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91411: ThinPrep® Pap and HPV mRNA HR E6/E7 with Reflex to HPV 16, 18/45 Print View
Source, Cervix (Y/N)      
Source, Endocervix (Y/N)      
Source, Vaginal (Y/N)      
LMP OR STATUS (MM/DD/YYYY      
Currently Pregnant (Y/N)      
Post Menopausal (Y/N)      
Post Partum (Y/N)      
TOTAL HYSTERECTOMY (Y/N)      
Supracerv Hysterect (Y/N)      
Hormon[HRT,BCP,Depo] (Y/N)      
IUD (Y/N)      
Vaccinated for HPV (Y/N)      
Hx HR HPV, Abn Pap/Tx/Bx)      
Abn Bleeding (Postcoital, PM)      
Personal/family Hx Gyn Ca(Y/N)      
Pelvic Irradiation (Y/N)      
DES Exposure (Y/N)      
No Pap in last 7 yrs (Y/N)      
Cigarette Smoker (Y/N)      
Other Risk Factors (Y/N)      
Other Findings, specify:      
ThinPrep(R) Pap      
HPV mRNA E6/E7   Not detected   
Additional Testing      

PRIMARY
1 PreservCyt(ThinPrep) 20 ( ) mL   Refrigerated - 30 Day(s)/Room Temperature - 30 Day(s)  
ALTERNATE

Collect cervical specimens in ThinPrep(R) Pap Test vials containing
PreservCyt(R) Solution with broom-type or cytobrush/spatula collection
devices according to the manufacturer's instructions.

If the ThinPrep(R) Aliquot Removal procedure will be used prior to
cytology processing, refer to the ThinPrep(R) 2000 or ThinPrep(R) 3000
System instructions for use on aliquot removal. Transfer 1 mL of the
removed aliquot into an APTIMA(R) Specimen Transfer tube according to
the instructions in the APTIMA(R) Specimen Transfer Kit package
insert.

If testing the specimen after cytology processing using the
ThinPrep(R) 2000 System, process the ThinPrep(R) liquid cytology
specimen in accordance with the ThinPrep(R) 2000 System
instructions for use and the APTIMA(R) Specimen Transfer Kit package
insert. Transfer and the APTIMA(R) Specimen Transfer Kit package
insert. Transfer 1 mL of the fluid remaining in the ThinPrep(R) Pap
test vial into an APTIMAr Specimen Transfer tube according to the
instructions in the APTIMA(R) Specimen Transfer Kit package insert.

Specimens should be transferred to an APTIMA(R) Specimen Transfer
tube within 30 days of collection if stored at room temperature (see
section 3.2).

ThinPrep PreservCyt(R) Solution Vials: 1 mL of PreservCyt(R) Solution
specimen must be transferred into 2.9 mL of APTIMA(R) specimen
transport media. Transfer into APTIMA(R) transport media tubes
contained in Specimen Transfer kits, Vaginal Swab collection kits,
or Unisex Swab collection kits.
Setup Schedule
Monday-Friday

Reported (Analytical Time)
5 days

CPT Codes
88142,87624

The CPT codes provided are based on AMA guidelines and are for informational purposes only. CPT coding is the sole responsibility of the billing party. Please direct any questions regarding coding to the payer being billed.

Notes
Methodology: Papanicolaou Staining/Bethesda System of Reporting, Target Capture, Transcription-Mediated Amplification (TMA), Hybridization Protection Assay (HPA) Transport Temperature: Room temperature If the Pap is Normal and the HPV mRNA E6/E7 is Detected, HPV, Genotypes 16,18/45 will be added at an additional charge (CPT code(s) 87625).






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