Last Modified:
8/30/2023 12:57:37 PM
Medicare Medical Necessity Restrictions May Apply
Medical Necessity Documentation:
Client Notes:
When sending to Parkview Dekalb: 1.0 mL Serum in a SST Gold Top Tube is the recommend specimen
Patient Preparation:
Specimen Requirements:
1.0 mL Plasma in a PST Mint Green Top Tube - Li Heparin (preferred)
or
1.0 mL Serum in a SST Gold Top Tube
Collection Instructions:
Minimum Volume:
0.5 mL Plasma
Transport & Storage: Temperature/Stability:
7 days Refrigerated
24 hours unspun
Reference Range:
0.25 - 4.5 uIU/ml
Free T4: 0.80 - 1.80 ng/dL
Critical Ranges:
Test Comments:
A Free T4 will automatically be performed and charged when the TSH is <0.25 or >4.50.
It has been noticed that allopurinol may falsely elevate TSH level. Cotesting with Free T4 and correlation with clinical symptoms are recommended in evaluation of thyroid function in this subset of patients.
TSH -- This assay utilizes biotin technology. Patients taking vitamin supplements containing high doses of biotin (>5 mg/day) may have falsely decreased test results generated.
T4FRE -- This assay utilizes biotin technology. Patients taking vitamin supplements containing high doses of biotin (>5 mg/day) may have falsely increased test results generated.
Methodology:
ECLIA
Clinical Significance:
This is the preferred alternative to the traditional Thyroid Profile (T4, T3 Uptake, FTI).
Documentation:
Any order of a Thyroid Profile will change to this test code TSHR
Custom Panel:
No
PRODUCTION SCHEDULE
Days Performed:
Sunday, Monday, Tuesday, Wednesday, Thursday, Friday, Saturday
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:
TSHR
EPIC Test Code:
LAB2322
Alternate Test Names:
Thyroid Profile; TSH with Free T4 Reflex
Included Tests:
Thyroid Stimulating Hormone (TSH); Thyroxine (Free T4)
CPT Coding:
84443 (Reflexes 84439)
Go back to the top of the page.