Test Change Alert #430
41
Undefined Department AATPH (AAT-PHENO) ............................................................................................................... ALPHA 1 ANTITRYPSIN PHENOTYPE 2/5/2015: Reference Ranges AILDR .................................................................................................................................................... AUTOIMMUNE LIVER EVAL RFLX 3/17/2015: New ASP23G (ASP23G ) ....................................................................................................................................... STREP PNEUMO ABS, IGG 3/17/2015: New: New Test - Replaces SPABGS BAMPH ...................................................................................................................................... AMPHETAMINES CONFIRM BILL ONLY 1/29/2015: Test Name,Reference Laboratory,CPT Codes,Please Note BBARB .................................................................................................................................................. BARBITURATE CONF BILL ONLY 1/29/2015: Test Name,Reference Laboratory,CPT Codes,Please Note BBENZ ......................................................................................................................................... BENZODIAZEPINES CONF BILL ONLY 1/29/2015: Test Name,Reference Laboratory,CPT Codes,Please Note BCANN ........................................................................................................................................ CANNABINOIDS CONFIRM BILL ONLY 1/29/2015: Test Name,Reference Laboratory,CPT Codes,Please Note BCOC ........................................................................................................................................................ COCAINE CONFIRM BILL ONLY 1/29/2015: Test Name,Reference Laboratory,CPT Codes,Please Note BETHAN ............................................................................................................................................ BILL ONLY ALCOHOL CONF RFLX 2/12/2015: New BFLUN .................................................................................................................................................. FLUNIT REFLEX TEST BILL ONLY 1/29/2015: Test Name,Reference Laboratory,CPT Codes,Please Note BFORRO ............................................................................. FORENSIC ROHYPNOL CONFIRMATION REFLEX TEST BILL ONLY 1/29/2015: Test Name,Reference Laboratory,CPT Codes,Please Note BHISUR ......................................................................................................................................... BILL ONLY HISTO AG UR QUAL POS 3/17/2015: New BKETAM ...................................................................................................... KETAMINE CONFIRMATION REFLEX TEST BILL ONLY 1/29/2015: Test Name,Reference Laboratory,CPT Codes,Please Note BLSDSC .................................................................................................................................................... LSDSCO CONFIRM BILL ONLY 1/29/2015: Test Name,Reference Laboratory,CPT Codes,Please Note BLSDUC .................................................................................................................................................... LSDSCO CONFIRM BILL ONLY 1/29/2015: Test Name,Reference Laboratory,CPT Codes,Please Note BMETH ..................................................................................................................................................... METHADONE CONF BILL ONLY 1/29/2015: Test Name,Reference Laboratory,CPT Codes,Please Note BOPIAF ............................................................................................................................................... OPIATES, FREE CONF BILL ONLY 1/29/2015: Test Name,Reference Laboratory,CPT Codes,Please Note BOPIAT ............................................................................................................................................ OPIATES, TOTAL CONF BILL ONLY 1/29/2015: Test Name,Reference Laboratory,CPT Codes,Please Note BOPIS .......................................................................................................................................................... OPISCO CONFIRM BILL ONLY 1/29/2015: Test Name,Reference Laboratory,CPT Codes,Please Note BOPISE ........................................................................................................ OPIATES SERUM CONFIRM REFLEX TEST BILL ONLY 1/29/2015: Test Name,Reference Laboratory,CPT Codes,Please Note BPROP ............................................................................................................................................. PROPOXYPHENE CONF BILL ONLY 1/29/2015: Test Name,Reference Laboratory,CPT Codes,Please Note CLAXSN (CLAXSN.2015) ..................................................................................................... CATHARTIC LAXATIVES PROF, STOOL 1/29/2015: CPT Codes,Please Note CUM12A (CUMB12A.2015) .......................................................................................................................... CORDSTAT 12 SCR W/ALC 1/29/2015: CPT Codes,Please Note CUM13A (CUM13A.2015) ........................................................................................................................... CORDSTAT 13 SCR W/ALC 1/29/2015: CPT Codes,Please Note Test Change Alert #430 February 16, 2015 Summary Of Changes page: 1
Transcript of Test Change Alert #430
Undefined Department
AATPH (AAT-PHENO) ............................................................................................................... ALPHA 1 ANTITRYPSIN PHENOTYPE2/5/2015: Reference Ranges
AILDR .................................................................................................................................................... AUTOIMMUNE LIVER EVAL RFLX3/17/2015: New
ASP23G (ASP23G ) ....................................................................................................................................... STREP PNEUMO ABS, IGG3/17/2015: New: New Test - Replaces SPABGS
BAMPH ...................................................................................................................................... AMPHETAMINES CONFIRM BILL ONLY1/29/2015: Test Name,Reference Laboratory,CPT Codes,Please Note
BBARB .................................................................................................................................................. BARBITURATE CONF BILL ONLY1/29/2015: Test Name,Reference Laboratory,CPT Codes,Please Note
BBENZ ......................................................................................................................................... BENZODIAZEPINES CONF BILL ONLY1/29/2015: Test Name,Reference Laboratory,CPT Codes,Please Note
BCANN ........................................................................................................................................ CANNABINOIDS CONFIRM BILL ONLY1/29/2015: Test Name,Reference Laboratory,CPT Codes,Please Note
BCOC ........................................................................................................................................................ COCAINE CONFIRM BILL ONLY1/29/2015: Test Name,Reference Laboratory,CPT Codes,Please Note
BETHAN ............................................................................................................................................ BILL ONLY ALCOHOL CONF RFLX2/12/2015: New
BFLUN .................................................................................................................................................. FLUNIT REFLEX TEST BILL ONLY1/29/2015: Test Name,Reference Laboratory,CPT Codes,Please Note
BFORRO ............................................................................. FORENSIC ROHYPNOL CONFIRMATION REFLEX TEST BILL ONLY1/29/2015: Test Name,Reference Laboratory,CPT Codes,Please Note
BHISUR ......................................................................................................................................... BILL ONLY HISTO AG UR QUAL POS3/17/2015: New
BKETAM ...................................................................................................... KETAMINE CONFIRMATION REFLEX TEST BILL ONLY1/29/2015: Test Name,Reference Laboratory,CPT Codes,Please Note
BLSDSC .................................................................................................................................................... LSDSCO CONFIRM BILL ONLY1/29/2015: Test Name,Reference Laboratory,CPT Codes,Please Note
BLSDUC .................................................................................................................................................... LSDSCO CONFIRM BILL ONLY1/29/2015: Test Name,Reference Laboratory,CPT Codes,Please Note
BMETH ..................................................................................................................................................... METHADONE CONF BILL ONLY1/29/2015: Test Name,Reference Laboratory,CPT Codes,Please Note
BOPIAF ............................................................................................................................................... OPIATES, FREE CONF BILL ONLY1/29/2015: Test Name,Reference Laboratory,CPT Codes,Please Note
BOPIAT ............................................................................................................................................ OPIATES, TOTAL CONF BILL ONLY1/29/2015: Test Name,Reference Laboratory,CPT Codes,Please Note
BOPIS .......................................................................................................................................................... OPISCO CONFIRM BILL ONLY1/29/2015: Test Name,Reference Laboratory,CPT Codes,Please Note
BOPISE ........................................................................................................ OPIATES SERUM CONFIRM REFLEX TEST BILL ONLY1/29/2015: Test Name,Reference Laboratory,CPT Codes,Please Note
BPROP ............................................................................................................................................. PROPOXYPHENE CONF BILL ONLY1/29/2015: Test Name,Reference Laboratory,CPT Codes,Please Note
CLAXSN (CLAXSN.2015)..................................................................................................... CATHARTIC LAXATIVES PROF, STOOL1/29/2015: CPT Codes,Please Note
CUM12A (CUMB12A.2015).......................................................................................................................... CORDSTAT 12 SCR W/ALC1/29/2015: CPT Codes,Please Note
CUM13A (CUM13A.2015) ........................................................................................................................... CORDSTAT 13 SCR W/ALC 1/29/2015: CPT Codes,Please Note
Test Change Alert #430 February 16, 2015
Summary Of Changes
page: 1
CUMB12 (CUMB12.2015)..................................................................................................................... CORDSTAT 12 DRUG SCR PNL1/29/2015: CPT Codes,Please Note
CUMB13 (CUMB13.2015)..................................................................................................................... CORDSTAT 13 DRUG SCR PNL1/29/2015: CPT Codes,Please Note
CUMB5 (CUMB5.2015)............................................................................................................................ CORDSTAT 5 DRUG SCR PNL1/29/2015: CPT Codes,Please Note
CUMB7 (CUMB7.2015)............................................................................................................................ CORDSTAT 7 DRUG SCR PNL1/29/2015: CPT Codes,Please Note
CUMB9 (CUMB9.2015)............................................................................................................................ CORDSTAT 9 DRUG SCR PNL1/29/2015: CPT Codes,Please Note
DANT (DANT.2015)........................................................................................................................................................................ DANTRIUM2/2/2015: Store and Transport,Preferred Volume,Minimum Volume,Room Temp,Refrigerated,Frozen -20c,Unacceptable Condition,TestSchedule,Turnaround Time,Please Note
DRASER (DRA1.2015) ........................................................................................................... DRUG/ALCOHOL SCRN, SERUM RFLX1/27/2015: Reflex Condition,Reflex Test Name,Reflex CPT codes,Reflex Billing Codes
DRUSER (DRU1.2015)........................................................................................................................... DRUG SCREEN, SERUM RFLX1/27/2015: Reflex CPT codes,Reflex Billing Codes
HISAG ................................................................................................................................................................................ HISTOPLASMA AG3/17/2015: Delete: This test is being discontinued. Use the ordercode HISAGB to order this test.
HISAGB ............................................................................................................................................................................ HISTOPLASMA AG3/17/2015: New: New Test - Replaces HISAG
LDLPS ............................................................................................................................................................................ LDL PARTICLE SIZE3/17/2015: Delete: This test is being discontinued. Use the ordercode LDLPSR to order this test.
