ROM plus

Test Code
LAB4133


Alias/See Also
Rupture of Membranes


CPT Codes
84112

Preferred Specimen
Swab


Specimen Stability
Ambient:  6 hours after swab placed in buffer


Reject Criteria (Eg, hemolysis? Lipemia? Thaw/Other?)
Significant amounts of blood


Methodology
Qualitative Immunochromatographic

Setup Schedule
Mon- Sun


Reference Range
Positive = Ruptured Amniotic Membrane
Negative = Intact Amniotic Membrane


Clinical Significance
The Clinical Innovations ROM Plus fetal membrane rupture test is a rapid, qualitative immunochromatographic test
for the in vitro detection of amniotic fluid in vaginal secretions of pregnant women with signs and symptoms of
ROM.


Performing Laboratory
Piedmont Athens Regional



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.