Parkview Health Laboratory: Test Directory

Medicare Medical Necessity Restrictions May Apply

Medical Necessity Documentation: Hemogram ABN Form: For Non-acceptable narrative descriptions and ICD-9 information see Addendum C

Specimen Requirements: 3.0 mL Whole Blood in a Lavender Top Tube - EDTA

Collection Instructions: Mix tube by inversion 5 times

Specimens must not be clotted. Overfilling or underfilling may allow blood to clot. Specimens may be rejected due to blood changes or deterioration resulting from improper storage or age of specimen

Minimum Volume: 1.5 mL

Transport & Storage: Temperature/Stability: 24 hours Ambient
72 hours Refrigerated

Reference Range:

For Pediatric Reference Ranges refer to Addendum B
Males > 14 Yrs

WBC: 4.5 - 11.0 TH/UL

RBC: 4.3 - 5.7 MI/UL

Hgb: 13.5 - 17.2 G/DL

Hct: 40.0 - 54.0%

MCV: 82.0 - 98.0 FL

MCH: 27.0 - 33.0 PG

MCHC: 32.0 - 36.0 GM/DL

Platelet: 150.0 - 450.0 TH/UL

RDWSD: 36.4 - 54.5 FL

RDWCV: 11.5 - 14.5%

Females > 14 Yrs

WBC: 4.5 - 11.0 TH/UL

RBC: 4.0 - 5.2 MI/UL

Hgb: 12.0 - 15.5 G/DL

Hct: 35.0 - 48.0%

MCV: 82.0 - 98.0 FL

MCH: 27.0 - 33.0 PG

MCHC: 32.0 - 36.0 G/DL

Platelet: 150.0 - 450.0 TH/UL

RDWSD: 36.4 - 54.5 FL

RDWCV: 11.5 - 14.5%

Critical Ranges:

Pediatric (< = 15 days old) Low Critical Limits

WBC: < = 2.0 T/UL

Hgb: < = 10.0 G/DL

Platelet: < = 30.0 T/UL

Pediatric (< = 15 days old) High Critical Limits

WBC: > = 39.0 T/UL

Hct: > = 70.0%
Hgb: > = 24.0 G/DL

Platelet: > = 850 T/UL

Low Critical Limits
WBC: < = 1.5 T/UL

Hgb: < = 6.0 G/DL

Platelet: < = 30 T/UL

High Critical Limits
WBC: > = 40.0 T/UL

Hgb: > = 19.0 G/DL

Platelet: > = 850 T/UL

NICU at PRMC & PVH Low Critical Limits:
HCT: >15 days old <=30% and >=70%
Platelet: <= 100.0 T/UL

NICU at PRMC & PVH High Critical Limits:
HCT: >15 days old <=25% and >=70%
Platelet: >= 600 T/UL

Oncology Wards at PRMC & PVH Low Critical Limits:
WBC: <=1.0 T/UL
Hgb: <=5.0 G/dL
Platelet: <=20 T/UL

OHP Low Critical Limit:
Hgb: <= 7.0 G/dL

Methodology: Blood Cell Analyzer

Custom Panel: No

Stat Eligible: Yes

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 Whitley

PHL Test Code: CBCND

Alternate Test Names: CBC; CBC No Differential; Hemogram; Hemogram (CBC/No Diff)

Included Tests: 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)

CPT Coding: 85027

Parkview Laboratory: Test Directory

Complete Blood Count

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