Clinical Laboratories and Outreach Services

Baptist's Clinical Laboratory and Outreach Services are accredited by the College of American Pathology, Clinical Laboratory Improvement Act, and the American Association of Blood Banks. The blood bank is also inspected and licensed by the Food & Drug Administration. The labs are medically supervised by board certified pathologists and staffed by certified medical technologists, cytology technologists, and by laboratory technicians and histology technicians.

Laboratory Outreach Services

In late 1985, Baptist Laboratories established a Clinical Outreach Program with the idea of providing quality lab work to Central Mississippi. Throughout the past decade, Baptist's commitment to the constantly changing needs of the healthcare community has prompted expansion of our services. Currently, the Outreach Program provides:

• Community-based full service comprehensive laboratory
• Services of Board-Certified Pathologists
• 24-hour Client Services Department
• Leading-edge testing facilities
• Personalized reporting capabilities and on-line interface capablilities
• Dedicated Courier Service and STAT specimen pick-up
• Variety of billing options
• Ongoing formal education program
• Optimal turn-around times for laboratory testing.

The Clinical Outreach Program has CAP and CLIA certification, JCAHO accreditation, including AABB and FDA certifications for Blood Bank Services.

Laboratory Procedures

Please use this link for a list of Laboratory Procedures.

Hours, Referral Lab, Courier and Outpatient Services

Availability of Services

The clinical laboratory is open 24 hours a day, 7 days a week. Medical Technologists are on the premises at all times.

Contact Us: 601-968-3070

Referral Laboratory Services

BHS Clinical Laboratory accepts clinical specimens on a referral basis. If a requested test is not available in the BHS Laboratory, the laboratory will arrange for transport of the specimen to another reference lab for testing. Testing performed by off-site reference labs may have increased turn-around times for results of 3 - 10 days.

Courier Service

Courier services for specimen pick up and report delivery may be arranged by contacting the Outreach Department. Courier runs are made on a regular schedule each weekday with limited STAT courier service available upon request. A STAT courier is available on weekends for life-threatening situations only.

Outpatient Services

Outpatient Laboratory services are provided at the Colonnades Laboratory.

Physicians referring a patient to BHS for outpatient work during a weekday should have an order phoned to the scheduling office prior to the patient's arrival. The scheduling office's phone number is 601-968-1400. All tests requiring more than 30 minutes for completion, such as glucose tolerance and coagulograms, must be scheduled at least 24 hours in advance. During regular business hours (6:15 a.m. - 6:00 p.m.) patients should report to the Outpatient Business Office located on the ground floor of the Colonnades Building. The patient will then be called to the Colonnades phlebotomy station or other appropriate drawstation for specimen collection.

Complete reports will be mailed or delivered to the physician's office. If requested, results will be faxed to the physician's office. All critical results are telephoned to the physician or nurse in charge of the patient.

Labeling Specimens

1. All specimens for laboratory testing should be labeled with the following information:
   • Patient's first and last name
   • Unique patient identifier (Eg. Inpatients, Patient Account #; Outreach Patients, Last four digits of social security number, date of birth, etc.)
   • Date and time of collection
   • Identification of collector (Initials)
2. All specimens for laboratory testing must be accompanied by a lab requisition slip or electronic order (inpatients). The request slip should contain the following information:
   • Patient's first and last name as it is presented on photo ID/Driver's license
   • Patient's birth date
   • Patient's sex
   • Patient's social security number
   • Patient's home address
   • Date and time of collection and collector's initials
   • Laboratory test(s) to be performed (include valid ICD-10 codes for each test ordered)
   • First and last name of physician requesting test
   • Specimen source
   • Call back/fax information if applicable
   • Name and address of clinic or hospital sending specimen
   • Clinical information when appropriate:
     • Medicare/Medicaid patients - include number and alpha code
     • Insurance company
     • Responsible party/guarantor information if patient is under 18 years of age
     • Group number
     • Policy number
     • Complete address and name of insurance company
     • Name and employer of policy holder
   • Signature of Medicare patient, advanced beneficiary notice, for all tests lacking medical necessity documentation.
3. Unlabeled or improperly identified specimens should be recollected. Outreach personnel will contact the clinic to request recollection of any unlabeled or improperly identified specimen. If recollection is not feasible and specimen is deemed "precious," the appropriate clinic personnel will be responsible for identifying the specimen.

