Urinalysis with Microscopic and Culture and Sensitivity if Indicated

Last Modified: 8/30/2023 1:20:05 PM


  Medicare Medical Necessity Restrictions May Apply
Medical Necessity Documentation:  
Client Notes:  
Patient Preparation:  
Specimen Requirements: 8.0 mL Urine in a Yellow Capped Tube 
and 
4.0 mL Urine in a Grey Top Tube - C&S Preservative

Both from a CCMS Collection Kit
Collection Instructions: First morning, CCMS collection is preferred

Order must include how the specimen was collection; Voided, Random,  First Morning, CCMS,  Pediatric Bag, Indwelling Catheter, Straight, Mini and In/Out Catheters, Supra Pubic, Cysto Collection

For CCMS Collection instructions see Addendum D
For CCMS Spanish patient collection instruction sheet see Addendum D
For CCMS Burmese patient collection instruction sheet see Addendum D
For CCMS Arabic patient collection instruction sheet see Addendum D

For Pediatric Bag patient instruction sheet see Addendum D
For Pediatric Bag Spanish patient instruction sheet see Addendum D
For Pediatric Bag Burmese patient instruction sheet see Addendum D
For Pediatric Bag Arabic patient instruction sheet see Addendum D
Minimum Volume: 2.0 mL Urine & Grey Top (Filled to Minimum Line)
Transport & Storage: Temperature/Stability:

Urinalysis - Yellow Top
24 hours Refrigerated
Do Not Freeze

Culture - Gray Top
48 hours Ambient
48 hours Refrigerated
Reference Range:

Color: Yellow/Straw
Clarity: Clear
Specific Gravity: 1.005 - 1.030
pH: 5.0 - 8.0
Protein: Negative
Glucose: Negative
Ketones: Negative
Blood Hemoglobin: Negative
Bilirubin: Negative
Urobilinogen: 0.0 - 0.2 mg/dl
Leukocyte Esterase: Negative
Nitrite: Negative
Microscopic: 0 - 2 RBC/hpf (No bacteria seen)
Microscopic: 0 - 5 WBC/hpf (No bacteria seen)
Critical Ranges:  
Test Comments: Culture and Sensitivity will be performed and charged when indicated
Methodology: Test Strip & Microscopic Exam
Clinical Significance:  
Documentation:  
Custom Panel: No

PRODUCTION SCHEDULE

Days Performed: Sunday, Monday, Tuesday, Wednesday, Thursday, Friday, Saturday
Sites Performed: Parkview Cancer Institute, Parkview Dekalb Hospital, Parkview Huntington Hospital, Parkview LaGrange Hospital, Parkview Noble Hospital, Parkview Randallia Hospital, Parkview Regional Medical Center, Parkview Southwest , Parkview Wabash Hospital, Parkview Warsaw , Parkview Whitley Hospital
PHL Test Code: UAMC2
EPIC Test Code: LAB2143
Alternate Test Names: UA with Microscopic and C&S if Indicated
Included Tests: Bilirubin; Blood Hemoglobin; Clarity; Color; Glucose; Ketones; Leukocyte Esterase; Microscopic Findings; Nitrite; pH; Protein; Specific Gravity; Urobilinogen
CPT Coding: 81001 (Reflex 87086)

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