ANAESN .......................................................................................................................... ANTI-NUCLEAR ANTIBODY (ANA), BY EIA7/17/2012, New

ANAESR ............................................................................................... ANTI-NUCLEAR ANTIBODY (ANA), BY EIA (REFLEXIVE)7/17/2012, New

AP1 (APP1)..................................................................................................................... ANTIPHOSPHOLIPID PANEL 1, (REFLEXIVE)7/17/2012,Alternate Specimens

APOA (APO A)....................................................................................................................................................... APOLIPOPROTEIN A-17/17/2012,Delete

APOAB ........................................................................................................................... APOLIPOPROTEIN A-1 & B100 WITH RATIO7/17/2012, New

APOB (APO B).................................................................................................................................................. APOLIPOPROTEIN B-1007/17/2012,Delete

APOLA .................................................................................................................................................................... APOLIPOPROTEIN A-17/17/2012, New

APOLB ............................................................................................................................................................... APOLIPOPROTEIN B-1007/17/2012, New

APP2 ............................................................................................................................... ANTIPHOSPHOLIPID PANEL 2, (REFLEXIVE)7/17/2012,Alternate Specimens

APP3 ............................................................................................................................... ANTIPHOSPHOLIPID PANEL 3, (REFLEXIVE)7/17/2012,Alternate Specimens

CARB ................................................................................................................................................................................ CARBAMAZEPINE7/17/2012,Reference Ranges

CHROM ...................................................................................................................................................... CHROMIUM, WHOLE BLOOD8/6/2012,Room Temp,Refrigerated,Frozen -20c

CK (CPK)........................................................................................................................................................................... CREATINE KINASE6/12/2012,Reference Ranges

COCOUA ...................................................................................................... CORTISOL/CORTISONE FREE, URINE 24HR [ARUP]7/17/2012, New

CORFUA ........................................................................................................... CORTISOL FREE, URINE 24HR LC-MS/MS [ARUP]7/17/2012, New

CORUFA ....................................................................................................... CORTISOL/CORTISONE FREE, URINE 24HR [ARUP]7/17/2012,Delete

CRCF ................................................................................................... CULTURE, RESPIRATORY CYSTIC FIBROSIS (REFLEXIVE)7/17/2012,Container Type

CUFAR ................................................................................................................ CORTISOL FREE, URINE 24HR LC-MS/MS [ARUP]7/17/2012,Delete

DEXMR ............................................................................................... DEXTROMETHORPHAN AND METABOLITE RATIO, URINE7/17/2012, New

DIG ......................................................................................................................................................................................................... DIGOXIN7/17/2012,Container Type

DILFR (DIL.FREE) ..................................................................................................................................... PHENYTOIN, FREE & TOTAL5/21/2012,Reference Ranges

G6PD ............................................................................................................................ GLUCOSE-6-PHOSPHATE DEHYDROGENASE7/17/2012,Specimen Type

GLUFL (GLU-FLD)......................................................................................................................................................... GLUCOSE, FLUID6/12/2012,Container Type

HDPAP ......................................................................................... HEPARIN-DEPENDENT PLATELET ANTIBODY (SRA) - PANEL7/17/2012,CPT Codes

TEST CHANGE ALERT #391 June 18, 2012

Summary Of Changes

page: 1

ICDAN ...................................................................................................... ALLERGEN, DANDELION (TARAXACUM VULGARE) IGE7/17/2012, New

LDFL (LDH.FLD)............................................................................................................................................................................. LD, FLUID6/12/2012,Container Type

LEF .......................................................................................................................................................... LEFLUNOMIDE AS METABOLITE8/6/2012,Alternate Specimens,Specimen Type

LIPAFL ................................................................................................................................................................................... LIPASE, FLUID6/12/2012,Container Type

MYAGAB ........................ MYELIN ASSOC. GLYCOPROTEIN (MAG) ANTIBODY W/REFLEX TO MAG-SGPG & MAG, EIA7/17/2012, New

NMRLP .......................................................................................................................................................................... NMR LIPOPROFILE6/26/2012,Reference Ranges

NMRLP2 ............................................................................................................................... NMR LIPOPROFILE TEST (LDL-P ONLY)6/26/2012,Reference Ranges

NOROPC ...................................................................................................................................... NOROVIRUS GROUP 1 & 2 RT-PCR5/14/2012,Test Schedule

PORFR .................................................................................................................... PORPHYRINS PROFILE, PLASMA (REFLEXIVE)7/17/2012, New

PORPHM ............................................................................................................... PORPHYRINS PROFILE, PLASMA (REFLEXIVE)5/23/2012,Delete

SIR ........................................................................................................................................................ SIROLIMUS, PARENT DRUG ONLY5/16/2012,Specimen Processing

STONA .................................................................................................................................................. STONE ANALYSIS WITH IMAGE7/17/2012, New

TANTIC ................................................................................................................................... THROMBIN-ANTITHROMBIN COMPLEX5/8/2012,Reference Ranges

TESTED ...................... TESTOSTERONE, TOTAL & FREE, SERUM BY EQUILIBRIUM DIALYSIS & LC & MS/MS [MAYO]5/31/2012,Alternate Specimens,Limitations,Unacceptable Condition

THRUSC .................................................................................................................................. THYROGLOBULIN (TG) + TGAB [USC]7/17/2012,Delete