LDLPSR ........................................................................................................................................................................ LDL PARTICLE SIZE3/17/2015: New: New Test - Replaces LDLPS
MEC12 (MEC12.2015)............................................................................................................................. MECONIUM 12 DRUG SCREEN1/29/2015: CPT Codes,Please Note
MEC12A (MEC12A.2015)........................................................................................................................... MECONIUM 12 DRUG + ALC1/29/2015: CPT Codes,Please Note
MEC13 (MEC13.2015)............................................................................................................................. MECONIUM 13 DRUG SCREEN1/29/2015: CPT Codes,Please Note
MEC13A (MEC13A.2015)........................................................................................................................... MECONIUM 13 DRUG + ALC1/29/2015: CPT Codes,Please Note
MEC5 (MEC5.2015) .................................................................................................................................... MECONIUM 5 DRUG SCREEN1/29/2015: CPT Codes,Please Note
MEC5A (MEC5A.2015)................................................................................................................................... MECONIUM 5 DRUG + ALC1/29/2015: CPT Codes,Please Note
MEC7 (MEC7.2015).......................................................................................................................................... MECONIUM 7 DRUG SCRN1/29/2015: CPT Codes,Please Note
MEC7A (MEC7A.2015) .......................................................................................................... MECONIUM 7 DRUG SCRN + ALCOHOL1/29/2015: CPT Codes,Please Note
MEC9SC (MEC9SC.2015)....................................................................................................................... MECONIUM 9 DRUG SCREEN1/29/2015: CPT Codes,Please Note
OPISCO (OPISCO.2015) ..................................................................................................................................................... OPIATES RFLX1/27/2015: Reflex CPT codes
ORAL10 (ORAL10.2015).................................................................................................................................................... ORAL FLUID 101/29/2015: CPT Codes,Please Note
ORAL12 (ORAL12.2015)................................................................................................................................................... ORAL FLUID 12 1/29/2015: CPT Codes,Please Note
Test Change Alert #430 February 16, 2015
Summary Of Changes
page: 2
ORAL5 (ORAL5.2015) .......................................................................................................................................................... ORAL FLUID 5 1/29/2015: CPT Codes,Please Note
ORAL7 (ORAL7.2015) ......................................................................................................................................................... ORAL FLUID 7 1/29/2015: CPT Codes,Please Note
ORAL9 (ORAL9.2015) .......................................................................................................................................................... ORAL FLUID 9 1/29/2015: CPT Codes,Please Note
SJCABI .................................................................................................................................................. STRATIFY JCV AB, INDEX, RFLX2/12/2015: Reflex Billing Codes,Please Note
SJCVAB ................................................................................................................................................................ STRATIFY JCV AB RFLX2/12/2015: Reflex Billing Codes,Please Note
SPABGS ..................................................................................................................................... S. PNEUMONIAE IGG ABS/SEROTYPE3/17/2015: Delete: This test is being discontinued. Use the ordercode ASP23G to order this test.
TOXPCR ...................................................................................................................................................... TOXOPLASMA GONDII (PCR)1/19/2015: Synonyms,Supply Item Number,Specimen Type,Minimum Volume,Specimen Processing,Room Temp,Refrigerated,Frozen -20c,Unacceptable Condition,Alternate Specimens,Turnaround Time,Method
ZINCSA .............................................................................................................................................................. ZINC, SERUM OR PLASMA3/17/2015: Delete: This test is being discontinued. Use the ordercode ZN to order this test.
ChemistryCARB .................................................................................................................................................................................. CARBAMAZEPINE
3/17/2015: Delete: This test is being discontinued. Use the ordercode CARBA to order this test. CARBA .............................................................................................................................................................................. CARBAMAZEPINE
3/17/2015: New: New Test - Replaces CARB CONV (CONV-PAN)................................................................................................................................... ANTI CONVULSANT PROFILE
3/17/2015: Delete: This test is being discontinued. Use the ordercode CONVUL to order this test. CONVUL ..................................................................................................................................................... ANTI CONVULSANT PROFILE
3/17/2015: New: New Test - Replaces CONV CORAM .................................................................................................................................................................................... CORTISOL, AM
3/17/2015: Frozen -20c,Department CORP (COR-2)....................................................................................................................................... CORTISOL PAIRED SPECIMENS
3/17/2015: Frozen -20c,Department CORRAN .................................................................................................................................................................... CORTISOL, RANDOM
3/17/2015: Frozen -20c,Department CST (COR-STIM)...................................................................................................................................... CORTISOL STIMULATION TEST
3/17/2015: Frozen -20c,Department CST3 (COR-STIM2).......................................................................................................................... CORTISOL STIMULATION (3 SPEC)
3/17/2015: Frozen -20c,Department DIG ........................................................................................................................................................................................................... DIGOXIN
3/17/2015: Delete: This test is being discontinued. Use the ordercode DIGOX to order this test. DIGOX ................................................................................................................................................................................................. DIGOXIN
3/17/2015: New: New Test - Replaces DIG DIL ..................................................................................................................................................................................................... PHENYTOIN
3/17/2015: Delete: This test is being discontinued. Use the ordercode PHTN to order this test. HBSAG ................................................................................................................................................. HEPATITIS B SURFACE AG RFLX
3/17/2015: Reference Ranges HBSAGC (HBSAG.CONFIRM) ........................................................................................................................ HBSAG CONFIRMATION
3/17/2015: Department,Reference Ranges HDL .................................................................................................................................................................................. HDL CHOLESTEROL
3/17/2015: Test Name,Reference Ranges PHB ....................................................................................................................................................................................... PHENOBARBITAL
Test Change Alert #430 February 16, 2015
Summary Of Changes
page: 3
3/17/2015: Delete: This test is being discontinued. Use the ordercode PHNB to order this test. PHNB ................................................................................................................................................................................... PHENOBARBITAL
3/17/2015: New: New Test - Replaces PHB PHTN ............................................................................................................................................................................................... PHENYTOIN
3/17/2015: New: New Test - Replaces DIL PRMPH ...................................................................................................................................................... PRIMIDONE AND METABOLITE
3/17/2015: New: New Test - Replaces PRPH PRPH (PRM) ............................................................................................................................................. PRIMIDONE AND METABOLITE
3/17/2015: Delete: This test is being discontinued. Use the ordercode PRMPH to order this test. RENALA ............................................................................................................................................................ RENAL FUNCTION PANEL
3/17/2015: Reference Ranges RENALD ............................................................................................................................................. RENAL FUNCTION PANEL W/GFR
3/17/2015: Synonyms,Reference Ranges TSHREF (TSH.R)................................................................................................................................................................. TSH (RFLX FT4)
3/17/2015: Room Temp,Refrigerated,Frozen -20c,Reference Ranges VALPRO ............................................................................................................................................................................. VALPROIC ACID
3/17/2015: New: New Test - Replaces VALP Chemistry, Special Immunology
HBCHR ..................................................................................................................................................... HBV PROGNOSIS PANEL RFLX3/17/2015: Department,Reference Ranges
HematologyEOSBOD (NASAL)....................................................................................................................... EOSINOPHILS, BODY SECRETIONS
3/17/2015: Reference Ranges Immunochemistry
VALP (VALPROIC) .............................................................................................................................................................. VALPROIC ACID3/17/2015: Delete: This test is being discontinued. Use the ordercode VALPRO to order this test.
MicrobiologyCMRSA .................................................................................................................................................. CULTURE, MRSA SCREEN RFLX
2/5/2015: Supply Item Number,Reflex Condition,Reflex Test Name,Reflex CPT codes,Reflex Billing Codes,Please Note,Please Note CSTAPH .................................................................................................................... CULTURE, STAPHYLOCOCCUS SCREEN RFLX
2/5/2015: Supply Item Number,Please Note MRSPCR (MRSPCA) ............................................................................................................................... MRSA NASAL SCREEN (PCR)
1/26/2015: Unacceptable Condition Molecular Genetics
HIVGT3 ........................................................................................................................................................................... HIV-1 GENOTYPING3/17/2015: New: New Test - Replaces HIVGT2
Special ImmunologyHISAGU ........................................................................................................................................... HISTOPLASMA AG, UR QUAL RFLX
3/17/2015: New Toxicology
KEP ................................................................................................................................................................... KEPPRA (LEVETIRACETAM)1/29/2015: CPT Codes,Please Note
LAMI ............................................................................................................................................................................................ LAMOTRIGINE1/29/2015: CPT Codes,Please Note
ZONI ............................................................................................................................................................................................... ZONISAMIDE1/29/2015: CPT Codes,Please Note
Toxicology, Separation ScienceDA600 ............................................................................................................................................................ DRUGS OF ABUSE 600 RFLX
3/17/2015: Please Note
Test Change Alert #430 February 16, 2015
Summary Of Changes
page: 4
EXDS ...................................................................................................................................................... EXTENDED DRUG SURVEY RFLX3/17/2015: Please Note
VirologyAPTTV ...................................................................................................................................................................... T. VAGINALIS (APTIMA)
1/29/2015: CPT Codes,Please Note HCVGTY ................................................................................................................................................... HCV GENOTYPE (PCR/PROBE)
2/13/2015: CPT Codes,Notes,Please Note HIVGT2 ............................................................................................................................................................................ HIV 1 GENOTYPING
3/17/2015: Delete: This test is being discontinued. Use the ordercode HIVGT3 to order this test.
Test Change Alert #430 February 16, 2015
Summary Of Changes
page: 5
ALPHA 1 ANTITRYPSIN PHENOTYPETest Code AATPH
Billing Code AAT-PHENOEffective 2/5/2015
ReferenceRanges
Title Ranges Units
AAT-Phenotype
Alpha-1-Antitrypsin 90-200 mg/dL
Interpret with caution if the patient has been transfused previous 21 days.
Test Change Alert #430 February 16, 2015
The following tables reflect revisions only; other existing data remain unchanged.
page: 6
AUTOIMMUNE LIVER EVAL RFLXTest Code AILDR
Billing Code AILDREffective 3/17/2015
Synonyms
Autoimmune Liver Disease Evaluation with Reflex to Smooth Muscle Antibody (SMA), IgG by IFA; AMA M2; anti-M2; Antinuclear Antibodies; F Actin; F-Actin (Smooth Muscle) Antibody, IgG; Liver-Kidney Microsome-1 Antibody,IgG; LKM1 IgG; Mito M2; Mitochondrial Antibodies; Mitochondrial M2 Antibody, IgG; SMA Titer; Smooth MuscleAntibodies; Smooth Muscle Antibody, IgG Titer
Container Type Serum separator tube (gold, brick, SST, or corvac)
Supply ItemNumber
1467
Store andTransport
Refrigerated
Specimen Type Serum
Preferred Volume 1.0 mL
Minimum Volume 0.6 mL
SpecimenProcessing
Separate serum from cells ASAP or within 2 hours of collection and transfer to a standard PAML aliquot tube.
