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80601M
XX / XY IN OPPOSITE SEX BONE MARROW TRANSPLANTATION, FLUORESCENCE IN SITU HYBRIDIZATION (FISH)

Test Code 80601M 
Test XX / XY IN OPPOSITE SEX BONE MARROW TRANSPLANTATION, FLUORESCENCE IN SITU HYBRIDIZATION (FISH) 
Methodology Fluorescence In Situ Hybridization (FISH) 
Description This procedure is handled as a consultation and includes an analysis of metaphase and interphase cells using FISH with probes for the X and Y chromosomes.
This information can be useful to monitor the success of bone marrow transplantation engraftment when the donor and recipient are of opposite sex. Monitoring the proportion of host and recipient cells over time may be useful to identify significant clinical changes.

NOTE: This test, when ordered on Medicare patients, is subject to the CMS Medicare Coverage Issues Manual (MCIM) Diagnostic Services policy "Cytogenetic Studies". Please verify that the diagnosis code (ICD-9) you have chosen demonstrates medical necessity for the test as documented in the physician's patient record. The CMS web site or the NorDx Limited Coverage Documentation Guide are available to assist you with this verification. A properly executed Advance Beneficiary Notice (ABN) must be submitted with the specimen if medical necessity is not demonstrated by the ICD-9 code chosen. 

Specimen NOTE: Please complete a Hematopathology/Molecular Oncology/Cytogenetics Request Form and forward it with the specimen.

Collect 1.0 - 2.0 mL (minimum: 1.0 mL) of bone marrow in a green-top (sodium heparin) tube. If bone marrow is not available, draw blood in green-top (sodium heparin) tube(s), and send 5.0 mL (minimum: 1.0-2.0 mL) of sodium heparin whole blood. Invert several times to mix bone marrow or blood. (CLOTTED BONE MARROW OR BLOOD IS NOT ACCEPTABLE.) Other anticoagulants may be harmful to the viability of the cells. Label vial with patient's name and laboratory control number. Send specimen refrigerated. SPECIMEN CANNOT BE FROZEN. 

Reference Values The reference value for interphase cells of normal, pre transplant females is up to 0.3% cells with XY signals and for normal, pre transplant males up to 0.6% cells with XX signals.

NOTE:
The efficacy of these probes is reported by Dewald GW, et al: Bone Marrow Transplant 12:149 - 154, 1993. 

Analytic Time 2 - 4 Days 
Day(s) Test Set Up Monday through Sunday 
CPT Code(s) 88271 x 2  DNA probe, each
88275  Interphase in situ hybridization
88291  Interpretation and report