THYCM ............................................................................................................................................... THYROID CANCER MONITORING7/17/2012, New

TOBIN (TOB2)..................................................................................................................................................... TOBRAMYCIN (PAIRED)5/22/2012,Room Temp

TOBR (TOB)......................................................................................................................................................... TOBRAMYCIN (SINGLE)5/22/2012,Room Temp

TOBRPK (TOB.PK)............................................................................................................................................... TOBRAMYCIN, PEAK5/22/2012,Room Temp

TOBRTR (TOB.TR)......................................................................................................................................... TOBRAMYCIN, TROUGH5/22/2012,Room Temp

TRIFLU (TRI)............................................................................................................................ TRIFLUOPERAZINE, SERUM/PLASMA7/17/2012,Room Temp,Notes,Refrigerated,Minimum Volume,Store and Transport,Test Schedule,Method,Frozen -20c,TurnaroundTime,Preferred Volume,Test Name,Specimen Processing

TSH ................................................................................................................................................................................................................. TSH6/12/2012,Reference Ranges

TEST CHANGE ALERT #391 June 18, 2012

Summary Of Changes

page: 2

ANTI-NUCLEAR ANTIBODY (ANA), BY EIATest Code ANAESN

Billing Code ANAESNEffective 7/17/2012

Synonyms Antinuclear Antibodies; Lupus; Connective Tissue Disorder; Autoimmune Disease; SLE; Anti-Nuclear Antibody,Screen; ANA Screen

Container Type SST tube

Specimen Type Serum

Preferred Volume 0.5 mL

Minimum Volume 0.4 mL

CollectionProcedure

Separate serum from cells and put in separate plastic tube. Avoid using lipemic or hemolyzed serum.

Room Temp 24 hours

Refrigerated 2 weeks

Frozen -20c 1 year

UnacceptableCondition

Plasma or heat inactivated samples, grossly lipemic, hemolyzed should be avoided

Limitations Interfering substances include turbidity and visible bacterial growth. Avoid repeated freeze/thaw cycles.

CPT Codes 86038

Test Schedule Mon, Wed, Fri

Turnaround Time 1-3 days

Method Enzyme-Linked Immunosorbent Assay

Test Includes ANA by EIA, Serum

ReferenceRanges

ANA by EIA, AB LT 1.0 UANA by EIA, Interp Negative

New New Test

TEST CHANGE ALERT #391 June 18, 2012

The following tables reflect revisions only; other existing data remain unchanged.

page: 3

ANTI-NUCLEAR ANTIBODY (ANA), BY EIA (REFLEXIVE)Test Code ANAESR

Billing Code ANAESREffective 7/17/2012

Synonyms Antinuclear Antibodies; Lupus; Connective Tissue Disorder; Autoimmune Disease; SLE; Anti-Nuclear Antibody,Screen; ANA Screen

Container Type SST tube

Specimen Type Serum

Preferred Volume 0.5 mL

Minimum Volume 0.4 mL

CollectionProcedure

Separate serum from cells and put in separate plastic tube. Avoid using lipemic or hemolyzed serum.

Room Temp 24 hours

Refrigerated 2 weeks

Frozen -20c 1 year

UnacceptableCondition

Plasma or heat inactivated samples, grossly lipemic, hemolyzed should be avoided

Limitations Interfering substances include turbidity and visible bacterial growth. Avoid repeated freeze/thaw cycles.

CPT Codes 86038

Test Schedule Mon, Wed, Fri

Turnaround Time 1-3 days

Method Enzyme-Linked Immunosorbent Assay, Multiplex Luminex

Test Includes ANA by EIA, Serum, ANA Confirmatory Antibodies (Reflex)

ReferenceRanges

ANA by EIA, AB LT 1.0 UANA by EIA, Interp Negative

ANA CONFIRMITORY ANTIBODIES

Rangescontinued

DSDNA Autoantibody Negative IU/mL LT 5Smith Autoantibody Negative AI LT 1.0JO-1 Autoantibody Negative AI LT 1.0Ribosomal P Autoantibody Negative AI LT 1.0

Rangescontinued

Chromatin Autoantibody Negative AI LT 1.0RNP Autoantibody Negative AI LT 1.0SMRMP Autoantibody Negative AI LT 1.0SCL-70 Autoantibody Negative AI LT 1.0

Rangescontinued

Centromere B Autoantibody Negative AI LT 1.0SSA (RO) Autoantibody Negative AI LT 1.0SSB (LA) Autoantibody Negative AI LT 1.0

Rangescontinued

Notes When the index value for ANA by EIA is greater than or equal to 2.6 units, it will reflex to additional testing forconfirmation.

Reflex TestingReflex Condition Reflex Test Name Reflex CPT codes

GT 2.6 Units ANAEIA BANAMP 86225, 86235 x 9, 83516

New New Test

ANTIPHOSPHOLIPID PANEL 1, (REFLEXIVE)Test Code AP1

Billing Code APP1Effective 7/17/2012

AlternateSpecimens

SST tube is also acceptable instead of red top tube

TEST CHANGE ALERT #391 June 18, 2012

The following tables reflect revisions only; other existing data remain unchanged.

page: 4

APOLIPOPROTEIN A-1Test Code APOA

Billing Code APO AEffective 7/17/2012

Delete This test is being discontinued. Use the ordercode APOLA to order this test.

