ABO, Blood Typing  CPT Code: 86900

ABO is a major blood group system recognized in human blood transfusion. The test determines the type of individual’s blood when planning for blood donation or transfusion.

AFB Smear CPT Code: 87206

+ AFB, PCR CPT Code: 87556

+ Reflex Culture, AFB (TB) CPT Code: 87116

+ Antibiotic Susceptibility CPT Code: 87188 (x5)

Microscopic screening of sputum or associated body fluids such as pleural fluid for acid fast bacilli search may be used in evaluating tuberculosis. To increase the sensitivity of diagnostic performance of this test, repeat or multiple sample collection is advised. Polymerase chain reaction (PCR) analysis is more sensitive method but it is not available at LBJLAB. It is our policy, in collaboration with Department of Health (DOH) for surveillance of tuberculosis in American Samoa, to send the sample specimen to DOH Reference Laboratory for further testing such as concentration technique, PCR method, and culture with antibiotic susceptibility.

Albumin, Serum/Plasma CPT Code: 82040

Albumin Globulin Ratio (Calculation)

Albumin is the most abundant protein in the blood. It primarily acts as a carrier of substances such as hormones, enzymes, and nutrients in the blood made by the liver. It is important gauge of general nutrition. The test can help to evaluate the function of liver and kidneys.

Globulin is the other major type of protein next to albumin in the blood and also produced in the liver mainly in support of the immune system. The total globulin level can be estimated by the difference of total protein and albumin in the blood. The result, Albumin Globulin Ratio can be used as an index of disease state. Though not a specific marker, globulin may be increased in inflammatory state particularly in chronic condition, autoimmune disorder , multiple myeloma and other malignancy. While it may be also decreased if there is associated hepatic or renal dysfunction or organ failure.

Albumin, Urine (also called “Microalbumin”)

Random Urine Albumin (Spot) CPT Code: 82043

24-hour Urine Albumin CPT Code: 82042

Normal kidneys usually do not allow albumin to pass from the blood to urine. A very small amount may be considered within normal limits (0 – 29 mg/day or per gram of creatinine). The test can assess early the function of the kidneys especially in diabetic patients.

The test is performed either in a 24-hour urine sample collection or random urine sample specimen. The latter type of sample collection needs additional test performance of urine creatinine to estimate total albumin excretion per day, thus – Albumin Creatinine Ratio.

Alcohol Ethyl, Blood CPT Code: 80320

This test measures the concentration level of ethyl alcohol or ethanol in the blood quantitatively within range of 10 mg/dL (0.01%) to 600 mg/dL (0.6%). Increased levels of lactic acid and lactate dehydrogenase (LDH) in samples may cause elevated ethanol results.

Alcohol Ethyl, Urine CPT Code: 80320 

Alcohol in urine sample can also be measured using the same method in the blood. However, the level concentration in urine is slightly higher than blood at a ratio of 1.3 in comparison.

Alkaline Phosphatase (ALP) CPT Code: 84075

Alkaline Phosphatase is mainly produced in the liver and bone. It can be also produced normally in the kidneys, digestive system, placenta, and other organs or tissues in lesser amount. The test is useful in the correlative diagnosis of hepatobiliary disorders and bone diseases associated with increased osteoblastic activity.

Alpha-Fetoprotein, Serum (AFP) CPT Code: 82105

AFP is a non-specific tumor marker (non-maternal or non-pregnant) in the serum which may be useful in the detection of primary hepatocellular carcinoma and non-seminomatous germ cell tumors. However, it can increased but less commonly in other neoplasms such as of the GI tract, lungs, breast and lymph node.  It may also increased in mild to moderate level in benign conditions i.e., alcohol liver disease, viral hepatitis. 

AFP level can also be useful in maternal or pregnant mother to check fetal risk of having genetic abnormality such as neural tube defect and Down Syndrome. This is usually requested to be done between 15 to 20 weeks of pregnancy.

ALT, Serum/Plasma (Alanine Transaminase) CPT Code: 84460

Also called Alanine Aminotransferase or Serum Glutamate-Pyruvate Transaminase (SGPT), is an enzyme mainly produced by the liver and in smaller amount by the kidneys, heart, and skeletal muscle. Measurement levels are useful in conditions affecting the liver such as in hepatitis and cirrhosis.

Amphetamines, Urine (Methamphetamines, MDMA) CPT Code: 80324

Amphetamines or Methamphetamines metabolites or derivatives i.e., Methylenedioxy Methamphetamines or MDMA (Ecstasy) can be detected and measured quantitatively in urine. The metabolites may remain detectable in urine 3 to 5 days after the drug administration. However, the interval may be longer for individuals who are chronic users. It can be detected in the hair for about 90 days. Blood or oral fluid samples may be useful but both have lower detection intervals than urine testing.

Amylase, Serum/Plasma CPT Code: 82150

This test measures alpha-amylase in the blood which is mainly produced by the pancreas and salivary glands. Measurement of level is useful in the management of pancreatitis, biliary tract disorder, bowel obstruction, and inflammation or diseases affecting the salivary glands.

Antibody Screen CPT Code: 86850

This is useful when planning to receive or before blood transfusion is given to ensure donor blood compatibility. The test screens circulating unexpected RBC antibodies from individual that may have been exposed through blood transfusion and pregnancy or foreign red blood cells.

Anti-Streptolysin O (ASO) CPT Code: 86063

This test measures antibodies to Streptolysin O concentrations in serum or plasma quantitatively. The test is sensitive for recent streptococcal infection. The rise of ASO level usually begins 1 week after the infection and peaks in 2 to 4 weeks later. ASO levels do not rise with cutaneous or localized infections. In the absence of complications or reinfection, the ASO level will fall to preinfection levels within 6 to 12 months. Over 80% of patients with acute rheumatic fever and 95% of patients with acute glomerulonephritis due to streptococci have elevated levels of ASO.

AST, Serum/Plasma (Aspartate Transaminase) CPT Code: 84450

Also called Aspartate Aminotransferase or Serum Glutamate-Oxaloacetate Transaminase (SGOT), is an enzyme mainly produced by the liver and the heart. It can also be found in the brain, kidneys, pancreas, lungs, skeletal muscles and other tissues of the body in lesser amount. In myocardial infarction, serum AST may begin to rise within 6-8 hours after onset, peaks within two days and return to normal by the fourth or fifth day post infarction. It can be useful also in diseases affecting the liver, rising in concentration level along with ALT.

Basic Metabolic Panel CPT Code: 80048

Basic Metabolic Panel (BMP) is a group of 8-test assays consisting of Sodium, Potassium, Chloride, Bicarbonate (CO2), Calcium, Glucose, Creatinine, and Urea Nitrogen (BUN). The test panel is generally useful in checking individual’s kidney function, blood sugar level, electrolytes and acid-base homeostasis.

Bilirubin Direct CPT Code: 82248

This test measures the concentration level of direct or conjugated bilirubin in the blood. The assessment of direct bilirubin is helpful in the differentiation of hepatobiliary disorders. The increased in level along with the total bilirubin is useful in the diagnosis of obstructive jaundice. 

Bilirubin Indirect or unconjugated portion (Calculation) is the difference of the Total Bilirubin and Direct Bilirubin.

Bilirubin Total CPT Code: 82247

This is the total measurement of both conjugated and unconjugated bilirubin in the blood. This is particularly useful together with the bilirubin fractions in the assessment of hepatobiliary disorder  in patients with jaundice.

Cytopathology,  Fine Needle Aspirate Interpretation & Report CPT Code: 88173

(+) Fine Needle Aspiration Procedure, without ultrasound imaging CPT Code: 10021

(+) Fine Needle Aspiration Procedure, with ultrasound imaging CPT Code: 10022

FNA Biopsy may be performed by a physician or pathologist.  The tissue fluids in the body extracted through fine-needle aspiration technique is evaluated, analyzed, and interpreted by a pathologist.

