Private Room

Semi-Private Room

Intensive Care Unit

Coronary Care Unit

Normal vaginal delivery without complications

Cesarean Section without complications

Other antepartum diagnoses w medical complications

Emergency Critical Care, Each Additional 30 Minutes

Critical care, evaluation and management of the critically ill or critically injured patient; each additional 30 minutes

Emergency Critical Care, First 30 Minutes

Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes

Emergency Department Visit - Level 1

Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: A problem focused history; A problem focused examination; and Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor.

Emergency Department Visit - Level 2

Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused examination; and Medical decision making of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity.

Emergency Department Visit - Level 3

Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate severity.

Emergency Department Visit - Level 4

Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: A detailed history; A detailed examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of high severity, and require urgent evaluation by the physician or other qualified health care professionals but do not pose an immediate significant threat to life or physiologic function.

Emergency Department Visit - Level 5

Emergency department visit for the evaluation and management of a patient, which requires these 3 key components within the constraints imposed by the urgency of the patient's clinical condition and/or mental status: A comprehensive history; A comprehensive examination; and Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of high severity and pose an immediate significant threat to life or physiologic function.

Application of Electrical Stimulation - 15 Minutes

Electrical stimulation involves the use of a transcutaneous electrical nerve stimulation device (TENS), functional electrical stimulation device (FES), or a neuromuscular electrical stimulation device (NMES). The physical therapist or other physical therapy aid places the electrodes of the selected device over the region to be stimulated. The electrical impulse is set to the desired strength and the control unit is turned on. Electrical impulses are transmitted to the skin. The electrical stimulation device causes the muscles to contract. The muscle contraction stimulates both muscle and nerve tissues to relieve pain and promote healing. Electrical stimulation may be provided as a supervised modality that does not require direct (one-on-one) patient contact or it may be provided under constant attendance with direct (one-on-one) patient contact.

Gait Training - 15 Minutes

Gait training is a therapeutic procedure that observes and educates an individual in the manner of walking including the rhythm, cadence, step, stride, and speed. The objective of gait training is to strengthen muscles and joints, improve balance and posture, and develop muscle memory. As the lower extremities are retrained for repetitive motion, the body also benefits from the exercise with increased endurance, improved heart/lung function, and reduced or improved osteoporosis. Gait training is an appropriate therapeutic procedure following brain and/or spinal cord injury, stroke, fracture of the pelvis and/or lower extremity, joint injury or replacement of the knee, hip, or ankle, amputation, and for certain musculoskeletal and/or neurological diseases. A treadmill fitted with a safety harness is initially used to ensure safe walking. As the patient gains strength and balance, step training and stair climbing is added to the treatment modality.

Physical Therapy, complex evaluation

A physical therapy evaluation or re-evaluation is performed. The physical therapist takes a history of the current complaint including onset of symptoms, comorbidities, changes since the onset, treatment received for the symptoms or condition, medications prescribed for it, and any other medications the patient is taking. A physical examination of body systems is done to assess physical structure and function, any activities or movements that exacerbate the symptoms, limit activity, or restrict participation in movement, as well as anything that helps to relieve the symptoms. The evaluation may involve provocative maneuvers or positions that increase symptoms; tests for joint flexibility and muscle strength; assessments of general mobility, posture, and core strength; evaluation of muscle tone; and tests for restrictions of movement caused by myofascial disorders. Following the history and physical, the therapist determines the patient's clinical presentation characteristics, provides a detailed explanation of the condition, identifies physical therapy treatment options, and explains how often and how long physical therapy modalities should be applied. The physical therapist will then develop a plan of care with clinical decision making based on patient assessment and/or measurable functional outcome. The plan of care may include both physical therapy in the clinic and exercises or changes in the home environment. Upon re-evaluation, the established care plan is reviewed and an interim history is taken requiring the use of standardized tests and measures. The patient's response to treatment is evaluated and the plan of care is revised based on the patient's measurable response.

Physical Therapy, standard evaluation - 20 minutes

A physical therapy evaluation or re-evaluation is performed. The physical therapist takes a history of the current complaint including onset of symptoms, comorbidities, changes since the onset, treatment received for the symptoms or condition, medications prescribed for it, and any other medications the patient is taking. A physical examination of body systems is done to assess physical structure and function, any activities or movements that exacerbate the symptoms, limit activity, or restrict participation in movement, as well as anything that helps to relieve the symptoms. The evaluation may involve provocative maneuvers or positions that increase symptoms; tests for joint flexibility and muscle strength; assessments of general mobility, posture, and core strength; evaluation of muscle tone; and tests for restrictions of movement caused by myofascial disorders. Following the history and physical, the therapist determines the patient's clinical presentation characteristics, provides a detailed explanation of the condition, identifies physical therapy treatment options, and explains how often and how long physical therapy modalities should be applied. The physical therapist will then develop a plan of care with clinical decision making based on patient assessment and/or measurable functional outcome. The plan of care may include both physical therapy in the clinic and exercises or changes in the home environment. Upon re-evaluation, the established care plan is reviewed and an interim history is taken requiring the use of standardized tests and measures. The patient's response to treatment is evaluated and the plan of care is revised based on the patient's measurable response.

PT Evaluation - Moderate Complexity

A physical therapy evaluation or re-evaluation is performed. The physical therapist takes a history of the current complaint including onset of symptoms, comorbidities, changes since the onset, treatment received for the symptoms or condition, medications prescribed for it, and any other medications the patient is taking. A physical examination of body systems is done to assess physical structure and function, any activities or movements that exacerbate the symptoms, limit activity, or restrict participation in movement, as well as anything that helps to relieve the symptoms. The evaluation may involve provocative maneuvers or positions that increase symptoms; tests for joint flexibility and muscle strength; assessments of general mobility, posture, and core strength; evaluation of muscle tone; and tests for restrictions of movement caused by myofascial disorders. Following the history and physical, the therapist determines the patient's clinical presentation characteristics, provides a detailed explanation of the condition, identifies physical therapy treatment options, and explains how often and how long physical therapy modalities should be applied. The physical therapist will then develop a plan of care with clinical decision making based on patient assessment and/or measurable functional outcome. The plan of care may include both physical therapy in the clinic and exercises or changes in the home environment. Upon re-evaluation, the established care plan is reviewed and an interim history is taken requiring the use of standardized tests and measures. The patient's response to treatment is evaluated and the plan of care is revised based on the patient's measurable response.

PT to Re-Educate Brain to Muscle Function (15 min)

Therapeutic procedures for neuromuscular reeducation are used to develop conscious control of a single muscle or muscle group and heighten the awareness of the body's position in space, especially the position of the extremities when sitting or standing. Neuromuscular reeducation is employed during the recovery or regeneration stage following severe injury or trauma, cerebral vascular accident, or systemic neurological disease. The goal of therapy is improved range of motion (ROM), balance, coordination, posture, and spatial awareness. Techniques may include proprioceptive neuromuscular facilitation which uses diagonal contract-relax patterns of skeletal muscles to stimulate receptors in the joints that communicate body position to the brain via motor and sensory nerves. Feldenkrais is a method which observes the patient's habitual movement patterns and teaches new patterns based on efficient active or passive repetitive conditioning. Additional techniques that may be useful for neuromuscular reeducation are Bobath concept, which promotes motor learning and efficient motor control, and biomechanical ankle platform system (BAPS) boards.

Physical Therapy 1 or More Regions (15 min)

Manual therapies are skilled, specific, hands-on techniques usually performed by physical therapists, occupational therapists, chiropractors, osteopaths, and/or physiatrists to diagnose and treat soft tissue and joint problems. The goal of manual therapy is to modulate pain and induce relaxation, increase range of motion (ROM), facilitate movement, function, and stability, decrease inflammation, and improve muscle tone and extensibility. Tissue mobilization involves slow, controlled myofascial stretching using deep pressure to break up fibrous muscle tissue and/or connective tissue adhesions. Manipulation is a more forceful stretching of the myofascial tissue that takes the joint just beyond its restricted barrier. Manual lymphatic drainage is a type of light massage employed to reduce swelling by gentle movement of the skin in the direction of lymphatic flow. Manual traction involves the controlled counterforce of the therapist to induce asymptomatic strain by gently stretching muscle and/or connective tissue.

Physical Therapy Exercise, 15 Minutes

Therapeutic exercise is the application of careful, graduated force to the body to increase strength, endurance, range of motion, and flexibility. Increased muscle strength is achieved by the deliberate overloading of a targeted muscle or muscle group and improved endurance is achieved by raising the intensity of the strengthening exercise to the targeted area(s) over a prolonged period of time. To maintain range of motion (ROM) and flexibility requires the careful movement and stretching of contractile and non-contractile tissue that may tighten with injury or neurological disease, causing weakness and/or spasticity. Therapeutic exercise can increase blood flow to the targeted area, reduce pain and inflammation, reduce the risk of blood clots from venous stasis, decrease muscle atrophy and improve coordination and motor control. Therapeutic exercise may be prescribed following acute illness or injury and for chronic conditions that affect physical activity or function.