APOLIPOPROTEIN A-1 & B100 WITH RATIOTest Code APOAB

Billing Code APOABEffective 7/17/2012

Synonyms Apolipoprotein A-1 & B (Apolipoprotein B/A Ratio); Apolipoprotein APO A/B Ratio (Apolipoprotein B/A Ratio)

Container Type Serum separator tube (gold, brick, SST or corvac) or red top tube (plain)

Store andTransport

Store and transport refrigerated

Specimen Type Serum

Preferred Volume 1.0 mL

Minimum Volume 0.5 mL

Patient Prep Fasting sample recommended

SpecimenProcessing

Separate serum from cells and place in separate plastic tube.

Room Temp 8 hours

Refrigerated 8 days

Frozen -20c 90 days

UnacceptableCondition

Hemolyzed specimen

CPT Codes 82172 x 2

Test Schedule Daily

Turnaround Time 1-3 days

Method Immunotubidometric/Calculation

Test Includes Apolipoprotein A-1, B100 and B/A Ratio, mg/dl

ReferenceRanges

Apolipoprotein A-1 M 79-169 mg/dlApolipoprotein A-1 F 76-214 mg/dlApolipoprotein B100 M 46-174 mg/dlApolipoprotein B100 F 46-142 mg/dl

Rangescontinued

Apolipoprotein B/A Reference range not established

Relative Risk: Male FemaleOne Half Average Risk 0.4 0.3

Rangescontinued

Average Risk 1.0 0.9Twice Average Risk 1.6 1.5

New New Test

TEST CHANGE ALERT #391 June 18, 2012

The following tables reflect revisions only; other existing data remain unchanged.

page: 5

APOLIPOPROTEIN B-100Test Code APOB

Billing Code APO BEffective 7/17/2012

Delete This test is being discontinued. Use the ordercode APOLB to order this test.

APOLIPOPROTEIN A-1Test Code APOLA

Billing Code APOLAEffective 7/17/2012

Synonyms APO-A; APO-A1; High Density Liproprotein; A-1

Container Type Serum separator tube (gold, brick, SST, or corvac) or red top tube (plain)

Store andTransport

Store and transport refrigerated

Specimen Type Serum

Preferred Volume 1.0 mL

Minimum Volume 0.5 mL

Patient Prep Fasting sample recommended

SpecimenProcessing

Separate serum from cells and place in separate plastic tube.

Room Temp 8 hours

Refrigerated 8 days

Frozen -20c 90 days

UnacceptableCondition

Hemolyzed specimen

CPT Codes 82172

Test Schedule Daily

Turnaround Time 1-3 days

Method Immunotubidometric

Test Includes Apolipoprotein A-1, mg/dl

ReferenceRanges

Apolipoprotein A-1 M 79-169 mg/dlApolipoprotein A-1 F 76-214 mg/dl

New New Test

TEST CHANGE ALERT #391 June 18, 2012

The following tables reflect revisions only; other existing data remain unchanged.

page: 6

APOLIPOPROTEIN B-100Test Code APOLB

Billing Code APOLBEffective 7/17/2012

Synonyms APO-B; APO-B100; Low Density Lipoprotein; B-100; Low Density Lipoprotein, B

Container Type Serum separator tube (gold, brick, SST, or corvac) or red top tube (plain)

Store andTransport

Store and transport refrigerated

Specimen Type Serum

Preferred Volume 1.0 mL

Minimum Volume 0.5 mL

Patient Prep Fasting sample recommended

SpecimenProcessing

Separate serum from cells and place in separate plastic tube.

Room Temp 8 hours

Refrigerated 8 days

Frozen -20c 90 days

UnacceptableCondition

Hemolyzed specimens

CPT Codes 82172

Test Schedule Daily

Turnaround Time 1-3 days

Method Immunoturbidimetric

Test Includes Apolipoprotein B-100, mg/dl

ReferenceRanges

Apolipoprotein B-100 M 46-174 mg/dlApolipoprotein B-100 F 46-142 mg/dl

New New Test

ANTIPHOSPHOLIPID PANEL 2, (REFLEXIVE)Test Code APP2

Billing Code APP2Effective 7/17/2012

AlternateSpecimens

SST tube is also acceptable instead of red top tube

ANTIPHOSPHOLIPID PANEL 3, (REFLEXIVE)Test Code APP3

Billing Code APP3Effective 7/17/2012

AlternateSpecimens

SST tube is also acceptable instead of red top tube

TEST CHANGE ALERT #391 June 18, 2012

The following tables reflect revisions only; other existing data remain unchanged.

page: 7

CARBAMAZEPINETest Code CARB

Billing Code CARBEffective 7/17/2012

ReferenceRanges

Carbamazepine ug/mL Therapeutic 4.0-12.0 Toxic GT 15.0

ReferenceRanges

Toxicity can also be seen at lower levels with combined therapy.