Level I Gross Examination Only CPT Code: 88300

Level II Gross and Microscopic CPT Code: 88302

• Appendix, Incidental
• Fallopian Tube, Ligation
• Fingers/Toes, Traumatic Amputation
• Foreskin
• Hernial Sac
• Hydrocele Sac
• Nerve
• Skin, Plastic Repair
• Testis, Castration
• Vaginal Mucosa
• Vas deferens, Sterilization

Level III Gross and Microscopic CPT Code: 88304

• Abortion, Induced
• Abscess
• Aneurysm
• Anus Tag
• Appendix, Other than Incidental
• Artery, Atheromatous
• Bartholin’s Gland Cyst
• Bone Fragments
• Bursa/ Synovial Cyst
• Carpal Tunnel Tissue
• Cartilage, Shavings
• Cholesteatoma
• Colon, Stoma
• Conjunctiva or Pterygeum
• Cornea
• Diverticulum
• Dupuytren’s Tissue
• Femoral Head, Other than Fracture
• Fissure or Fistula
• Foreskin, Other than Newborn
• Gallbladder
• Ganglion Cyst
• Hematoma
• Hemorrhoids
• Hydatid of Morgagni
• Intervertebral Disc
• Joint, Loose Body
• Meniscus
• Mucocele, Salivary
• Neuroma, Traumatic
• Pilonidal Cyst or Sinus
• Polyps, Inflammatory/ Nasal
• Skin, Cyst/Tag/Debridement
• Soft Tissue Debridement
• Soft Tissue Lipoma
• Spermatocele
• Tendon or Tendon Sheath
• Testicular Appendage
• Thrombus or Embolus
• Tonsils and  or Adenoids
• Varicocele
• VAs Deferens, Other than Sterilization
• Vein, Varicose

Level IV Gross and Microscopic CPT Code: 88305

• see CPT Book Masterlist

Level V Gross and Microscopic CPT Code: 88307

• see CPT Book Masterlist

Level VI Gross and Microscopic CPT Code: 88309

• see CPT Book Masterlist

Surgical Tissue Biopsies are analyzed by pathologist.  Gross and microscopic examinations are usually performed to determine tissue abnormality and to conclude a definitive diagnosis.

Blood Culture And Sensitivity

Aerobic Blood Culture CPT Code: 87040

Anaerobic Blood Culture CPT Code: 87040

If Positive Culture,

(+) Bacterial Identification, Each Microorganism CPT Code: 87077

(+) Antibiotic Susceptibility Panel (MIC) Per Microorganism CPT Code: 87186

(+) Additional Susceptibility Disk (Manual), Each CPT Code: 87184

Bacterial sepsis constitutes one of the most serious diseases. The test involves the detection of microorganism(s) in a patient’s blood and if detected, the bacterial organism(s) is/are subjected to susceptibility test to a panel of antibiotics to help physician in the selection of antimicrobial treatment.

Blood Smear CPT Code: 85008

Blood smear microscopic examination with manual differential WBC count is invaluable additional test after the automated complete blood count (CBC) to assess blood cellular morphology and validate the result of CBC. This test may be added to CBC as a reflex test (automatic) triggered by certain conditions and abnormal flags on the automated CBC result.

Blood Smear With Interpretation by Pathologist CPT Code: 85060

Blood smear microscopic examination reviewed by pathologist with interpretation.

Urea Nitrogen, Serum/Plasma CPT Code: 84520

Urea is major waste product of protein catabolism. It is used in the assessment of renal function and metabolic diseases. Increased BUN concentration may result from increased production of urea due to (1) diet or excessive destruction of cellular proteins as occurs in massive infection and fevers, (2) reduced renal perfusion resulting from dehydration or heart failure, (3) nearly all types of kidney disease, and (4) mechanical obstruction to urine excretion such as is caused by stones, tumors, infection, or stricture. Decreased urea levels are less frequent and occur primarily in advanced liver disease and in overhydration.

Natriuretic Peptide CPT Code: 83880

This test is used in the assessment and diagnosis of congestive heart failure. May also be used in the risk stratification of patients with acute coronary syndrome.

Body Fluid Cell Count CPT Code: 89050

Refers to the counting of cellular elements that may be found in the body fluids following tap or aspiration of the body cavity such as pleural fluid, peritoneal fluid, and pericardial fluid. This test aids in the assessment whether fluid is transudate or exudate. These terms may give clue to the disease state whether benign inflammatory or a malignant condition.

Glucose, Body Fluid CPT Code: 82945

Protein, Body Fluid CPT Code: 84157

LDH, Body Fluid CPT Code: 83615

Refers to the total concentration of glucose, protein, and lactate dehydrogenase (LDH) in the body fluid tap or aspirated. This test aids in the assessment whether fluid is transudate or exudate. These terms may give clue to the disease state whether benign inflammatory or a malignant condition.

Body Fluid Culture And Sensitivity (See Specific Body Fluid such as CSF, Pericardial, Peritoneal, and Pleural Fluids)

The test is used as a tool to determine the cause of infectious disease and the susceptibility of the offending organism/s to antibiotics.

CA 125 CPT Code: 86304

The CA 125 level can aid in the prognostication of patients with ovarian cancer. It is not recommended as screening test to detect cancer in general population. It is affected by menstrual cycle and ectopic endometrial tissue.

CA 15-3 CPT Code: 86300

CA 15-3 level is widely recognized as breast cancer marker. It is not recommended as screening test to detect cancer in general population. Elevated levels can be seen in non-malignant conditions such as in benign breast tumor, cirrhosis and hepatitis.

CA 19-9 CPT Code: 86301

CA 19-9 level can be used as an aid in prognostication and monitoring the response to therapy in patient with colorectal cancer. The antigen may also be found in hepatopancreatic biliary cancers, stomach, and non-cancerous conditions such as cirrhosis, hepatitis, pancreatitis, and benign GI tumors. It is not recommended as screening test to detect cancer in general population.

Calcium Total, Serum/Plasma CPT Code: 82310

Calcium is important in body system regulation such as in CNS, muscle, bone enzymatic function and blood coagulation as well. Blood levels are controlled by parathyroid hormone, vitamin D, calcitonin and adrenal steroids. Deficiency may lead in tetany while hypercalcemia may result to kidney stone, heart problems, osteoporosis and CNS dysfunction.

Carbamazepine CPT Code: 80156

Carbamazepine is an anticonvulsant which is structurally related to the tricyclic antidepressants and is useful in treating patients with temporal lobe epilepsy. Carbamazepine levels are monitored to assure adequate therapeutic levels are achieved and to avoid toxicity.

CBC (Complete Blood Count) With Differentials & Platelets, Automated CPT Code: 85025

CBC is used as a screening test for various disease including anemia, leukemia and inflammatory processes.

CEA (Carcinoembryonic Antigen) CPT Code: 82378 

Increased serum CEA levels have been detected in persons with primary colorectal cancer and in patients with other malignancies involving the gastrointestinal tract, breast, lung, ovarian, prostatic, liver and pancreatic cancers. Elevated serum CEA levels have also been detected in patients with nonmalignant disease, especially patients who are older or who are smokers. Approximately 5% of colorectal cancers are not associated with increased levels of CEA.

Chlamydia, Amplified DNA CPT Code: 87491

Gonorrhea, Amplified DNA CPT Code: 87591

Chlamydia trachomatis is the most common cause of sexually transmitted venereal infection in the world, with an incidence estimated at 3 – 4 million cases per year in the US. C. trachomatis has both a high prevalence and asymptomatic carriage rate, with frequent serious complications in both women and neonates. Neisseria gonorrhea is also common sexually transmitted disease if left untreated can lead to infertility and problems during pregnancy. WHO estimated 82.4 million new infections with N. gonorrhea among adults aged 15 to 49 years in 2020.

