New Tests and Test Updates

Nocardia Smear and Culture

Proven Diagnostics® has added a new test called “Nocardia Smear and Culture” (test code NCRD). Previously, this culture was included in a fungal culture (FCO) only when a specific comment (usually “look for nocardia”) accompanied the request. We have created this new test code to simplify the process and ensure that we are providing complete results.Specimen requirements/collection will remain the same.  Please see the test catalog for additional information.

Respiratory Virus Panel

Proven Dignostics now offers the xTAG RVP (Respiratory Virus Panel) assay. The xTAG RVP assay is a multiplex PCR assay that detects 12 respiratory viruses or viral subtypes (adenovirus, rhinovirus, human metapneumovirus, RSV types A and B, parainfluenza Types 1-3, influenza B, influenza A with subtypes H1 and H3).
 
The RVP assay offers several significant advantages over the direct antigen detection/rapid culture method currently used for the detection of respiratory viruses:

  • More rapid detection of respiratory viruses than currently used methods
  • Increased recovery for the viruses that we currently detect
  • Typing/subtyping of influenza A isolates
  • Detection of additional types of viruses

The commonly used rapid tests for influenza A cannot distinguish 2009 Influenza A/H1N1 (swine flu) from normal seasonal influenza A strains. In contrast, xTAG RVP can be used as an aid in the detection of 2009 Influenza A/H1N1.  The xTAG panel tests for the influenza A matrix gene shared by all subtypes, including swine flu.  It also includes specific probes for the seasonal strains of H1 and H3.  Testing carried out by the New York State Laboratory during the spring 2009 swine flu outbreak has shown that 99% of H1N1 swine flu specimens generate a “Flu A positive – nontypeable” result. Consequently, an Influenza A result that is neither H1 “seasonal” subtype nor H3 subtype can presumptively be identified as Influenza A/H1N1.  As a result, there are 4 possible types of positive Flu A results generated by the test:

  • Influenza A positive – nontypeable
  • Influenza A positive – seasonal H1
  • Influenza A positive – seasonal H3
  • Influenza A positive- probable novel H1N1 strain.

The RVP primers that detect rhinovirus cross-react with enterovirus. Consequently, a result of rhinovirus/enterovirus should be interpreted in conjunction with the clinical presentation.

The xTAG RVP assay requires the use of NP swab, per the FDA-approved product insert. We will not perform the xTAG RVP assay on NP aspirates, BAL specimens, or sputum/tracheal aspirate specimens. For any of these latter specimens, we will be performing the currently utilized culture method. We will continue to use the same standard viral transport media, Universal Transport Media (UTM), for transport of NP swab specimens to the laboratory for RVP testing.

The xTAG RVP assay is utilized in conjunction with the 3M rapid antigen assay for Influenza A or B and RSV.  The determination to screen for RSV and or Influenza A or B will be determined by age and season (RSV) and prevalence in the community (Flu A or Flu B). Specimens with negative rapid antigen test results will reflexively be tested using the xTAG RVP assay.

You can order this test by requesting Respiratory Viral Panel,  test code RVPCR.

New CPT codes

CPT code for BCXM is now 86826. 

CPT code for TCXM is now 86826.

Shiga Toxin Testing

Microbiology testing now include detection of Shiga toxin-producing E. coli as part of the routine stool culture. Therefore, in addition to Salmonella, Shigella, and Campylobacter, all stools will also be tested for Shiga toxin-producing E. coli. Four possible results may be reported:

(1) E. coli shiga toxin 1 detected.
     E. coli shiga toxin 2 not detected.
(2) E. coli shiga toxin 2 detected
     E. coli shiga toxin 1 not detected.
(3) E. coli shiga toxin 1 and shiga toxin 2 detected.
(4) E. coli shiga toxin 1 and shiga toxin 2 not detected.

CPT codes are now 87945, 87946 87015 and 87899 x2 for Stool Culture (STCUL) and 87045, 87046 x2, 87015, and 87899 x2 for Comprehensive Stool Culture (STCOM).


If we detect Shiga toxin, we will send a specimen to the PA Dept. of Health laboratory for confirmatory testing and organism typing.