CHROMIUM, WHOLE BLOODTest Code CHROM

Billing Code CHROMEffective 8/6/2012

Room Temp 30 days

Refrigerated 30 days

Frozen -20c 30 days

CREATINE KINASETest Code CK

Billing Code CPKEffective 6/12/2012

ReferenceRanges

CK (CPK) F 30-240 U/L M 55-400

TEST CHANGE ALERT #391 June 18, 2012

The following tables reflect revisions only; other existing data remain unchanged.

page: 8

CORTISOL/CORTISONE FREE, URINE 24HR [ARUP]Test Code COCOUA

Billing Code COCOUAEffective 7/17/2012

Container Type Urine, 24-hour plastic urine container

Store andTransport

Store and transport refrigerated

Specimen Type 24-hr urine collection

Preferred Volume 4 mL

Minimum Volume 1 mL

CollectionProcedure

Collect a 24-hour urine specimen. Refrigerate during collection.

SpecimenProcessing

Aliquot 4 mL of a well-mixed 24-hour urine collection into a leakproof plastic urine container. Record total volumeand collection time interval.

Required PatientInfo

Record total volume and collection time interval

Room Temp Unacceptable

Refrigerated 7 days

Frozen -20c 1 month

UnacceptableCondition

RT samples, preservatives or acidified samples

AlternateSpecimens

Random urine specimen

ReferenceLaboratory

ARUP

Reference labTest Code

0092100

CPT Codes 82530, 83789

Test Schedule Sun-Sat

Turnaround Time 2-3 days

Method Quantitative HPLC-TMS

Test IncludesHours Collected, hr; Total Volume, mL; Creatinine, Urine, mg/dL; Creatinine, Urine, mg/d; Cortisol, Urine, Free,ug/gCR; Cortisol Urine, Free, ug/L; Cortisol Urine, Free, ug/d; Cortisone, Urine Free, ug/gCR; Cortisone, Urine,Free, ug/L; Cortisone, Urine, Free ug/d; Cortisol/Cortisone Ratio, Ratio; Interpretation

ReferenceRanges

Hours Collected hrTotal Volume mLCreatinine, Urine mg/dLCreatinine, Urine mg/d

Rangescontinued

M 3-8 yrs 140-700 9-12 yrs 300-1300 13-17 yrs 500-2300 18-50 yrs 1000-2500

Rangescontinued

51-80 yrs 800-2100 81+ yrs 600-2000 F 3-8 yrs 140-700 9-12 yrs 300-1300

Rangescontinued

13-17 yrs 400-1600 18-50 yrs 700-1600 51-80 yrs 500-1400 81+ yrs 400-1300

Rangescontinued

Cortisol, Urine, Free ug/gCR F Prepubertal LT 25 18+ yrs LT 45 Pregnancy LT 59

Rangescontinued

M Prepubertal LT 25 18+ yrs LT 32Cortisol Urine, Free ug/LCortisol Urine, Free ug/d

Rangescontinued

M 3-8 yrs LT 18 9-12 yrs LT 37 13-17 yrs LT 56 18+ yrs LT 60

TEST CHANGE ALERT #391 June 18, 2012

The following tables reflect revisions only; other existing data remain unchanged.

page: 9

CORTISOL/CORTISONE FREE, URINE 24HR [ARUP]Ranges

continued

F 3-8 yrs LT 18 9-12 yrs LT 37 13-17 yrs LT 56 18+ yrs LT 45

Rangescontinued

Cortisone, Urine Free ug/gCRCortisone, Urine Free ug/LCortisone, Urine Free ug/dCortisol/Cortisone Ratio Ratio

Rangescontinued

M 0-17 yrs To be determined 18 yrs 0.15-0.50 F 0-17 yrs To be determined 18+ yrs 0.15-0.50

Rangescontinued

Interpretation The optimal specimen for this testing is a 24-hour urine collection. Mass per day calculations are not reported for the following specimen

Rangescontinued

types: a random collection, a collection with duration of less than 20 hours, a collection with duration of greater than 28 hours, or a collection with total volume less than 400 mL. Ratios to creatinine may be useful for these evaluations.

Rangescontinued Baseline urinary free cortisol excretion less than 5 ug/d may be consistent

with adrenal insufficiency.

New New Test

TEST CHANGE ALERT #391 June 18, 2012

The following tables reflect revisions only; other existing data remain unchanged.

page: 10

CORTISOL FREE, URINE 24HR LC-MS/MS [ARUP]Test Code CORFUA

Billing Code CORFUAEffective 7/17/2012

Container Type 24-hour leak-proof plastic urine container

Supply ItemNumber

1108

Store andTransport

Store and transport refrigerated

Specimen Type 24-hour urine collection

Preferred Volume 4 mL

Minimum Volume 1 mL

CollectionProcedure

Collect a 24-hour urine in a 24-hour leak-proof plastic urine container. Refrigerate during collection.

SpecimenProcessing

Aliquot 4 mL of a well-mixed 24-hour urine collection into a leakproof plastic urine container. Record collectiontime and total volume.

Required PatientInfo

Collection period and total volume on transport tube and request form.

Room Temp Unacceptable

Refrigerated 2 weeks

Frozen -20c 6 months

UnacceptableCondition

Samples with preservatives or acidified and RT samples.

