Code Information and Courses from MediaLab, Inc.

Alpha thalassemia demonstrates problems with alpha globin chain production. One to four loci that code for the alpha chain may be deleted from chromosome 16. The greater the number of loci deleted or inactivated, the greater the severity of the anemia which develops. Many different mutations exist that result from partial deletions of alpha genes. This unit of study deals only with the forms of alpha thalassemia that have entire loci deleted.

Beta thalassemia demonstrates problems with beta globin chain production. One or two loci that code for the beta chain may be deleted from chromosome 11. The greater the number of loci deleted or inactivated, the greater the severity of the anemia which develops. Many different mutations exist that result from partial deletions of beta genes. This unit of study deals only with the forms of beta thalassemia that have entire loci deleted. Deletions of additional globin genes coded for on chromosome 11 can result in such combinations as delta-beta thalassemia.

If a security seal is broken while being removed from the CCF or during the application of the first seal on the primary specimen vial, the collector should transfer the information to a new CCF and use the seals from the second CCF.If one seal is already in place on a specimen vial and second seal is broken while being removed from the CCF or is broken during application on the second specimen vial or while the employee is initialing either seal, the collector should initiate a new CCF and note in the "Remarks" section how the seals were broken. The seals from the second CCF should be placed perpendicular to the original seals to avoid obscuring information on the original seals. The donor must initial the second set of seals also. The initials on all the seals must match. The collector should then draw a line through the specimen ID number (and bar code if present) on the original seals to ensure that the laboratory does not use that number for reporting the results. The collector must not pour the specimen into new vials.

Much research has been conducted to identify the alphabet of the human cellular language otherwise known as the human genome. This identification or roadmap of the human genetic material has opened the door to the mainstreaming of molecular diagnostics within the clinical laboratory setting.While the mapping of the human genome project is complete, many times it is not necessary to be able to identify the entire sequence; rather, we can use the specific portion of the code that is unique to the disease or condition in question. These short portions of the genetic molecular sequence or oligonucleotides, can then be used as probes to seek out and detect or amplify the target sequence.

Term Definition Codon A three nucleotide base sequence that codes for an amino acid Genome The genetic code composed of 64 codons that code for 21 amino acids and 3 stop codons. (amino acids are the building blocks of proteins and stop codons stop the writing process much like a period at the end of a sentence) Nucleic acid Polymer made of monomers; two examples are RNA and DNA Transcription Process of transferring information from DNA into an RNA message Translation The formation of an amino acid from RNA Deoxyribonucleic Acid (DNA) A double-stranded polymer of nucleotides that houses genetic information Ribonucleic acid (RNA) Typically a single-stranded polymer that is much shorter than DNA but chemically similar with a few differences (e.g.- uracil replaces thymine). Replication Reproduction of DNA content from parent to daughter cell during cell division Amplification methods Techniques that increase the amount of the target, the detection signal, or the probe so that sequences are readily detected Fluorescence The emission of light at a longer wavelength when the light is excited at a shorter wavelength Oligonucleotide Short single-stranded nucleic acid Probe A nucleic acid used to identify a hybridization target Polymerase Chain Reaction (PCR) An amplification method performed in vitro

The United States Code, Title 22, Chapter 38, Section 2656f(d)(2) defines terrorism as: “Premeditated, politically motivated violence perpetrated against noncombatant targets by sub-national groups or clandestine agents.”  Terrorism, then, is the use of force or violence against persons or property in violation of the criminal laws of the United States for purposes of intimidation, coercion, or ransom. Terrorists use threats to create fear among the public in an effort to convince them that their government  is powerless to stop acts of terrorism.  It is also a way for the terrorists to get publicity for their causes.

