Semen Screen, Post Vasectomy

Last Modified: 8/30/2023 1:18:40 PM


Medical Necessity Documentation:  
Client Notes:  
Patient Preparation: Patient should be instructed to collect a semen sample after at least 2 months post vasectomy and after 20 ejaculations.
2 - 7 day abstinence prior to collection
Specimen Requirements:

Semen in a Non-Sterile Yellow Capped Container 
Collection Instructions:

Specimen must be delivered to the Testing laboratory within 24 hours of collection.

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

Reciept of an incorrect collection container will not be rejected but will be reported as such on the report with the results.
Transport & Storage: Temperature/Stability: 24 hours Ambient
Reference Range:

No sperm seen / hpf
Critical Ranges:  
Test Comments:

WBC will be noted with > 5 hpf are present.
Methodology: Microscopic; Wet mount: concentrated or non-concentrated will be noted
Clinical Significance:  
Documentation:  
Custom Panel: No

PRODUCTION SCHEDULE

Days Performed: Monday, Tuesday, Wednesday, Thursday, Friday
Sites Performed: 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: SSPV
EPIC Test Code: LAB2128
Alternate Test Names: Post Vas; Post Vasectomy; Semen Screen-Post Vas
Included Tests:  
CPT Coding: 89321

Go back to the top of the page.