Urinalysis with Culture and Sensitivity if Indicated

Last Modified: 8/30/2023 1:24:16 PM


Medical Necessity Documentation:  
Client Notes:  
Patient Preparation:  
Specimen Requirements: Urinalysis
8.0 mL Urine in a Yellow Capped Tube 

and 

Culture if Indicated
4.0 mL Urine in a Grey Top Tube - C&S Preservative

both from 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:

Yellow Top Tube
Ambient if testing can be completed within 2 hours of collection
24 hours Refrigerated
Do Not Freeze

Grey Top
48 hours Ambient or Refrigerated.
Rejection Criteria: If only the Grey Top is recieved (Urinalysis will not be done)
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)


Microscopic
WBC 0 - 5 / hpf
RBC 0 - 2 / hpf
Bact None Seen
Epithelial cells 0 - 4 / 1pf
Casts 0 - 4 / 1pf
RBC/hpf (No bacteria seen)
0 - 5 WBC/hpf (No bacteria seen)
Critical Ranges:  
Test Comments: Culture and Sensitivity will be performed and charged when these criteria are met: 
Dipstick Testing: 
 Nitrite: > or = to trace
 Leuk. Esterase: > or = to trace

Microscopic Exam: 
Bacteria: > 3+ /hpf
WBC: > 6 /hpf
Yeast present (All males. Females if does not appear to be vaginal contamination)
Methodology: Test Strip & Microscopic Exam if indicated
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: UACI
EPIC Test Code: LAB2138
Alternate Test Names: UA C&S if WBC>5 ; UA with C&S if Indicated; Urinalysis Culture if Indicated
Included Tests: Bilirubin; Blood Hemoglobin; Clarity; Color; Glucose; Ketones; Leukocyte Esterase; Microscopic Findings; Nitrite; pH; Protein; Specific Gravity; Urobilinogen
CPT Coding: 81003: If microscopic is reflexed, CPT 81001 will be billed instead of 81003; CPT 87086 will reflex if culture is indicated

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