Notifications Archive - CHI Health, Nebraska (NE) - Southwest Iowa (IA)
Please feel free to contact CHI Health Laboratory at 402-717-5227 with any questions. 

Change in Reflex Urine Culture Criteria Urinalysis (UA) with Culture
September 1, 2015

  • Change refers to orders for urinalysis (UA) with culture, if indicated.
  • Sole UA criterium for performing a reflex urine culture is now dipstick leukocyte esterase positive (greater than trace) with greater than 10 WBC/high power field on microscopic exam.
  • All other criteria (odor, bacteriuria, etc.) are discontinued.
  • Rationale is to reduce unnecessary urine cultures with concomitant reduction in the inappropriate treatment of asymptomatic bacteriuria
  • Urinalysis and urine culture may still be ordered separately

New eGFR Equation and Reference Range
July 21, 2015

On July 21, 2015 the CHI Health Laboratory switched to an IDM-traceable Creatinine assay as announced in the July Lab Update. This prompted some confusion with the new estimated GFR (eGFR) equation and reference range.  Below explains why patients previously reported as > 60 ml/min and normal, will now flag as low unless > 90 ml/min.


New Test Methodology: Creatinine
July 21, 2015

CHI Health Omaha labs including Schuyler, Missouri Valley and Corning will be switching to an IDM-traceable Creatinine assay. GFR’s will be calculated using the 2009 CKD-EPI equation and GFR’s will be reported to 90 mL/min/1.73 m2 New GFR equation GFR = 141 × min (creat /k, 1)a × max(creat /k, 1)-1.209 × 0.993Age × 1.018 [if female] ×1.159 [if black]
k=0.7 if female
k= 0.9 if male
a= -0.329 if female
a= -0.411 if male

CPT Code: 82565
Methodology: Enzymatic
Reference Range: Female: 0.5 – 1.1 mg/dl Male: 0.6-1.3 mg/dl
Specimen Type: One 5 mL serum separator tube (gold) or one 3 mL plasma separator tube-light green (Min: 1.0 mL whole blood)
Container Type: Serum separator tube-gold or PST-green
Stability: Room Temp: 8 hours; Refrig 7 days; Frozen (-20 °C) for 6 months months
Test Schedule: Saturday -Sunday
Turnaround Time: Same Day
Start Date: July 21, 2015
EPIC ORDERABLE: Creatinine, Serum
Fee Change: No Change
Special Handling: No Change

Now Performed at CHI Health F Street Lab: Homocysteine
July 7, 2015

Homocysteine will be performed at CHI Health Lab.

CPT Code: 83090
Methodology: Nephlometric
Reference Range: 3.2 – 10.7 µmol/L
Specimen Type: Serum or Plasma immediately placed in an ice bath
Container Type: SST/PST
Stability: Refrigerated: 7 day Frozen: 3 months
Test Schedule: Sunday-Saturday
Turnaround Time: Same Day
Start Date: Tuesday, July 7, 2015
EPIC ORDERABLE: Homocysteine, Serum
Fee Change: No Change

Specimen Handling: To minimize synthesis of homocysteine in erythrocytes after drawing, prepare the patient samples as follows:

  1. Store blood samples (serum and plasma) on ice immediately following venipuncture.
  2. Do not store blood samples at room temperature prior to centrifugation.
  3. Centrifuge within one hour to separate the serum or plasma from the blood cells.

Now Performed at CHI Health F Street Lab: Hepatitis B Core Total Antibodies
July 7, 2015

Hepatitis B Core Total Antibodies will be performed at CHI Health Lab.

CPT Code: 86704
Methodology: Chemiluminescent
Reference Range: Non-reactive
Specimen Type: 1 mL serum or plasma at 2-8 C. (Min: 0.5 mL)
Container Type: One 5 mL serum separator tube-gold or one 3 mL plasma separator tube-light green (Min: 1.0 mL whole blood)
Stability: Rm Temp 12 hours; Refrig 3 days; Frozen (-20 °C) 6 month
Test Schedule: Sunday-Saturday
Turnaround Time: Same Day
Start Date: Tuesday, July 7, 2015
EPIC ORDERABLE: Hepatitis B Core Antibody, Total
Fee Change: No Change

Remarks: Testing on patients

Specimen Requirement Change: Clozapine
July 1, 2015

The specimen container for Clozapine will change from the current lavender top-tube (EDTA) to a red top-tube.