Room Temp 2 days
Refrigerated 2 weeks
Frozen -20c 1 year (avoid repeated freeze/thaw cycles)
UnacceptableCondition
Non-serum specimens; contaminated, heat-inactivated, grossly hemolyzed, grossly icteric, severely lipemicspecimens, or inclusion of fibrin clot
ReferenceLaboratory
ARUP
Reference labTest Code
2007210
CPT Codes 83516 x 2, 86376
Test Schedule Daily: Mitochondrial M2 Antibody, IgG and F-Actin; Sun, Tue, Thu: Liver-Kidney Microsome - 1 Antibody, IgG
Turnaround Time 2-5 days
Method Semi-Quantitative Enzyme-Linked Immunosorbent Assay/Semi-Quantitative Indirect Fluorescent Antibody
ReferenceRanges
Title Ranges Units
F Actin 0-19 Units
Mitochondrial M2 Ab IgG 0.0-20.0 Units
Liver Kid Microsome 0.0-24.9 Units
Smooth Muscle Ab IgG < 1:20 Titer
ReferenceRanges
continued
Notes Ordering Recommendation: Initial test in conjunction with ANCA-associated vasculitis profile for evaluation ofautoimmune liver disease.
Reflex Testing
Reflex Condition Reflex Test Name Reflex CPT codes Reflex Billing Codes
If F-Actin, IgG result is 20 Unitsor greater
Smooth Muscle Antibody, IgGTiter
86256 SMAGG
New New Test
Please Note This test may reflex to additional tests depending upon the results of this test. An additional fee will be added if thereflex test is necessary.
Test Change Alert #430 February 16, 2015
The following tables reflect revisions only; other existing data remain unchanged.
page: 7
STREP PNEUMO ABS, IGGTest Code ASP23G
Billing Code ASP23GEffective 3/17/2015
SynonymsStreptococcus pneumoniae Antibodies, IgG (23 Serotypes); Pneumo Conjugate Vaccine; Pneumo PolysaccharideVaccine; S. Pneumoniae Vaccine; Strep Antibodies 23 Serotypes; Strep Pneumo Antibodies; Strep PneumoniaeAntibody; Strep Vaccine
Container Type Serum separator tube (gold, brick, SST, or corvac)
Supply ItemNumber
1467
Store andTransport
Refrigerated. Pre and post pneumococcal vaccine specimens can be submitted separately or together for testing.
Specimen Type Serum
Preferred Volume 1.5 mL
Minimum Volume 0.25 mL
CollectionProcedure
Post-immunization specimen should be drawn 30 days after immunization and, if shipped separately, must bereceived within 60 days of pre-immunization specimen. MARK SPECIMENS CLEARLY AS "PRE" OR "POST."
SpecimenProcessing
Separate serum from cells ASAP or within 2 hours of collection and transfer to a standard PAML aliquot tube.MARK SPECIMENS CLEARLY AS "PRE" OR "POST" SO SPECIMENS WILL BE SAVED AND TESTEDSIMULTANEOUSLY.
Room Temp 2 days
Refrigerated 2 weeks
Frozen -20c 1 year (avoid repeated freeze/thaw cycles)
UnacceptableCondition
Plasma or other body fluids; contaminated, hemolyzed, or severely lipemic specimens
ReferenceLaboratory
ARUP
Reference labTest Code
2005779
CPT Codes 86317 x 23
Test Schedule Tue, Fri
Turnaround Time 2-5 days
Method Quantitative Multiplex Bead Assay
ReferenceRanges
Title Units
Pneumococcal Serotype 1 IgG ug/mL
Pneumococcal Serotype 2 IgG ug/mL
Pneumococcal Serotype 3 IgG ug/mL
Pneumococcal Serotype 4* IgG ug/mL
ReferenceRanges
continued
Pneumococcal Serotype 5 IgG ug/mL
Pneumococcal Serotype 6B* IgG ug/mL
Pneumococcal Serotype 7F IgG ug/mL
Pneumococcal Serotype 8 IgG ug/mL
ReferenceRanges
continued
Pneumococcal Serotype 9N IgG ug/mL
Pneumococcal Serotype 9V* IgG ug/mL
Pneumococcal Serotype 10A IgG ug/mL
Pneumococcal Serotype 11A IgG ug/mL
ReferenceRanges
continued
Pneumococcal Serotype 12F IgG ug/mL
Pneumococcal Serotype 14* IgG ug/mL
Pneumococcal Serotype 15B IgG ug/mL
Pneumococcal Serotype 17F IgG ug/mL
Test Change Alert #430 February 16, 2015
The following tables reflect revisions only; other existing data remain unchanged.
page: 8
STREP PNEUMO ABS, IGG
ReferenceRanges
continued
Pneumococcal Serotype 18C* IgG ug/mL
Pneumococcal Serotype 19A IgG ug/mL
Pneumococcal Serotype 19F* IgG ug/mL
Pneumococcal Serotype 20 IgG ug/mL
ReferenceRanges
continued
Pneumococcal Serotype 22F IgG ug/mL
Pneumococcal Serotype 23F* IgG ug/mL
Pneumococcal Serotype 33F IgG ug/mL
Pneumo Serotype Intrepretation
ReferenceRanges
continued
ComplianceRemarks
This test was developed and its performance characteristics determined by ARUP Laboratories. The U.S. Food andDrug Administration has not approved or cleared this test; however, FDA clearance or approval is not currentlyrequired for clinical use. The results are not intended to be used as the sole means for clinical diagnosis or patientmanagement decisions.
NotesThis assay is designed to use both pre- and post-immunization specimens to assess immune responsiveness topneumococcal vaccine. This test is not designed to determine protection to Streptococcus pneumoniae based ona single specimen.
New New Test - Replaces SPABGS
AMPHETAMINES CONFIRM BILL ONLYTest Code BAMPH
Billing Code BAMPHEffective 1/29/2015
ReferenceLaboratory
NMS
CPT Codes 80324
Please Note Previous CPT Codes: 82145
BARBITURATE CONF BILL ONLYTest Code BBARB
Billing Code BBARBEffective 1/29/2015
ReferenceLaboratory
NMS
CPT Codes 80345
Please Note Previous CPT Codes: 82205
BENZODIAZEPINES CONF BILL ONLYTest Code BBENZ
Billing Code BBENZEffective 1/29/2015
ReferenceLaboratory
NMS
CPT Codes 80346
Please Note Previous CPT Codes: 80154
Test Change Alert #430 February 16, 2015
The following tables reflect revisions only; other existing data remain unchanged.
page: 9
CANNABINOIDS CONFIRM BILL ONLYTest Code BCANN
Billing Code BCANNEffective 1/29/2015
ReferenceLaboratory
NMS
CPT Codes 80349
Please Note Previous CPT Codes: 82542
COCAINE CONFIRM BILL ONLYTest Code BCOC
Billing Code BCOCEffective 1/29/2015
ReferenceLaboratory
NMS
CPT Codes 80353
Please Note Previous CPT Codes: 82520
BILL ONLY ALCOHOL CONF RFLXTest Code BETHAN
Billing Code BETHANEffective 2/12/2015
ReferenceLaboratory
NMS
Reference labTest Code
53251B
CPT Codes 80302
New New Test
FLUNIT REFLEX TEST BILL ONLYTest Code BFLUN
Billing Code BFLUNEffective 1/29/2015
ReferenceLaboratory
NMS
CPT Codes 80346
Please Note Previous CPT Codes: 80154
FORENSIC ROHYPNOL CONFIRMATION REFLEX TEST BILL ONLYTest Code BFORRO
Billing Code BFORROEffective 1/29/2015
ReferenceLaboratory
NMS
CPT Codes 80346
Please Note Previous CPT Codes: 80102
Test Change Alert #430 February 16, 2015
The following tables reflect revisions only; other existing data remain unchanged.
page: 10
BILL ONLY HISTO AG UR QUAL POSTest Code BHISUR
Billing Code BHISUREffective 3/17/2015
ReferenceLaboratory
Miravista
CPT Codes 87385
New New Test
KETAMINE CONFIRMATION REFLEX TEST BILL ONLYTest Code BKETAM
Billing Code BKETAMEffective 1/29/2015
ReferenceLaboratory
NMS
CPT Codes 80357
Please Note Previous CPT Codes: 82542
LSDSCO CONFIRM BILL ONLYTest Code BLSDSC
Billing Code BLSDSCEffective 1/29/2015
ReferenceLaboratory
NMS
CPT Codes 80323
Please Note Previous CPT Codes: 82542
LSDSCO CONFIRM BILL ONLYTest Code BLSDUC
Billing Code BLSDUCEffective 1/29/2015
ReferenceLaboratory
NMS
CPT Codes 80323
Please Note Previous CPT Codes: 82542
METHADONE CONF BILL ONLYTest Code BMETH
Billing Code BMETHEffective 1/29/2015
ReferenceLaboratory
NMS
CPT Codes 80358
Please Note Previous CPT Codes: 83840
Test Change Alert #430 February 16, 2015
The following tables reflect revisions only; other existing data remain unchanged.
page: 11
OPIATES, FREE CONF BILL ONLYTest Code BOPIAF
Billing Code BOPIAFEffective 1/29/2015
ReferenceLaboratory
NMS
CPT Codes 80361
Please Note Previous CPT Codes: 83925
OPIATES, TOTAL CONF BILL ONLYTest Code BOPIAT
Billing Code BOPIATEffective 1/29/2015
ReferenceLaboratory
NMS
CPT Codes 80361
Please Note Previous CPT Codes: 83925
OPISCO CONFIRM BILL ONLYTest Code BOPIS
Billing Code BOPISEffective 1/29/2015
ReferenceLaboratory
NMS
CPT Codes 80361
Please Note Previous CPT Codes: 83925
OPIATES SERUM CONFIRM REFLEX TEST BILL ONLYTest Code BOPISE
Billing Code BOPISEEffective 1/29/2015
ReferenceLaboratory
NMS
CPT Codes 80361
Please Note Previous CPT Codes: 83925
PROPOXYPHENE CONF BILL ONLYTest Code BPROP
Billing Code BPROPEffective 1/29/2015
ReferenceLaboratory
NMS
CPT Codes 80367
Please Note Previous CPT Codes: 82542
Test Change Alert #430 February 16, 2015
The following tables reflect revisions only; other existing data remain unchanged.