Chloride, Serum/Plasma CPT Code: 82435

Chloride is the major extracellular anion and counter-balances the major cation, sodium, maintaining electrical neutrality of the body fluids. Two thirds of the total anion concentration in extracellular fluids is chloride and it is significantly involved in maintaining proper hydration and osmotic pressure. Movement of chloride ions across the red blood cell membrane is essential for the transport of bicarbonate ions in response to changing concentrations of carbon dioxide. Chloride measurements are used in the diagnosis and treatment of electrolyte and metabolic disorders such as cystic fibrosis and diabetic acidosis.

Chloride, Urine CPT Code: 82436

Urine chloride excretion approximates the dietary intake. The chloride content of most foods parallel that of sodium. An increase in urine chloride may result from water deficient dehydration, diabetic acidosis, Addison’s disease, and salt-losing renal disease. Decreased urine levels are seen in congestive heart failure, severe diaphoresis and in hypochloremic metabolic alkalosis due to prolonged vomiting.

Cholesterol Total, Serum/Plasma CPT Code: 82465

Total serum cholesterol analysis is useful in the diagnosis of hyperlipoproteinemia, atherosclerosis, hepatic and thyroid diseases. Together with LDL and HDL cholesterol, in conjunction with a triglyceride determination, the test provide valuable information for the risk of coronary artery disease.

CK Total, Serum CPT Code: 82552

Test is generally used for skeletal muscle and heart injuries. Elevated results may be due to myocarditis, myocardial infarction (heart attack), muscular dystrophy, muscle trauma or excessive exercise. Increased level may also be seen in stroke, kidney disorders and other organ injuries.

CK-MB, Serum CPT Code: 82553

The MB fraction of Creatine Kinase is more specific to cardiac muscle injury. The probability of myocardial damage is high when both total CK and MB fraction are abnormally high with Relative Index of more than 6%. A fraction above 25% may indicate the presence of macro-CK and may require further evaluation or clinical correlation. Macro-CK is associated with various pathologies that may include cardiovascular etiology, autoimmune disorders, and malignancies.

CO2 Total, Serum/Plasma CPT Code: 82374

Total CO2 content includes the serum/plasma bicarbonate as well as available forms of carbon dioxide such as dissolved CO₂ and carbonic acid. Generally, the bicarbonate comprises about 95% of the total CO₂ content. Measurements are used in the diagnosis and treatment of numerous potentially serious disorders associated with changes in body acid-base balance.

Cocaine, Urine CPT Code: 80353

Cocaine (Benzoylecgonine) metabolites can be detected and measured quantitatively in urine. Cocaine is rapidly metabolized, with less than 5% excreted unchanged in the urine. The metabolites may be detectable in urine for up to 3 weeks after long term, heavy use of cocaine. 

Comprehensive Metabolic Panel CPT Code: 80053

(CMP) is a group of 14-test assays consisting of Sodium, Potassium, Chloride, Bicarbonate (CO2), Calcium, Glucose, Creatinine, Urea Nitrogen (BUN), Total Protein, Albumin, ALP, AST, ALT, and Total Bilirubin. The test panel is not only useful in checking individual’s kidney function, blood sugar level, electrolytes and acid-base homeostasis but liver function as well.

Coombs, Direct CPT Code: 86880

The test is also called direct antiglobulin test (DAT). It is used primarily to help determine if the cause of hemolytic anemia is due to antibodies attached to RBCs. Useful to diagnose hemolytic disease of the newborn (HDN) due to an incompatibility between the blood types of a mother and baby. 

Creatinine Clearance CPT Code: 82575

Creatinine Clearance is used to evaluate the glomerular filtration rate (GFR). Clearance is defined as that volume of plasma from which a measured amount of substance could be completely eliminated into the urine per unit of time. Daily creatinine production is fairly constant except when there is massive injury to muscle. The test involves 24-hour urine collection and blood draw during the 24-hour collection time for both urine and serum/plasma creatinine assays.

Creatinine, Serum/Plasma CPT Code: 82565

Creatinine is useful in the evaluation of kidney function and in monitoring renal dialysis. A creatinine result within the reference range does not rule out renal function impairment. It is not sensitive to early renal damage since it varies with age, gender and ethnic background. The impact of these variables in chronic condition can be reduced by an estimation of the glomerular filtration rate (eGFR) using an equation that includes serum creatinine, age and gender.

Creatinine, Urine CPT Code: 82570

Creatinine is the end product of creatine metabolism. Creatine is present primarily in muscle and the amount of creatinine produced is related to total skeletal muscle mass. Daily creatinine production is fairly constant except when there is massive injury to muscle. The kidneys excrete creatinine very efficiently and blood levels and daily urinary excretion of creatinine fluctuates little in healthy normal people. Since blood and daily urine excretion of creatinine shows minimal fluctuation, creatinine excretion is useful in determining whether 24-hour urine specimens for other analytes (e.g., protein) have been completely and accurately collected. Similarly in random collection, the level of creatinine is useful in checking the reliability of other analytes such in random albumin and urine drug testing.

Crossmatch RBC or WB, Each Blood Unit CPT Codes: 86920 (immediate spin), 86921 (incubation), and 86922 (antiglobulin)

The test is to determine if the donor’s blood is compatible with the blood of an intended recipient.

C-Reactive Protein CPT Code: 86140

Increased CRP levels are found in inflammatory conditions including bacterial infection, rheumatic fever, active arthritis, myocardial infarction, malignancies and in the post-operative state. This test, in contrast to High-Sensitive CRP Test, cannot detect the relatively small elevations of CRP that are associated with increased cardiovascular risk.

CSF Cell Count CPT Code: 89051

CSF is produced by the ventricular lining cells in the brain at a rate of about 0.35 mL per minute for a total daily volume of 500 mL. The CSF is reabsorbed by the arachnoid cells in the brain. The normal adult has a total CSF volume of only 90 to150 mL at a time. Risk of traumatic tap is high. Published data shows nearly 20% of spinal taps performed are traumatic. It is important to identify clot formation because it is usually associated with traumatic tap from contamination of peripheral blood. It will aid as well in the interpretation whether the condition is true subarachnoid hemorrhage (SAH) because CSF normally does not clot. The breakdown of RBCs in SAH results to xanthochromia (yellow) 2 to 3 hours after the intracranial bleed and may persist for weeks. Decreasing amount of blood (pink-red) in the sequential tube collection suggests traumatic tap rather than SAH. Cells of normal CSF include lymphocytes (~97% T-cells), monocytes, and occasional neuro-ectodermal lining cells (ependymal or choroid plexus cells) which is more often seen in infants. Neutrophils are not normally present. Occasional neutrophils are attributed to the sensitivity of cytocentrifugation capable of detecting these cells introduced from lumbar tap contamination.

CSF Chemistry Panel

Glucose, CSF CPT Code: 82945

Protein, CSF CPT Code: 84157

The test involves routine determination of glucose and protein concentration levels on CSF. 

The normal ratio of proteins in serum to CSF is about 200:1.  Elevation of protein level may be seen in infections, intracranial hemorrhages, multiple sclerosis, Guillain Barré syndrome, malignancies, some endocrine abnormalities, certain medication use, and a variety of inflammatory conditions. However, protein concentration can be falsely elevated by the presence of RBCs in a traumatic tap situation. Low CSF protein levels can occur in conditions such as repeated lumbar puncture or a chronic leak, in which CSF is lost at a higher than normal rate. Low CSF protein levels also are seen in some children between the ages of six months and two years, in acute water intoxication, and in a minority of patients with idiopathic intracranial hypertension.

Glucose in CSF under normal condition is 60-80% of that in the serum or plasma. A true normal range cannot be given. Glucose in the CSF of neonates varies much more than in adults, and the CSF-to-serum ratio is generally higher than in adults. CNS infections can cause lowered CSF glucose levels (viral infection is usually normal), however, normal glucose levels do not rule out infection, because up to 50 percent of patients who have bacterial meningitis will have normal CSF glucose levels. Chemical meningitis, inflammatory conditions, subarachnoid hemorrhage, and hypoglycemia may also cause decreased glucose levels. Elevated levels of glucose in the blood is the only cause of having an elevated CSF glucose level. There is no pathologic process that causes CSF glucose levels to be elevated.