AlternateSpecimens

Random urine specimens

ReferenceLaboratory

ARUP

Reference labTest Code

0097222

CPT Codes 82530

Test Schedule Sun-Sat

Turnaround Time 3-4 days

Method Tandem MS (LC-MS/MS)

Test Includes Time, h; Volume, mL; Creatinine Urine, mg/dL; Creatinine, Urine; mg/d; Cortisol Urine Free, ug/gCr; Cortisol, UrineFree, ug/L; Cortisol, Urine, ug/d; Interpretation

ReferenceRanges

Collection Period hrsVolume mLCreatinine, Urine mg/dLCreatinine, Urine mg/d

Rangescontinued

M 0-2 yrs Not established 3-8 yrs 140-700 9-12 yrs 300-1300 13-17 yrs 500-2300

Rangescontinued

18-50 yrs 1000-2500 51-80 yrs 800-2100 81+ yrs 600-2000 F 0-2 yrs Not established

Rangescontinued

3-8 yrs 140-700 9-12 yrs 300-1300 13-17 yrs 400-1600 18-50 yrs 700-1600

Rangescontinued

51-80 yrs 500-1400 81+ yrs 400-1300Cortisol, Urine Free ug/gCr F Prepubertal LT 25

Rangescontinued

18+ yrs LT 25 Pregnancy LT 59 M Prepubertal LT 25 18+ yrs LT 32

TEST CHANGE ALERT #391 June 18, 2012

The following tables reflect revisions only; other existing data remain unchanged.

page: 11

CORTISOL FREE, URINE 24HR LC-MS/MS [ARUP]Ranges

continued

Cortisol, Urine Free ug/LCortisol, Urine ug/d F 3-8 yrs LT 18 9-12 yrs LT 37

Rangescontinued

13-17 yrs LT 56 18+ yrs LT 45 M 3-8 yrs LT 18 9-12 yrs LT 37

Rangescontinued

13-17 yrs LT 56 18+ yrs LT 60

Interpretation

Rangescontinued

The optimal specimen for this testing is a 24-hour urine collection. Mass per day calculations are not reported for the folliwng specimen types: a random collection, a collection with duration of less than 20 hours, a collection with duration of greater than 28 hours, or a

Rangescontinued

collection with total volume less than 400 mL. Ratios to creatinine may be useful for these evaluations.

Baseline urinary free cortisol excretion less than 5 ug/d may beRanges

continued consistent with adrenal insufficiency.

New New Test

CORTISOL/CORTISONE FREE, URINE 24HR [ARUP]Test Code CORUFA

Billing Code CORUFAEffective 7/17/2012

Delete This test is being discontinued. Use the ordercode COCOUA to order this test.

CULTURE, RESPIRATORY CYSTIC FIBROSIS (REFLEXIVE)Test Code CRCF

Billing Code CRCFEffective 7/17/2012

Container Type Sterile leakproof container for lower respiratory secretions or bacterial transport media for throat swabs

CORTISOL FREE, URINE 24HR LC-MS/MS [ARUP]Test Code CUFAR

Billing Code CUFAREffective 7/17/2012

Delete This test is being discontinued. Use the ordercode CORFUA to order this test.

TEST CHANGE ALERT #391 June 18, 2012

The following tables reflect revisions only; other existing data remain unchanged.

page: 12

DEXTROMETHORPHAN AND METABOLITE RATIO, URINETest Code DEXMR

Billing Code DEXMREffective 7/17/2012

Container Type Urine, leakproof plastic urine container

Store andTransport

Refrigerated

Specimen Type Urine, random

Preferred Volume 2 mL

Minimum Volume 0.7 mL

CollectionProcedure

Collect in a preservative free container.

SpecimenProcessing

See attached

Room Temp Indefinitely

Refrigerated Indefinitely

Frozen -20c Indefinitely

ReferenceLaboratory

NMS

Reference labTest Code

2917U

CPT Codes 82492

Test Schedule Mon-Sun

Turnaround Time Up to 9 days; this is a batched test

Method High Performance Liquid

ReferenceRanges

Dextromethorphan uMolDextrorphan uMolMetablic Ratio

Rangescontinued

Typically, if the dextromethorphan metabolic ratio is greater than 0.30 patients areconsidered to have a deficiency in CYP2D6 expression, while a metabolicratio less than 0.30 categorizes them as an Extensive Metabolizer (normal).

Rangescontinued

New New Test

DIGOXINTest Code DIG

Billing Code DIGEffective 7/17/2012

Container Type Red top tube (plain)

TEST CHANGE ALERT #391 June 18, 2012

The following tables reflect revisions only; other existing data remain unchanged.

page: 13

PHENYTOIN, FREE & TOTALTest Code DILFR

Billing Code DIL.FREEEffective 5/21/2012

ReferenceRanges

Phenytoin, Free ug/mL 1.0-2.0 Toxic 3.0 or more Critical GT 3.0

Rangescontinued

Phenytoin, Total ug/mL 10.0-20.0 Toxic GT 25.0 Critical GT 25

Rangescontinued

% Free 1.0-13.0 % International reference calibrators implemented on March 01, 2010. Expect results to be 10-15% higher than with previous calibrators. No change in therapeutic range.