page: 12
CATHARTIC LAXATIVES PROF, STOOLTest Code CLAXSN
Billing Code CLAXSN.2015Effective 1/29/2015
CPT Codes 80375, 84100
Please Note Previous CPT Codes: 80103 x 2, 83735, 84100
CORDSTAT 12 SCR W/ALCTest Code CUM12A
Billing Code CUMB12A.2015Effective 1/29/2015
CPT Codes 80301, 80302 x 3 (HCPCS G0431) (HCPCS G6040)
Please Note Previous CPT Codes: 80101 x 12, 80100
CORDSTAT 13 SCR W/ALCTest Code CUM13A
Billing Code CUM13A.2015Effective 1/29/2015
CPT Codes 80301, 80302 x 3 (HCPCS G0431) (HCPCS G6040)
Please Note Previous CPT Codes: 80101 x 13, 80100
CORDSTAT 12 DRUG SCR PNLTest Code CUMB12
Billing Code CUMB12.2015Effective 1/29/2015
CPT Codes 80301, 80302 x 2 (HCPCS G0431)
Please Note Previous CPT Codes: 80101 x 12
CORDSTAT 13 DRUG SCR PNLTest Code CUMB13
Billing Code CUMB13.2015Effective 1/29/2015
CPT Codes 80301, 80302 x 2 (HCPCS G0431)
Please Note Previous CPT Codes: 80101 x 13
CORDSTAT 5 DRUG SCR PNLTest Code CUMB5
Billing Code CUMB5.2015Effective 1/29/2015
CPT Codes 80301 (HCPCS G0431)
Please Note Previous CPT Codes: 80101 x 5
Test Change Alert #430 February 16, 2015
The following tables reflect revisions only; other existing data remain unchanged.
page: 13
CORDSTAT 7 DRUG SCR PNLTest Code CUMB7
Billing Code CUMB7.2015Effective 1/29/2015
CPT Codes 80301 (HCPCS G0431)
Please Note Previous CPT Codes: 80101 x 7
CORDSTAT 9 DRUG SCR PNLTest Code CUMB9
Billing Code CUMB9.2015Effective 1/29/2015
CPT Codes 80301 (HCPCS G0431)
Please Note Previous CPT Codes: 80101 x 9
DANTRIUMTest Code DANT
Billing Code DANT.2015Effective 2/2/2015
Store andTransport
Frozen
Preferred Volume 1 mL
Minimum Volume 0.3 mL - Minimum volume allows for a single analysis. Repeat analysis will not be performed.
Room Temp Unacceptable
Refrigerated Unacceptable
Frozen -20c 1 week
UnacceptableCondition
No SST or PST tubes, no room temp or refrigerated specimens
Test Schedule Mon
Turnaround Time 3-7 days
Please Note Critical frozen
Test Change Alert #430 February 16, 2015
The following tables reflect revisions only; other existing data remain unchanged.
page: 14
DRUG/ALCOHOL SCRN, SERUM RFLXTest Code DRASER
Billing Code DRA1.2015Effective 1/27/2015
Reflex Testing
Reflex Condition Reflex Test Name Reflex CPT codes Reflex Billing Codes
If screen for Propoyxphene ispositive
Propoxyphene and MetaboliteConfirmation by GC/MS
80367 BPROP.2015
If screen for Cocaine is positive Cocaine and MetabolitesConfirmation by GC/MS
80353 BCOC.2015
If screen for Benzodiazepines ispositive
Benzodiazepines ConfirmationBY LC-MS/MS
80346 BBENZ.2015
If screen for Opiates is positive Opiates - Total Confirmation byGC/MS
80361 BOPIAT.2015
Opiates - Free (Unconjugated)Confirmation BY GC/MS
80361 BOPIAF.2015
Opiates - Serum Confirmation byGC/MS
80361 BOPISE.2015
If screen for Cannabinoids ispositive
Cannabinoids Confirmation byGC-GC-GC/MS
80349 BCANN.2015
If screen for Barbiturates ispositive
Barbiturates Confirmation byGC/MS
80345 BBARB.2015
If screen for Phencyclidine ispositive
Phencyclidine Confirmation byGC/MS
83992 BPHEN.2015
If screen for Methadone ispositive
Methadone and MetaboliteConfirmation by GC/MS
80358 BMETH.2015
If screen for Amphetamines ispositive
Amphetamines Confirmation byLC-MS/MS
80324 BAMPH.2015
If screen for Alcohol is positive Ethanol Confirmation by GC 80302 BETHAN
Test Change Alert #430 February 16, 2015
The following tables reflect revisions only; other existing data remain unchanged.
page: 15
DRUG SCREEN, SERUM RFLXTest Code DRUSER
Billing Code DRU1.2015Effective 1/27/2015
Reflex Testing
Reflex Condition Reflex Test Name Reflex CPT codes Reflex Billing Codes
If screen for Propoxyphene ispositive
Propoxyphene and MetaboliteConfirmation by GC/MS
80367 BPROP.2015
If screen for Cocaine is positive Cocaine and MetabolitesConfirmation by GC/MS
80353 BCOC.2015
If screen for Benzodiazepines ispositive
Benzodiazepines ConfirmationBY LC-MS/MS
80346 BBENZ.2015
If screen for Opiates is positive Opiates - Total Confirmation byGC/MS
80361 BOPIAT.2015
Opiates - Free (Unconjugated)Confirmation BY GC/MS
80361 BOPIAF.2015
Opiates - Serum Confirmation byGC/MS
80361 BOPISE.2015
If screen for Cannabinoids ispositive
Cannabinoids Confirmation byGC-GC-GC/MS
80349 BCANN.2015
If screen for Barbiturates ispositive
Barbiturates Confirmation byGC/MS
80345 BBARB.2015
If screen for Phencyclidine ispositive
Phencyclidine Confirmation byGC/MS
83992 BPHEN.2015
If screen for Methadone ispositive
Methadone and MetaboliteConfirmation by GC/MS
80358 BMETH.2015
If screen for Amphetamines ispositive
Amphetamines Confirmation byLC-MS/MS
80324 BAMPH.2015
HISTOPLASMA AGTest Code HISAG
Billing Code HISAGEffective 3/17/2015
Delete This test is being discontinued. Use the ordercode HISAGB to order this test.
Test Change Alert #430 February 16, 2015
The following tables reflect revisions only; other existing data remain unchanged.
page: 16
HISTOPLASMA AGTest Code HISAGB
Billing Code HISAGBEffective 3/17/2015
Synonyms Histoplasma Antigen Quantitative EIA
Container Type Serum separator tube (gold, brick, SST, or corvac)
Supply ItemNumber
1467
Store andTransport
Refrigerated
Specimen Type Serum
Preferred Volume 2 mL
Minimum Volume Serum/plasma: 1.2 mL
SpecimenProcessing
Separate serum or plasma from cells and transfer to a standard PAML aliquot tube. Specimen source required.
Required PatientInfo
Specimen source
Room Temp 2 days
Refrigerated 2 weeks
Frozen -20c Indefinitely
UnacceptableCondition
If specimen is too viscous to pipette. Tissue, biopsy, sputum, bronchial brush, tracheal aspirate, FNA, bonemarrow aspirate, or stool. Samples in transport media, fixative or Isolator tubes.
AlternateSpecimens
Plasma (EDTA, heparin or sodium citrate); urine, CSF & BAL in a sterile leak-proof container (Minimum Volume:Urine, BAL & other body fluid: 0.5 mL; CSF: 0.8 mL)
ReferenceLaboratory
MiraVista
Reference labTest Code
310
CPT Codes 87385
Test Schedule Mon-Fri
Turnaround Time 3-7 days (positive samples may require confirmation which could extend TAT)
Method Quantitative Sandwich Enzyme Immunoassay
ReferenceRanges
Title Descriptor Ranges Units
310 MVista® Histoplasma Ag None Detected ng/mL
Reference interval None Detected
Results reported as ng/mL in 0.4-19 ng/mL range
Results above the limit of detection but below 0.4 ng/mL are reported as 'Positive, Below the Limit of Quantification'
ReferenceRanges
continued
Results above 19 ng/mL are reported as 'Positive, Above the Limit of Quantification'
ComplianceRemarks
This test was developed and its performance characteristics determined by MiraVista Diagnostics. It has not beencleared or approved by the FDA; however, FDA clearance or approval is not currently required for clinical use. Theresults are not intended to be used as the sole means for clinical diagnosis or patient management decisions.
Notes
The histoplasma quantitative antigen test aids the diagnosis of histoplasmosis. Monitoring the histoplasmosishelps determine when treatment can be stopped and to diagnose relapse.
Interfering Substances and Cross-Reactivities: Sodium hydroxide and sputolysin. Cross-reactivity occurs betweenblastomycosis and histoplasmosis and in paracoccidioidomycosis, penicillosis, coccidioidomycosis, aspergillosisand sporotrichosis.
New New Test - Replaces HISAG
Test Change Alert #430 February 16, 2015
The following tables reflect revisions only; other existing data remain unchanged.
page: 17
LDL PARTICLE SIZETest Code LDLPS
Billing Code LDLPSEffective 3/17/2015
Delete This test is being discontinued. Use the ordercode LDLPSR to order this test.
LDL PARTICLE SIZETest Code LDLPSR
Billing Code LDLPSREffective 3/17/2015
Synonyms Density Gradient Ultracentrifigation, DGUC
Container Type Lavender top tube (EDTA)
Supply ItemNumber
1222
Store andTransport
Frozen - Separate samples must be submitted when multiple tests are ordered.
Specimen Type Plasma
Preferred Volume 1.5 mL
Minimum Volume 1.2 mL (enough volume to provide repeat anlaysis if needed); 0.6 mL (no repeats possible)
Patient Prep Patient must be fasting 12-16 hours. Nothing by mouth except water.