CSF Culture And Sensitivity CPT Code: 87040

If Positive Culture,

(+) Bacterial Identification, Each Microorganism CPT Code: 87077

(+) Antibiotic Susceptibility Panel (MIC) Per Microorganism CPT Code: 87186

(+) Additional Susceptibility Disk (Manual), Each CPT Code: 87184

The test helps to determine the cause of infectious disease in CNS and the susceptibility of the offending organism/s to antibiotics.

Cytology (Cytopathology), Body Fluids (Except Cervical or Vaginal) CPT Code: 88104

The test includes all body fluids except non-gynecology i.e., pleural, cerebrospinal, urine, sputum and synovial. Analyzed by a pathologist to determine cells abnormality to conclude a sensible pre-definitive diagnosis, usually whether benign or malignant condition.

D-Dimer, Plasma CPT Code: 85379

The test helps to determine blood clotting abnormality in patients with significant risk of developing thromboembolism. A negative D-dimer test means that a blood clot is highly unlikely. Having a high D-dimer level can be a sign of a blood clotting disorder such as in pulmonary embolism and deep venous thrombosis. However, the test is not specific and elevated levels can also be seen in advanced age, malignancy, and pregnancy.

Digoxin, Serum CPT Code: 80162

Measurements are used in the diagnosis and treatment of digoxin overdose and in monitoring levels of digoxin to ensure proper therapy.

Drugs of Abuse (Panel 5), Urine CPT Code: 80305

This test panel includes qualitative detection of amphetamines, cocaine, tetrahydrocannabinoids, opiates, and phencyclidines, including all their derivatives or metabolites in urine for screening of individuals suspected of substance abuse.

Ear Canal Culture And Sensitivity CPT Code: 87070

If Positive Culture,

(+) Bacterial Identification, quantitative aerobic isolation and presumptive identification, each microorganism CPT Code: 87071

(+) Bacterial Identification, definitive aerobic ID, each isolate CPT Code: 87077

(+) Bacterial Identification, quantitative anaerobic isolation and presumptive identification, each microorganism CPT Code: 87073

(+) Bacterial Identification, definitive anaerobic ID, each isolate CPT Code: 87076

(+) Antibiotic Susceptibility Panel (MIC) Per Microorganism CPT Code: 87186

(+) Additional Susceptibility Disk (Manual), Each CPT Code: 87184

The test involves the detection of pathogenic microorganism(s) in the ear canal and if detected, the bacterial organism(s) is/are subjected to susceptibility test to a panel of antibiotics to help physician in the selection of antimicrobial treatment. The significance of any isolate(s) in pure or mixed culture must be assessed with respect to the source cultured, the organism’s pathogenic potential, the possibility of colonization versus infection, and the number of other organisms recovered from the same culture.

Electrolytes, Serum/Plasma CPT Code: 80051

The test panel includes Sodium, Potassium, Chloride, and CO2 (Bicarbonates) concentration levels in the blood. The test provides information about body fluids, hydration and blood’s acid-base balance.

ESBL – Resistant Culture Screen CPT Code: 87081

If Positive Culture,

(+) Bacterial Identification, definitive aerobic ID, each isolate CPT Code: 87077

(+) Antibiotic Susceptibility Panel (MIC) Per Microorganism CPT Code: 87186

(+) Additional Susceptibility Disk (Manual), Each CPT Code: 87184

The test is used to screen individual if their body has been colonized by potentially resistant strain of bacteria known as “Extended Spectrum Beta-Lactamase Bacteria” for infection control purpose. This may applies to patient travelling or being transferred to one health institution to another facility. This may also applies to health care workers to mitigate spread of this multi-drug resistant bacteria to health care facilities. 

Erythrocyte Sedimentation Rate CPT Code: 85651

The test is useful in differentiating inflammatory and neoplastic diseases and as an index of disease severity. Patients with polycythemia and many hemoglobin abnormalities may have depressed sedimentation rates whereas patients with anemia
may have elevated sedimentation rates.

Estradiol, Serum CPT Code: 82670

The test aids in the assessment of ovarian function in women. Increased levels in males may be seen in gynecomastia due to aromatization of androgens.

Eye Culture And Sensitivity, CPT Code: 87070

Culture of fluid, pus or tissue material coming from or aseptically suctioned from the eye.

If Positive Culture,

(+) Bacterial Identification, quantitative aerobic isolation and presumptive identification, each microorganism CPT Code: 87071

(+) Bacterial Identification, definitive aerobic ID, each isolate CPT Code: 87077

(+) Bacterial Identification, quantitative anaerobic isolation and presumptive identification, each microorganism CPT Code: 87073

(+) Bacterial Identification, definitive anaerobic ID, each isolate CPT Code: 87076

(+) Antibiotic Susceptibility Panel (MIC) Per Microorganism CPT Code: 87186

(+) Additional Susceptibility Disk (Manual), Each CPT Code: 87184

The test involves the detection of pathogenic microorganism(s) in the eye and if detected, the bacterial organism(s) is/are subjected to susceptibility test to a panel of antibiotics to help physician in the selection of antimicrobial treatment. 

Ferritin, Serum/Plasma CPT Code: 82728

Measurement of ferritin in serum or plasma is a useful indicator of body iron stores in normal persons, and in individuals with iron deficiency. A ferritin level of less than 10 ng/mL usually indicates iron deficiency anemia. It is also considered an inflammatory marker. An increased ferritin concentration is observed in a large number of chronic diseases. These include chronic infections, chronic inflammatory disorders, heart diseases, and malignancies, especially lymphomas, leukemias, breast cancers, and neuroblastoma. In patients who have any of these disorders together with iron deficiency, ferritin concentration is often normal. Ferritin concentrations may be extremely high in patients suffering from hemochromatosis (iron overload).

Filaria, Blood Smear (Parasitology), CPT Code: 87177

The test aids in the screening and identification of blood parasites such as microfilaria. To increase the sensitivity of the test (recovery of parasite) , repeat the test as necessary. 

FSH (Follicle Stimulating Hormone), Serum CPT Code: 83001

The test helps to evaluate fertility issues concerning function of reproductive organs (ovaries or testicles), and or pituitary. In children, it is used to evaluate early or delayed sexual maturation.

Fungal (KOH) Smear CPT Code: 87220

This examination can provide the physician with early information regarding the possible need for antifungal treatment on infected skin disorders.

GBS (Group B Streptococcus) Culture Screen CPT Code: 87081

The test is used to screen pregnant women. Most women with colonized GBS do not have any GBS infections or symptoms. However, GBS can cause urinary tract infections and other serious infections in the newborn such as meningitis, pneumonia and sepsis.

Gentamicin, Serum CPT Code: 80170

Gentamicin is an aminoglycoside antibiotic used in the treatment of gram positive and gram negative bacterial infections, especially Pseudomonas, Proteus, Klebsiella and Staphylococcus. Gentamicin is potentially nephrotoxic and ototoxic and serial monitoring of peak & trough levels may provide the clinician with information to maintain safe & therapeutic levels.
Trough concentrations between 1 – 2 ug/mL usually ensure that drug elimination is adequate.

Glucose, Serum/Plasma CPT Code: 82947

Glucose measurements are used in the diagnosis and treatment of carbohydrate metabolic disorders including diabetes mellitus, idiopathic hypoglycemia, and pancreatic islet cell neoplasm.

Glucose Tolerance Test (2-Hour OGTT) CPT Code: 82951

This test may be used for the diagnosis of diabetes in children and adult particularly gestational DM. For appropriate interpretation of this test, the patient must fully rest and fast at least 8 hours overnight.

Glucose 2-Hour Postprandial CPT Code: 82947

Postprandial glucose levels may be abnormally high in patients with gestational diabetes. If results are positive, and the patient is pregnant, a 2-hour oral glucose tolerance test should be performed for confirmation of gestational diabetes.