As a clinical laboratory science worker in the state of Florida, you are bound by several sets of laws designed to protect you, your employer, and patients of the facility in which you work. This program summarizes the major pieces of legislation that govern Clinical Laboratory Science in Florida and explain how these laws affect you at your job. These are Chapter 483, Part III Florida Statutes: Clinical Laboratory Personnel, and Rules: Chapter 64B3, Florida Administrative Code. Important: This course is only a brief summary of Florida legislation. While every effort has been taken to include all relevant laws and requirements, we encourage you to review the complete legislation, available at http://www.doh.state.fl.us/mqa/ClinLab/clp_statutes.html.

CPT (Current Procedural Terminology) codes are used to describe specific tests or services. The amount of payment for a test is dependent on the CPT code. It is against the law to use the wrong CPT code for a test for the purpose of causing or increasing payment for a test. ICD-9CM (International Classification of Disease, 9th Edition, Clinical Modification) codes are used to classify diseases and conditions, and describe signs, symptoms and medical circumstances. ICD-9CM codes are used to indicate the medical necessity of a particular test. It is against the law to use the wrong ICD-9CM code for the purpose of causing or increasing payment for a test.

The HCFA (Health Care Financing Administration) Common Procedural Coding System (HCPCS) and the CPT (Current Procedural Terminology) codes are used to describe specific tests or services. The amount of payment for a test is dependent on the HCPCS or CPT code. HCPCS or CPT codes should be assigned under the supervision of the laboratory technical staff. Billing department employees should never change a HCPCS or CPT code without the approval of a manager or compliance officer. If a billing department clerk notices that a particular HCPCS or CPT code is being rejected by a payer they should report it to their manager. It is against the law to use the wrong HCPCS or CPT code for the purpose of causing or increasing payment for a test.

LMRPs (Local Medical Review Policies) are published by Medicare for some laboratory tests. They are usually developed for tests that can be used for screening or diagnosis of disease. LMRPs use CPT codes to identify the tests and ICD-9 codes to determine when coverage is allowed. If an LMRP test is ordered by a physician, an ICD-9 code that is included in the LMRP must be given to the laboratory or the Medicare program will not pay for the test. It is against the law for laboratory to change or add an ICD-9 code submitted by a physician. A laboratory should not submit a claim for an LMRP test that is not accompanied by an acceptable ICD-9 code. The Balanced Budget Act of 1997 made it illegal for physicians to order LMRP tests and not supply an ICD-9CM code with the order.

A Laboratory may not bill a Medicare Beneficiary for a test unless it notifies the patient in writing before the testing is done that Medicare is not going to pay for the test. This notice is called an ABN. Laboratories cannot make all Medicare beneficiaries sign ABNs. The ABN must contain the specific name of the test and give a specific reason the laboratory thinks payment for the test will be denied. The beneficiary should sign the ABN and a copy should be sent to the laboratory and one given to the beneficiary. The billing department must have evidence that the ABN has been signed before it bills a patient.A laboratory may bill Medicare even though it knows it will not be paid when it has evidence an ABN has been signed. A modifier (GA) must be added to the CPT code for a test where an ABN has been signed.

The setting is a billing office in a laboratory where two or more clerks work together in very close proximity with each other, so that each can easily see what the other is doing. A billing clerk notices that one of his fellow employees is changing or adding codes to requisitions he is processing. This employee is a friend of his and he knows that he really needs the job at the laboratory because he is a single parent raising two kids. He also knows that what the employee is doing is against the company's compliance policies.He asks the employee about it and is given the explanation that because the computer requires something to be entered in the ICD-9 code field and he only does this with non-Medicare patients, it doesn't matter. The employee explains that it saves him a lot of time he uses to call to get codes for the Medicare patients. What should this clerk do about this?Correct Answer: She should talk to the supervisor about the problem even if she talks to the employee about it and the employee says she will talk to the supervisor and stop doing it.Discussion: Every employee who becomes aware of a violation of the law or a compliance policy has a responsibility to take action, which includes reporting the problem to a supervisor or the compliance officer. It doesn't matter that these patients are not Medicare patients, the important thing is that the employee is violating a compliance policy. If this employee does not report the problem he is himself violating a compliance policy. If it is subsequently discovered that he knew and didn't report it, he could be terminated. If there is a need for refunds to be done or other action, it will not occur and could create a big problem for the lab in a subsequent audit or other action.