SpecimenProcessing
Separate plasma from cells and transfer to a standard PAML aliquot tube and freeze.
Room Temp Not acceptable
Refrigerated 1 week
Frozen -20c 1 month
Frozen -70c Indefinitely
ReferenceLaboratory
NW Lipid Research Laboratories
Reference labTest Code
DGUC Plus
CPT Codes 83701, 83721
Test Schedule Varies
Turnaround Time 2-3 weeks
Method Density Gradient Ultracentrifigation, DGUC
ReferenceRanges
Title Descriptor
LDL Particle Size Separate Report to Follow
New New Test - Replaces LDLPS
MECONIUM 12 DRUG SCREENTest Code MEC12
Billing Code MEC12.2015Effective 1/29/2015
CPT Codes 80301, 80302 x 2 (HCPCS G0431)
Please Note Previous CPT Codes: 80101 x 12
Test Change Alert #430 February 16, 2015
The following tables reflect revisions only; other existing data remain unchanged.
page: 18
MECONIUM 12 DRUG + ALCTest Code MEC12A
Billing Code MEC12A.2015Effective 1/29/2015
CPT Codes 80301, 80302 x 3 (HCPCS G0431) (HCPCS G6040)
Please Note Previous CPT Codes: 80101 x 12, 80100 x 7
MECONIUM 13 DRUG SCREENTest Code MEC13
Billing Code MEC13.2015Effective 1/29/2015
CPT Codes 80301, 80302 x 2 (HCPCS G0431)
Please Note Previous CPT Codes: 80101 x 13
MECONIUM 13 DRUG + ALCTest Code MEC13A
Billing Code MEC13A.2015Effective 1/29/2015
CPT Codes 80301, 80302 x 3 (HCPCS G0431) (HCPCS G6040)
Please Note Previous CPT Codes: 80101 x 13, 80100
MECONIUM 5 DRUG SCREENTest Code MEC5
Billing Code MEC5.2015Effective 1/29/2015
CPT Codes 80301 (HCPCS G0431)
Please Note Previous CPT Codes: 80101 x 5
MECONIUM 5 DRUG + ALCTest Code MEC5A
Billing Code MEC5A.2015Effective 1/29/2015
CPT Codes 80301, 80302 (HCPCS G0431) (HCPCS G6040)
Please Note Previous CPT Codes: 80101 x 5, 80100
MECONIUM 7 DRUG SCRNTest Code MEC7
Billing Code MEC7.2015Effective 1/29/2015
CPT Codes 80301 (HCPCS G0431)
Please Note Previous CPT Codes: 80101 x 7
Test Change Alert #430 February 16, 2015
The following tables reflect revisions only; other existing data remain unchanged.
page: 19
MECONIUM 7 DRUG SCRN + ALCOHOLTest Code MEC7A
Billing Code MEC7A.2015Effective 1/29/2015
CPT Codes 80301, 80302 (HCPCS G0431) (HCPCS G6040)
Please Note Previous CPT Codes: 80101 x 7, 80100
MECONIUM 9 DRUG SCREENTest Code MEC9SC
Billing Code MEC9SC.2015Effective 1/29/2015
CPT Codes 80301 (HCPCS G0431)
Please Note Previous CPT Codes: 80101 x 9
OPIATES RFLXTest Code OPISCO
Billing Code OPISCO.2015Effective 1/27/2015
Reflex Testing
Reflex Condition Reflex Test Name Reflex CPT codes Reflex Billing Codes
If screen for Opiates is positive Opiates - Free (Unconjugated)Confirmation Serum/Plasma byGC/MS
80361 BOPIAF
ORAL FLUID 10Test Code ORAL10
Billing Code ORAL10.2015Effective 1/29/2015
CPT Codes 80301 (HCPCS G0431)
Please Note Previous CPT Codes: 80101 x 10
ORAL FLUID 12Test Code ORAL12
Billing Code ORAL12.2015Effective 1/29/2015
CPT Codes 80301, 80302 x 2 (HCPCS G0431)
Please Note Previous CPT Codes: 80101 x 12
ORAL FLUID 5Test Code ORAL5
Billing Code ORAL5.2015Effective 1/29/2015
CPT Codes 80301 (HCPCS G0431)
Please Note Previous CPT Codes: 80101 x 5
Test Change Alert #430 February 16, 2015
The following tables reflect revisions only; other existing data remain unchanged.
page: 20
ORAL FLUID 7Test Code ORAL7
Billing Code ORAL7.2015Effective 1/29/2015
CPT Codes 80301 (HCPCS G0431)
Please Note Previous CPT Codes: 80101 x 7
ORAL FLUID 9Test Code ORAL9
Billing Code ORAL9.2015Effective 1/29/2015
CPT Codes 80301 (HCPCS G0431)
Please Note Previous CPT Codes: 80101 x 9
STRATIFY JCV AB, INDEX, RFLXTest Code SJCABI
Billing Code SJCABIEffective 2/12/2015
Reflex Testing
Reflex Condition Reflex Test Name Reflex CPT codes Reflex Billing Codes
If the Index Value is between0.19 and 0.41 (not inclusive)
JCV Ab by Inhibition 86711 SJCINH
Please Note Please refer to IMB for important update information.
STRATIFY JCV AB RFLXTest Code SJCVAB
Billing Code SJCVABEffective 2/12/2015
Reflex Testing
Reflex Condition Reflex Test Name Reflex CPT codes Reflex Billing Codes
If the JCV Antibody result isindeterminate
JCV Ab by Inhibition 86711 SJCINH
Please Note Please refer to IMB for important update information.
S. PNEUMONIAE IGG ABS/SEROTYPETest Code SPABGS
Billing Code SPABGSEffective 3/17/2015
Delete This test is being discontinued. Use the ordercode ASP23G to order this test.
Test Change Alert #430 February 16, 2015
The following tables reflect revisions only; other existing data remain unchanged.
page: 21
TOXOPLASMA GONDII (PCR)Test Code TOXPCR
Billing Code TOXPCREffective 1/19/2015
Synonyms Coccidia; T gondi DNA detection; T. gondii PCR; Toxoplasma gondii, Molecular Detection, PCR
Supply ItemNumber
1467 & 7211
Specimen Type Serum
Minimum Volume 0.5 mL
SpecimenProcessing
Separate serum or plasma from cells and transfer to a sterile plastic tube and freeze.
Room Temp Tissue: Unacceptable; All other samples: 8 hrs
Refrigerated Tissue: Unacceptable; All other samples: 5 days
Frozen -20c Tissue & all other samples: 3 months
UnacceptableCondition
Heparinized specimens
AlternateSpecimens
Lavender (EDTA) plasma, pink (K2EDTA) plasma, OR Amniotic fluid, CSF, ocular fluid in a sterile container frozen.Tissue: Transfer to a sterile container and freeze immediately.
Turnaround Time 2-5 days
Method Qualitative Polymerase Chain Reaction
ZINC, SERUM OR PLASMATest Code ZINCSA
Billing Code ZINCSAEffective 3/17/2015
Delete This test is being discontinued. Use the ordercode ZN to order this test.
CARBAMAZEPINETest Code CARB
Billing Code CARBEffective 3/17/2015
Delete This test is being discontinued. Use the ordercode CARBA to order this test.
Test Change Alert #430 February 16, 2015
The following tables reflect revisions only; other existing data remain unchanged.
page: 22
CARBAMAZEPINETest Code CARBA
Billing Code CARBAEffective 3/17/2015
Synonyms Tegretol; Carbatol
Container Type Red top tube (plain)
Supply ItemNumber
1372
Store andTransport
Refrigerated
Specimen Type Serum
Preferred Volume 1 mL
Minimum Volume 0.2 mL
CollectionProcedure
Draw sample just prior to next dose. Note times of dose and drawing.
SpecimenProcessing
Separate serum from cells within 2 hours of collection and transfer to a standard PAML aliquot tube.
Required PatientInfo
Note times of dose and drawing
Refrigerated 4 days
UnacceptableCondition
Serum collected and stored in SST for more than 24 hours
AlternateSpecimens
Heparin or EDTA plasma (green or lavender top tube)
Department Chemistry
ReferenceLaboratory
PAML
CPT Codes 80156
Test Schedule Mon-Sat and STAT
Turnaround Time 1-2 days
Method ICMA
ReferenceRanges
Title Descriptor Ranges Units
Carbamazepine Therapeutic 4.0-12.0 ug/mL
Toxic > 15.0
New New Test - Replaces CARB
ANTI CONVULSANT PROFILETest Code CONV
Billing Code CONV-PANEffective 3/17/2015
Delete This test is being discontinued. Use the ordercode CONVUL to order this test.
Test Change Alert #430 February 16, 2015
The following tables reflect revisions only; other existing data remain unchanged.
page: 23
ANTI CONVULSANT PROFILETest Code CONVUL
Billing Code CONVULEffective 3/17/2015
Container Type Red top tube (plain)
Supply ItemNumber
1372
Store andTransport
Refrigerated
Specimen Type Serum
Preferred Volume 1 mL
Minimum Volume 0.5 mL
CollectionProcedure
Draw just prior to next oral dose or 2-4 hours after IV loading dose. Note times of dose and drawing.
SpecimenProcessing
Separate serum from cells and transfer to a standard PAML aliquot tube.
Required PatientInfo
Note times of dose and drawing
Refrigerated 2 weeks
UnacceptableCondition
Plasma samples other than lithium heparin plasma and grossly hemolyzed specimens
AlternateSpecimens
Lithium heparin plasma (green top tube). SST and other gel type tubes, however, they may artifactually randomlylower results if they are not promptly centrifuged and separated.