Glucose, Body Fluid (Pleural, Pericardial, Peritoneal and Synovial Fluids) CPT Code: 82945

See also Body Fluid Chemistry Panel

Glucose level is usually decreased in exudative body fluids. This can be  caused by bacterial infection, TB, malignancy, and rheumatoid inflammation. Glucose in synovial fluid is significantly decreased in bacterial infection of the joints.

Glucose, CSF (Cerebrospinal Fluid) CPT Code: 82945

See also CSF Chemistry Panel

Determinations of CSF glucose helps distinguish bacterial from viral meningitis. The glucose value is often low (less than 40% to 45% of simultaneously analyzed serum glucose) in bacterial meningitis and TB meningitis and is generally normal in viral disease. Carcinomatous meningitis also drives CSF glucose values below the normal range.

Glucose, Urine (Quantitative) CPT Code: 82945

The test is used for detection and monitoring of patients with diabetes mellitus.

Gonococcal Culture And Sensitivity CPT Code: 87070

N. gonorrhea culture is required to evaluate suspected cases of gonorrhea, treatment failure, and to monitor developing resistance to current treatment regimens.

If Positive Culture,

(+) Bacterial Identification, definitive aerobic ID,  CPT Code: 87077

(+) Antibiotic Susceptibility Panel (MIC) CPT Code: 87186

(+) Additional Susceptibility Disk (Manual), Each CPT Code: 87184

The test involves identification of N. Gonorrhea in sample tissue or fluid specimen coming from genital and related organs or suspicious lesions and if detected, the bacterial organism is subjected to susceptibility test to a panel of antibiotics to help physician in the selection of antimicrobial treatment. 

Gram Stain CPT Code: 87205

The test is used to detect suspicious pathogenic bacterial organisms in tissue, fluid and aspirate sample specimen. The Gram stain is important preliminary step in the initial characterization  and classification of bacteria (Gram positive or Gram negative).

HCG-Beta, Serum (Quantitative) CPT Code: 84702

Human Chorionic Gonadotropin (hCG) beta sub-unit may reach detectable limits within 7-10 days of conception. The concentration of hCG in blood varies dramatically over time. Concentrations can range from only 5-400 mIU/mL at week 4 to over 250,000 mIU/mL at week 9 of gestation. hCG is a glycoprotein hormone produced by the syncytiotrophoblast of the placenta and secreted during normal pregnancy. However, it can also be produced by pathologic conditions such as hydatidiform mole, choriocarcinoma and testicular neoplasm. 

HCG-Beta, Urine or Urine Pregnancy Test (Qualitative) CPT Code: 81025

The pregnancy test detects presence of human chorionic gonadotropin (hCG), a hormone produced by the placenta during pregnancy. hCG is detectable as early as 12-14 days after conception. If hCG is detected in urine, a pregnancy can be assumed if the history and menstrual patterns are consistent with pregnancy. The concentration cut-off for most urine hCG devices is around 25 mIU/mL. Some cancerous tumors can also produce this hormone, therefore, the presence of hCG or positive test when the patient is not pregnant can lead to a cancer diagnosis.

HDL (High Density Lipoprotein) Cholesterol, Serum/Plasma CPT Code: 83719

HDL cholesterol is inversely related to the risk for cardiovascular disease. It increases following regular exercise, moderate alcohol consumption and with oral estrogen therapy. Decreased levels are associated with obesity, stress, cigarette smoking,  and diabetes mellitus.

Hemoglobin A1C CPT Code: 83036

The test is a diagnostic tool for diabetes mellitus. It is also used to monitor and assess long term glucose control in patients with diabetes mellitus.

Hemoglobin And Hematocrit

Hemoglobin CPT Code: 85014

Hematocrit CPT Code: 85018

The test is usually requested after blood transfusion to evaluate and monitor the treatment of anemia or blood loss. The test may also aid in screening of anemia and evaluation of dehydration.

Hepatitis A IgM Antibody, Serum CPT Code: 86709

IgM antibody to Hepatitis A suggests a current, acute or recent Hepatitis A viral infection.

Hepatitis B Core Antibody Total, Serum (HBcAb) CPT Code: 86704

This assay does not distinguish between Total B core antibody IgG and IgM detected before or at the onset of symptoms; however, such reactivity can persist for years after illness, and may even outlast anti-HBs. Occasionally, Hepatitis B core antibody may be the only marker of either current or past Hepatitis B infection. Results obtained from immunosuppressed patients should be interpreted with caution. Patients receiving mouse antibody therapy may produce false negative results. False positives may be detected shortly after immunization to influenza and with patients with hypergammalobulinemia, positive rheumatoid factor, and connective tissue disorders.

Hepatitis B Surface Antibody, Serum (HBsAb) CPT Code: 86706

The detection of anti-HBs is indicative of a prior immunologic exposure to the antigen or vaccine. Therefore, the determination of the titer of this antibody will evaluate the immune status of the individual against Hepatitis B virus infection.  The immune status optimal recommendation should be ≥10 mIU/mL as per CDC guidelines.

Hepatitis B Surface Antigen, Serum (HBsAg) CPT Code: 87340

Hepatitis B surface antigen usually appears in the serum after an incubation period of 1 to 6 months following exposure to Hepatitis B virus and peaks shortly after onset of symptoms. It typically disappears within 1 to 3 months. Persistence of Hepatitis B surface antigen for greater than 6 months is a prognostic indicator of chronic Hepatitis B infection. Results obtained from immunosuppressed patients should be interpreted with caution. Patients receiving mouse antibody therapy may produce false negative results.

Hepatitis C Antibody, Serum CPT Code: 86803

The test is a screening for Hepatitis C (HepC) virus infection by detection of anti-HCV (IgG). Anti-HCV (IgG) can be initially detected in patients about four weeks after infection but is more likely to be detected by six months. Unlike hepatitis B (HepB), antibodies to HepC do not provide immunity against this viral infection.  As with all IgG tests, a reactive (positive) result does not distinguish between a past, resolved, and current infection. A positive anti-HCV test requires confirmation using another methodology. HepC PCR testing (not available at LBJLab) is used to confirm HepC infection as well as to monitor HepC infection. There are several HepC genotypes, the most common HepC genotypes in the US are 1a and 1b. The American Association for the Study of Liver Diseases (AASLD) and the Infectious Disease Society of America (IDSA) recommend genotype testing to treat and manage chronic HepC infections. Once genotype PCR sequencing is performed and the genotype is known, NS5a testing may also be ordered. NS5a is a HepC protein associated with resistance to NS5a inhibitor drugs. Thus, testing for NS5a resistance-associated variants before starting treatment can be useful, particularly for those with genotype 1a infections.

HIV Antibody, Serum CPT Code: 86703

The test is intended to be used as an aid in the diagnosis of HIV-1 and HIV-2 infection. There are different strains of HIV (a retrovirus), with HIV-1 being the most predominant (more than 95% of infections). HIV-2 is less common, is seen mostly in West Africa, and generally progresses slower than HIV-1. The test is 4th generation qualitative assay that also detects p24 antigen in addition to the total concentration of HIV IgM and IgG antibodies to HIV-1 and HIV-2.  If positive, this initial screening test is further reflexed for confirmation and differentiation of HIV-1 and HIV-2.

Influenza A & B Virus, Nasal or Nasopharyngeal CPT Code: 87400 

Acute influenza viral infection is commonly seasonal in incidence. Influenza viruses are divided into 4 types (A, B, C, & D). A – aquatic birds are the primary source but also commonly widespread among mammals including humans and pigs. It has several subtypes such as H1N1 and H3N2 which can cause majority of clinically significant viral disease of upper respiratory tract. B  and C primarily infect humans, with influenza C virus being responsible only for very mild illness usually in children. D  can infect humans but is not known to cause illness. This test is intended to detect antigens from influenza A and B viruses in upper respiratory tract secretions. Patients who present with suspected influenza from A and B type may benefit from treatment with antiviral agents. Since the therapeutic options have expanded from influenza A to include options for the treatment of influenza B disease, it is important to rapidly distinguish A from B in order to allow physicians a choice in selective antiviral intervention. This will also allow for the appropriate preventative intervention to be taken in institutions where measures can be taken for susceptible individuals. The test may be subjected to reflex to further confirmation of subtype when outbreak is suspected.