Occupational Therapy, standard evaluation - 30 minutes

An occupational therapy evaluation or re-evaluation is performed. Occupational therapy assists the patient in developing or regaining skills that allow independent functioning and enhance health and personal well-being. A patient history is taken that includes an occupational profile and medical and therapy history with review of records as well as an extensive review of physical, cognitive, or psychosocial elements related to current performance of daily activities. The occupational therapist evaluates the patient's physical functioning, mental, and/or neurobehavioral impairment and performs tests to identify functional limitations or performance deficits. Physical functioning is evaluated, including an evaluation of any musculoskeletal conditions that may impair function. The ability to perform basic activities of daily living such as dressing, bathing, mobility, and other activities for living independently, such as shopping, cooking, driving, or accessing public transportation are all assessed. Barriers in the home, school, work, and community environments are identified. The need for adaptive equipment is assessed. The occupational therapist develops a treatment plan using clinical decision making from the patient analysis, assessment data, comorbidities, and possible treatment options. During a re-evaluation, an interim history is taken; the patient's response to treatment is evaluated; and the plan of care is revised based on the patient's response to treatment, functional and medical status, and any changes in condition or environment that affect future interventions or goals.

Occupational Therapy Evaluation - Moderate Complexity

An occupational therapy evaluation or re-evaluation is performed. Occupational therapy assists the patient in developing or regaining skills that allow independent functioning and enhance health and personal well-being. A patient history is taken that includes an occupational profile and medical and therapy history with review of records as well as an extensive review of physical, cognitive, or psychosocial elements related to current performance of daily activities. The occupational therapist evaluates the patient's physical functioning, mental, and/or neurobehavioral impairment and performs tests to identify functional limitations or performance deficits. Physical functioning is evaluated, including an evaluation of any musculoskeletal conditions that may impair function. The ability to perform basic activities of daily living such as dressing, bathing, mobility, and other activities for living independently, such as shopping, cooking, driving, or accessing public transportation are all assessed. Barriers in the home, school, work, and community environments are identified. The need for adaptive equipment is assessed. The occupational therapist develops a treatment plan using clinical decision making from the patient analysis, assessment data, comorbidities, and possible treatment options. During a re-evaluation, an interim history is taken; the patient's response to treatment is evaluated; and the plan of care is revised based on the patient's response to treatment, functional and medical status, and any changes in condition or environment that affect future interventions or goals.

Paraffin Wax Bath

A paraffin bath may be used on small, irregular surfaces such as the wrists, hands, and feet to treat acute or chronic pain and stiffness. Paraffin is a mineral wax derived from petroleum with a low melting point, which allows extended contact with the skin without the risk of thermal injury. Paraffin is melted in a small tub and the extremity is immersed in the liquid. The moist heat from the wax increases blood flow to the area and relaxes muscle tissue. Paraffin bath treatments may be used prior to exercise to reduce joint stiffness and increase range of motion. This treatment modality is helpful for patients with osteoarthritis, rheumatoid conditions, fibromyalgia, and scleroderma. Paraffin baths may also be prescribed for bursitis, tendonitis, and muscle sprains or strains.

Occupational Therapy, re-evaluation

An occupational therapy evaluation or re-evaluation is performed. Occupational therapy assists the patient in developing or regaining skills that allow independent functioning and enhance health and personal well-being. A patient history is taken that includes an occupational profile and medical and therapy history with review of records as well as an extensive review of physical, cognitive, or psychosocial elements related to current performance of daily activities. The occupational therapist evaluates the patient's physical functioning, mental, and/or neurobehavioral impairment and performs tests to identify functional limitations or performance deficits. Physical functioning is evaluated, including an evaluation of any musculoskeletal conditions that may impair function. The ability to perform basic activities of daily living such as dressing, bathing, mobility, and other activities for living independently, such as shopping, cooking, driving, or accessing public transportation are all assessed. Barriers in the home, school, work, and community environments are identified. The need for adaptive equipment is assessed. The occupational therapist develops a treatment plan using clinical decision making from the patient analysis, assessment data, comorbidities, and possible treatment options. During a re-evaluation, an interim history is taken; the patient's response to treatment is evaluated; and the plan of care is revised based on the patient's response to treatment, functional and medical status, and any changes in condition or environment that affect future interventions or goals.

Self Care - Home Management Training - 15 Minutes

Self-care/home managemeThe patient receives one-on-one training to improve the ability to care for himself/herself and maintain independence. This may include training in activities of daily living (ADL), such as bed mobility, transfers, dressing, grooming, eating, bathing and toileting. The patient is given instruction on compensatory measures that can be taken to overcome any physical, mental or emotional disabilities. The patient receives training in how to adapt meal preparation to his/her specific needs and how to perform activities safely. The patient may also receive instruction in the use of assistive technology devices and adaptive equipment which includes any item used to improve the functional capability of the patient in the home and with ADL. This code is reported for each 15 minutes of one-on-one self-care/home management training designed to meet the specific needs of the patient.nt training, which includes instructions in the use of any assisting equipment.

Therapeutic Activities Involving Functional Activities (15 min)

In a one-on-one physical therapy session, the provider instructs and assists the patient in therapeutic activities designed to address specific functional limitations. The therapeutic activities are specifically developed and modified for the patient. Dynamic/movement activities, also called kinetic activities, that are designed to improve functional performance such as lifting, bending, pushing, pulling, jumping and reaching are included in this service. For example, the patient may be given therapeutic activities to perform to improve the ability to sit, stand, and get out of bed after an injury without straining or risking reinjury. This code is reported for each 15 minutes of one-on-one therapeutic activity provided.

Aerosol Treatment

A patient or caregiver receives a demonstration of and training in the use of an aerosol generator, nebulizer, metered dose inhaler, or IPPB device. The effectiveness of inhaled medications is in part dependent on the proficiency of the patient or a caregiver in using the prescribed device. The delivery device is selected based on the type of medication being administered and the ability of the patient or caregiver to master use of the device. The provider, usually a respiratory therapist, demonstrates use of the device and explains in detail why and how the medication and device must be used for maximum effectiveness. The patient or caregiver is then observed as he/she uses the device. The respiratory therapist offers help and clarification on the use of the device as needed. Correct use of the device may require more than one demonstration and training session.

Routine EKG - Minimum 12 Leads

An ECG is used to evaluate the electrical activity of the heart. The test is performed with the patient lying prone on the exam table. Small plastic patches are attached at specific locations on the chest, abdomen, arms, and/or legs. Leads (wires) from the ECG tracing device are then attached to the patches. A tracing is obtained of the electrical signals from the heart. Electrical activity begins in the sinoatrial node which generates an electrical stimulus at regular intervals, usually 60 to 100 times per minute. This stimulus travels through the conduction pathways to the sinoatrial node causing the atria to contract. The stimulus then travels along the bundle of His which divides into right and left pathways providing electrical stimulation of the ventricles causing them to contract. Each contraction of the ventricles represents one heart beat. The ECG tracing includes the following elements: P wave, QRS complex, ST segment, and T wave. The P wave, a small upward notch in the tracing, indicates electrical stimulation of the atria. This is followed by the QRS complex which indicates the ventricles are electrically stimulated to contract. The short flat ST segment follows and indicates the time between the end of the ventricular contraction and the T wave. The T wave represents the recovery period of the ventricles. The physician reviews, interprets, and provides a written report of the ECG recording taking care to note any abnormalities.

Spirometry - breathing test

Spirometry is a pulmonary function test that is used to help diagnose the cause of shortness of breath and to monitor existing pulmonary disease, such as chronic bronchitis, emphysema, pulmonary fibrosis, chronic obstructive pulmonary disease (COPD), and asthma. A spirometry device consisting of a mouthpiece and tubing connected to a machine that records and displays results is used to perform the test. The patient inhales deeply and then exhales through the mouthpiece. Inhalation and exhalation measurements are first taken with the patient breathing normally. The patient is then instructed to perform rapid, forceful inhalation and exhalation. The spirometer records the volume of air inhaled, exhaled, and the length of time each breath takes. The test results are displayed on a graph that the physician reviews and interprets in a written report.

Spirometry - medicated breathing procedure

Spirometry with bronchodilation responsiveness is a pulmonary function test that is used to help diagnose the cause of shortness of breath and to monitor existing pulmonary disease, such as chronic bronchitis, emphysema, pulmonary fibrosis, chronic obstructive pulmonary disease (COPD), and asthma. The test is first performed without administration of a bronchodilator. A spirometry device consisting of a mouthpiece and tubing connected to a machine that records and displays results is used to perform the test. The patient inhales deeply and then exhales through the mouthpiece. Inhalation and exhalation measurements are first taken with the patient breathing normally. The patient is then instructed to perform rapid, forceful inhalation and exhalation. The spirometer records the volume of air inhaled, exhaled, and the length of time each breath takes. A bronchodilator medication is administered and the test is repeated. The test results are displayed on a graph that the physician reviews and interprets in a written report.

Stress Test with EKG tracing

An ECG is used to evaluate the electrical activity of the heart using treadmill, bicycle exercise, and/or pharmacologically induced stress. Small plastic patches are attached at specific locations on the chest, abdomen, arms, and/or legs. Leads (wires) from the stress ECG device are then attached to the patches. A baseline ECG is obtained. The exercise portion of the study is then initiated. Heart rate and blood pressure are monitored. Staged stress protocol is used and the patient's response to stress is monitored as the stress ECG is recorded. Unless contraindicated, exercise or pharmacological stress continues until the patient is unable to continue or until the target heart rate is achieved. Upon completion of the study, the stress ECG is reviewed and a written interpretation of findings is provided.