Rangescontinued

GLUCOSE-6-PHOSPHATE DEHYDROGENASETest Code G6PD

Billing Code G6PDEffective 7/17/2012

Specimen Type Whole blood

GLUCOSE, FLUIDTest Code GLUFL

Billing Code GLU-FLDEffective 6/12/2012

Container Type Green top tube (lithium heparin)

HEPARIN-DEPENDENT PLATELET ANTIBODY (SRA) - PANELTest Code HDPAP

Billing Code HDPAPEffective 7/17/2012

CPT Codes 86022

TEST CHANGE ALERT #391 June 18, 2012

The following tables reflect revisions only; other existing data remain unchanged.

page: 14

ALLERGEN, DANDELION (TARAXACUM VULGARE) IGETest Code ICDAN

Billing Code ICDANEffective 7/17/2012

Container Type Serum separator tube (gold, brick, SST, or corvac)

Store andTransport

Store and transport refrigerated

Specimen Type Serum

Preferred Volume 0.5 mL

Minimum Volume 0.5 mL

SpecimenProcessing

Separate serum from cells and put in separate plastic tube.

Room Temp 4 weeks

Refrigerated 4 weeks

Frozen -20c 1 year

UnacceptableCondition

Lipemic samples may lead to rejection

ReferenceLaboratory

Viracor-IBT

Reference labTest Code

70110S

CPT Codes 86003

Test Schedule Mon-Fri

Turnaround Time 3-4 days

Method ImmunoCAP FEIA

ReferenceRanges

Dandelion IgE < 0.35 kU/L

New New Test

LD, FLUIDTest Code LDFL

Billing Code LDH.FLDEffective 6/12/2012

Container Type Green top tube (lithium heparin)

LEFLUNOMIDE AS METABOLITETest Code LEF

Billing Code LEFEffective 8/6/2012

Specimen Type Serum or plasma

AlternateSpecimens

Lavendar top tube (EDTA), pink (K2EDTA)

TEST CHANGE ALERT #391 June 18, 2012

The following tables reflect revisions only; other existing data remain unchanged.

page: 15

LIPASE, FLUIDTest Code LIPAFL

Billing Code LIPAFLEffective 6/12/2012

Container Type Green top tube (lithium heparin)

MYELIN ASSOC. GLYCOPROTEIN (MAG) ANTIBODY W/REFLEX TOMAG-SGPG & MAG, EIA

Test Code MYAGAB

Billing Code MYAGABEffective 7/17/2012

Container Type Serum separator tube (gold, brick, SST, or corvac)

Store andTransport

Refrigerated

Specimen Type Serum

Preferred Volume 2 mL

Minimum Volume 0.6 mL

Patient Prep Overnight fasting is preferred

CollectionProcedure

Avoid hemolysis

SpecimenProcessing

Separate serum from cells and put in separate plastic tube.

Room Temp 24 hours

Refrigerated 7 days

Frozen -20c 30 days

ReferenceLaboratory

Quest Diagnostics Nichols Institute (SJC)

Reference labTest Code

10063

CPT Codes 84181

Test Schedule Mon, Wed

Turnaround Time 7-12 days

Method Western Blot/Enzyme Immunoassay

ReferenceRanges

MAG Ab (IgM), Western Bl NegMAG-SGPG Ab < or = 1:1600 titerMAG Ab, (IgM), EIA < 1:1600 titer

ReferenceRanges

ComplianceRemarks

This test was developed and its performance characteristics have been determined by Quest Diagnostics NicholsInstitute, San Juan Capistrano. It has not been cleared or approved by the U.S. Food and Drug Administration.The FDA has determined that such clearance or approval is not necessary. Performance characteristics refer tothe analytical performance of the test.

Reflex Testing

Reflex Condition Reflex Test Name Reflex CPT codes

If MAG Ab (IgM), Western Blot is positive MAG-SGPG Ab (IgM), EIA 83520

If MAG Ab (IgM), Western Blot is positive MAG Ab (IgM), EIA 83520

New New Test

Reflex This test may reflex to additional tests depending upon the results of this test. An additional fee will be added if thereflex test is necessary.

TEST CHANGE ALERT #391 June 18, 2012

The following tables reflect revisions only; other existing data remain unchanged.

page: 16

NMR LIPOPROFILETest Code NMRLP

Billing Code NMRLPEffective 6/26/2012

ReferenceRanges

LDL-P LT 1000 nmol/LLDL-C LT 100 mg/dLHDL-C GT 39 mg/dLTriglycerides LT 150 mg/dL

Rangescontinued

Total Cholesterol LT 200 mg/dLHDL-P LT 30.4 umol/LSmall LDL-P LT 528 nmol/LLDL Size GT 20.5 nm

Rangescontinued

LP-IR Score LT 46 umol/L

NMR LIPOPROFILE TEST (LDL-P ONLY)Test Code NMRLP2

Billing Code NMRLP2Effective 6/26/2012

ReferenceRanges

LDL-P LT 1000 nmol/LHDL-P GT 30.4 umol/LSmall LDL-P LT 528 nmol/LLDL Size GT 20.5 nm

ReferenceRanges

LP-IR Score LT 46 umol/L

NOROVIRUS GROUP 1 & 2 RT-PCRTest Code NOROPC

Billing Code NOROPCEffective 5/14/2012

Test Schedule Tue, Fri

TEST CHANGE ALERT #391 June 18, 2012

The following tables reflect revisions only; other existing data remain unchanged.

page: 17

PORPHYRINS PROFILE, PLASMA (REFLEXIVE)Test Code PORFR

Billing Code PORFREffective 7/17/2012

Container Type Green top tube (sodium heparin)

Store andTransport

Frozen

Specimen Type Plasma

Preferred Volume 2 mL

Minimum Volume 0.4 mL

CollectionProcedure

Collect blood sample with foil-wrapped green top tube. Avoid hemolysis.