Department Chemistry
ReferenceLaboratory
PAML
CPT Codes 80185, 80184
Test Schedule Mon-Sat
Turnaround Time 1-2 days
Method ICMA
ReferenceRanges
Title Descriptor Ranges Units
Phenytoin Therapeutic 10.0-20.0 ug/mL
Toxic > 25.0
Phenobarbital Therapeutic 15.0-40.0 ug/mL
Toxic > 50.0
ReferenceRanges
continuedNew New Test - Replaces CONV
CORTISOL, AMTest Code CORAM
Billing Code CORAMEffective 3/17/2015
Frozen -20c 1 month
Department Chemistry
Test Change Alert #430 February 16, 2015
The following tables reflect revisions only; other existing data remain unchanged.
page: 24
CORTISOL PAIRED SPECIMENSTest Code CORP
Billing Code COR-2Effective 3/17/2015
Frozen -20c 1 month
Department Chemistry
CORTISOL, RANDOMTest Code CORRAN
Billing Code CORRANEffective 3/17/2015
Frozen -20c 1 month
Department Chemistry
CORTISOL STIMULATION TESTTest Code CST
Billing Code COR-STIMEffective 3/17/2015
Frozen -20c 1 month
Department Chemistry
CORTISOL STIMULATION (3 SPEC)Test Code CST3
Billing Code COR-STIM2Effective 3/17/2015
Frozen -20c 1 month
Department Chemistry
DIGOXINTest Code DIG
Billing Code DIGEffective 3/17/2015
Delete This test is being discontinued. Use the ordercode DIGOX to order this test.
Test Change Alert #430 February 16, 2015
The following tables reflect revisions only; other existing data remain unchanged.
page: 25
DIGOXINTest Code DIGOX
Billing Code DIGOXEffective 3/17/2015
Synonyms Lanoxin
Container Type Red top tube (plain)
Supply ItemNumber
1372
Store andTransport
Refrigerated
Specimen Type Serum
Preferred Volume 1 mL
Minimum Volume 0.5 mL
CollectionProcedure
Draw just prior to next dose. Note times of dose and drawing.
SpecimenProcessing
Separate serum from cells within 2 hours of collection and transfer to a standard PAML aliquot tube.
Required PatientInfo
Time of dose and time drawn
Room Temp 1 day
Refrigerated 5 days
Frozen -20c 1 month
AlternateSpecimens
SST and other gel type tubes; however, they may artifactually, randomly lower results if they are not promptlycentrifuged and transferred to a standard PAML aliquot tube. PSHMC can run plasma samples.
Department Chemistry
ReferenceLaboratory
PAML
CPT Codes 80162
Test Schedule Mon-Sat and STAT
Turnaround Time 1-2 days
Method ICMA
ReferenceRanges
Title Descriptor Ranges Units
Digoxin Therapeutic 0.8-2.0 ng/mL
Toxic > 2.5
Increased risk of Digoxin toxicity at levels GT 2.0 ng/mL, with a wide zone of concentrations that may be toxic in one individualand not in another. The risk is greater with CHD and with decreases in Potassium, Calcium and Magnesium. Digoxin distributionphase complete after 8-15 hours.
ReferenceRanges
continuedNotes Brand names include: Lanoxin, Acylanid, Cedilanid, Cedilanid-D, Davoxin, Deslanoslide, Lantoslide C and Saroxin.
New New Test - Replaces DIG
PHENYTOINTest Code DIL
Billing Code DILEffective 3/17/2015
Delete This test is being discontinued. Use the ordercode PHTN to order this test.
Test Change Alert #430 February 16, 2015
The following tables reflect revisions only; other existing data remain unchanged.
page: 26
HEPATITIS B SURFACE AG RFLXTest Code HBSAG
Billing Code HBSAGEffective 3/17/2015
ReferenceRanges
Title Ranges
HBsAg Screen Nonreactive
HBsAg Confirmation Nonreactive
HBSAG CONFIRMATIONTest Code HBSAGC
Billing Code HBSAG.CONFIRMEffective 3/17/2015
Department Chemistry
ReferenceRanges
Title Ranges
HBsAg Confirmation Nonreactive
HDL CHOLESTEROLTest Code HDL
Billing Code HDLEffective 3/17/2015
ReferenceRanges
Title Descriptor Ranges Units
HDL Low < 40 mg/dL
Within normal limits 40-59
High > = 60
ReferenceRanges
continued
HDL Cholesterol greater than or equal to 60 mg/dL is considered to be a 'negative' risk factor, serving to remove one risk factorfrom the total count.
PHENOBARBITALTest Code PHB
Billing Code PHBEffective 3/17/2015
Delete This test is being discontinued. Use the ordercode PHNB to order this test.
Test Change Alert #430 February 16, 2015
The following tables reflect revisions only; other existing data remain unchanged.
page: 27
PHENOBARBITALTest Code PHNB
Billing Code PHNBEffective 3/17/2015
Synonyms Luminal
Container Type Red top tube (plain)
Supply ItemNumber
1372
Store andTransport
Refrigerated
Specimen Type Serum
Preferred Volume 1 mL
Minimum Volume 0.2 mL
CollectionProcedure
Draw just prior to next dose. Note times of dose and drawing.
SpecimenProcessing
Separate serum from cells within 2 hours of collection and transfer to a standard PAML aliquot tube.
Required PatientInfo
Note times of dose and drawing
Refrigerated 2 weeks
Frozen -20c 1 month
UnacceptableCondition
Plasma samples other than lithium heparin plasma and grossly hemolyzed specimens
AlternateSpecimens
SST and other gel-type tubes; however, they may artifactually, randomly lower results if they are not promptlycentrifuged; and separated and lithium heparin plasma (green top tubes).
Department Chemistry
ReferenceLaboratory
PAML
CPT Codes 80184
Test Schedule Mon-Sat and STAT
Turnaround Time 1-2 days
Method ICMA
ReferenceRanges
Title Descriptor Ranges Units
Phenobarbital Therapeutic 15.0-40.0 ug/mL
Toxic > 50.0
New New Test - Replaces PHB
Test Change Alert #430 February 16, 2015
The following tables reflect revisions only; other existing data remain unchanged.
page: 28
PHENYTOINTest Code PHTN
Billing Code PHTNEffective 3/17/2015
Synonyms Dilantin
Container Type Red top tube (plain)
Supply ItemNumber
1372
Store andTransport
Refrigerated
Specimen Type Serum
Preferred Volume 1 mL
Minimum Volume 0.2 mL
CollectionProcedure
Draw just prior to next oral dose or 2-4 hours after IV loading dose. Note times of dose and drawing.
SpecimenProcessing
Separate serum from cells within 2 hours of collection and transfer to a standard PAML aliquot tube.
Required PatientInfo
Note times of dose and drawing
Refrigerated 2 weeks
UnacceptableCondition
Plasma samples other than lithium heparin plasma and grossly hemolyzed specimens
AlternateSpecimens
Lithium heparin plasma (green top tubes); SST and other gel-type tubes, however, they may artificially, randomlylower results if they are not promptly centrifuged and separated.
Department Chemistry
ReferenceLaboratory
PAML
CPT Codes 80185
Test Schedule Mon-Sat and STAT
Turnaround Time 1-2 days
Method LA
ReferenceRanges
Title Descriptor Ranges Units
Phenytoin Therapeutic 10.0-20.0 ug/mL
Toxic > 25.0
New New Test - Replaces DIL
Test Change Alert #430 February 16, 2015
The following tables reflect revisions only; other existing data remain unchanged.
page: 29
PRIMIDONE AND METABOLITETest Code PRMPH
Billing Code PRMPHEffective 3/17/2015
Synonyms Mysoline
Container Type Red top tube (plain)
Supply ItemNumber
1372
Store andTransport
Refrigerated
Specimen Type Serum
Preferred Volume 1.5 mL
Minimum Volume 1 mL
CollectionProcedure
Draw just prior to next dose. Notes times of dose and drawing.
SpecimenProcessing
Two (2) standard PAML aliquot tubes required. Separate serum from cells and transfer to 2 standard PAML aliquottubes.
Required PatientInfo
Note times of dose and drawing
Refrigerated 2 weeks
UnacceptableCondition
Plasma samples other than lithium heparin plasma and grossly hemolyzed specimens
AlternateSpecimens
Lithium heparin plasma (green top tube). SST and other gel type tubes, however, they may artifactually randomlylower results if they are not promptly centrifuged and separated.
Department Chemistry
ReferenceLaboratory
PAML
CPT Codes 80184, 80188
Test Schedule Mon-Sat
Turnaround Time 1-2 days
Method ICMA and Enzymatic
ReferenceRanges
Title Descriptor Ranges Units
Phenobarbital Therapeutic 15.0-40.0 ug/mL
Toxic > 50.0
Primidone Therapeutic 5.0-12.0 ug/mL
Toxic > 15.0
ReferenceRanges
continuedNew New Test - Replaces PRPH
PRIMIDONE AND METABOLITETest Code PRPH
Billing Code PRMEffective 3/17/2015
Delete This test is being discontinued. Use the ordercode PRMPH to order this test.
Test Change Alert #430 February 16, 2015
The following tables reflect revisions only; other existing data remain unchanged.
page: 30
RENAL FUNCTION PANELTest Code RENALA
Billing Code RENALAEffective 3/17/2015
ReferenceRanges
Title Gender Descriptor Ranges Units
Glucose 0-2 days premature 30-80 mg/dL
0-2 days fullterm 40-90
2 days-1 month 60-105
Adult 65-99
ReferenceRanges
continued
Pregnant 65-94
ADA DiagnosticCategories fornonpregnant adults
Impaired fasting glucose 100-125 mg/dL
A fasting glucose result of 126 mg/dL or greater indicates diabetes if the abnormality is confirmed on a subsequent day.
ReferenceRanges
continued
A random glucose result of GT 200 mg/dL indicates diabetes if the abnormality is confirmed on a subsequent day.