Swallow Evaluation

An evaluation of the oral and pharyngeal phase of the swallowing function is performed in a patient who is suspected of having oropharyngeal dysphagia. The initial evaluation is typically performed by a dysphagia specialist, usually a speech-language pathologist. This evaluation is performed to determine whether more extensive studies are warranted. Swallowing function is divided into oral, pharyngeal, and esophageal phases. The oral and pharyngeal phases are made up of oral preparation for solid foods (not required for liquids or pureed foods), oral transfer, and initiation of the swallow. Both oral and pharyngeal movements are necessary in preparing, transferring, and swallowing food. The patient is given both solids and liquids to swallow. During oral preparation of solid food the ability of the tongue to move the food from side-to-side so that the solid can be chewed and prepared for swallowing is evaluated. Once the solid food is prepared and transferred to the back of the throat, the swallowing movements are evaluated. Propelling solids or liquids requires a complex set of movements including retraction of the base of the tongue, elevation of the hyolarynx, closure of the velopharyngeus, contraction of the pharynx, opening of the upper esophageal sphincter, and closure of the airway. The speech-language pathologist observes the patient to determine whether solids and liquids are being prepared, transferred, and propelled from the pharynx into the esophagus. A written report of findings is provided.

Swallow Treatment

Swallowing dysfunction and/or oral function are treated in an individual with difficulty passing food or liquid from the mouth or throat into the stomach. A swallowing or oral function disorder can occur in any age group or at any point in the swallowing process as food or liquid passes from the mouth, through the pharynx and esophagus, into the stomach. Swallowing disorders are common in individuals with degenerative neurological disorders such as cerebral palsy, amyotrophic lateral sclerosis (ALS), postpolio syndrome, myasthenia gravis, multiple sclerosis, and Parkinson's disease. A swallowing disorder may also result from neurological damage such as a stroke or head or spinal cord injury, or from a congenital or acquired deformity of the mouth, pharynx, esophagus, or stomach. Medical treatment is provided for a patient with a swallowing or oral function disorder. The diet is modified. Swallowing posture is assessed and modified as needed. Swallowing technique is modified to strengthen oropharyngeal muscle groups and improve the mechanics of swallowing so that food and liquid can pass into the esophagus and then into the stomach without aspiration into the lungs.

ADH (antidiuretic hormone) level

Activated protein resistance assay

Acute hepatitis panel

An acute hepatitis panel is obtained to detect and diagnose acute or chronic viral liver infections. Hepatitis A virus (HAV) is highly contagious but usually causes only a mild illness. HAV is found in contaminated food and water but may also be spread person to person by close physical contact. It does not cause a chronic infection and a vaccine is available. Hepatitis B virus (HBV) is found in blood and body fluids and is the most common hepatitis virus contracted. It is a chronic infection and a vaccine is available against HBV. Hepatitis C virus is also found in blood and body fluids, and is chronic, however no vaccine is yet available to protect against this virus. Tests in an acute hepatitis panel should include Hepatitis A antibody, IgM antibody (HAAb IgM Ab), Hepatitis B core antibody, IgM antibody (HBcAb IgM Ab), Hepatitis B surface antigen (HBsAg), and Hepatitis C antibody (by CIA or Interp). Hepatitis A Virus antibody, IgM develops 2-3 weeks post exposure and remains elevated for 2-6 months. Hepatitis B Virus core antibody, IgM is produced in response to the presence of Hepatitis B core antigen. It will be elevated with acute initial infection and during flare up of disease activity in chronic infection. Hepatitis B Virus surface antigen is a protein located on the surface of HBV. Elevated levels of HBsAg may be an early sign of exposure to the virus or indicate an acute or chronic infection. When testing for Hepatitis C antibody, it is not possible to distinguish whether elevated levels are due to active acute infection or a chronic disease state unless differentiated by further testing. A specimen is obtained by separately reportable venipuncture. Serum/plasma is tested using quantitative chemiluminescent immunoassay.

Adrenocorticotropic hormone (ACTH) level

Albumin (protein) level

A blood test is performed to measure albumin levels in serum, plasma, or whole blood. Albumin is a plasma protein responsible for regulating the colloidal osmotic pressure of blood. It is capable of binding water, electrolytes (sodium, potassium, calcium), fatty acids, hormones, bilirubin, and drugs/medications. Albumin levels are used to assess nutritional status. A blood sample is obtained by separately reportable venipuncture. The plasma, serum or whole blood is tested using spectrophotometry or quantitative nephelometry.

Aldolase (enzyme) level

Alpha-1-antitrypsin; phenotype

Alpha-Fetoprotein (AFP) Level, Serum

Alpha-fetoprotein (AFP) is measured in serum or amniotic fluid during pregnancy to screen for neural tube defects such as spina bifida and anencephaly, chromosomal abnormalities such as Down syndrome or Edwards syndrome, and omphalocele. AFP is a protein produced by the yolk sac of the fetus in early gestation and then later by the liver and gastrointestinal tract of the fetus. A blood sample is obtained by separately reportable venipuncture between 14 and 22 weeks gestation. The blood (serum) test screens for high and low levels of AFP. High levels are associated with neural tube defects while low levels are associated with chromosomal abnormalities.

Alpha-fetoprotein (AFP) analysis

Amikacin (antibiotic) level

Ammonia level

A blood test is performed to measure ammonia levels. Ammonia is a by product of protein metabolism and is normally converted to urea by the liver and excreted via the kidney. Elevated ammonia levels may result from cirrhosis or hepatitis. Symptoms of elevated ammonia levels are confusion, tremors, excessive sleepiness, or coma. Testing may be performed in disease states such as Reyes syndrome or liver failure. A blood sample is obtained by a separately reportable venipuncture or arterial access line. The specimen is then tested using colorimetry.

Amylase (enzyme) level

Laboratory testing for amylase may be performed on blood, urine, and other body fluids. Amylase is an enzyme responsible for the break down of starches into sugar molecules (disaccharides and trisaccharides) and eventually into glucose for energy use by the cells. Amylase is produced in saliva and the pancreas. Abnormal amylase levels may result from pancreatic inflammation or trauma, perforated peptic ulcer, ovarian cyst (torsion), strangulation ileus, macroamylasemia, mumps, and cystic fibrosis. A blood or body fluid sample is obtained. The sample is then tested using quantitative enzymatic methodology.

Analysis for antibody (IgM) to Cytomegalovirus (CMV)

Analysis for antibody Borrelia burgdorferi (Lyme disease bacteria)

Analysis for antibody to Chlamydia (bacteria)

Analysis for antibody to Cytomegalovirus (CMV)

Antibody; Epstein-Barr (EB) virus, early antigen (EA)

Antibody; Epstein-Barr (EB) virus, nuclear antigen (EBNA)

Antibody; Epstein-Barr (EB) virus, viral capsid (VCA)

Analysis for antibody to HIV-1 and HIV-2 virus

Lab test for HIV-1/HIV-2

Analysis for antibody to Herpes simplex virus, type 2

Analysis for antibody to Mycoplasma (bacteria)

Analysis for antibody to mumps virus

Analysis for antibody to varicella-zoster virus (chicken pox)

Lab test for Varicella-Zoster antibody (Chickenpox/Shingles)

Analysis for antibody to virus

Analysis for detection of tumor marker

Analysis test for HIV-1 virus; reverse transcriptase and protease regions

Analysis test for Hepatitis C virus

Antibody Screen

A laboratory test is performed to identify specific red blood cell (RBC) antibodies. This test may be ordered when an antibody screening test that detects IgG and/or complement fragments (direct anti-globulins) on the surface of RBCs. It is used to monitor antibody levels during pregnancy and assess the risk of hemolytic disease in a newborn. Maternal IgG alloantibodies to RBC antigens have the ability to cross the placenta. An antigen-antibody reaction may cause RBC hemolysis in the fetus resulting in harmful and/or fatal fetal anemia and hyperbilirubinemia. A blood sample is obtained by separately reportable venipuncture. Serum is tested using hemagglutination.

Antithrombin III antigen (clotting inhibitor) activity

Arterial Blood Gases Measurement

A laboratory test is performed to measure one or more components of blood gases. The homeostatic acid-base balance is measured as blood pHùthe number of hydrogen ions (H+) dissolved in the blood. Partial pressure of carbon dioxide (pCO2) is the amount of carbon dioxide dissolved in the blood and reflects how well the lungs can move CO2 out of the body. Partial pressure of oxygen (pO2) is the level of oxygen dissolved in the blood and reflects the exchange of oxygen molecules in the alveoli. Bicarbonate (HCO3) is calculated from pH and pCO2 and is the metabolic component of acid-base balance reflecting the kidney's response to changes in pH. Oxygen saturation (O2 Sat) is the percent of hemoglobin that is carrying oxygen. Calculated O2 saturation uses a mathematical model to determine the percentage of hemoglobin that is carrying oxygen based on the level of pO2. Blood gas monitoring may be performed to evaluate lung function; detect an acid-base imbalance; monitor metabolic, respiratory, and kidney disorders; and evaluate the effectiveness of treatment. A blood sample is obtained by separately reportable venipuncture, heelstick, arterial, or umbilical cord draw.