SpecimenProcessing

Separate plasma by centrifugation. Remove plasma to a light-protected tube. Freeze immediately after separation.

Room Temp 8 hours

Refrigerated 8 hours

Frozen -20c 90 days

UnacceptableCondition

Hemolysis, not light-protected, serum separator tube (SST)

AlternateSpecimens

Plasma not collected in an EDTA (lavendar top) tube. Serum collected in a red top tube (no gel).

ReferenceLaboratory

Quest Diagnostics Nichols Institute (SJC)

Reference labTest Code

5519X

CPT Codes 82492

Test Schedule Tue, Thu

Turnaround Time 4-7 days

Method High Performance Liquid Chromatography (HPLC)

Test Includes Uroporphyrin, mcg/L; Heptacarboxyporphyrin, mcg/L; Hexacarboxyporphyrin, mcg/L; Pentacarboxyporphyrin,mcg/L; Coproporphyrin, mcg/L; Protoporphyrin, mcg/L; Total Porphyrins, mcg/L

ReferenceRanges

Uroporphyrin 0.2 or less mcg/LHeptacarboxyporphyrin 0.2 or less mcg/LHexacarboxyporphyrin 0.3 or less mcg/LPentacarboxyporphyrin 0.4 or less mcg/L

Rangescontinued

Coproporphyrin 0.8 or less mcg/LProtoporphyrin 0.4-4.8 mcg/LTotal Porphyrins 1.0-5.6 mcg/L

Rangescontinued

INTERPRETIVE GUIDE: Elevated Plasma Porphyrins Expected

Acute intermittent porphyria None

Rangescontinued

ALA dehydratase deficiency porphyria NoneCongenital erythropoietic porphyria NoneErythropoietic protoporphyria ProtoporphyrinHepatoerythropoietic porphyria None

Rangescontinued

Hereditary coproporphyria CoproporphyrinPorphyria cutanea tarda Uroporphyrin, HeptacarboxyporphyrinVariegate porphyria Coproporphyrin, Protoporphyrin

Rangescontinued

Patients with hereditary forms of porphyria usually will present with profoundelevations of these analytes (>5-fold) during acute episodes. Moderateelevations (<3-fold) are more often due to medications or environmental factors.

Rangescontinued

New New Test

TEST CHANGE ALERT #391 June 18, 2012

The following tables reflect revisions only; other existing data remain unchanged.

page: 18

PORPHYRINS PROFILE, PLASMA (REFLEXIVE)Test Code PORPHM

Billing Code PORPHMEffective 5/23/2012

Delete This test is being discontinued. Use the ordercode PORFR to order this test.

SIROLIMUS, PARENT DRUG ONLYTest Code SIR

Billing Code SIREffective 5/16/2012

SpecimenProcessing

DO NOT CENTRIFUGE. Draw 30 minutes before next dose as a trough specimen.

STONE ANALYSIS WITH IMAGETest Code STONA

Billing Code STONAEffective 7/17/2012

Synonyms Kidney Stone; Calculi

Container Type Sterile screw cap container

Store andTransport

Ship ambient

Specimen Type Dry kidney stone

CollectionProcedure

Dry stone in sterile screw cap container. Stones originating from sources not related to the kidney should be air-dried, then placed in a plastic tube or a urine collection cup. Do not use tape. Minute specimens may be placed in agelatin capsule.

Room Temp 12 months

Refrigerated 12 months

Frozen -20c 12 months

AlternateSpecimens

Filtered material

ReferenceLaboratory

Quest Diagnostics Nichols Institute (VAL)

Reference labTest Code

4161

CPT Codes 82365

Test Schedule Mon-Sat

Turnaround Time 4-5 days

Method IR (FTIR), Gravimetric

Test Includes Nidus, Component 1, Component 2, Stone Weight

ReferenceRanges

Specimen SourceNidusComponent 1Component 2

ReferenceRanges

Stone Weight

New New Test

TEST CHANGE ALERT #391 June 18, 2012

The following tables reflect revisions only; other existing data remain unchanged.

page: 19

THROMBIN-ANTITHROMBIN COMPLEXTest Code TANTIC

Billing Code TANTICEffective 5/8/2012

ReferenceRanges

Thrombin-Antithrombin Complex < 4.3 ng/mL

TESTOSTERONE, TOTAL & FREE, SERUM BY EQUILIBRIUMDIALYSIS & LC & MS/MS [MAYO]

Test Code TESTED

Billing Code TESTEDEffective 5/31/2012

UnacceptableCondition

Hemolysis, lipemia, or icteric samples. REMOVE THE FOLLOWING: Samples collected in gel separator tubes.

AlternateSpecimens

SST gel tubes

Limitations REMOVE THE FOLLOWING: Serum separator gel tubes are not acceptable.

THYROGLOBULIN (TG) + TGAB [USC]Test Code THRUSC

Billing Code THRUSCEffective 7/17/2012

Delete This test is being discontinued. Use the ordercode THYCM to order this test.

TEST CHANGE ALERT #391 June 18, 2012

The following tables reflect revisions only; other existing data remain unchanged.

