | 82204-9 |
| 1230000440 | Plesiomonas shigelloides | 82198-3 |
| 1230000441 | Rotavirus A | 82212-2 |
| 1230000442 | Salmonella species | 82199-1 |
| 1230000443 | Sapovirus ( I, II, IV and V) | 82213-0 |
| 1230000445 | Shiga-like E.coli (STEC) stx1/stx2 | 82203-1 |
| 1230000446 | Vibrio species | 82200-7 |
| 1230010000 | Enterotoxigenic E.coli (ETEC) it/st | 80351-0 |
| 1230010037 | Vibrio cholera | 82201-5 |
| 1629075 | Yersinia enterocolitica | 82202-3 |
| 1810922 | NOTE: |
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