Automated white blood cell count

Bacterial Blood Culture

A blood sample is drawn and placed in a medium conducive to the growth of bacteria. Any bacteria present in the blood sample will then reveal themselves.

Bacterial culture and colony count

Bacterial culture for anaerobic isolates

Bacterial urine culture

Blood test, basic group of blood chemicals

A basic metabolic blood panel is obtained that includes ionized calcium levels along with carbon dioxide (bicarbonate) (CO2), chloride, creatinine, glucose, potassium, sodium, and urea nitrogen (BUN). A basic metabolic panel with measurement of ionized calcium may be used to screen for or monitor overall metabolic function or identify imbalances. Ionized or free calcium flows freely in the blood, is not attached to any proteins, and represents the amount of calcium available to support metabolic processes such as heart function, muscle contraction, nerve function, and blood clotting. Total carbon dioxide (bicarbonate) (CO2) level is composed of CO2, bicarbonate (HCO3-), and carbonic acid (H2CO3) with the primary constituent being bicarbonate, a negatively charged electrolyte that works in conjunction with other electrolytes, such as potassium, sodium, and chloride, to maintain proper acid-base balance and electrical neutrality at the cellular level. Chloride is also a negatively charged electrolyte that helps regulate body fluid and maintain proper acid-base balance. Creatinine is a waste product excreted by the kidneys that is produced in the muscles while breaking down creatine, a compound used by the muscles to create energy. Blood levels of creatinine provide a good measurement of renal function. Glucose is a simple sugar and the main source of energy for the body, regulated by insulin. When more glucose is available than is required, it is stored in the liver as glycogen or stored in adipose tissue as fat. Glucose measurement determines whether the glucose/insulin metabolic process is functioning properly. Both potassium and sodium are positively charged electrolytes that work in conjunction with other electrolytes to regulate body fluid, stimulate muscle contraction, and maintain proper acid-base balance and both are essential for maintaining normal metabolic processes. Urea is a waste product produced in the liver by the breakdown of protein from a sequence of chemical reactions referred to as the urea or Krebs-Henseleit cycle. Urea is taken up by the kidneys and excreted in the urine. Blood urea nitrogen, BUN, is a measure of renal function, and helps monitor renal disease and the effectiveness of dialysis.

Bilirubin level (Total)

A laboratory test is performed to measure total or direct bilirubin. Bilirubin is a pigmented waste product normally produced when red blood cells (RBCs) break down. Non-water soluble (unconjugated) bilirubin is carried on albumin to the liver where it attaches to sugar molecules to become conjugated. Conjugated (direct) bilirubin is water soluble and able to pass from the liver to the small intestine. Further breakdown of bilirubin occurs in the small intestine and it is eventually eliminated in the feces in the form of stercobilin. Total bilirubin is the sum of conjugated (direct) and unconjugated bilirubin. A test for either conjugated or direct bilirubin or total bilirubin may be ordered to diagnose and monitor liver disorders, hemolytic anemia, and newborn (physiologic) jaundice. A blood sample is obtained by separately reportable venipuncture or heel stick. Other body fluids, including cerebral spinal fluid, may be collected and tested for total bilirubin. Serum/plasma is tested using quantitative spectrophotometry.

Bilirubin level (Direct)

A laboratory test is performed to measure total or direct bilirubin. Bilirubin is a pigmented waste product normally produced when red blood cells (RBCs) break down. Non-water soluble (unconjugated) bilirubin is carried on albumin to the liver where it attaches to sugar molecules to become conjugated. Conjugated (direct) bilirubin is water soluble and able to pass from the liver to the small intestine. Further breakdown of bilirubin occurs in the small intestine and it is eventually eliminated in the feces in the form of stercobilin. Total bilirubin is the sum of conjugated (direct) and unconjugated bilirubin. A test for either conjugated or direct bilirubin or total bilirubin may be ordered to diagnose and monitor liver disorders, hemolytic anemia, and newborn (physiologic) jaundice. A blood sample is obtained by separately reportable venipuncture or heel stick. Other body fluids, including cerebral spinal fluid, may be collected and tested for total bilirubin. Serum/plasma is tested using quantitative spectrophotometry.

Blood creatinine level

A blood sample is taken to measure creatinine levels. Creatinine is a waste product produced by the muscles in the breakdown of creatine, which is a compound used by the muscles to create energy for contraction. The waste product, creatinine, is excreted by the kidneys and blood levels provide a good measurement of renal function. Creatinine may be checked to screen for or monitor treatment of renal disease. Creatinine levels may also be monitored in patients with acute or chronic illnesses that may impair renal function and in patients on medications that affect renal function. Creatinine is measured using spectrophotometry.

Blood glucose (sugar) level

A blood sample is obtained to measure total (quantitative) blood glucose level. Glucose is a simple sugar that is the main source of energy for the body. Carbohydrates are broken down into simple sugars, primarily glucose, absorbed by the intestine, and circulated in the blood. Insulin, a hormone produced by the pancreas, regulates glucose level in the blood and transports glucose to cells in other tissues and organs. When more glucose is available in the blood than is required, it is converted to glycogen and stored in the liver or converted to fat and stored in adipose (fat) tissue. If the glucose/insulin metabolic process is working properly, blood glucose will remain at a fairly constant, healthy level. Glucose is measured to determine whether the glucose/insulin metabolic process is functioning properly. It is used to monitor glucose levels and determine whether they are too low (hypoglycemia) or too high (hyperglycemia) as well as test for diabetes and monitor blood sugar control in diabetics.

Blood osmolality (concentration) measurement

Osmolality of blood or urine is tested. Osmolality refers to the number of solutes present in blood (plasma or serum) or urine. Osmotically active particles include sodium, chloride, potassium, urea, and glucose. Osmolality is tested using freezing point methodology or vapor pressure osmometer. The higher the concentration of solutes, the lower the freezing point as compared to water.

Blood potassium level

A blood sample is obtained to measure potassium level. Potassium is a positively charged electrolyte that works in conjunction with other electrolytes, such as sodium, chloride, and carbon dioxide (CO2), to regulate body fluid, stimulate muscle contraction, and maintain proper acid-base balance. Potassium is found in all body fluids but mostly stored within cells, not in extracellular fluids, blood serum, or plasma. Small fluctuations in blood potassium, either too high (hyperkalemia) or too low (hypokalemia), can have serious, even life-threatening, consequences. Potassium level is used to screen for and monitor renal disease; monitor patients on certain medications, such as diuretics, as well as patients with acute and chronic conditions, such as dehydration or endocrine disorders. Because blood potassium affects heart rhythm and respiratory rate, it is routinely checked prior to major surgical procedures. Potassium is measured by ion-selective electrode (ISE) methodology.

Blood sodium level

A blood sample is obtained to measure sodium level. Sodium is a positively charged electrolyte that works in conjunction with other electrolytes, such as potassium, chloride, and carbon dioxide (CO2), to regulate fluid in the body and maintain proper acid-base balance. Sodium is an essential mineral in the body, necessary for maintaining normal metabolic processes, fluid levels, and vascular pressure. Sodium level is used to screen for and monitor elevated blood sodium (hypernatremia), low blood sodium (hyponatremia), and electrolyte imbalances. Sodium may be monitored in patients on certain medications, such as diuretics, that can cause electrolyte imbalance. Sodium is measured by ion-selective electrode (ISE) methodology.

Blood Typing, ABO

A blood specimen is tested to determine blood type (ABO) or Rh(D). Blood is grouped using an ABO blood typing system which identifies four blood types: type A, B, AB, or O. The blood sample is mixed with antibodies against Type A and B blood and then checked to determine if the blood cells agglutinate, or stick together. Type A blood has anti-B antibodies; type B blood has anti-A antibodies; type O blood has antibodies to both A and B; and type AB blood does not have anti-A or anti-B antibodies. Type A blood agglutinates when type B antibodies are introduced. Type B blood agglutinates when type A antibodies are introduced. Type O blood agglutinates when type A or B antibodies are introduced. Type AB blood does not agglutinate when type A or B antibodies are introduced. The blood is then back typed. Blood serum is mixed with blood that is known to be type A or B.

Blood Typing, Rh (D)

A blood specimen is tested to determine blood type (ABO) or Rh(D). In Rh(D), blood is tested for Rh factor, which is an antigen on red blood cells. Blood is Rh+ if the antigen is present or Rh- if the antigen is absent. Blood is tested by mixing the blood sample with antibodies against Rh factor and then checking for agglutination. If agglutination occurs, the blood is Rh+. If the blood does not agglutinate, it is Rh-.

Blood chloride level

Blood glucose (sugar) level after receiving dose of glucose

Glucose; tolerance test (GTT), 3 specimens (includes glucose)

Blood glucose (sugar) tolerance test (Added Samples)

Blood test, basic group of blood chemicals

Blood viscosity measurement

Bone marrow, smear interpretation

Calcium level

A blood sample is taken to measure the amount of total calcium. Calcium is one of the most important minerals in the body. About 99 percent of the calcium found the body is stored in the bones. The remaining one percent circulates in the blood. Calcium may be ionized (free) or attached (bound) to proteins. Free calcium is the calcium metabolically active in the body. Bound calcium is inactive. Total calcium is a measurement of the total amount of both free calcium and bound calcium circulating in the blood. Total calcium is measured to screen for or monitor a number of conditions, including those affecting the bones, heart, nerves, kidneys and teeth. Total calcium is measured using spectrophotometry.