Iron Panel, Serum

The panel is composed of serum Iron, Transferrin, calculated total iron binding capacity (TIBC), calculated unsaturated iron binding capacity (UIBC), calculated iron saturation % (Transferrin Saturation %), and Ferritin.

Iron, Serum CPT Code: 83540

Transferrin, Serum CPT Code: 84466

Ferritin, Serum CPT Code: 82728

Iron in serum or plasma is bound to the transport protein transferrin (TRF). Iron saturation % (also called Transferrin Saturation %) is the percentage of transferrin saturated with iron.  TRF is responsible for 50 – 70% of the iron binding capacity of serum or plasma. TIBC measures the total amount of iron that can be bound by proteins in the blood. It is an indirect measurement of transferrin availability since transferrin is the primary iron-binding protein. Unsaturated Iron Binding Capacity (UIBC) is the portion of transferrin that has not yet been saturated with iron. Therefore, it can be calculated as UIBC = TIBC – Serum Iron (Normal: 110 – 470 ug/dL). Measurement of Iron Binding Capacity may facilitate clinician’s ability to evaluate iron disorders, certain type of anemia, chronic inflammatory, and neoplastic disorders in conjunction with serum iron, transferrin, and ferritin. Measurement of ferritin in serum or plasma is a useful indicator of body iron stores in normal persons.

Iron, Serum CPT Code: 83540

Serum iron measurements are useful in the diagnosis of iron deficiency and hemochromatosis. Measured serum iron concentration is principally the iron bound to serum transferrin and does not include the iron contained in serum as free hemoglobin.

Lactate, Plasma CPT Code: 83605

L-lactate is the end product of anaerobic glycolysis. It is derived predominantly from skeletal muscle, brain, skin, renal medulla and erythrocytes. Lactate dehydrogenase catalyzes the reduction of pyruvate to lactate. Lactic acidosis occurs in conditions associated with hypoxia e.g. shock including sepsis, congestive heart failure, myocardial infarction, blood loss, pulmonary edema, metabolic disorders and drugs or toxin related disorders.

LDH, Body Fluid (Pleural, Peritoneal, Pericardial) CPT Code: 83615

This test aids in the assessment whether the body fluid is transudate or exudate. It becomes even more reliable when this test is compared to serum or plasma LDH (ratio), and the total body fluid protein concentration. These terms may give clue to the disease state whether benign inflammatory or a malignant condition.

LDH Total, Serum/Plasma CPT Code: 83615

Although total LDH measurement is not specific test due to widespread distribution of this enzyme in the body, the test can be used as diagnostic support of other tests, may be used as tumor marker, and as a potential prognostic tool to monitor variety of diseases including malignancies. Enzyme increases are usually related to their leakage from tissue injury and damaged cells. Elevations of serum or plasma concentration are commonly seen in myocardial infarction, liver disease, pernicious and megaloblastic anemia, pulmonary emboli, malignancies, and muscular dystrophy.  

LDL (Low Density Lipoprotein) Cholesterol Direct, Serum/Plasma CPT Code: 83719

This test is usually requested or as a reflex component of  lipid panel test when calculation or indirect method of measurement is limited or not applicable due to excessive increased in the triglyceride level (>400mg/dL). LDL cholesterol is a key factor in the pathogenesis of atherosclerosis and Coronary Artery Disease (CAD), while HDL cholesterol has often been observed to have a protective effect. Even within the normal range of total cholesterol concentrations, an increase in LDL cholesterol can produce an associated increased risk for CAD. LDL cholesterol binds to receptor sites on macrophages in blood vessel walls inciting several changes to the blood wall which enhance atherosclerotic plaque development.

LH (Luteinizing Hormone), Serum CPT Code: 83002

Increased LH levels are associated with menopause, primary ovarian hypofunction, & polycystic ovary disease in females & primary hypogonadism in males. Decreased LH levels are associated with primary ovarian hyperfunction in females and primary hypergonadism in males.

Lipid Panel, Serum/Plasma CPT Code: 80061

The panel test includes total Cholesterol, Triglycerides, HDL and calculated LDL Cholesterols. The profile test is used to assess the risk of development of cardiovascular disease particularly Coronary Artery Disease.

Liver Function Test (LFT) Panel, Serum/Plasma CPT Code: 80076

This blood test panel includes (7) direct measurements of Total Protein, Albumin, Alkaline Phosphatase (ALP), Alanine Transaminase (ALT), Aspartate Transaminase (AST), Total Bilirubin, and Direct Bilirubin which generally screens the condition or status of the liver. The indirect or calculated measurements include Indirect Bilirubin, Globulin, and Albumin & Globulin Ratio.

Magnesium, Serum/Plasma CPT Code: 83735

Magnesium measurements are used in the diagnosis and treatment of hypomagnesemia and hypermagnesemia. Magnesium is decreased in chronic nephritis, acute pancreatitis, and alcoholic cirrhosis. It is increased in acute or chronic renal failure and Addison’s Disease.

Malaria Blood Smear CPT Code: 87177

This is also called thick and thin blood smear for parasitic malarial screening in the blood. The test aids in the search and identification of blood parasites. To increase the sensitivity or recovery of parasites, the test if negative may be repeated every 8 hours for a couple of days or as needed. 

MRSA (Methicillin Resistant Staphylococcus Aureus) Screen CPT Code: 87081

The test aids to screen asymptomatic individual for MRSA colonization in the body. MRSA colonization is a significant risk factor for future MRSA infection. It is often highly transmissible and carriage seems to lead to clinical infection frequently than with MSSA (Methicillin Susceptible Staphylococcus Aureus) carriage. It is also responsible for many outbreaks of nosocomial infections.

Occult Blood, Stool CPT Code: 82274

Also called “Guaiac Test” or “FIT” (Fecal Immunochemical Test) depending on the available methodology. It is mainly used as a screening for early colorectal cancer. It may also be used if there is suspicion of bleeding at any sites of lower gastrointestinal tract. 

Opiates, Urine CPT Code: 80361

Opiates (opium-based) and its metabolites or derivatives can be detected and measured quantitatively in urine. Depending on the dose and frequency of usage, morphine and other opiates i.e., codeine and heroin may be detected in urine within 72 hours or longer after the last administration.

Ova & Parasites, Stool CPT Code: 87177

The test is used to screen or to identify the presence of intestinal parasites that can cause diarrhea and other abdominal diseases.

Ova & Parasites, Other Than Stool CPT Code: 87177

This test is used to screen or identify the presence of parasites other than stool or intestinal site such as in urine and other body fluids except blood.

Pap Smear (Conventional) CPT Code: 88164

Pap smear is a screening test for women to detect early signs of cervicovaginal malignancies and other related gynecological diseases. It is analyzed by cytotechnologist and or pathologist to determine cytological abnormality to conclude a sensible predefinitive diagnosis.

Partial Thromboplastin Time (PTT) CPT Code: 85732

PTT or activated PTT is a screening test for deficiencies of plasma coagulation factors other than Factors VII and XIII. The test is also frequently used to monitor patients on heparin therapy.

Pericardial Fluid Cell Count CPT Code: 89051

The pericardial sac normally contains up to 50mL of fluid. Excessive fluid accumulation or pericardial effusion may be the result of inflammation of the pericardium (pericarditis) following surgery, myocardial infarct, infection or traumatic injury. It may also be due to systemic disorders such as uremia, autoimmune, malignancy and some drugs (chemotherapy, hydralazine, phenytoin, isoniazid).

