Medicare Medical Necessity Restrictions May Apply
Medical Necessity Documentation:
Client Notes:
Do not collect on Friday's, weekends or the day before holiday. HLA B-27 specimen must be sent to the laboratory the same day as collection.
Patient Preparation:
Patient should discontinue taking Biotin, Vitamin B7, or Vitamin H 48 hours before getting blood drawn.
Specimen Requirements:
5.0 mL Serum from a Red Top Tube in a Plastic Vial
and
6.0 mL Whole Blood in a Yellow Top Tube - ACD
and
3.0 mL Plasma in a PST Mint Green Top Tube - Li Heparin
and
3.0 mL Plasma from a Lavender Top Tube - EDTA in a Plastic Vial
and
3.0 mL Whole Blood in a Lavender Top Tube - EDTA
and
10.0 mL aliquot from a well mixed 24 hour Urine Collection in a Plastic Container
and
20.0 mL aliquot from a well mixed 24 hour Urine Collection in a Plastic Container
Collection Instructions:
Order and specimens must include the patients age
Serum Collection: Avoid Hemoloysis; Centrifuge and separate from cells within 1 hour of collection
24-Hour Urine Collection:
1. When starting the 24-hour period, urinate and discard (throw-away) this specimen. NOTE THE TIME
2. From that time on, collect all urine by urinating into a clean container and transfer into the provided container.
DO NOT URINATE DIRECTLY INTO CONTAINER.
3. Try to pass the last urine just prior to the end of the 24 hour period. Add this urine into the container.
4. Urine Specimen should be kept refrigerated during and after collection.
For patient collection instruction sheet see Addendum D
Plasma from Lavendar Top Tube: needs centrifuged and separate from cells immediately
Whole Blood Lavendar Top Tube: Mix tube by inversion 5 times; Do not centrifuge; Specimens must not be clotted and cannot contain microclots. Overfilling or underfilling may allow blood to clot.
Transport & Storage: Temperature/Stability:
ESR Whole Blood Lavender:
Must be tested within 4 hours of collection, if testing delayed longer than this Refrigerate
Do not Freeze
Reference Range:
Refer to Individual Tests
Critical Ranges:
Test Comments:
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.
Patients taking vitamin supplements containing high doses of biotin (>5 mg/day) may have falsely increased or decreased test results generated.
Methodology:
Multiple
Clinical Significance:
Documentation:
Custom Panel:
No
PRODUCTION SCHEDULE
Days Performed:
Sunday, Monday, Tuesday, Wednesday, Thursday, Friday, Saturday
Sites Performed:
Parkview Hospital Randallia, Parkview Huntington, Parkview LaGrange, Parkview Noble, Parkview Regional Medical Center, Parkview Wabash, Parkview Warsaw , Parkview Whitley, Quest - Valencia
PHL Test Code:
FIBRO
EPIC Test Code:
LAB2303
Included Tests:
Antinuclear Antibody Screen (ANA); Anti Strptolysin-O (ASO); Calcium (Ca); Chem 6 [Blood Urea Nitrogen (BUN); Creatinine; Electrolytes [Carbon Dioxide (CO2); Chloride (CL); Potassium (K); Sodium (Na)]; Complete Blood Count [Automated Differential; Hematocrit (Hct); Hemoglobin (Hgb); Mean Corpuscular Hemoglobin (MCH); Mean Corpuscular Hemoglobin Concentration (MCHC); Mean Corpuscular Volume (MCV); Platelet (PLT); Red Blood Cell Count (RBC); Red Cell Distribution Width Standard Deviation (RDWSD); Red Cell Distribution Width Coefficient Variation (RDWCV); White Blood Cell Count (WBC)]; Cortisol, Free 24-hr Urine; C-Reactive Protein (CRP); Creatine Kinase (CK); Epstein-Barr Virus Basic Panel [Epstein-Barr Virus Antibody IgG; Epstein-Barr Virus Antibody IgM]; Estrogen, Total; Glucose Random; HLA-B27 Antigen; Insulin - Like Growth Factor 1 (IGF-1 / Somatomedin C); Magnesium (Mg); Parathyroid Hormones Intact (PTH Intact); Progesterone; Protein Electrophoresis; Protein Electrophoresis 24-hr Urine; Rheumatoid Factor (RF); Sedimentation Rate (ESR); Testosterone, Total; Thyroid Profile with TSH [Free Thyroxine Index (FTI); T3 Uptake; Thyroid Stimulated Hormone (TSH); Thyroxine Total (T4)]; Uric Acid
CPT Coding:
84305, 86665 x 2, 82530, 85652, 80051, 82565, 84520, 84436, 84479, 84443, 86430, 84550; 86038; 86140; 86063; 82310; 83735