Test Lab: PAML (No Change)
CPT Code: 80342
Specimen Type: new Red-Top Tube (previous Lavender)
Turnaround Time: new 1-3 days (previous1-4 days)
Preferred Volume: 0.5 ml (previous 1.0 ml)
Effective Date: July 1

Reference Range Change: Cortisol
June 15, 2015

A new antibody pool for Cortisol started to be used that changed the lower end of the reference range for both the AM and PM testing.

CPT Code: 82533
Methodology: Chemiluminescent
Reference Range: Specimens drawn outside the listed times do not have a reference range. Drawn between 0700 - 0900: 5.3 - 22.4 ug/dl Drawn between 1500 - 1700: 3.4 - 16.7 ug/dl
Specimen Type: Serum
Container Type: Serum Separator tube (gold)
Stability: Rm Temp 8 hours; Refrig: 2 days; Frozen: (-20°C) 6 months
Test Schedule: Sunday-Saturday
Turnaround Time: Same Day
Start Date: Monday, June 15, 2015
EPIC ORDERABLE: Cortisol, Random Cortisol, AM Cortisol, PM
Fee Change: No Change

Specimen Handling: Allow serum tube to clot completely at room temperature. Centrifuge within 2 hours of collection to separate serum from cells. Suggested collection time for Cortisol 7AM-9AM if drawn during this time order as Cortisol AM and 3PM-5PM if drawn at this time order Cortisol PM.

MICROBIOLOGY: BioFire Blood Culture “No Organism Detected” Results
June 1, 2015

The BioFire Blood Culture Identification system (BCID) is capable of detecting 24 microorganism targets, and 3 antibiotic resistance genes from a positive blood culture. Although these 24 microorganisms are the most commonly isolated pathogens from positive blood cultures, there are many organisms that may be present that cannot be detected by BioFire. Thus a result of “no organism detected” indicates a microorganism, not on the BCID target list, is growing in the blood culture. The identity of other microorganisms will be revealed by the conventional culture.


C. Difficile Testing by PCR
September 5, 2014 (Posted June 3, 2015)

Effective September 15, 2014, CHI Health Laboratory will be upgrading the PCR based assay for Clostridium difficile testing. There are no changes to sample collection or specimen handling conditions.

  • The new orderable in Cerner will be C. difficile by PCR
  • The assay will be run once daily with a cut-off time of 1:00 PM on Mon-Fri and 10:00 AM on Sat-Sun.


Reference Range Change: Osmolality (Serum/Plasma)
May 1, 2015

Effective May, 1, 2015 the reference range for Osmolality Serum/Plasma will change to 285-305 mOsm/kg. This change is based on a recently conducted patient reference range study at CHI Health Laboratory.

CPT Code: 83930
Methodology: Freezing Point Depression
New Reference Range: 285-305 mOsm/kg
Specimen Type: Serum or Plasma
Test Schedule: Sunday-Saturday
Turnaround Time: Same Day
Start Date: Friday, May 1, 2015


Reminder: Cortisol Timed Draws
May 1, 2015

  • Specimens drawn outside the listed times below do not have a reference range. Outside these times, order a Cortisol, Random.
  • Reference ranges are only valid if specimens are drawn during the correct timeframe as shown below.
    • Cortisol AM must be drawn during 0700 - 0900
    • Cortisol PM must be drawn during 1500 - 1700
CPT Code: 82533
Methodology: Chemiluminescent
Specimen Type: Serum
Test Schedule: Sunday-Saturday
Turnaround Time: Same day
EPIC Orderable: Cortisol, Random
  Cortisol AM
  Cortisol PM


Test Change: HIV 1& 2 Antibodies/Antigen
April 3, 2015

On April 3, 2015, the lab will change to 4th Generation HIV testing that allows detection of the p24 antigen.  In summary, for the screening of blood or for diagnosis, the current serologic window period represents a period of about 3-4 weeks when HIV infection cannot be demonstrated using antibody tests.  Methods that detect p24 antigen can shorten this period by about 1 week, although not all seronegative HIV-infected individuals will be identified.

Test to be Replaced: HIV 1&2 Antibodies  CPT 86703
New Test: HIV 1& 2 Antibodies/Antigen CPT 87389
Methodology Enzyme Immunoassay
Reference Range Negative
Specimen Type Serum or plasma
Test Schedule Monday-Friday, batched once per day
Turnaround Time 24-48 hours if negative
Start Date Friday, April 3, 2015
  • Positives will reflex to Human Immunodeficiency Virus Types 1 and 2 (HIV-1/HIV-2) Antibody Differentiation by Multispot CPT 86701, 86702. See algorithm
  • EPIC Users: New Epic orderable will be HIV1/2 Ag/AB. Remember to remove the previous orderable (HIV-1 and HIV-2 Antibodies) from any personal favorite list.
  • Other EMR users need to coordinate these changes with their appropriate analysts.