Carbamazepine level

A laboratory test is performed to determine total or free carbamazepine levels. Carbamazepine, also referred to as Tegretol, is an anticonvulsant used to treat epilepsy and may also be used as an analgesic to treat trigeminal neuralgia. Carbamazepine, carbamazepine metabolite (10,11-epoxide), and free carbamazepine are routinely measured to determine optimal doses in patients with epilepsy as well as to monitor for carbamazepine toxicity. A blood sample is obtained by separately reportable venipuncture. Blood serum is then tested using one of several techniques including high performance liquid chromatography or fluorescent polarization immunoassay. Total carbamazepine tests the total amount present in the blood. Under normal circumstances, circulating carbamazepine is 75% protein bound. In some patients carbamazepine may be displaced from protein resulting in higher levels of free carbamazepine circulating in the blood. In these patients, lower levels of the drug may result in toxicity, so the unbound (free) levels must be monitored.

Sugars (mono-, di-, and oligosaccharides); single quantitative, each specimen

Carbon dioxide (bicarbonate) level

Carcinoembryonic antigen (CEA) protein level

A laboratory test is obtained to measure carcinoembryonic antigen (CEA) levels in blood and body fluids. CEA is a protein normally present at high levels during fetal development but is low or absent after birth. Elevated levels of CEA may occur with colorectal, breast, lung, pancreatic, prostate, ovarian, and medullary thyroid cancers. CEA testing can help determine tumor size, stage, and metastasis. A baseline level is usually obtained following a cancer diagnosis. Serial testing is done to monitor treatment and response to therapy. Elevated levels of CEA have also been noted in smokers and in patients diagnosed with inflammatory disorders, cirrhosis, peptic ulcer, ulcerative colitis, rectal polyps, emphysema, and benign breast disease. CEA testing should not be used for screening in the general population. A blood sample is obtained by separately reportable venipuncture. Cerebral spinal fluid (CSF) is obtained by separately reportable lumbar puncture. Pleural and peritoneal fluids are obtained by needle aspiration. Serum/plasma and body fluids are tested using quantitative electrochemiluminescent immunoassay.

Cardiolipin antibody (tissue antibody) measurement

Carotene level

Catecholamines (organic nitrogen) level

Cell examination of specimen

Cell examination of urine; computer-assisted technology

Column chromatography/, includes mass spectrometry, if performed (eg, HPLC, LC, LC/MS, LC/MS-MS, GC, GC/MS-MS, or GC/MS, HPLC/MS), non-drug analyte(s) not elsewhere specified, qualitative or quantitative, each specimen

Chemical analysis using spectrophotometry (light)

Cholesterol level

A laboratory test is performed to measure total cholesterol in serum or whole blood. Cholesterol is a waxy, fat-like steroid substance present in the cell membranes of all body tissues and organs. The majority of cholesterol is produced intrinsically by the body and a small amount is ingested from food sources. Cholesterol is an important component of hormones that regulate growth, development, and reproduction. It also forms bile acids that are necessary for digestion of food and nutrient absorption. Elevated cholesterol may be a risk factor for cardiovascular disease and stroke. Certain individuals may have a genetically inherited risk for elevated cholesterol. A blood sample is obtained by separately reportable venipuncture or fingerstick. Serum/plasma and whole blood are tested using quantitative enzymatic method.

Clotting factor VIII (AHG) measurement

Clotting factor VIII (VW factor) antigen

Clotting factor VIII (VW factor) measurement

Russell viper venom time (includes venom); diluted

Clotting factor XIII (fibrin stabilizing) screening test

Coagulation time; activated

Collagen cross links test, (urine test to evaluate bone health)

Complete blood cell count - automated test with out Differential

An automated complete blood count (CBC) is performed with or without automated differential white blood cell (WBC) count. A CBC is used as a screening test to evaluate overall health and symptoms such as fatigue, bruising, bleeding, and inflammation, or to help diagnose infection. A CBC includes measurement of hemoglobin (Hgb) and hematocrit (Hct), red blood cell (RBC) count, white blood cell (WBC) count with or without differential, and platelet count. Hgb measures the amount of oxygen-carrying protein in the blood. Hct refers to the volume of red blood cells (erythrocytes) in a given volume of blood and is usually expressed as a percentage of total blood volume. RBC count is the number of red blood cells (erythrocytes) in a specific volume of blood. WBC count is the number of white blood cells (leukocytes) in a specific volume of blood. There are five types of WBCs: neutrophils, eosinophils, basophils, monocytes, and lymphocytes. If a differential is performed, each of the five types is counted separately. Platelet count is the number of platelets (thrombocytes) in the blood. Platelets are responsible for blood clotting. The CBC is performed with an automated blood cell counting instrument that can also be programmed to provide an automated WBC differential count.

Complete blood cell count - automated differential WBC count

An automated complete blood count (CBC) is performed with or without automated differential white blood cell (WBC) count. A CBC is used as a screening test to evaluate overall health and symptoms such as fatigue, bruising, bleeding, and inflammation, or to help diagnose infection. A CBC includes measurement of hemoglobin (Hgb) and hematocrit (Hct), red blood cell (RBC) count, white blood cell (WBC) count with or without differential, and platelet count. Hgb measures the amount of oxygen-carrying protein in the blood. Hct refers to the volume of red blood cells (erythrocytes) in a given volume of blood and is usually expressed as a percentage of total blood volume. RBC count is the number of red blood cells (erythrocytes) in a specific volume of blood. WBC count is the number of white blood cells (leukocytes) in a specific volume of blood. There are five types of WBCs: neutrophils, eosinophils, basophils, monocytes, and lymphocytes. If a differential is performed, each of the five types is counted separately. Platelet count is the number of platelets (thrombocytes) in the blood. Platelets are responsible for blood clotting. The CBC is performed with an automated blood cell counting instrument that can also be programmed to provide an automated WBC differential count.

Blood test, comprehensive group of blood chemicals

A comprehensive metabolic panel is obtained that includes albumin, bilirubin, total calcium, carbon dioxide, chloride, creatinine, glucose, alkaline phosphatase, potassium, total protein, sodium, alanine amino transferase (ALT) (SGPT), aspartate amino transferase (AST) (SGOT), and urea nitrogen (BUN). This test is used to evaluate electrolytes and fluid balance as well as liver and kidney function. It is also used to help rule out conditions such as diabetes. Tests related to electrolytes and fluid balance include: carbon dioxide, chloride, potassium, and sodium. Tests specific to liver function include: albumin, bilirubin, alkaline phosphatase, ALT, AST, and total protein. Tests specific to kidney function include: BUN and creatinine. Calcium is needed to support metabolic processes such as heart function, muscle contraction, nerve function, and blood clotting. Glucose is the main source of energy for the body and is regulated by insulin. Glucose measurement determines whether the glucose/insulin metabolic process is functioning properly.

Concentration of specimen for infectious agents

Confirmation test for antibody to Borrelia burgdorferi (Lyme disease bacteria)

Cortisol (hormone) measurement

Cortisol Measurement

Cortisol is a glucocorticoid (steroid hormone) produced by the adrenal gland in response to stress. The hormone causes an elevation in blood glucose levels, a decrease in immune system function and aids in the metabolism of fats, proteins and carbohydrates. The test may be used to diagnose Cushing syndrome (elevated cortisol levels) or Addison disease (decreased cortisol levels). A blood or saliva test is performed to measure total cortisol (hydrocortisone) levels. A blood sample is obtained by separately reportable venipuncture. Serum or plasma is tested using quantitative chemiluminescent immunoassay or quantitative liquid chromatography-tandom mass spectrometry. A saliva sample is obtained by separately reportable oral swab using a saliva collection device. Saliva is tested using quantitative enzyme immunoassay.

Creatine kinase Level (cardiac enzyme) - Total

Creatine kinase (CK) also known as, creatine phosphokinase (CPK), is an enzyme found in the heart, brain, skeletal muscle and certain other tissue. The subtypes are known as CK-MM found primarily in skeletal and heart muscle, CK-MB found in heart muscle and CK-BB located in the brain. CK circulating in blood rarely contains CK-BB but is largely comprised of CK-MM or CK-MB. Levels may be elevated following heart muscle damage (heart attack/myocardial infarction) and skeletal muscle injury (trauma, vigorous exercise). Statin drugs that lower cholesterol level and alcohol intake may cause elevated CK blood levels. A blood test is performed to measure total creatine kinase (CK) levels. A blood specimen is obtained by separately reportable venipuncture. Serum or plasma is tested using quantitative enzymatic methodology.