Nucleated cell count is preferable term than WBC count due to the fact that not all nucleated cells being counted in the manual counting chamber are WBC such as epithelial lining and non-hematopoietic cells. RBC counts are of little diagnostic value in serous fluids. Blood may be present in serous fluids for a variety of reasons, the most common being a traumatic tap, malignant effusion, or traumatic injury. A hematocrit can be used to differentiate bloody effusions from true hemorrhagic fluids. A hematocrit greater than 50% of the peripheral blood level indicates a hemorrhagic fluid, most likely due to trauma. Nucleated cell count reference range is not well established. The clinical value is likewise limited and focus on whether the fluid is transudate or exudate. Transudative fluids are generally the result of systemic disorders while exudative fluids are that of localized diseases such as infection and malignancies.

Pericardial Fluid Chemistry Panel

Glucose, Body Fluid CPT Code: 82945

Protein, Body Fluid CPT Code: 84157

LDH, Body Fluid CPT Code: 83615

Refers to the total concentration of glucose, protein, and lactate dehydrogenase (LDH) in the body fluid tap or aspirated. This test aids in the assessment whether fluid is transudate or exudate. These terms may give clue to the disease state whether benign inflammatory or a malignant condition.

Pericardial Fluid Culture And Sensitivity CPT Code: 87070

If Positive Culture,

(+) Bacterial Identification, Each Microorganism CPT Code: 87077

(+) Antibiotic Susceptibility Panel (MIC) Per Microorganism CPT Code: 87186

(+) Additional Susceptibility Disk (Manual), Each CPT Code: 87184

The test is used as a tool to determine the cause of infectious disease and the susceptibility of the offending organism/s to antibiotics.

Peritoneal (Ascitic) Fluid Cell Count CPT Code: 89051

The peritoneal cavity is a space between parietal peritoneum that surrounds the abdominal wall and visceral peritoneum that surrounds the abdominal internal organs. The potential space between these two layers is filled with a small amount of serous fluid that allows the two layers to slide freely against each other. The volume of peritoneal fluid which is ultrafiltrate of plasma is maintained by delicate balance of differences of hydrostatic and oncotic pressure in between tissue compartments and flow to lymphatic drainage. The normal amount of fluid at a time is less than 50 mL, slightly higher in women during menstrual cycle (some references less than 100 mL). Any disturbances on these mechanisms may result to pathology and manifest as peritoneal excess or effusion. The clinical value is limited and usually focus on whether the fluid is transudate or exudate. Transudative fluids are generally the result of systemic disorders while exudative fluids are that of localized diseases such as infection and malignancies. Nucleated cell count reference range is not well established. Total cell counts may increase markedly following diuretic therapy. The total nucleated count and absolute neutrophilic count (ANC) are usually the standards for diagnosing spontaneous bacterial peritonitis. ANC of ≥250/uL is suggestive of peritonitis. In TB peritonitis, the total nucleated count is usually >1000/uL with lymphocytic predominance. RBC count is of little diagnostic value in serous fluids. Blood may be present in serous fluids for a variety of reasons, the most common being a traumatic tap, malignant effusion, or traumatic injury. A hematocrit can be used to differentiate bloody effusions from true hemorrhagic fluids. A hematocrit
greater than 50% of the peripheral blood level indicates a hemorrhagic fluid, most likely due to trauma.

Nucleated cell count is preferable term than WBC count due to the fact that not all nucleated cells being counted in the manual counting chamber are WBC such as epithelial lining and non-hematopoietic cells. RBC counts are of little diagnostic value in serous fluids. Blood may be present in serous fluids for a variety of reasons, the most common being a traumatic tap, malignant effusion, or traumatic injury. A hematocrit can be used to differentiate bloody effusions from true hemorrhagic fluids. A hematocrit greater than 50% of the peripheral blood level indicates a hemorrhagic fluid, most likely due to trauma. Nucleated cell count reference range is not well established. The clinical value is likewise limited and focus on whether the fluid is transudate or exudate. Transudative fluids are generally the result of systemic disorders while exudative fluids are that of localized diseases such as infection and malignancies.

Peritoneal (Ascitic) Fluid Chemistry Panel

Glucose, Body Fluid CPT Code: 82945

Protein, Body Fluid CPT Code: 84157

LDH, Body Fluid CPT Code: 83615

Refers to the total concentration of glucose, protein, and lactate dehydrogenase (LDH) in the body fluid tap or aspirated. This test aids in the assessment whether fluid is transudate or exudate. These terms may give clue to the disease state whether benign inflammatory or a malignant condition.

Peritoneal (Ascitic) Fluid Culture And Sensitivity CPT Code: 87070

If Positive Culture,

(+) Bacterial Identification, Each Microorganism CPT Code: 87077

(+) Antibiotic Susceptibility Panel (MIC) Per Microorganism CPT Code: 87186

(+) Additional Susceptibility Disk (Manual), Each CPT Code: 87184

The test is used as a tool to determine the cause of infectious disease and the susceptibility of the offending organism/s to antibiotics.

Phencyclidine (PCP), Urine CPT Code: 83992

Phencyclidine or Phenylcyclohexyl Piperidine (PCP), popularly known as “Angel Dust”, is hallucinogenic illicit drug excreted primarily as unchanged drug and inactive conjugates. Complete excretion of the drug usually occurs within 72 hours of administration; however, urine samples may remain positive for as long as 2 weeks after administration. Renal clearance of PCP is increased markedly with urinary acidification.

Phenobarbital, Serum CPT Code: 80184

Phenobarbital is an anticonvulsant used for the long-term treatment of generalized tonic-clonic (grand mal) seizures and cortical focal seizures.
Phenobarbital levels are monitored to assure adequate therapeutic levels are achieved and to avoid toxicity.

Phenytoin, Serum CPT Code: 80185

Phenytoin is an anticonvulsant hydantoin used for the treatment of generalized tonic-clonic (grand mal) and complex partial seizures. Phenytoin is also used for prophylaxis in neurosurgical procedures. Phenytoin levels are monitored to assure adequate therapeutic levels are achieved and to avoid toxicity.

Phosphorus, Serum/Plasma CPT Code: 84100

Serum phosphorus (Inorganic Phosphate) levels alone are of limited diagnostic value and should be correlated with serum calcium levels. An increased phosphorus with decreased calcium suggests either hypoparathyroidism or renal disease. A decreased phosphorus and an increased calcium suggests hyperparathyroidism or sarcoidosis. When both calcium and phosphorus are decreased diagnostic considerations include malabsorption, vitamin D deficiency and renal tubular acidosis. Increased phosphorus and normal or increased calcium suggests Milk-Alkali Syndrome or Hypervitaminosis D.

Pinworm (Scotch Tape Prep) Exam CPT Code: 87172

The test is used to confirm suspicion of enterobiasis (Enterobius vermicularis) parasitic infestation at the perianal area.

Pleural Fluid Cell Count CPT Code: 89051

The inner chest wall surface of the thoracic cavity is lined completely by parietal pleura while both lungs are tightly enveloped by visceral pleura. The space in between normally contains small amount of fluid to lubricate and facilitate the sliding motion of both pleural surfaces against each other during inspiration and expiration. The volume of pleural fluid is maintained by delicate balance of hydrostatic and oncotic pressure as well as the flow drainage to the peripheral lymphatics. Any disturbances on these mechanisms may lead to pathology and manifest as pleural effusion. The amount of fluid is 0.13mL/kg (about 10mL) under normal condition. The clinical value is limited and usually focus on whether the fluid is transudate or exudate. Transudative fluids are generally the result of systemic disorders while exudative fluids are that of localized diseases such as infection and malignancies. Differential count is important in determining the etiology of an effusion. Etiology may be extensive from pulmonary to non-pulmonary. However, most of pleural effusions are caused by CHF, pneumonia, malignancy or pulmonary embolism. Neutrophilia of >50% usually indicates an acute inflammatory process i.e. parapneumonic effusions. Parapneumonic effusions must be recognized and treated promptly
(urgent tube drainage) to prevent sequelae of empyema, constrictive pleural fibrosis, and sepsis. Indications for urgent drainage include (1) gross purulent fluid, (2) a pleural fluid pH of less than 7.1, (3) loculated effusions, and (4) bacteria on Gram stain or culture. Eosinophilia may also provide a clue to underlying pathology if more than 10%. This is seen many conditions such as pneumothorax, lung emboli, traumatic hemothorax, immuno-allergic reaction to chest tube, parasitic diseases, and Churg-Strauss syndrome. RBC count is of little diagnostic value in serous fluids. Blood may be present in serous fluids for a variety of reasons, the most common being a traumatic tap, malignant effusion, or traumatic injury. A hematocrit can be used to differentiate bloody effusions from true hemorrhagic fluids. A hematocrit greater than 50% of the peripheral blood level indicates a hemorrhagic fluid, most likely due to trauma.

