What the 21909 is for
The 21909 orders first trimester prenatal risk assessment: nuchal translucency on ultrasound plus serum b-hCG and PAPP-A, combined into a risk for common aneuploidies. It applies to patients whose ultrasound is done in the Edmonton, North or Central zones. It isn’t a diagnostic test, and it is a different order from cell-free DNA screening or diagnostic testing such as CVS.
Who completes it
The authorizing provider completes the patient and provider details and orders the test. The background questions are written to the patient, asking about ethnic background, diabetes, assisted reproduction, previous pregnancies with aneuploidy, smoking and weight. An NT-certified sonographer completes the ultrasound section when the measurements are available.
In most clinics the background questions get answered out loud during the visit and handwritten onto the requisition, or the patient fills them in at the lab, and gaps are common. In Medulla, you can send the background questions to the patient over a secure link before the prenatal visit. They answer on the requisition itself, their answers land on the PDF you complete the order on, and the lab gets one form with every field the risk calculation needs.
How to fill in the requisition
Patient and provider details
Enter PHN, legal name, date of birth, phone and address, and the authorizing provider with Connect Care provider or submitter IDs where you have them. Add copy-to providers, such as the obstetrician or midwife, so they receive the result.
Background
The form states a complete background is required for accurate risk assessment. Check that diabetes type and treatment at the time of collection, IVF or ICSI with fresh, frozen or donor eggs and the relevant age, ovulation induction, multiple gestation, total pregnancies, deliveries after 20 weeks and most recent weight are all filled in.
Ultrasound
The sonographer records the ultrasound date, fetal heart rate, crown-rump length, NT and nasal bone as present, absent or hypoplastic, or unable to assess. For twins, both fetuses and chorionicity. Their certification code and name are required.
Common reasons results are delayed or inaccurate
- An outdated version of the requisition without the current fields.
- Blood drawn outside 11 weeks 2 days to 13 weeks 6 days, or before the ultrasound.
- Background questions left blank, especially IVF details and weight.
- Missing sonographer certification code or NT measurements.
- The hypoplastic option for nasal bone missing because an old form was used.
Submitting and who pays
The patient takes the requisition to the ultrasound and to an APL collection site. Check the APL Test Directory for collection requirements. Results go to the authorizing provider and copy-to providers. Ordering is part of the prenatal visit, so there is no separate form fee.