Last Modified: 11/17/2021 9:19:12 AM

Medical Necessity Documentation:  
Client Notes:  
Patient Preparation:  
Specimen Requirements:

1.0 mL Plasma from a PST Mint Green Top Tube - Lithium Heparin (preferred)
1.0 mL Serum in a SST Gold Top Tube

Collection Instructions:  
Minimum Volume: 0.2 mL Plasma or Serum
Neonatal Volume: 0.3 mL Whole Blood Green Microtainer
Transport & Storage: Temperature/Stability: 5 days Refrigerated

48 hours unspun
Reference Range:
   <1 year: 8.7 - 10.5 mg/dL
  1 year to 4 years: 8.5 - 10.6 mg/dL
  4 years to 20 years: 8.9 - 10.4 mg/dL
   >20 yrs: 8.5-10.3 mg/dl
Critical Ranges:
NICU (Infants in a Parkview Health Neonatal Intensive Care Unit): 
Low: < 6.0 mg/dL 
High: > 11.5 mg/dL

Low: < 7.0 mg/dL 
High: > 13.0 mg/dL
Test Comments:  
Methodology: Colorimetric
Clinical Significance:  
Custom Panel: No


Stat Eligible: Yes
Days Performed: Sunday, Monday, Tuesday, Wednesday, Thursday, Friday, Saturday
Sites Performed: Parkview Cancer Institute, Parkview Dekalb, Parkview Hospital Randallia, Parkview Huntington, Parkview LaGrange, Parkview Noble, Parkview Regional Medical Center, Parkview Wabash, Parkview Warsaw , Parkview Whitley
PHL Test Code: CA
EPIC Test Code: LAB53
Alternate Test Names: CA
Included Tests:  
CPT Coding: 82310

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