McLaren Northern Michigan
Lab Specimen McLaren Northern Michigan

Lab Specimen Information

Specimen Handling

  1. When collecting multiple blood tubes the following is the recommended sequence:
    a) Blood Cultures
    b) Red Top
    c) Blue Top
    d) Gold SST Barrier
    e) Green Top, plain or SST
    f) Lavender Top
    g) Gray Top
  2. Mix ALL tubes with anticoagulants (especially Blue, Green, Lavender and Gray) by inverting 6-8 times after filling. Gold SST Barrier tubes and Red Top Tubes should be allowed to clot for at least 20 minutes before centrifuging.
  3. Do not remove the stopper on any blood tubes. Stoppers should remain on the tube prior to and during centrifugation. Barrier tubes must be centrifuged for at least 15 minutes at a speed of 3000-3500 RPM's. Centrifugation should occur within 30 minutes of drawing.
  4. When it is necessary to remove serum from a tube, use a disposable transfer pipette to place serum in a plastic screw top tube.
  5. Warning: All blood and body fluid should be considered as potentially infections. Gloves and a lab coat must be worn when procuring or handling blood and body fluid specimens. Blood procurement safety devices must be used when drawing blood. The safety devices and instruction on their use can be obtained from the McLaren Northern Michigan Laboratory.

Specimen Collection and Handling

Phlebotomy Services

The McLaren Northern Michigan Laboratory has five available draw sites for outpatient blood draws and/or specimen collection and drop off. Each patient must present with a Laboratory requisition form that has been completed by the requesting physician office. Click here to see our draw site locations.

Patients arriving after hours or on weekends or holidays should report to the McLaren Northern Michigan Laboratory on the lower level.

Specimen Referral

All specimens for testing not performed in the McLaren Northern Michigan Laboratory shall be sent to Mayo Medical Laboratory, a CAP accredited and approved laboratory.

McLaren Northern Michigan Laboratory Couriers

Courier services are available for transporting specimens to the McLaren Northern Michigan Laboratory from many locations throughout northern Michigan. This service provides same day delivery of specimens under controlled conditions. In many cases, couriers are already in place. Special courier services can be established. Frequency of pick-up is determined by testing volume.

Add-on Tests

Additional tests may be ordered on specimens already received in the McLaren Northern Michigan Laboratory. A signed laboratory requisition form must be sent or faxed to the laboratory for all additional tests prior to testing. The laboratory will determine if the retained specimens are suitable for additional testing.

Reporting Results

For most tests, the McLaren Northern Michigan Laboratory is able to fax or electronically print reports at preset times throughout the day. Please include all Attending, Consulting, and"Copy To" information including physicians first and last name, and fax number for accurate report routing. Couriers are also able to deliver results as necessary.

Cancellation of Tests

Cancellations received prior to test setup will be honored at no charge. Requests following test setup cannot be accepted. A report will be generated automatically and charged appropriately.

Confidentiality

The McLaren Northern Michigan Laboratory endeavors to maintain the confidentiality of all patient information. Results will not be given to a third party except in accordance with established release of information policy and procedure. To ensure the appropriate release of patient results in response to a telephone inquiry, the following steps are taken:

  • Laboratory staff will verify that the caller is the ordering physician, admitting, referring, "copy to" physician or their office staff, by checking the laboratory computer system order. If results are complete they may be given out. Whenever possible results are faxed to the office to avoid possible transcription or verbal error.
  • Non ordering, referring, etc. physicians or office staff calls may be transferred to McLaren Northern Michigan Medical Records during office hours for release of these test results, OR
  • The non-ordering, referring, etc. physician may complete and fax the McLaren Northern Michigan"Authorization for Release of Information" form. If needed, this form may be obtained by mail or fax from the McLaren Northern Michigan Laboratory.

Understanding Medical Necessity

Medicare is a federal program established in 1965 to provide health insurance for nearly everyone age 65 or older, those entitled to Social Security disability benefits and individuals requiring dialysis or renal transplantation for end stage renal disease (ESRD). There are two separate divisions within the Medicare Program, Part A which covers hospital insurance and Part B which covers medical insurance.

Unlike Part A - which is free to qualified persons - Medicare Part B is an optional program. Subscribers must enroll in the program and pay premiums in order to have Part B coverage. Part B does not cover all medical services, just like homeowner's insurance does not pay for all costs of home upkeep. A main concept to remember when understanding Part B coverage is that it does not pay for items or services that are not reasonable or necessary by accepted medical standards.

Reasonableness and medical necessity determinations are made by the Health Care Financing Administration, a division of the U.S. Health and Human Services Department, and local Medicare carriers. Carriers are entities that contract with HCFA to administer the Medicare Part B program. A contractual obligation of the carrier is to establish policies and lists of procedures, tests, and services which limit their payments to only those items that are medically necessary. It is the ordering physician who bears the burden of proof in medical necessity decisions. In that regard, the ordering physician is held to the standard of ensuring that the service is medically necessary by not only coding the service with an appropriate diagnosis, but also by documenting the necessity of the service in the patient's medical record. Compliance with medical necessity regulations, service documentation, and reporting is required by federal law.

Billing Information

In most cases, the McLaren Northern Michigan Billing Department will directly bill the patient's insurance for laboratory services. It is very important that the Laboratory Requisition Form be completely filled out with all of the pertinent insurance information.