BUN 8-25 mg/dL
Creatinine Male 0.70-1.30 mg/dL
Female 0.50-1.00
ReferenceRanges
continued
Calcium 8.5-10.2 mg/dL
Phosphorus 0-10 days 4.2-9.6 mg/dL
10 days-24 months 4.2-7.2
24 mo-12 years 4.2-5.9
ReferenceRanges
continued
12-60 years 2.3-4.8
Male 60+ years 2.1-3.9
Female 60+ years 2.6-4.4
Albumin 0-4 days 2.9-4.6 g/dL
ReferenceRanges
continued
4 days-14 years 3.9-5.6
14-18 years 3.3-4.7
18-60 years 3.5-5.0
60-90 years 3.3-4.8
ReferenceRanges
continued
90+ years 3.0-4.7
Sodium 135-145 mmol/L
Potassium 0-30 days 3.9-6.9 mmol/L
1-12 months 3.6-6.8
ReferenceRanges
continued
1-5 years 3.2-5.7
5-10 years 3.4-5.4
10+ years 3.5-5.3
Chloride 99-109 mmol/L
ReferenceRanges
continued
C02 0-10 days 13-22 mmol/L
11 days-4 years 20-28
5+ years 22-31
Anion Gap 5-16
ReferenceRanges
continued
Creatinine 0-2- days 0.32-0.98 mg/dL
21 days-12 months 0.10-0.58
1-3 years 0.19-0.41
4-5 years 0.23-0.54
ReferenceRanges
continued
6-9 years 0.32-0.63
10-11 years 0.37-0.69
12-14 years 0.43-0.87
15-16 years 0.49-0.98
Test Change Alert #430 February 16, 2015
The following tables reflect revisions only; other existing data remain unchanged.
page: 31
RENAL FUNCTION PANEL
ReferenceRanges
continued
Male 17-18 years 0.62-1.11
19+ years 0.70-1.30
Female 17-18 years 0.51-0.97
19+ years 0.50-1.00
ReferenceRanges
continued
Test Change Alert #430 February 16, 2015
The following tables reflect revisions only; other existing data remain unchanged.
page: 32
RENAL FUNCTION PANEL W/GFRTest Code RENALD
Billing Code RENALDEffective 3/17/2015
Synonyms Renal Function Panel
ReferenceRanges
Title Gender Description Ranges Units
Glucose 0-2 days premature 30-80 mg/dL
0-2 days fullterm 40-90
2 days-1 month 60-105
Adult 65-99
ReferenceRanges
continued
Pregnant 65-94
ADA Diagnostic Categories for nonpregnant
adults Impaired fasting glucose 100-125 mg/dL
ReferenceRanges
continued
A fasting glucose result of 126 mg/dL or greater indicates diabetes if the abnormality is confirmed on a subsequent day.
A random glucose result of GT 200 mg/dL indicates diabetes if the abnormality is confirmed on a subsequent day.
BUN 8-25 mg/dL
Creatinine Male 0.70-1.30 mg/dL
ReferenceRanges
continued
Female 0.50-1.00
Calcium 8.5-10.2 mg/dL
Phosphorus 0-10 days 4.2-9.6 mg/dL
10 days-24 months 4.2-7.2
ReferenceRanges
continued
24 months-12 years 4.2-5.9
12-60 years 2.3-4.8
Male 60+ years 2.1-3.9
Female 60+ years 2.6-4.4
ReferenceRanges
continued
Albumin 0-4 days 2.9-4.6 g/dL
4 days-14 years 3.9-5.6
14-18 years 3.3-4.7
18-60 years 3.5-5.0
ReferenceRanges
continued
60-90 years 3.3-4.8
90+ years 3.0-4.7
Sodium 135-145 mmol/L
Potassium 0-30 days 3.9-6.9 mmol/L
ReferenceRanges
continued
1-12 months 3.6-6.8
1-5 years 3.2-5.7
5-10 years 3.4-5.4
10+ years 3.5-5.3
ReferenceRanges
continued
Chloride 99-109 mmol/L
C02 0-10 days 13-22 mmol/L
11 days-4 years 20-28
5+ years 22-31
ReferenceRanges
continued
Anion Gap 5-16
Estimated Glomerular mL/min/1.73m2
Filtration Rate Chronic kidney disease, iffound over a 3 monthperiod
LT 60
Kidney failure LT 15
ReferenceRanges
continued
For African Americans, multiply the calculated GFR by 1.21.
Creatinine 0-2- days 0.32-0.98 mg/dL
21 days-12 months 0.10-0.58
1-3 years 0.19-0.41
Test Change Alert #430 February 16, 2015
The following tables reflect revisions only; other existing data remain unchanged.
page: 33
RENAL FUNCTION PANEL W/GFR
ReferenceRanges
continued
4-5 years 0.23-0.54
6-9 years 0.32-0.63
10-11 years 0.37-0.69
12-14 years 0.43-0.87
ReferenceRanges
continued
15-16 years 0.49-0.98
Male 17-18 years 0.62-1.11
19+ years 0.70-1.30
Female 17-18 years 0.51-0.97
ReferenceRanges
continued
19+ years 0.50-1.00
TSH (RFLX FT4)Test Code TSHREF
Billing Code TSH.REffective 3/17/2015
Room Temp 4 hours
Refrigerated 1 week
Frozen -20c 2 months
ReferenceRanges
Title Gender Description Ranges Units
TSH (Reflex) Male 0-30 days 0.52-16.00 uIU/mL
1 month-5 years 0.55-7.10
5-18 years 0.37-6.00
Female 0-30 days 0.72-13.10
ReferenceRanges
continued
1 month-5 years 0.46-8.10
5-18 years 0.36-5.80
18+ years 0.45-5.10
Free T4 Birth-7 days 1.4-3.3 ng/dL
ReferenceRanges
continued
8 days-1 month 0.6-2.5
1-12 months 0.7-1.4
12 months-18 years 0.6-1.2
18+ years 0.7-1.5
ReferenceRanges
continued
Test Change Alert #430 February 16, 2015
The following tables reflect revisions only; other existing data remain unchanged.
page: 34
VALPROIC ACIDTest Code VALPRO
Billing Code VALPROEffective 3/17/2015
Synonyms Depakene; Depakote; Divalproex
Container Type Red top tube (plain)
Supply ItemNumber
1372
Store andTransport
Refrigerated
Specimen Type Serum
Preferred Volume 1 mL
Minimum Volume 0.3 mL
CollectionProcedure
Draw just prior to next dose. Note times of dose and drawing.
SpecimenProcessing
Separate serum from cells within 2 hours of collection and transfer to a standard PAML aliquot tube.
Required PatientInfo
Note times of dose and drawing
Refrigerated 2 days
Frozen -20c 1 month
AlternateSpecimens
Heparin or EDTA plasma (green or lavender top tube)
Department Chemistry
ReferenceLaboratory
PAML
CPT Codes 80164
Test Schedule Mon-Sat and STAT
Turnaround Time 1-2 days
Method ICMA
ReferenceRanges
Title Descriptor Ranges Units
Valproic Acid Therapeutic 50-100 ug/mL
Toxic > 150
New New Test - Replaces VALP
HBV PROGNOSIS PANEL RFLXTest Code HBCHR
Billing Code HBCHREffective 3/17/2015
Department Chemistry, Special Immunology
ReferenceRanges
Title Descriptor Ranges Units
HBsAg Screen Nonreactive
HBsAg Confirmation Nonreactive
Hepatitis B Surface Ab Non-Immune < 10.0 mIU/mL
Indicates vaccine response orHBV infection
> = 10.0
ReferenceRanges
continued
Samples with a calculated value of 10 mIU/mL or greater are considered reactive (protective) in accordance with the CDC guidelines
HBeAg Nonreactive
Hepatitis Be Ab Nonreactive
Test Change Alert #430 February 16, 2015
The following tables reflect revisions only; other existing data remain unchanged.
page: 35
EOSINOPHILS, BODY SECRETIONSTest Code EOSBOD
Billing Code NASALEffective 3/17/2015
ReferenceRanges
Title Ranges
Eosinophils, Nasal Smear Absent
VALPROIC ACIDTest Code VALP
Billing Code VALPROICEffective 3/17/2015
Delete This test is being discontinued. Use the ordercode VALPRO to order this test.
CULTURE, MRSA SCREEN RFLXTest Code CMRSA
Billing Code CMRSAEffective 2/5/2015
Supply ItemNumber
1932 or 5486
Reflex Testing
Reflex Condition Reflex Test Name Reflex CPT codes Reflex Billing Codes
Organism identification Aerobe identification -definitive
87077 ORGB1
Please NoteThis test screens only for MRSA colonization. No other isolates are identified or reported, and antimicrobialsusceptibility is not routinely performed. For culture and susceptibility of organisms associated with skin or softtissue infections, order a CULTURE WOUND (CWD).
Please Note Reflex test information has been modified.
CULTURE, STAPHYLOCOCCUS SCREEN RFLXTest Code CSTAPH
Billing Code CSTAPHEffective 2/5/2015
Supply ItemNumber
1932 or 5486
Please Note
This test screens only for Staphylococcus aureus colonization (MRSA or MSSA). No other isolates are identifiedor reported, and antimicrobial susceptibility is not routinely performed accept to differentiate MRSA and MSSA.For culture and susceptibility of organisms associated with skin or soft tissue infections, order a CULTUREWOUND (CWD).
MRSA NASAL SCREEN (PCR)Test Code MRSPCR
Billing Code MRSPCAEffective 1/26/2015
UnacceptableCondition
Samples that have been frozen or exposed to excessive heat. Only nares specimens are acceptable for the PCRassay. Transport media containing gel cannot be used. Swabs with wire shafts and transport media with charcoalhave not been validated for use with this assay.
Test Change Alert #430 February 16, 2015
The following tables reflect revisions only; other existing data remain unchanged.
page: 36
HIV-1 GENOTYPINGTest Code HIVGT3
Billing Code HIVGT3Effective 3/17/2015
SynonymsHIV-1 drug resistance; HIV-1 gene sequencing; HIV-1 mutations; HIV Genotyping; HIV Resistance; HIV-1 DrugResistance Mutation Analysis; HIV-1 Genotyping for Drug Resistance; HIV-1 Mutation Analysis; HumanImmunodeficiency Virus-1 Genotyping
Container Type Frozen EDTA plasma in a PPT tube or polypropylene tube containing plasma that has been poured off from a PPTtube
Supply ItemNumber
1253
Store andTransport
Frozen. Ship Category B
Specimen Type EDTA Plasma
Preferred Volume 3 mL
Minimum Volume 1.5 mL
CollectionProcedure
Collect whole blood in two 5 mL EDTA (lavender) tubes. Vacutainer PPT Brand tubes, Becton-Dickinson # 36278 orequivalent and immediately invert the tubes 8 to 10 times. IMPORTANT: specimens collected with heparin are notsuitable for this assay.
SpecimenProcessing
Separate plasma within 30 minutes, but no later than 2 hours, if using PPT tubes or equivalent. Centrifuge at 1,000to 2,000 x g at RT for 15 minutes. ASAP, transfer to 2 sterile polypropylene tubes and immediately freeze at -65 to -80C. Ship at -70C or colder on dry ice.