The Outreach Department will acknowledge verification of the specimen only after being authorized by clinic personnel to do so. A note will be made upon admission that the specimen was received unlabeled, along with the name of the person at the clinic verifying the specimen. This information will be recorded on the appropriate quality assurance form.

Exceptions:

• All unlabeled or improperly identified specimens for cytology and histology are unacceptable and will be returned to the physician's office.

It is recommended that a copy of the requisition be maintained in the patient's file by the ordering facility.

Medical Necessity

Under section 1862(a)(1) of the Medicare law, claims submitted for service or supplies will only be paid if the service meets Medicare coverage criteria, and is "reasonable and necessary" for the beneficiary (patient), given his/her medical condition. If Medicare determines that a particular service, although it would otherwise be covered, is "not reasonable and necessary" under Medicare program standards, Medicare will deny payment for that service.

MEDICARE will pay only for service or supplies that:

• Are proper and needed for the diagnosis or treatment of the patient's medical condition according to coverage criteria.
• Are used for the diagnosis, direct care, and treatment of the patient's medical condition according to coverage criteria.
• Meet "frequency limitations."
• Are not for experimental or research use.
• Are not mainly for the convenience of the patient and his/her doctor.

Physicians are required by Federal law to provide a diagnosis that medically justifies the laboratory test(s) at the time of the request. Prior to furnishing the service, the physician/provider must present to the patient an Advanced Beneficiary Notice (ABN) that Medicare will probably deny payment and that the patient will be personally and fully responsible for payment if Medicare denies payment.

All diagnosis information should be designated in the spaces provided on the Outreach requisition for each requested laboratory test.

National Coverage Determinations (NCD) and Local Coverage Determinations (LCD) are readily available upon request or from CMS website(s).

ABN (Advanced Beneficiary Notice)

Details on the ABN form, when to use an ABN, and how to complete the form may be found at website:

Advanced Beneficiary Notice Information

Click here for the current MBHS ABN form. [PDF, 152 KB]

Order of Draw and Specimen Collection

Note: When using a winged collection set for venipuncture and a blue top is the first tube to be drawn, a discard tube should be drawn first (do not completely fill). The discard tube should be a non-additive (plain red) or an extra blue top.

To ensure that the chance of carry-over of anticoagulants/additives has a minimal effect on sample integrity, collect samples in this order.

1. BLOOD CULTURES
2. BLUE
3. GOLD
4. RED (CLOT ACTIVATOR)
5. LIGHT GREEN
6. GREEN
7. PINK
8. PURPLE
9. GRAY

Specimen Collection

• Always identify the patient prior to collecting samples by verifying the patient's full name and other unique identifiers such as the billing (encounter) number.
• If a sample is drawn from a line, at least 10 ml of blood must be drawn and discarded before the test sample is drawn. If heparin is used to flush the line, an equal amount of blood must be drawn and discarded before the test sample is drawn. It is recommended NOT to draw a PTT from a heparin flushed line.
• All tubes should be filled to the volume indicated on the label.
• Follow the correct order of draw when using evacuated blood collection tubes.
• A waste tube should be used to clear air from butterfly tubing when collecting a blue top first.

All tubes must be inverted gently for at least 8 times at collection. Gold top tubes must be allowed to clot at least 30 minutes prior to centrifugation.

