ROM (Rupture of Membranes) Plus

Test Code
LAB5908 65


Alias/See Also
ROM
ROM PLUS
RUPTURE MEMBRANE


CPT Codes
84112

Includes
RUPTURE OF MEMBRANES


Instructions


Required Specimen



Specimen Rejection:
Sample too bloody (greater than 10% blood present).
Sample/buffer vial is received for testing with improper identification (no patient name, MR# or DOB, or without patient label).
Sample/buffer vial received for testing without collection time documentation.
Sample/buffer vial received for testing after 6 hours from collection time.
Sample/buffer vial received without the buffer in the vial.
Sample/buffer vial received without the swab left in the vial.


Transport Container
ROM DEVICE


Transport Temperature
Room Temperature


Specimen Stability
Store at Room Temp


Reference Range
Result Checking Type Values
Reference Range Negative
Abnormality - Critical  Positive


Clinical Significance
The ROM Plus test is a rapid, non-instrumented, qualitative test for the detection of amniotic fluid in the vaginal discharge of pregnant patients who report signs, symptoms or complaints suggestive of rupture of membranes. The test uses the principle of immunochromatography to detect human placenta protein-12 (PP12) and Alpha-feta Protein (AFP) present in the amniotic fluid of pregnant women. The ROM Plus Test is a lateral flow immunochromatographic device.

Specimen stable for 6 hours, ambient.


Performing Laboratory
MWH LAB SH LAB



The CPT Codes provided in this document are based on AMA guidelines and are for informational purposes only. CPT coding is the sole responsibility of the billing party. Please direct any questions regarding coding to the payor being billed. Any Profile/panel component may be ordered separately. Reflex tests are performed at an additional charge.