Creatine kinase level (cardiac enzyme) - Muscle/Brain

Creatine kinase (CK) also known as, creatine phosphokinase (CPK), is an enzyme found in the heart, brain, skeletal muscle and certain other tissue. The subtypes are known as CK-MM found primarily in skeletal and heart muscle, CK-MB found in heart muscle and CK-BB located in the brain. CK circulating in blood rarely contains CK-BB but is largely comprised of CK-MM or CK-MB. Levels may be elevated following heart muscle damage (heart attack/myocardial infarction) and skeletal muscle injury (trauma, vigorous exercise). Statin drugs that lower cholesterol level and alcohol intake may cause elevated CK blood levels. Only creatine kinase (CK) MB fraction is measured. Testing for this isoenzyme can help identify heart muscle damage following a heart attack (myocardial infarction). A blood test is obtained by separately reportable venipuncture. Serum is tested using chemiluminescent immunoassay.

Creatine kinase (CK), (CPK); isoenzymes

Creatinine level to test for kidney function or muscle injury

A sample other than blood is taken to measure creatinine levels. Creatinine is a waste product produced by the muscles in the breakdown of creatine, which is a compound used by the muscles to create energy for contraction. The waste product, creatinine, is excreted by the kidneys and blood levels provide a good measurement of renal function. Creatinine may be checked to screen for or monitor treatment of renal disease. Creatinine levels may also be monitored in patients with acute or chronic illnesses that may impair renal function and in patients on medications that affect renal function. Creatinine clearance, also known as urea or urea nitrogen clearance tests both blood and urine samples for a calculation of creatinine content adjusted for urine volume and physical size as a general indicator of glomerular filtration function.

Creatinine clearance measurement to test for kidney function

Cryoglobulin (protein) measurement

Culture for acid-fast bacilli

Cyanocobalamin (vitamin B-12) level

Cyanocobalamin is a vitamer of the B-12 vitamin family and plays an important role in metabolism, red blood cell production and nervous system function. Blood levels of cyanocobalamin are measured. Blood levels may be reduced with pernicious and other forms of anemia, and in individuals who follow a strict vegan diet, have chronic infections (such as HIV) and during pregnancy. A blood sample is obtained by separately reportable venipuncture. Serum is tested using quantitative chemiluminescent immunoassay.

Cyclosporine level

Dehydroepiandrosterone (DHEA) hormone level

Detection Test for Hepatitis C Virus; Includes Reverse Transcription

The hepatitis C virus (HCV) causes inflammation of the liver. Individuals infected with HCV often develop chronic hepatitis C which can lead to cirrhosis and liver cancer. Nucleic acid detection of HCV is performed to evaluate whether a patient has an ongoing or chronic HCV infection. DNA or RNA probing detects much lower levels of the infectious agent, sometimes even the presence of a single organism. Probing involves identifying the infectious agent's nucleic acid (DNA or RNA) by releasing it from the cell and extracting it through nucleic acid hybridization using a probe. A direct probe consists of laboratory-prepared, complimentary strands of nucleic acid, often labeled with chemical fluorescence, specifically designed to align and bind with the target nucleic acid to form stable, double-stranded complexes or hybrids. Amplified probing provides greater sensitivity for more direct, qualitative detection by using techniques such as reverse transcription polymerase chain reaction (RT-PCR) to enzymatically replicate certain target sequences or positions in the nucleic acid which allows exponential amplification of the original target nucleic acid. An amplification primer is used in addition to the probe. Primers are artificial, short strands of nucleic acid complementary to the beginning or end of the nucleic acid fragment to be amplified. The primer adheres to the target nucleic acid at these points. The polymerase enzyme copies the region and builds the new nucleic acid. Following amplification, the amount of the infectious agent in the sample may be evaluated using reverse transcription and quantification. Quantification is performed to evaluate the severity of the infection and response to treatment.

Detection test for Cytomegalovirus (CMV)

Detection test for HIV-1 and HIV-2

Detection test for HIV-1 virus, amplified probe technique

Detection test for Hepatitis Be surface antigen

Detection test for Hepatitis C virus; amplified probe technique

Detection test for trichomonas vaginalis (genital parasite); direct probe technique

Detection test for adenovirus enteric types 40/41

Detection test for candida species (yeast); direct probe technique

Detection test for clostridium difficile

Detection test for cytomegalovirus, quantification

Detection test for entamoeba histolytica dispar group (parasite)

Detection test for gardnerella vaginalis (bacteria); direct probe technique

Detection test for identification of organism

Infectious agent detection by nucleic acid (DNA or RNA); respiratory virus (eg, adenovirus, influenza virus, coronavirus, metapneumovirus, parainfluenza virus, respiratory syncytial virus, rhinovirus), includes multiplex reve

Detection test for organism; quantification, each organism

Digoxin level

A laboratory test is performed to measure digoxin levels. Digoxin, also known as Lanoxin, is a cardiac glycoside that controls sodium and potassium levels in the cells. Digoxin is primarily prescribed to treat atrial fibrillation, atrial flutter, and congestive heart failure. The drug increases the strength of cardiac muscle contractions which increases cardiac output and lowers the heart rate and venous pressure. Digoxin has a narrow therapeutic window but antidotal treatment is available (Digibind, Digoxin Immune FAB). The test for total digoxin measures Fab fragment-bound (inactive) digoxin and free (active) digoxin. This test is primarily used to monitor digoxin therapy and should be drawn 8-12 hours following an oral dose. The test for free digoxin (80163) may be used to evaluate breakthrough digoxin toxicity in patients with renal failure, access the need for additional antidigoxin Fab, determine when to reintroduce digoxin therapy, and monitor patients with possible digoxin-like immune reactive factors. To measure free digoxin, a blood sample is obtained by separately reportable venipuncture 6-8 hours after the last dose. Serum is tested for total digoxin using immunoassay and for free digoxin using ultrafiltration followed by electrochemiluminescent immunoassay.

Dihydroxyvitamin D, 1, 25 level

Blood test panel for electrolytes (sodium potassium, chloride, carbon dioxide)

"An electrolyte panel is obtained to detect problems with fluid and electrolyte balance and monitor the health status of persons with acute or chronic medical conditions including high blood pressure, heart failure, and kidney or liver disease. The test measures electrically charged minerals such as sodium, potassium, and chloride found in body tissues and blood. Sodium is primarily found outside cells and maintains water balance in the tissues, as well as nerve and muscle function. Potassium is primarily found inside cells and affects heart rhythm, cell metabolism, and muscle function. Chloride moves freely in and out of cells to regulate fluid levels and help maintain electrical neutrality. Carbon dioxide, or bicarbonate, maintains body pH and the acid/base balance of the blood. A test called an ""anion gap"" may be included in the electrolyte panel. Anion gap is a calculated value of the test components that measures the difference between the negatively charged ions (anions) and the positivity charged ions (cations). Anion gap values can be affected by many conditions such as metabolic disorders, starvation, and diabetes, or exposure to toxins. A blood sample is obtained by separately reportable venipuncture, heel or finger stick. Serum/plasma is tested using quantitative ion-selective electrode/enzymatic method."

Electron microscopy for diagnosis

Enzyme activity measurement

Estradiol (hormone) level

Estrogen analysis; fractionated

Estrone (hormone) level

Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral); agar dilution method

Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral); disk method

Ferritin (blood protein) level

A blood test is performed to measure ferritin levels. Ferritin is an intracellular protein that stores iron and releases it into circulation in a controlled manner to protect the body against iron overload and iron deficiency. Ferritin levels may be obtained to evaluate for elevated levels caused by excess storage diseases such as hemochromatosis and following multiple transfusions. Levels may also be obtained to evaluate for decreased levels due to iron deficiency. A blood sample is obtained by separately reportable venipuncture. Serum is tested using quantitative chemiluminescent immunoassay.

Fibrinogen (factor 1) activity measurement

Folic acid level

A blood test is performed to measure folic acid (folate) levels in serum or red blood cells (RBC). Folic acid (folate) may also be referred to as Vitamin B9 and is essential for the growth, division and repair of cells, especially fetal growth during pregnancy and in early infancy. It is also necessary for the production of healthy red blood cells and to prevent anemia at all ages. The test may be used to diagnose anemia or certain neuropathies and to monitor the effectiveness of treatment for these conditions. A blood sample is obtained by separately reportable venipuncture.

Folic acid level

Fungal culture (mold or yeast)

Fungal culture, yeast

G6PD (enzyme) level

Gabapentin level

Gastrin (GI tract hormone) level

Gene analysis (Janus kinase 2) variant

Gene analysis (coagulation factor V) Leiden variant

Gene analysis (hemochromatosis) common variants

Gene analysis (prothrombin, coagulation factor II) A variant

Glucose Level on Body Fluid

A sample of body fluid other than blood is tested for glucose. Body fluids that may be tested include pericardial, peritoneal, pleural, or synovial fluid. Decreased glucose concentration in these body fluids is typically associated with septic or inflammatory processes. In the case of pleural effusion, low glucose is associated with empyema, tuberculosis, malignant neoplasm, and rheumatoid effusion. Specimen is collected by separately reportable pericardiocentesis, thoracentesis, peritoneocentesis, or aspiration of synovial fluid. The body fluid is tested using enzymatic methodology.

Glutamyltransferase (liver enzyme) level

A blood test is performed to measure gamma glutamyltransferase (GGT) levels. GGT is an enzyme that assists with the transfer of amino acids across cell membranes, including cells found in the liver, kidney, pancreas, heart, brain, and seminal vesicles. GGT levels are used as a diagnostic marker for certain diseases of the liver, bile ducts, and pancreas. A blood sample is obtained by separately reportable venipuncture. Serum or plasma is tested using quantitative enzymatic methodology.