DO NOT COLLECT SAMPLES FOR THERAPEUTIC DRUG MONITORING IN ANY TUBE THAT CONTAINS A GEL SEPARATOR. (I.E. GOLD TOP)

• Use aseptic technique when collecting blood samples, particularly if you are collecting blood cultures. Always allow the cleansing solution to dry prior to performing the venipuncture.
• Appropriately label all samples with:
  1. The patient's first and last name.
  2. A unique identifier (last four digits of Social Security Number, Date of Birth, etc.).
  3. Date and time specimen was collected.
• Do not remove the tops of vacutainer tubes. Do not transfer blood from one tube to another. Do not vigorously shake vacutainer tubes once they are filled with blood.
• Do not send samples to the laboratory in syringes with needles still attached.
• Please call the laboratory prior to drawing the blood for any test not included in the Laboratory Procedures List.

Specimen Packaging and Handling

Client specimen should be stored in one of the following three thermal environments depending upon the client, specimen, and test requirements:

• Ambient or room temperature
• Refrigerated
• Frozen

The viability of each specimen depends upon how well the thermal environment is maintained through the specimen transport process. All specimens must be maintained at the proper temperature to prevent the need to recollect due to thermal damage. The thermal environment of each specimen should be clearly defined by the client and the location of the specimen at the account.

Laboratory specimens are packed in primary, secondary, and tertiary containers for transportation.

Primary = tube, cup, or slide
Secondary = biohazard bag
Tertiary = Courier bag

• The client is responsible for primary and secondary packaging
• The courier is not to pick up a sample if the specimen container is contaminated or leaking
• Specimens with needles attached should not be transported
• The client should label all radioactive materials as such

Unacceptable Bacteriological Specimens

• Specimens received without a label or with incorrect label.
• Specimens received in unsterile container (i.e. ziplock bag) or on a dry swab.
• Stool specimen for OCP, Wright’s stain or fat stain which contains barium.
  *OCP in any fixative other than the Ecofix Vial (Green Label).*
• Foley cath tips are unacceptable for culture.
• Sputum collected in alcohol or fixative. Sputum that is obviously saliva.
• Pooled sputum collections (such as 24 hour collection for routine, AFB, or fungal cultures).
• Specimens for anaerobic culture collected in aerobic container.
• Urines in vacutainer tubes with the red and yellow marbled top.
• Specimens received in containers visibly contaminated on the outside.
• Specimens received on diapers, gloves, toilet paper, bed pans, plastic bags or any other inappropriate containers.

Unsuitable for anaerobic cultures

Sputum, Throats, NP, Bronchial washes, Vaginal or cervical swabs, Urines (voided), Stool (except for C. difficile).

Additional Notes for Bacteriology

Sites for lone anaerobic culture are highly unusual. It is recommended that both aerobic and anaerobic cultures be performed from the site being cultured.

The following culture types will include a gram stain automatically when ordered and billed separately from the culture for patient billed accounts:

Respiratory – sputum, gastric, bronchial washings, bronchial brush, etc.
External – wound, abdominal, abscess, etc.
Genital – vaginal, urethral, cervical, etc.
Body fluids – joint, spinal fluid, peritoneal, chest, ascites, etc.
OTHER – eye, surgical specimens, etc.
AFB cultures will include an AFB smear, and fungal cultures will include a KOH or a Wright stain.

Reflex or Supplementary Testing

Reflex testing

For some laboratory test results that meet reflex criteria, additional testing is generated to provide more conclusive laboratory information for diagnosis and treatment. Our reference labs may reflex other tests indicated as necessary.