Medicare & Medicaid

McLaren Northern Michigan accepts assignment for Medicare and Medicaid patients and will bill these programs directly.

Direct Billing for Laboratory Services

McLaren Northern Michigan can also directly bill for those patients wishing to pay out of pocket for laboratory testing. It is imperative that the Laboratory Requisition Form be completely filled out with all of the pertinent patient information. Pricing information for those tests which are performed through the McLaren Northern Michigan Laboratory is available from the Billing Department by calling 231.487-4855.

Compliance

To comply with federal laws, physicians should:

  • Only order tests that are medically necessary in diagnosing or treating their patients
  • Ensure that the medical necessity is documented per AMA/HCFA Guidelines
  • Be certain to enter the appropriate and correct ICD-10 code in both their patient files and on the test requisition form
  • Always have their patients sign and date the Advanced Beneficiary Notice (ABN) if they believe that the service is likely to be denied

Cytology Specimen Handling

Specimens Collected for Cytology

Follow the collection instructions for each specific cytology specimen. They can be found in the Lab Test Menu section.

Specimen Labeling

All specimens must have:

  • Patients full name (first and last)
  • Date of Birth
  • A unique identifier sticker from the requisition slip.
  • Date and time of collection
  • Initials of person collecting specimen

The Pathology Specimen Requisition must be filled out to include:

  • Patient's name
  • Date of Birth
  • Medical Record Number
  • Date of Service
  • Doctor's name
  • Specimen and Site (e.g.. Skin - right arm)
  • Pre-op diagnosis
  • Post-op diagnosis
  • Pertinent Clinical History
  • ICD-10 Diagnosis Code

All specimens must have:

  • Patient's full name (first and last)
  • Date of Birth
  • A unique identifier sticker from the requisition slip
  • Date

Microbiology Specimen Collection

Click here for Microbiology Specimen Collection Information

Specimen Rejection

Some specimens cannot be analyzed because of improper collection or degradation in transit. Other specimens may have prolonged turnaround times because of lack of necessary ancillary specimen(s) or patient information. Every effort will be made to test specimens unless results are compromised.

A specimen may be deemed unsatisfactory for processing for various reasons, including the following:

  • Insufficient volume
  • Unlabeled or improperly labeled
  • Laboratory Requisition Form is missing or has erroneous information
  • Improper collection
  • Damaged in transit
  • Contamination
  • Specimen integrity
  • Hemolysis or turbidity (if the test is performed, this condition will be noted on the report)
  • Failure to meet the preparation requirements for the specific procedure as outlined in the Laboratory Procedure Manual

Blood Collection and Handling Problems

  • Clotted for whole blood or plasma tests
  • Gross hemolysis or turbidity
  • Contaminated with IV fluid
  • Wrong tube used
  • Plasma not frozen if necessary
  • Damaged in transit
  • Delayed in transit

Urine Collection and Handling Problems

  • Urine obviously contaminated (e.g. Stool)
  • Urine not collected with proper preservative
  • Specimen not refrigerated after collecting and delivery
  • Specimen delayed (2 hours if not refrigerated, 24 hours if refrigerated)
  • Specimen obviously not a 24 hour collection

Culture Collection and Handling Problems

  • Specimen received obviously contaminated or damaged
  • Grossly contaminated specimen
  • Unrefrigerated urine culture received 2 hours after collection - no holding medium
  • 24 Hour delay in refrigerated or holding medium urine
  • 2 Hour delay in non-holding medium swab/fluid
  • 48 Hour delay in holding medium swab
  • 30 minute delay in non-holding medium swab for G.C.
  • 24 Hour delay in holding medium swab for G.C. culture
  • 2 Hour delay in sputum transport
  • 30 Minute delay in gastric aspirate transport\
  • 1 Hour delay in feces transport (if no holding medium or fixative)

Surgical Pathology

  1. Routine tissue biopsy specimens should be immediately placed in formalin fixative (obtain from the McLaren Norhtern Michigan Lab) in a tightly closed specimen container. Optimal fixation requires approximately a volume of fixative 10 times the volume of the specimen.
  2. Frozen Section, Surgical Pathology Consultation tissue specimens, and specimens for Lymphoma should be submitted without fixation, wrapped in saline moistened gauze, placed in a clean tightly closed container and immediately sent to the histology laboratory.
  3. A Pathology Specimen Requisition MUST accompany each tissue specimen. Instructions for submission of tissue are included on the back of the form.
  4. Specimen Identification - All specimens submitted to Surgical Pathology must have proper identification.

Complete identification and appropriate clinical data are required. Delays or specimen rejection can occur if required information is not included on the container and requisition slip.

Label the specimen container with:

  • Patient's name and birth date
  • Date of Service
  • Doctor's name
  • Specimen and Site (e.g. skin - right arm) or ID number from the requisition form

The Pathology Specimen Requisition must be filled out to include:

  • Patient's name and birth date
  • Date of Service
  • Medical record number
  • Doctor's name
  • Specimen and Site (e.g.. Skin - right arm)
  • Pre-op diagnosis
  • Post-op diagnosis
  • Pertinent Clinical History
  • ICD-10 Diagnosis Code