Glycated protein level

Gonadotropin (reproductive hormone) analysis

A specimen is tested for chorionic gonadotropin (hCG). A qualitative test is performed to test for the presence of absence of hCG only. This test may be performed on blood or urine. Qualitative hCG testing is performed to confirm pregnancy.

Gonadotropin, chorionic (reproductive hormone) level

Lab test for Chorionic Gonadotropin

Gonadotropin, follicle stimulating (reproductive hormone) level

Gonadotropin, luteinizing (reproductive hormone) level

HDL cholesterol level

Haptoglobin (serum protein) level

Heavy metal level

Hemoglobin A1C level

A blood test is performed to measure glycosylated hemoglobin (HbA1C) levels. Plasma glucose binds to hemoglobin and the HbA1C test measures the average plasma glucose concentration over the life of red blood cells (approximately 90-120 days). HbA1C levels may be used as a diagnostic reference for patients with suspected diabetes mellitus (DM) and to monitor blood glucose control in patients with known DM. HbA1C levels should be monitored at least every 6 months in patients with DM and more frequently when the level is >7.0%. A blood sample is obtained by separately reportable venipuncture. Whole blood is tested using quantitative high performance liquid chromatography/boronate affinity.

Hemoglobin fractionation and quantitation; electrophoresis (eg, A2, S, C, and/or F)

Hepatitis B Antibody Measurement

A blood sample is tested for hepatitis B core antibody (HBcAB). Hepatitis B is an inflammation of the liver caused by the hepatitis B virus (HBV) and has an acute and chronic phase. The core antibody is produced during and after an acute HBV infection, even in individuals who have cleared the virus without developing a chronic infection, and also during the chronic phase. In 86704, total HBcAB is tested using chemiluminescent assay. Both IgG and IgM antibodies are identified in a single test that does not differentiate between the two. Since IgM antibody is found in the initial phase of the infection and IgG in the later phase, this test is not specific to the acute or chronic phase of the infection.

Hepatitis B surface antibody measurement

A blood sample is tested for hepatitis B surface antibody (HBsAB). Hepatitis B is an inflammation of the liver caused by the hepatitis B virus (HBV). HBsAB testing is performed to identify previous exposure to HBV without current acute or chronic infection, to determine the need for vaccination, and whether or not a previously administered vaccination has been successful. Individuals with a positive HBsAB test have been exposed to the virus but no longer carry an active form of the virus, cannot pass it on to others, and are immune from future HBV infection. HBsAB is tested using chemiluminescent assay.

Hepatitis B core antibody (IgM) measurement

Hepatitis Be antibody measurement

Hepatitis C Antibody Measurement

A laboratory test is performed to measure Hepatitis C virus (HCV) antibodies. Hepatitis C causes acute or chronic liver inflammation and may be transmitted via blood transfusion, needle sticks or sharing of needles in occupational situations or recreational drug use, unprotected sex, placental transfer during pregnancy, or sharing personal items such as a razor or toothbrush. The test is used to screen individuals at risk for infection with HCV. A blood sample is obtained by separately reportable venipuncture. Serum is tested using qualitative chemiluminescent immunoassay. Antibodies toward HCV may not start to elevate until 2 months after exposure, so a negative test screening should be repeated if there is a strong suspicion of HCV infection.

Homocysteine (amino acid) level

Hydroxyindolacetic acid (product of metabolism) level

Hydroxyprogesterone, 17-D (synthetic hormone) level

IgE (immune system protein) level

Lab test for Gammaglobulin IgE

Immunologic analysis for detection of tumor antigen (CA 125)

A quantitative immunoassay for tumor antigen CA 125 is performed. Tumor antigens, also referred to as tumor markers, are indicators that a malignant neoplasm may be present. Significant circulating levels found in serum are often associated with malignancy. Tumor antigen CA 125 is used in patients with a documented ovarian mass to help determine whether the mass is benign or malignant. It is also used to monitor response to treatment in patients with an established diagnosis of ovarian, fallopian tube, or endometrial cancer. CA 125 uses an electrochemiluminescent immunoassay test kit. Periodic tumor antigen testing is used in conjunction with other clinical methods to monitor progression or regression of the malignancy.

Immunologic analysis for detection of organism; qualitative or semiquantitative; multiple-step method

Immunologic analysis technique on body fluid; Immunofixation electrophoresis

Immunofixation electrophoresis; serum

Infection agent detection by nucleic acid (DNA or RNA); Human Papillomavirus (HPV), high-risk types

Infusion, albumin (human), 5%, 250 ml

Insulin Measurement; Total

Lab test for Insulin

Ionized Calcium

A blood sample is taken to measure the amount of ionized or free calcium. Ionized or free calcium is calcium that flows freely in the blood and is not attached to any proteins. Ionized calcium is metabolically active and available to support and regulate heart function, muscle contraction, central nervous system function, and blood clotting. Ionized calcium measurements may be obtained prior to major surgery, in critically ill patients, or when protein levels are abnormal. Ionized calcium is measured by ion selective electrode (ISE) or pH electrode methodology.

Iron level

A blood, urine or liver test is performed to measure iron levels. Iron (Fe) is an essential element that circulates in the blood attached to the protein transferrin. Iron is necessary component of hemoglobin, found in red blood cells (RBCs) and myoglobin found in muscle cells. Low iron levels may cause a decrease in red blood cells and iron deficiency anemia. High iron levels may be caused by excessive intake of iron supplements or a hereditary genetic condition such as hemochromatosis from a mutation of the RGMc gene or HAMP gene. A blood sample is obtained by separately reportable venipuncture. Serum or plasma is tested using quantitative spectrophotometry. A random voided or 24 hour urine specimen is obtained and tested using quantitative inductively coupled plasma/emission spectrometry. Patient should wait 2-4 days after receiving iodine or gadolinium contrast media to collect a urine specimen. A liver sample is obtained by a separately reportable procedure. Liver tissue is tested using quantitative inductively coupled plasma-mass spectrometry.

Islet cell (pancreas) antibody measurement

LDL cholesterol level

Lab test for LDL Cholesterol

Lactate dehydrogenase (enzyme) level

A blood or body fluid test is performed to measure lactate dehydrogenase (LD) (LDH) levels. LDH is an enzyme present in red blood cells (RBCs) and in the tissue of heart, liver, pancreas, kidney, skeletal muscle, brain and lungs. LDH levels are used as a marker for tissue and RBC damage. Elevated blood levels can be caused by stroke, myocardial infarction, liver disease, pancreatitis, muscular dystrophy, infectious mononucleosis, hemolytic anemia and tumors/cancers such as lymphoma. Elevated cerebral spinal fluid (CSF) levels are usually indicative of bacterial meningitis. LDH levels in pleural and/or pericardial fluid can indicate if the effusion is an exudate, caused by an infection or a transudate caused by fluid pressure problem. A blood sample is obtained by separately reportable venipuncture. Cerebral spinal fluid is obtained by separately reportable lumbar puncture (spinal tap). Pericardial fluid is obtained by separately reportable pericardiocentesis. Fluid from a pleural effusion is obtained by separately reportable thoracentesis. Serum or plasma and all body fluids are tested using quantitative enzymatic methodology.

Lactic acid level

A blood or body fluid test is performed to measure lactate (lactic acid) levels. Lactic acid is produced primarily by muscle tissue and red blood cells in the body. Elevated levels may be caused by strenuous exercise, heart failure, severe infection (sepsis), shock states (cardiogenic, hypovolemic) and liver disease. A blood sample is obtained by separately reportable venipuncture. Cerebral spinal fluid (CSF) is obtained by lumbar puncture (spinal tap). Other body fluids may also be collected and tested. Plasma, CSF, and other body fluids are tested using enzymatic methodology.

Lamotrigine level

Lipase (fat enzyme) level

A test is performed on blood and body fluids to measure lipase levels. Lipase is an enzyme released by the pancreas into the small intestine and is essential for the digestion of dietary fats. Elevated levels may result from small bowel obstruction, celiac disease, cholecystitis, duodenal ulcer, severe gastroenteritis, macrolipasemia, pancreatitis, and pancreatic tumors. The test may be ordered when there is a family history of lipoprotein lipase deficiency. A blood sample is obtained by separately reportable venipuncture. Other body fluids collected by other methods. Blood and other body fluids are tested using quantitative enzymatic methodology.

Blood test, lipids (cholesterol and triglycerides)

"A lipid panel is obtained to assess the risk for cardiovascular disease and to monitor appropriate treatment. Lipids are comprised of cholesterol, protein, and triglycerides. They are stored in cells and circulate in the blood. Lipids are important for cell health and as an energy source. A lipid panel should include a measurement of triglycerides and total serum cholesterol and then calculate to find the measurement of high density lipoprotein (HDL-C), low density lipoprotein (LDL-C) and very low density lipoprotein (VLDL-C). HDL contains the highest ratio of cholesterol and is often referred to as ""good cholesterol"" because it is capable of transporting excess cholesterol in the blood to the liver for removal. LDL contains the highest ratio of protein and is considered ""bad cholesterol"" because it transports and deposits cholesterol in the walls of blood vessels. VLDL contains the highest ratio of triglycerides and high levels are also considered ""bad"" because it converts to LDL after depositing triglyceride molecules in the walls of blood vessels. A blood sample is obtained by separately reportable venipuncture or finger stick. Serum/plasma is tested using quantitative enzymatic method."

