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
Collection Instructions:
Order and specimens must include the patients age
Serum Collection: Avoid Hemoloysis; Centrifuge and separate from cells within 1 hour of collection
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; If submitting a specimen that is greater than 24 hours, please also submit a slide for the differential; Specimens must not be clotted and cannot contain microclots. Overfilling or underfilling may allow blood to clot. Specimens may be rejected due to WBC deterioration resulting from improper storage or age of specimen; For slide preparation see Addendum D
Transport & Storage: Temperature/Stability:
ESR Whole Blood Lavendar:
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 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, Quest - Chantilly
PHL Test Code:
FIBNU
EPIC Test Code:
LAB2366
Alternate Test Names:
Fibro Panel (no Urines); Fibro Panel w/out Urines
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)]; 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; 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, 85652, 80051, 82565, 84520, 84436, 84479, 84443, 86431, 84550; 86038; 86140; 86060; 82310; 83735, 83970 (Reflex 86039)