The setting is a billing office in a laboratory where clerks work in close proximity to each other, so that each can easily see what the other is doing. A billing clerk notices that one of his fellow employees is changing or adding codes to requisitions he is processing. This employee is a friend of his and he knows that he really needs the job at the laboratory because he is a single parent raising two kids. He also knows that what the employee is doing is against the company's compliance policies.He asks the employee about it and is given the explanation that because the computer requires something to be entered in the ICD-9 code field and he only does this with non-Medicare patients, it doesn't matter. The employee explains that it gives him more time to call for codes for the Medicare patients. What should this clerk do about this situation?Correct Answer: He should talk to the supervisor about the problem even if he talks to his fellow employee about it and the employee says he will stop doing it.Discussion: Every employee who becomes aware of a violation of the law or a compliance policy has a responsibility to take action, which includes reporting the problem to a supervisor or the compliance officer. It doesn't matter that these patients are not Medicare patients, the important thing is that the employee is violating a compliance policy. If this employee does not report the problem he is himself violating a compliance policy. If it is subsequently discovered that he knew and didn't report it, he could be terminated. The employee's addition of the codes could create a big problem for the lab iif an audit or inspection occurred.

The Healthcare Common Procedure Coding System (HCPCS) and the Current Procedural Terminology (CPT) codes are used to describe specific tests or services. The amount of payment for a test is dependent on the HCPCS or CPT code. HCPCS or CPT codes should be assigned under the supervision of the laboratory technical staff. Billing department employees should never change a HCPCS or CPT code without the approval of a manager or compliance officer. If a billing department clerk notices that a particular HCPCS or CPT code is being rejected by a payer they should report it to their manager. It is against the law to use the wrong HCPCS or CPT code for the purpose of causing or increasing payment for a test.

Local Medical Review Policies (LMRPs) are published by Medicare for some laboratory tests. They are usually developed for tests that can be used for screening or diagnosis of disease. LMRPs use CPT codes to identify the tests and ICD-9 codes to determine when coverage is allowed. If an LMRP test is ordered by a physician, an ICD-9 code that is included in the LMRP must be given to the laboratory or the Medicare program will not pay for the test. It is against the law for a laboratory to change or add an ICD-9 code submitted by a physician. A laboratory should not submit a claim for an LMRP test that is not accompanied by an acceptable ICD-9 code. The Balanced Budget Act of 1997 made it illegal for physicians to order LMRP tests and not supply an ICD-9CM code with the order.

In December of 1991, OSHA issued a standard to guard against occupational exposure to bloodborne pathogens. This standard, part 1910.1030 of the Code of Federal Regulations was published in the Federal Register.On November 27, 2001, OSHA published a compliance directive 2-2.69 that now includes the revisions to the original standard.These regulations are law!Many states have an additional occupation exposure statute that must be followed as well. Your supervisor will know if this applies to you.

Electrical space heaters are prohibited unless they are approved for use and inspected by your facility's management department. Space heaters are not permitted in hospital sleeping areas or in laboratories containing flammable liquids or gases.

The training requirements that are stated in the US Code of Federal Regulations at 49 CFR 172.704 must be met by all personnel who are involved in shipping hazardous materials in the United States and training must be completed within 90 days of employment or performance of the required hazmat function (relevant documented training from a previous employer is acceptable).These requirements include: General awareness/familiarization training Function-specific training Safety training Security awareness training (Category A substances) Safety training, must be provided by the facility where the infectious materials are packaged and must include: Emergency response information Measures to protect the employee from the hazards associated with hazardous materials to which they may be exposed in the work place, including specific measures the hazmat employer has implemented to protect employees from exposure Methods and procedures for avoiding accidents, such as the proper procedures for handling packages containing hazardous materials

Your personal appearance will also affect the impression you make. Comply with your facility’s dress code and personal appearance policies. Avoid strong perfume, excessively long fingernails, and open toed shoes.