Billing Change: Midwest Pathology Pro Fees
March 1, 2015

Effective March 1, 2015, Midwest Pathology Specialists, anatomic and clinical pathologists group will no longer independently bill for their professional fees.   Their professional charges will be billed through
CHI Health, CHI Health Business Office 7261 Mercy Road Omaha, NE  68124.  
  • For specimens collected prior to March 1, 2015, patients will receive statements for professional fees from Midwest Pathology Services.  Questions for these charges should be referred to phone number 877-307-5864.
  • For specimens collected on and after March 1, 2015, patients will receive statements for professional fees from CHI Health.  Questions for these charges should be referred to phone number 402-717-4800 or 855-515-9372

New Test Keppra (Levetiracetam)
February 25, 2015

CPT 80177
Methodology Immunoassay
Reference Range 12.0-46.0 µg/ml
Specimen Type Serum or plasma (Do not use gel barrier tubes)
Test Schedule Daily (Monday-Sunday)
Turnaround Time Same Day
Approximate Start Date March 2, 2015


Test Methodology Change: Ammonia
January 30, 2015

  • Our Ammonia method has been revised by the manufacturer.
  • The new reference range is 11-35 umol/L.
  • Ammonia can no longer be sent frozen.

Modified Assay: 25OH Vitamin D
January 30, 2015

Our current vendor for 25OH Vitamin D has modified their assay to be in alignment with the
ID-LC/MS/MS 25(OH)vitamin D Reference Measurement Procedure (RMP) , the reference procedure for the Vitamin D Standardization Program (VDSP). Read more...

Test Methodology Change: Hemoglobin A1C (HGB A1C)
January 27, 2015

On January 27, 2015, Hemoglobin A1C methodology was changed to High-Performance Liquid Chromatography (HPLC).
  • No changes in patient results anticipated
  • CPT Code: 83021
  • LOINC Code: 17856-6

Changes in Ordering Laboratory Specimen Collection Supplies
November 10, 2014

Effective November 10, 2014, the following changes to ordering laboratory supplies will be implemented.

  • CHI Bergan Mercy Hospital Materials Management will fill orders for CHI Health CHI Clinics and independent (non-CHI) clinics. No changes to ordering for CHI Health hospitals.
  • CHI Health Couriers will deliver supplies to Omaha area CHI Health CHI Clinics and independent (non-CHI) clinics.
  • Capital Express will continue to deliver supplies to areas outside the Omaha area. Included in Nebraska are Blair, Fort Calhoun, Grand Island, Lincoln, Schuyler, Tekamah and in Iowa Corning, Dunlap, Glenwood, Logan, Missouri Valley, Oakland, and Woodbine. Read more...

Free and Total Testosterone for Female/Child Test Updates
July 18, 2014

Effective immediately, CHI Health Laboratory test requirements for Free and Total Testosterone for Females and Children require a Red Top Serum Tube as the only acceptable container type due to new methodology. Internal investigations at Pathology Associates Medical Laboratories, our Reference Lab, have indicated that use of SST tubes (Gold tops) may result in falsely elevated values. The online lab directory has been updated to reflect this change. 

Vitamin B1 Plasma versus Vitamin B1 Whole Blood -- Clarification
July 18, 2014

Due to the recent influx of issues with ordering and collection of Vitamin B1 (Thiamine), CHI Health Laboratory (ACL) is providing the following clarification between Vitamin B1 Plasma and Vitamin B1 Whole Blood. These specimens are not interchangeable.

 For the Vitamin B1 Plasma:

  • Used to monitor recent intake of Thiamine
  • EPIC Lab Order Summary will say "Vitamin B1".  The Cerner barcode label will say "VitB1PL". 
  • Collect - Green sodium / lithium heparin tube or Lavender EDTA.
  • Centrifuge and transfer plasma to an amber transport tube. The plasma must be protected from light.  The specimen will be rejected if it is not protected from light.
  • Write “Plasma” on the aliquot tube.
  • Send to Reference Lab frozen, as it is a critical frozen test.