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THYROID CANCER MONITORINGTest Code THYCM

Billing Code THYCMEffective 7/17/2012

Container Type Serum separator tube (gold, brick, SST, or corvac)

Store andTransport

Room temperature

Specimen Type Serum

Preferred Volume 2.5 mL

Minimum Volume 1.5 mL

Patient Prep No sample should be drawn until at least 8 hours after last biotin administration

SpecimenProcessing

Separate serum from cells and put in separate plastic tube

Room Temp 6 days

Refrigerated 7 days

Frozen -20c 28 days

UnacceptableCondition

Hemolysis, lipemia, plasma, icteric

ReferenceLaboratory

Quest Diagnostics Nichols Institute (SJC)

Reference labTest Code

90814

CPT Codes 86800

Test Schedule Mon-Fri

Turnaround Time 9-19 days

Method Electrochemiluminescence/Chemiluminescence/Liquid Chromatography/Tandem Mass Spectrometry

Test Includes Thyroglobulin Antibody, ElectrochemiluminescenceReflex tests: Thyroglobulin, Second Generation (Beckman Coulter) or Thyroglobulin, LC/MS/MS

ReferenceRanges

Thyroglobulin Ab, ECL < or = 20 IU/mL

This Thyroglobulin antibody test was performed using theRoche Modular Analytics E170 Electrochemiluminescent method.

Rangescontinued

Values obtained from different assay methods cannot be usedinterchangeably. Thyroglobulin antibody levels, regardless ofvalue, should not be interpreted as absolute evidence of the presenceor absence of disease.

Rangescontinued

Tg (2nd gen), Beckman < 0.05 ng/mL

Reference range applies to differentiated thyroid cancer patients

Rangescontinued

following treatment.This Thyroglobulin test was performed using the Beckman CoulterChemiluminscent method. Values obtained from different assaymethods cannot be used interchangeably. Thyroglobulin levels,

Rangescontinued

regardless of value, should not be interpreted as absolute evidenceor absence of disease.

Thyroglobulin, LC/MS/MS Adults: < 0.4 ng/mL

Rangescontinued

Reference range applies to differentiated thyroid cancer patientsfollowing treatment.This Thyroglobulin test was performed by tandem mass spectrometry

Rangescontinued

(LC/MS/MS) and does provide quantitative measurements ofThyroglobulin in the presence of anit-Tg antibodies. Valuesobtained from different assay methods cannot be usedinterchangeably. Thyroglobulin levels, regardless of value, should not

Rangescontinued

be interpreted as absolute evidence of the presence or absence ofdisease.

This test was developed and its performance characteristics have

TEST CHANGE ALERT #391 June 18, 2012

The following tables reflect revisions only; other existing data remain unchanged.

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THYROID CANCER MONITORINGRanges

continued

been determined by Quest Diagnostics Nichols Institute, San JaunCapistrano. Performance characteristics refer to the analyticalperformance of the test.

Rangescontinued

Reflex Testing

Reflex Condition Reflex Test Name Reflex CPT codes

If Thyroglobulin Antibody,Electrochemiluminescence is <10 IU/mL

Thyroglobulin, Second Generation 84432

If Thyroglobulin Antibody,Electrochemiluminescence is 10 IU/mL orabove

Thyroglobulin, LC/MS/MS 84432

New New Test

Reflex This test may reflex to additional tests depending upon the results of this test. An additional fee will be added if thereflex test is necessary.

TOBRAMYCIN (PAIRED)Test Code TOBIN

Billing Code TOB2Effective 5/22/2012

Room Temp Unacceptable

TOBRAMYCIN (SINGLE)Test Code TOBR

Billing Code TOBEffective 5/22/2012

Room Temp Unacceptable

TOBRAMYCIN, PEAKTest Code TOBRPK

Billing Code TOB.PKEffective 5/22/2012

Room Temp Unacceptable

TOBRAMYCIN, TROUGHTest Code TOBRTR

Billing Code TOB.TREffective 5/22/2012

Room Temp Unacceptable

TEST CHANGE ALERT #391 June 18, 2012

The following tables reflect revisions only; other existing data remain unchanged.

page: 22

PAML Web Test Directory

TRIFLUOPERAZINE, SERUM/PLASMATest Code TRIFLU

Billing Code TRIEffective 7/17/2012

Store andTransport

Store and transport refrigerated

Preferred Volume 5 mL

Minimum Volume 2.5 mL

SpecimenProcessing

Promptly centrifuge and separate serum into a separate plastic tube.

Room Temp 9 days

Refrigerated 9 days

Frozen -20c 9 months

Test Schedule Mon,Wed,Fri

Turnaround Time 4-7 days

Method Gas Chromatography (GC)

Notes NMS Labs has no experimental or literature-based data regarding the choice of specific specimen collectioncontainers for this test.

TSHTest Code TSH

Billing Code TSHEffective 6/12/2012

ReferenceRanges

TSH uIU/mL M 0-30 days 0.52-16.00 1 mo-5 yrs 0.55-7.10 5-18 yrs 0.37-6.00

Rangescontinued

F 0-30 days 0.72-13.10 1 mo-5 yrs 0.46-8.10 5-18 yrs 0.36-5.80 18+ yrs 0.45-5.10

Rangescontinued

TEST CHANGE ALERT #391 June 18, 2012

The following tables reflect revisions only; other existing data remain unchanged.

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