	Clinical Pathology Reflex Testing
Test		Reflex Criteria	Additional Tests
WBG-whole blood glucose		> 600 mg/dl	Glucose, Blood
ANA Screen for Reflex		> or = 1.000	Centromere, dsDNA, SSA, SSB, RNP, SM, Scleroderma
Antibody Screen (Blood Bank)		Positive	Antibody Identification (panel)
		Positive – hospital in-house patient	Antibody Identification (panel) with 2 XM compatible units
C. difficile Toxin Panel by EIA		Disagreement with the EIA antigen and toxin results or an invalid result	Molecular C. difficile Toxin assay.
CBC with Diff		Abnormal Automated Diff (Flags Generated by Analyzer)	Manual Diff; Peripheral Smear Review/Consult Hematology by Pathologist (as needed)
Celiac Disease Comprehensive Panel ·  Tissue transglutaminase IgA ·  IgA		·  Positive ·  <10 mg/dl	·     Endomysial Ab Screen ·     Tissue transglutaminase IgG
Cryptococcal Antigen		Positive	Cryptococcal Titer
Drug Screen, serum or meconium		Positive (1 or more drugs)	Confirmation for specific drug(s) (sendout)
Fetal Screen (Blood Bank)		Positive	Fetal Hemoglobin Stain
Hepatitis C Virus antibody		Reactive	HCV Quantitative RNA, (HCV Viral Load)
Hgb Electrophoresis		Band in S position	Sickle Prep (If not previously performed)and citrate agar Hgb electrophoresis for Sickle disease confirmation
		Band in C (or other abnormal) position	Citrate agar Hgb electrophoresis
		Rare Hgb	HPLC Hgb evaluation
HIV Combo Ab/ Ag: HIV-1 and HIV-2 Antibody & HIV-1 p24 Ag		Reactive	HIV-1 & HIV-2 Differentiation

Clinical Pathology Reflex Testing continued

Surgical Pathology Reflex Testing

Test	Reflex Criteria	Additional Tests
Brain	Glioblastoma (malignant glioma)	IDH-1 R132H and MGMT Promoter Methylation
Breast or metastatic	Breast Cancer	ER, PR, HER2, (if HER2 = 2+ equivocal, order HER2 by FISH), Ki-67 (if tests not previously performed)
Breast	Ductal carcinoma in-situ (DCIS)	ER, if not previously performed
Colon resections	Colon Cancer (not squamous)	MMR panel (MLH1, MSH2, MSH6, PMS2). If MLH1 and PMS2 are ABSENT, send for BRAF. If BRAF Not Detected, do MLH1 Promoter Methylation Analysis), if either test not previously performed.
Endometrium	Endometrioid endometrial Carcinoma	MMR panel (MLH1, MSH2, MSH6, PMS2). If MLH1 shows Loss of MLH1, send for MLH1 Promoter Methylation Analysis, if not previously performed.
Esophagogastric junction (distal esophagus) on initial biopsies	Adenocarcinoma	HER2 by IHC with reflex to HER2 by FISH if 2+ (equivocal), if not previously performed
GYN cases	Carcinoma with serous component (not serous borderline tumors)	HER2 by IHC with reflex to HER2 by FISH if 2+ (equivocal), if not previously performed
Lung (other than small cell carcinoma)	Squamous cell/non-small cell/large cell, adenocarcinoma	ALK by IHC (if result is indeterminate, referral dept. will order ALK gene arrangement), EGFR, PD-L1, ROS-1 and PanTRK by IHC (if PanTRK expressed/ Equivocal test will reflex to NTRK Fusion Panel), if not previously performed
Oropharynx	Squamous cell carcinoma	P16 immunohistochemistry or other test for HPV unless previously done
Skin	Melanoma	BRAF, if not previously performed.
All stomach biopsies	Adenocarcinoma	HER2 by IHC with reflex to HER2 by FISH if 2+ (equivocal), if not previously performed.

Supplementary Testing

Supplementary testing will automatically be performed for the tests below which may be billed separately.

Initial Test	Supplementary Test(s)
Anaerobic Culture	Aerobic Culture
Coagulogram	Peripheral Smear Review by Pathologist plus indicated Factor Assays/Tests
Cryptococcal Antigen, CSF	CSF Culture
Directogen CSF	CSF Culture
Electrophoresis, Hemoglobin	Peripheral Smear Review by Pathologist
Electrophoresis, Immunofixation (IFE) Serum	Immunoglobulins (IgA, IgG, IgM)
Electrophoresis, Immunofixation (IFE) Urine	Urine Creatinine, Urine Protein
Electrophoresis, Protein	Total Protein
Microalbumin, Random Urine	Urine Creatinine
Urinalysis with reflex to culture	Urine Culture if >10 WBC/hpf