Ordering Tests for Seasonal Flu A/B and H1N1

To assist our physicians in ordering tests to manage patients who present with flu-like symptoms, Regional Medical Laboratories, Inc. offers the following testing options for your consideration.

Seasonal Flu

• Order Flu A/B as a screening test – This test detects the viral antigen associated with seasonal flu.  Tests are performed at RML and are available the same day.
• CPT-4 Code:  87804 + 87804-91                       
•  Test Kit is Binax NOW®  
•  Test Charge is $48.00

A negative test does not exclude infection with influenza A and B.  Therefore, negative results obtained with the Binax NOW^® Influenza A and B test should be used in conjunction with clinical findings to make an accurate diagnosis.  A positive test is not specific for any particular subtypes or strains.  Differentiation of these subtypes or strains requires additional testing.

Suspicion of Novel H1N1

• Order Flu A/B and H1N1 – The Flu A/B screen is done locally and the PCR test will be sent to Warde Medical Laboratory if the screen is positive for Flu A.  The PCR for H1N1 will only be performed if the sample is positive for Flu A by the screening method.  The Influenza A, (Swine-origin) H1N1 test only detects the presence of the novel swine-origin influenza virus and a negative result does not rule out the presence of seasonal influenza types.  Results from Warde should be available approximately 24-48 hrs. later.
• CPT-4 Code: 87804 + 87804-91 + 87798 
• Flu A/B Charge is $48.00
• PCR Cost is $50.30

 Decision for Antiviral Therapy

• Order Influenza A, B, and Swine Panel – This PCR panel tests for the presence of influenza A, B, and swine-origin influenza A.  While differentiating novel H1N1 influenza from seasonal influenza is not necessary in all cases, testing is indicated when antiviral therapies are contemplated.  Two issues with ordering this panel are cost and turnaround time.  Results from Warde should be available approximately 24-48 hrs. later  
• CPT-4 code:  87798 x 3        PCR Cost is $120.40

It is important to note that testing from Warde is available starting September 21, 2009.  As Flu Season progresses, turnaround time for reference and confirmation testing will likely increase.

Acceptable Specimens:

NP and throat swabs in viral transport medium

Swabs in Culturettes must be transferred to viral transport within 24 hours of collection

The Michigan Department of Community Health Laboratory will only accept specimens from targeted populations and must be referred to them by the Calhoun County Health Department.  Prior approval is necessary.  Reasons for testing include: ICU patient, pregnant & severely ill, patient with unusual & severe presentation, death, or outbreak investigation by local health department.