Required PatientInfo
HIV viral load
Refrigerated 1 day
Frozen -20c 4 weeks
Frozen -70c 6 months
UnacceptableCondition
Specimens collected with heparin are not suitable for this assay. Plasma samples cannot go through more than 2freeze/thaw cycles. Patients must have viral load > 1,000 copies/mL.
Limitations Plasma samples cannot go through more than 2 freeze-thaw cycles.
Department Molecular Genetics
ReferenceLaboratory
PAML
CPT Codes 87901
Test Schedule Mon, Wed
Turnaround Time 3-10 days
Method PCR/Sequencing
Test Includes
Resistance Associated Mutations; NRTI Class: Emtricitabine, FTC (EMTRIVA®), Lamivudine, 3TC (EPIVIR®),Zidovudine, ZDV (RETROVIR®), Didanosine, ddl (VIDEX®), Tenofovir, TDF (VIREAD®), Stavudine, d4T (ZERIT®),Abacavir, ABC (ZIAGEN®); NNRTI Class: Rilpivirine, RPV (EDURANT®), Etravirine, ETR (INTELENCE®), Efavirenz,EFV (SUSTIVA®), Nevirapine, NVP (VIRAMUNE®); PI Class: Tipranavir, TPV (APTIVUS®), Indinavir, IDV(CRIXIVAN®), Saquinavir, SQV (FORTOVASE®/INVIRASE®), Lopinavir + Ritonavir, LPV (KALETRA®),Fosamprenavir, FPV (LEXIVA®), Darunavir, DRV (PREZISTA®), Atazanavir, ATV (REYATAZ®), Nelfinavir, NFV(VIRACEPT®).
ReferenceRanges
Title Descriptor Ranges
Drug Resistance Evidence of Resistance
NRTI Class
Emtricitabine (FTC)
Lamivudine (3TC)
ReferenceRanges
continued
Zidovudine (ZDV)
Didanosine (ddl)
Tenofovir (TDF)
Stavudine (d4T)
Test Change Alert #430 February 16, 2015
The following tables reflect revisions only; other existing data remain unchanged.
page: 37
HIV-1 GENOTYPING
ReferenceRanges
continued
Abacavir (ABC)
NNRTI Class
Rilpivirine (RPV)
Etravirine (ETR)
ReferenceRanges
continued
Efavirenz (EFV)
Nevirapine (NVP)
PI Class
Tipranavir (TPV)
ReferenceRanges
continued
Indinavir (IDV)
Saquinavir (SQV)
Lopinavir + Ritonavir (LPV)
Fosamprenavir (FPV)
ReferenceRanges
continued
Darunavir (DRV)
Atazanavir (ATV)
Nelfinavir (NFV)
ReferenceRanges
continued
Comment All HIV 1 Genotype results must be interpreted in the context of both clinical andlaboratory findings. This information is protected by various state laws to clientlocation and, in such cases, cannot be further disclosed without the patient's specificwritten consent, or as otherwise permitted by law. The protease inhibitor (PI)evidence of resistance interpretations were developed to estimate the expectedvirological response to standard doses of protease inhibitors with pharmacokineticboosting by Ritonavir. This has become the most common method of administeringeach of the protease inhibitors, except Nelfinavir, to ensure adequate drug levels inall patients. Boosted PIs are more active in the presence of resistance than non-boosted PIs.
ClinicalSignificance
HIV-1 genotyping for drug resistance provides useful information regarding key mutations associated withresistance to nucleotide reverse-transcriptase inhibitors (NRTIs), non-nucleotide reverse-transcriptase inhibitors(NNRTIs), and protease inhibitors (PIs). Monitoring drug resistance when clinically indicated during treatment isone important factor for guiding therapeutic decisions.
ComplianceRemarks
This test was developed and its performance characteristics determined by PAML Division of Laboratory Medicine.The U.S. Food and Drug Administration (FDA) has not approved or cleared this test. However, FDA approval orclearance is currently not required for clinical use of this test. The results are not intended to be used as the solemeans for clinical diagnosis or patient management decisions. PAML is authorized under Clinical LaboratoryImprovement Amendments (CLIA) to perform high-complexity testing.
Notes
This test is intended to be used to monitor known HIV-1 positive infections, and should not be used for primarydetection of HIV. PCR amplification and sequencing results may be poor or unreliable for HIV-1 viral loads below1000 copies/mL. This test may not detect minor HIV-1 populations present below 30 percent of the total population.In rare cases, insertions or deletions may be difficult to detect with this method, and may lead to an inaccurateDrug Resistance Report.
Notes on Evidence of Resistance:
Resistance: Mutations present constitute a high level of genetic evidence for viral resistance
Possible Resistance: Mutations present suggest the possibility of viral resistance
None: There is insufficient evidence for viral resistance
The protease inhibitor (PI) evidence of resistance interpretations were developed to estimate the expectedvirological response to standard doses of protease inhibitors with pharmacokinetic boosting by Ritonavir. Thishas become the most common method of administering each of the protease inhibitors, except Nelfinavir, toensure adequate drug levels in all patients. Boosted PIs are more active in the presence of resistance than non-boosted PIs.
New New Test - Replaces HIVGT2
Test Change Alert #430 February 16, 2015
The following tables reflect revisions only; other existing data remain unchanged.
page: 38
HISTOPLASMA AG, UR QUAL RFLXTest Code HISAGU
Billing Code HISAGUEffective 3/17/2015
Synonyms Histoplasma Capsulatum Urine Antigen EIA, Qualitative; Galactomannan; Histoplasma Antigen Screen
Container Type Urine, leakproof plastic urine container
Supply ItemNumber
1387
Store andTransport
Refrigerated
Specimen Type Random urine
Preferred Volume 10 mL
Minimum Volume 5 mL
CollectionProcedure
Collect a random urine in a leakproof plastic urine container.
Room Temp 2 days
Refrigerated 2 weeks
Frozen -20c 1 month
UnacceptableCondition
Urine in boric acid; urine in preservative
Department Special Immunology
ReferenceLaboratory
PAML (Positive samples will be sent to MiraVista)
Reference labTest Code
310
CPT Codes 87385
Test Schedule Tue, Thu, Sat
Turnaround Time 1-3 days (It will take an additional 3-7 days if the sample is positive to get the quantitation.)
Method Qualitative sandwich enzyme immunoassay (EIA)
ReferenceRanges
Title Descriptor Ranges
Histoplasma Antigen Negative Not Detected
ClinicalSignificance
Histoplasma Ag, Ur Qual (Rflx) is suitable for the screening of patients who are at risk for histoplasmosis. Thisassay detects an antigen associated with Histoplasma capsulatum in urine (galactomannan) in patients withdisseminated Histoplasmosis.
This test should not be used as the sole means of diagnosis, but can be used as an aid in the diagnosis ofhistoplasmosis. Clinical diagnosis should be made in conjunction with other diagnostic procedures including butnot limited to radiographic examination, microbiological culture, and/or histological examination of sample biopsyfrom the lung, skin, liver or bone marrow.
When a quantitative result is necessary such as when the patient has an known diagnosis of histoplasomosis andis undergoing treatment, please refer the testing to (Quantitative Histoplasma Antigen Test).
ComplianceRemarks
This test was developed and its performance characteristics determined by PAML. The U.S. Food and DrugAdministration (FDA) has not approved or cleared this test. However, FDA approval or clearance is currently notrequired for clinical use of this test. The results are not intended to be used as the sole means for clinicaldiagnosis or patient management decisions. PAML is authorized under Clinical Laboratory ImprovementAmendments (CLIA) to perform high-complexity testing.
Notes
Intended Use: Aid in diagnosis of histoplasmosis.
Positive results will be sent to Mira Vista Diagnostics for confirmation and quantitation.
Blastomyces species have demonstrated reactivity with the monoclonal antibodies used in the assay and mayyield a positive test result.
Reflex TestingReflex Condition Reflex Test Name Reflex CPT codes Reflex Billing Codes
Positive HISAGB 87385 BHISUR
New New Test
Test Change Alert #430 February 16, 2015
The following tables reflect revisions only; other existing data remain unchanged.
page: 39
HISTOPLASMA AG, UR QUAL RFLX
Please Note
This test may reflex to additional tests depending upon the results of this test. An additional fee will be added if thereflex test is necessary.
This test is a lab developed test. For further information, see the Compliance Remarks section below.
KEPPRA (LEVETIRACETAM)Test Code KEP
Billing Code KEPEffective 1/29/2015
CPT Codes 80177
Please Note Previous CPT Codes: 80299
LAMOTRIGINETest Code LAMI
Billing Code LAMIEffective 1/29/2015
CPT Codes 80175
Please Note Previous CPT Codes: 80299
ZONISAMIDETest Code ZONI
Billing Code ZONIEffective 1/29/2015
CPT Codes 80203
Please Note Previous CPT Codes: 80299
DRUGS OF ABUSE 600 RFLXTest Code DA600
Billing Code DA600Effective 3/17/2015
Please Note Please refer to IMB for important update information.
EXTENDED DRUG SURVEY RFLXTest Code EXDS
Billing Code EXDSEffective 3/17/2015
Please Note Please refer to IMB for important update information.
T. VAGINALIS (APTIMA)Test Code APTTV
Billing Code APTTVEffective 1/29/2015
CPT Codes 87661
Please Note Previous CPT Codes: 87798
Test Change Alert #430 February 16, 2015
The following tables reflect revisions only; other existing data remain unchanged.
page: 40
PAML Web Test Directory Link
HCV GENOTYPE (PCR/PROBE)Test Code HCVGTY
Billing Code HCVGTYEffective 2/13/2015
CPT Codes 87902
NotesThis procedure may not be successful when the HCV viral load is < 500 IU/mL. This assay incorporates ferrocene-labeled signal probes to detect the six major genotypes and their most common subtypes (1a, 1b, 2a/c, 2b, 3, 4, 5,6).
Please Note Previous CPT Codes: 87522
HIV 1 GENOTYPINGTest Code HIVGT2
Billing Code HIVGT2Effective 3/17/2015
Delete This test is being discontinued. Use the ordercode HIVGT3 to order this test.
Test Change Alert #430 February 16, 2015
The following tables reflect revisions only; other existing data remain unchanged.
page: 41