 For Vitamin B1 Whole Blood:

  • Used to determine Thiamine deficiency
  • EPIC Lab Order Summary will say "Vitamin B1, whole blood".  The Cerner barcode label will say "VitB1WB".
  • Collect - Lavender EDTA or Green sodium / lithium heparin and protect tube from light
  • Do NOT centrifuge.  Transfer whole blood to an amber transport tube.  This specimen must be protected from light. It will be rejected if not protected from light.
  • Write “Whole Blood” on the aliquot tube.
  • Send to Reference Lab frozen, as it is a critical frozen test.

Please share this information with the appropriate staff.  

Reference Lab Changing to PAML 
June 16, 2014

Effective Monday, June 23rd, 2014, CHI Laboratory (ACL) will change our reference laboratory to Pathology Associates Medical Laboratories (PAML) in Spokane, WA. Reference lab is defined as the lab that performs testing that ACL does not perform. Some testing requirements may change, so please refer to the test directory located on for specimen requirements. Note that the barcode labels that print in your clinic will have "Send Out" printed on them for your send out specimens.

Beta hCG Tumor Marker Testing 
June 16, 2014

Beta hCG tumor markers will be performed at PAML so providers who would like to re-baseline their patients may do so. Re-baselining would be performed by evaluating two samples collected together to reestablish a baseline on two data points with the new methodology. In order to facilitate the re-baselining transition, a second tumor marker assay will be performed by the new method at no charge, Please contact Customer Service at 402-717-5227 to obtain the proper form to fill out and return with patient specimens. All re-baselining needs to be completed by October 1. 2014.

CHI Laboratory Is a "Preferred Provider"
for Patients with United Healthcare Coverage
June 2, 2014

A national lab has been calling on CHI Clinics and independent providers communicating that the CHI Laboratory is not a "Preferred Provider" for patients that are currently covered by United Healthcare.

The CHI Health Laboratory is listed as "Preferred Providers" by United Healthcare. Coverage benefits are maximized based on the agreement with CHI Health and UniNet.

CHI Health Laboratory provides locally -tested, quality laboratory results that are integrated within the CHI Health electronic health record to provide a continuum of care for our patients.

Volatiles testing no longer available at ACL 
May 6, 2014

Effective immediately, testing for volitaile chemicals, such as Ethylene Glycol, Methanol, and Isopropanol will no longer be offered.

Temperature Changes for the Specimen Storage and Transport of PT/INR and PTT
May 1, 2014

Blue top tubes (Na Citrate) for PT/INR and PTT testing must be stored and transported at room temperature.

Recommendations have changed for coagulation tests (PT / INR and PTT) as it has now been shown that coagulation Factors V and VIII are better preserved at room temperature, and the patient will get more accurate results.•

Quad Screen Analysis Upgrade
February 3, 2014

The Quad Screen analysis program upgrade for second trimester prenatal screening provides a number of important enhancements to ensure more accurate results.

Courier Request Option
January 20, 2014  

To help improve phone wait times, CHI Laboratory has added an option to the Client Service Phone line dedicated to
courier requests.

Cobas PCR Media-Potential Tube Leakage
January 20, 2014  

Effective immediately, CHI Laboratory has received notification from the manufacturer of Cobas PCR Urine sample kits that there is a defect and a potential for tube leakage.

Hepatitis C Virus RNA Qualitative PCR
January 16, 2014

Effective immediately, there is a critical change for the collection and submission of specimens for Hepatitis C Virus RNA Qualitative PCR test performed at ARUP. 

Tumor Markers Standardization
October 1, 2013

As we continue the integration of CHI Health Laboratory and Creighton Medical Laboratories; Effective October 1, 2013, we will standardize the methodologies used to perform Tumor Marker testing.  Please note the changes outlined in the letter from Drs. Patrick Bogard and Poonam Sharma.

Lab Alert Notification - Chlamydia trachomatis and Neisseria gonorrhoeae
August 23, 2013 

Positive samples for Chlamydia trachomatis and Neisseria gonorrhoeae will no longer be called to the provider.

Letter from Drs. Zanone and Bogard regarding Interface Issues
August 19, 2013

Many interface issues have been identified and corrected between the laboratory and the various EHR systems. 

Consolidation Announcement
July 1, 2013

On Monday, July 1, 2013, CHI Health Laboratory (AHL) and the Creighton Medical Laboratories (CML) consolidated operations, forming CHI Laboratory (ACL). This consolidation will continue to provide you the same testing selection with the same process.