Bilirubin total + Bilirubin direct = Neonatal Bilirubin?

[CompBeth]

We have recently moved our testing to new Ortho analyzers. To get the result reported out as "Neonatal Bilirubin", the new analyzer measures total bili (82247) and direct bili (82248). Then a calculation is made with those results, conjugated and unconjugated bili and a delta bili to produce the neonatal bili result. We were told to report the end result using code 82247. Does anyone know if that is correct?

[Bill]

This is the way Ortho (Kodak) has advocated for 30+ years. There method does include the Delta Bili that liquid reagents do not include. The method works very well except when you transfer a neonate to regional NICU whose lab uses liquid reagent methods--the coorelation of neonates is not that good. Overall though, my experience with this method vs liquid is much better. The test CV for the slide method is excellent.

[CompBeth]

Thank you...sounds like a good move for us. Can you please affirm that you're reporting only the 82247 CPT code for the result, however?

[Bill]

I'm out of that loop--sorry

[Zagami]

The Coding and Payment Guide for the Physical Therapist (CPT) is a numeric code that codify for specific analyte determined by means a specified methodology with a automated or manual procedure that for Bilirubin Total & Direct is 82247 for Bilirubin total (Neonatal Bilirubin) and 82248 for Bilirubin direct when measured with Jendrassik-Grof modified methodology applied on automated instrument. Through Bilirubin total reagent are measured in single determination conjugated, unconjugated and delta bilirubin (neonatal samples contain little or no direct δ-bilirubin) that produce a single result Bilirubin total (Neonatal Bilirubin) identified with 82247 code in CPT, therefore your approach is correct. I for measure neonatal bilirubin employ plasma obtained by capillary whole blood and as method a Jendrassik-Grof modified methodology two liquid stable reagents (Sulfanilic Acid Reagent  : dissolve 5.58 g [32.2 mM] of sulfanilic acid to 15.5 -16 ml of HCl conc. 37% fuming and dilute to 500 ml con dH2O. Mix 250 ml [3.5 M] of DMSO with 250 ml [4.44 M] of ethylene glycol and fill up to 500 with dH2O. Mix the DMSO/ethylene glycol solution with the sulfanilic acid solution and store in polyethylene opaque at 4 °C stable 1 year. The solvent mixture of dimethyl sulfoxide, and ethylene glycol besides as solvent for the total bilirubin assay, eliminates interference from hemolysis [neonatal plasma] up to 10 g/L of hemoglobin; Sodium nitrite solution pH 8.0 : dissolve in 60 ml dH2O, 0.752 g [109 mM] of sodium nitrite, and 0.240 g [16.9 mM] of disodium hydrogen phosphate anhydrous [Na2HPO4], then 0.010 – 0.040 g [0.96 mM]  ethylenediaminetetraacetic acid tetrasodium salt dihydrate, and fill up to 100 ml with dH2O with final pH about 8.0. Store under refrigeration, at 4 °C, in  brown glass-stoppered bottle, resulting stable for 1 year, but must be discard if it becomes tinged with yellow. In aqueous solution the sodium nitrite is immediately degrade and convert itself to nitric oxide, while in a pH neutral or slightly alkaline solution, the sodium nitrite is stable). Ratio reagents SAR:sample:SNS is 1:0.1:0.01 and read Abs at 555 nm