Reflex Testing

As the number of tests increase, more clinicians seek guidance on test selection and interpretation. Physicians can request a laboratory evaluation of an abnormal test value or a specific clinical sign or symptom, and the MGH Clinical Laboratories can perform an appropriate series of tests in a sequence based upon the results of tests.

Reflex tests fall into two categories: standard industry practice (example: sensitivities and confirmations) and institutional practice based on standard staff practice. There is currently no CMS reimbursement policy for (or against) reflex testing. Tests that are reflexed should be reasonable and medically necessary. The medical community should approve reflex protocols.

The goals of reflex testing are:

• Support physician decision making
• Decrease time to diagnosis
• Reduce patient length of stay
• Decrease laboratory utilization

For your reference, here is the list of reflex testing algorithms in use at the MGH.

Reflex testing occurs when initial test results are positive or outside normal parameters and indicate that a second related test is medically appropriate.

These are the key requirements for the use of algorithms:

• Content of algorithm is medically appropriate
• Algorithm is used only when needed
• Rules are continually available to physician
• Physician has the option to select individual components of the algorithm