Nucleated cell count is preferable term than WBC count due to the fact that not all nucleated cells being counted in the manual counting chamber are WBC such as epithelial lining and non-hematopoietic cells. RBC counts are of little diagnostic value in serous fluids. Blood may be present in serous fluids for a variety of reasons, the most common being a traumatic tap, malignant effusion, or traumatic injury. A hematocrit can be used to differentiate bloody effusions from true hemorrhagic fluids. A hematocrit greater than 50% of the peripheral blood level indicates a hemorrhagic fluid, most likely due to trauma. Nucleated cell count reference range is not well established. The clinical value is likewise limited and focus on whether the fluid is transudate or exudate. Transudative fluids are generally the result of systemic disorders while exudative fluids are that of localized diseases such as infection and malignancies.

Pleural Fluid Chemistry Panel

Glucose, Body Fluid CPT Code: 82945

Protein, Body Fluid CPT Code: 84157

LDH, Body Fluid CPT Code: 83615

Refers to the total concentration of glucose, protein, and lactate dehydrogenase (LDH) in the body fluid tap or aspirated. This test aids in the assessment whether fluid is transudate or exudate. These terms may give clue to the disease state whether benign inflammatory or a malignant condition.

Pleural Fluid Culture And Sensitivity CPT Code: 87070

If Positive Culture,

(+) Bacterial Identification, Each Microorganism CPT Code: 87077

(+) Antibiotic Susceptibility Panel (MIC) Per Microorganism CPT Code: 87186

(+) Additional Susceptibility Disk (Manual), Each CPT Code: 87184

The test is used as a tool to determine the cause of infectious disease and the susceptibility of the offending organism/s to antibiotics.

Potassium, Serum/Plasma CPT Code: 84132

Potassium measurements are useful in monitoring electrolyte balance in the diagnosis and treatment of disease conditions characterized by low or high blood potassium levels. Potassium is elevated in adrenal cortical insufficiency, acute renal failure and in some cases of diabetic acidosis. Potassium is decreased in diuretic administration and renal tubular acidosis.

Potassium, Urine

Random Urine Potassium (Spot) CPT Code: 84133

24-hour Urine Potassium CPT Code: 84133

Urinary excretion of potassium is increased in primary aldosteronism. It is often increased in dehydration and in salicylate toxicity. Decreased levels are seen in malabsorption.

Progesterone, Serum CPT Code: 84144

The test aids in the assessment of ovarian function in women and in pregnancy.

Prolactin, Serum CPT Code: 84146

During pregnancy and postpartum lactation, serum prolactin can increase 10- to 20-fold. Exercise, stress, and sleep also cause transient increases in
prolactin levels. Consistently elevated serum prolactin levels (>30 ng/mL), in the absence of pregnancy and postpartum lactation, are indicative of hyperprolactinemia. Hypersecretion of prolactin can be caused by pituitary adenomas, hypothalamic disease, breast or chest wall stimulation, renal
failure or hypothyroidism. A number of drugs, including many antidepressants are also common causes of abnormally elevated prolactin levels. Hyperprolactinemia often results in galactorrhea, amenorrhea, and infertility in females, and in impotence and hypogonadism in males. Renal failure, hypothyroidism, and prolactin-secreting pituitary adenomas are also common causes of abnormally elevated prolactin levels.

Protein, Body Fluid CPT Code: 84157

Specify whether Pericardial, Peritoneal, Pleural or Synovial Fluid.

See also Body Fluid Chemistry Panel.

Measurement of total protein body fluid is useful in the differentiation of exudates and transudates.

Protein Creatinine Ratio, Urine

Random Urine Protein CPT Code: 84156

Random Urine Creatinine CPT Code: 82570

A random urine protein/creatinine ratio has been shown to correlate with a 24-hour urine protein estimation. It can be used to predict the presence or absence of significant proteinuria as a risk factor for cardiovascular and renal diseases i.e. hypertension, preeclampsia, and diabetic nephropathy.

Protein, CSF (Cerebrospinal Fluid) CPT Code: 84157

See also CSF Chemistry Panel

The CSF normally contains less than 1% of the amount of protein present in plasma. Clinical disorders associated with increased CSF protein include
traumatic spinal tap, increased blood-CSF permeability due to meningitis or hemorrhage, endocrine/metabolic disorders, drug toxicity, and CSF circulation disorders. Clinical disorders associated with decreased CSF total protein includes CSF leakage from dural tear, increased intracranial pressure, removal of CSF, hyperthyroidism and leukemia. Young children (6 months to 2 years) also have decreased CSF total protein.

Protein, Serum/Plasma CPT Code: 84155

Total protein is useful in evaluating patient for nutritional status, liver disease, protein-losing renal and gastrointestinal diseases, and many other medical conditions. Elevated concentrations may be observed in patients with monoclonal gammopathies, autoimmune hepatitis, inflammation, and other medical conditions.

Protein, Urine

Random Urine Protein (Spot) CPT Code: 84156

24-hour Urine Protein CPT Code: 84156

Proteinuria is characteristic of renal disease and concentrations may be increased with diabetes, hypertension, nephritic syndrome, and drug
nephrotoxicity. Proteinuria, mainly glomerular, is often a manifestation of primary renal disease although transient proteinuria may occur with fever, thyroid disorders, and in heart disease. In the absence of renal disease, the degree of proteinuria is slight, usually amounting to less than 2 grams per day. In chronic glomerulonephritis and in the nephrotic syndrome including lipoid nephrosis and in some forms of hypertensive vascular disease, protein loss may vary from a few grams to as much as 30 g/day.

Prothrombin Time (PT) CPT Code: 85610

Prothrombin Time usually includes International Normalized Ratio (INR) reporting which is used to monitor effects of Warfarin therapy. It is a screening test for abnormalities of coagulation factors that are involved in the extrinsic pathway to study patients with hereditary and acquired clotting disorders.

PSA Free (%), Serum

PSA Free, Serum CPT Code: 84154

PSA Total, Serum CPT Code: 84153

The Free (%) PSA (Prostate Specific Antigen) is calculated  from the concentration of the total and the free (unbound) portion of PSA. It aids to assess probability of prostate cancer when the total PSA concentration is high or marginally elevated. The lower the free PSA percentage, the higher is the probability of the patient having prostate cancer.

PSA Total, Serum CPT Code: 84153

Prostate Specific Antigen (PSA) is a protein produced by prostate gland cells which circulates through the body in two forms either bound to other proteins or on its own (free). The total PSA represents both forms and it is used as a screening test for prostate cancer in men above 50 years of age. However, the test is not specific for cancer because elevation of total PSA can also be seen in benign enlarged prostate and prostatitis.

PTH (intact Parathyroid Hormone), Serum CPT Code: 83970

PTH is normally produced by parathyroid glands and it is released as needed to control the level of calcium in the blood. This test measures the intact molecule form of PTH.

Common causes of hyperparathyroidism are the following:

• Failure of the kidneys to respond normally to PTH

• Inherited vitamin D deficiency

• Spinal cord injury

• Low calcium not related to the parathyroid glands

Common causes of hypoparathyroidism are the following:

• Overactive thyroid gland, or hyperthyroidism

• Magnesium deficiency

• Elevated calcium not related to the parathyroid glands