TEST DIRECTORY... | MIDx Labs

GRAM STAIN WITH REFLEX TO SPUTUM CULTURE (SPCX)

Rapid microscopic evaluation of a respiratory specimen used to guide preliminary treatment decisions, with automatic reflex to sputum culture for definitive organism identification when specimen quality criteria are met.

LIS PANEL CODE: (MID) Gram Stain with Reflex to Sputum Culture

INDIVIDUAL LIS TEST CODES INCLUDED WITHIN PANEL: Sputum Culture, ORG, Squamous Epithelial Cells, White Blood Cells (WBCs), Gram Reaction, Bacterial Morphology

CPT CODE: 87205 (Gram Stain) + 87070 (Sputum Culture, if indicated)

ALIASES: SPCX, Sputum Gram Stain, Gram Stain and Culture, Sputum C&S

METHODOLOGIES: Gram Stain (Microscopic), Bacterial Culture (Aerobic & Anaerobic, Selective Media), with Reflex to Automated Organism Identification & AST

Laboratory Developed Test (LDT): Performance characteristics determined by Michigan Innovative Diagnostics. This test has not been cleared or approved by the FDA.

SPECIMEN:

- Type: Expectorated or Induced Sputum

- Container: Sterile Container

- Minimum Volume Required: 1 mL

- Storage/Handling: Instruct patient to produce a deep cough specimen (not saliva) directly into the sterile container. Transport to the laboratory promptly.

NOTE: Specimens deemed to be of poor quality (i.e., predominantly contaminated by saliva) may be rejected or have recollection requested prior to culture setup, per the Special Instructions section listed below.

- Stability:

Room Temperature (20-25 °C): 5 days

Refrigerated (2-8 °C): 5 days

Frozen (-20 or colder): Not Accepted

- Turnaround Time: 24 hours for Gram Stain findings; 48 – 72 hours if reflexed to culture.

Special Instructions: A large component of our specimen quality assessment relies on the use of Bartlett's Q score (# of PMNs + mucus, if present + # of Epithelial Cells) prior to culture setup:

Category A (Acceptable, Q score >= 1): Significant inflammatory response with minimal oral contamination — proceeds directly to routine sputum culture.

Category B (Borderline, Q score = 0): Moderate contamination with uncertain clinical significance; proceeds to culture only if Gram stain findings, predominant organism morphology, and available clinical history support a lower respiratory infection. Laboratory Supervisor review may be required.

Category C (Unacceptable, Q score < 0): Excessive oral contamination and poor representation of lower respiratory secretions; culture order is rejected and reported as "Specimen appears contaminated with oral flora and is not suitable for culture interpretation. Repeat specimen recommended."

NOTE: Laboratory Supervisor may authorize culture if specifically requested by the ordering provider. Any additional testing performed following reflex to culture will be added to the original order.

REJECTION REASONS: QNS, Specimen Represents Oral Contamination (Category C), Stability Violation, Unlabeled/Mislabeled Specimen, Incorrect Container

EXPECTED FINDINGS:

Gram Stain: Normal oropharyngeal flora expected; predominant organism morphology reported if present.

Sputum Culture (SPCX): No growth of pathogenic organisms expected; pathogen identification & AST reported if isolated.