Lipoprotein measurement; nuclear resonance spectroscopy

Liver enzyme (SGOT), level

A blood test is performed to measure aspartate aminotransferase (AST) levels. This enzyme was previously referred to as serum glutamic oxaloacetic transaminase (SGOT). AST is an enzyme found primarily in liver and muscle cells. Elevated levels may result from liver disease or damage such as hepatitis, cirrhosis, ischemia, drug toxicity, and/or muscle damage, especially cardiac muscle (myocardial infarction). This test is often ordered in conjunction with alanine transferase, ALT or other liver function tests (LFTs) to diagnose disease and monitor individuals taking cholesterol lowering medications. A blood sample is obtained by separately reportable venipuncture. Serum/plasma is tested using quantitative enzymatic method.

Liver enzyme (SGPT), level

A blood test is performed to measure alanine aminotransferase (ALT) levels. This enzyme was previously referred to as serum glutamic pyruvic transaminase (SGPT). ALT is an enzyme found primarily in liver and muscle cells. Elevated levels may result from liver disease or damage such as hepatitis, cirrhosis, ischemia, drug toxicity, and/or muscle damage, especially cardiac muscle (myocardial infarction). This test is often ordered in conjunction with aspartate transferase, AST or other liver function tests (LFTs) to diagnose disease and monitor individuals taking cholesterol lowering medications. A blood sample is obtained by separately reportable venipuncture. Serum/plasma is tested using quantitative enzymatic method.

Liver function blood test panel

A hepatic function panel is obtained to diagnose acute and chronic liver disease, inflammation, or scarring and to monitor hepatic function while taking certain medications. Tests in a hepatic function panel should include albumin (ALB), total and direct bilirubin, alkaline phosphatase (ALP), total protein (TP), alanine aminotransferase (ALT, SGPT), and aspartate aminotransferase (AST, SGOT). Albumin (ALB) is a protein made by the liver that helps to nourish tissue and transport hormones, vitamins, drugs, and calcium throughout the body. Bilirubin, a waste product from the breakdown of red blood cells, is removed by the liver in a conjugated state. Bilirubin is measured as total (all the bilirubin circulating in the blood) and direct (the conjugated amount only) to determine how well the liver is performing. Alkaline phosphatase (ALP) is an enzyme produced by the liver and other organs of the body. In the liver, cells along the bile duct produce ALP. Blockage of these ducts can cause elevated levels of ALP, whereas cirrhosis, cancer, and toxic drugs will decrease ALP levels. Circulating blood proteins include albumin (60% of total) and globulins (40% of total). By measuring total protein (TP) and albumin (ALB), the albumin/globulin (A/G) ratio can be determined and monitored. TP may decrease with malnutrition, congestive heart failure, hepatic disease, and renal disease and increase with inflammation and dehydration. Alanine aminotransferase (ALT, SGPT) is an enzyme produced primarily in the liver and kidneys. In healthy individuals ALT is normally low. ALT is released when the liver is damaged, especially with exposure to toxic substances such as drugs and alcohol. Aspartate aminotransferase (AST, SGOT) is an enzyme produced by the liver, heart, kidneys, and muscles. In healthy individuals AST is normally low. An AST/ALT ratio is often performed to determine if elevated levels are due to liver injury or damage to the heart or skeletal muscles. A specimen is obtained by separately reportable venipuncture. Serum/plasma is tested using quantitative enzymatic method or quantitative spectrophotometry.

Magnesium Level

A blood, urine, or fecal test is performed to measure magnesium levels. Magnesium is an essential dietary mineral responsible for enzyme function, energy production, and contraction and relaxation of muscle fibers. Decreased levels may result from severe burns, metabolic disorders, certain medications, and low blood calcium levels. A blood sample is obtained by separately reportable venipuncture. Red blood cells (RBCs) are tested using quantitative inductively coupled plasma-mass spectrometry. Serum/plasma is tested using quantitative spectrophotometry. A 24-hour voided urine specimen is tested using quantitative spectrophotometry. A random or 24-hour fecal sample is tested using quantitative spectrophotometry.

Measurement C-reactive protein

A blood test is performed to measure C-reactive protein (CRP) levels. This standard test has a wide value range. CRP is an acute phase protein, synthesized by the liver and released in response to inflammation and infection. The test is not diagnostic for any specific disease or condition but can be used as a marker to monitor the body's response to treatment(s) or to evaluate the need for further testing. Elevation of CRP levels may be found during pregnancy, with the use of oral contraceptives, or hormone replacement therapy. Diseases/conditions that cause an elevation of CRP include: lymphoma, arteritis/vasculitis, osteomyelitis, inflammatory bowel disease, rheumatoid arthritis, pelvic inflammatory disease (PID), systemic lupus erythematosus (SLE), acute infections, burns, surgical procedures, and organ transplants. A blood sample is obtained by separately reportable venipuncture. Serum in neonates is tested using immunoassay. Serum/plasma in all other patients is tested using quantitative immunoturbidimetric method.

Measurement high sensitivity C-reactive protein

Lab test for High Sensitivity C-reactive protein

Measurement of Complement (Immune System Proteins)

A blood test is performed to measure complement antigen levels. Complement factors help to clear immune complexes from the blood. Proteins are activated in response to the immune complex and generate peptides that bind the complexes and complement receptors. The cell membrane breaks apart and an attack complex is formed. A blood sample is obtained by separately reportable venipuncture. Complements are tested in serum or plasma samples, using specified methods, particularly quantitative radial immunodiffusion. Report for each complement component tested: 2-9 (2 being the most common inherited complement deficiency), 3A (the most abundant of all complement components), 4A, and 1Q; complement factor B and Bb; and C1-esterase inhibitor.

Measurement of Hepatitis A antibody

Measurement of Hepatitis A antibody (IgM)

Measurement of antibody (IgE) to allergic substance

Lab test for Allergen-specific antibodies

Measurement of antibody for assessment of autoimmune disorder

Measurement of complement (immune system proteins)

Immunoassay for analyte other than infectious agent antibody or infectious agent antigen; quantitative, not otherwise specified

Metanephrines level

Microscopic genetic analysis of tumor; using computer-assisted technology

Morphometric analysis, in situ hybridization (quantitative or semi-quantitative), using computer-assisted technology, per specimen; each multiplex probe stain procedure

Natriuretic peptide (heart and blood vessel protein) level

The level of the natriuretic peptide in the blood is measured to evaluate heart failure and to differentiate symptoms that might be indicative of heart failure from other disorders that cause similar symptoms. A separately reportable venipuncture is performed and whole blood or plasma collected using EDTA as an anticoagulant. An automated immunoassay is performed using murine monoclonal and polyclonal antibodies against natriuretic peptide. The antibodies are labeled with a fluorescent dye and immobilized on the solid phase. The specimen is placed in the sample chamber and the analysis is run. The physician reviews the results and uses them to make diagnosis and treatment decisions.

Nephelometry, test method using light

Nucleotidase 5' (enzyme) level

Organic acid level

Oxalate level

Oxcarbazepine level

PSA (prostate specific antigen) measurement

Prostate specific antigen (PSA) is measured. PSA is a protein produced by normal prostate cells found in serum and exists in both free form and complexed with other proteins. Total PSA is measured ad the total amount of both free and complexed forms. Total PSA levels are higher in men with benign prostatic hyperplasia (BPH), acute bacterial prostatitis, or prostate cancer. Total PSA is used to screen for prostate cancer and evaluate the response to treatment in those with prostate cancer, but cannot be used by itself to definitively diagnose prostate cancer.

Partial Thromblostatin Time, Activated

This test may also be referred to as an activated PTT or aPTT. PTT may be performed to diagnose the cause of bleeding or as a screening test prior to surgery to rule-out coagulation defects. A silica and synthetic phospholipid PTT reagent is mixed with the patient plasma. The silica provides a negatively-charged particulate surface that activates the contact pathway for coagulation. Clot formation is initiated by adding calcium chloride to the mixture. Clotting time is measured photo-optically.

Pathology examination of tissue using a microscope, moderately low complexity

Tissue removed during a surgical procedure, such as a biopsy, excision, or resection, is examined macroscopically (gross or visual examination) and then under a microscope. The cells, tissues, or organ are transported from the surgical suite to the pathologist. The pathologist first visually examines the specimen and notes any defining characteristics. The specimen is then prepared for microscopic evaluation. The physician carefully analyzes the specimens to help establish a diagnosis, identify the presence or absence of malignant neoplasm, identify the exact type malignancy if present, examine the margins of the specimen to determine whether or not the entire diseased area was removed. A written report of findings is then prepared and a copy sent to the treating physician. Pathology services are reported based on the type of tissue examined, whether or not the tissue is expected to be normal or diseased, the difficulty of the pathology exam, and the time required to complete the exam.

Pathology examination of tissue during surgery

Pathology examination of tissue using a microscope

Pathology examination of tissue using a microscope, limited examination

Phenobarbital level

A blood test is performed to measure phenobarbital levels. Phenobarbital, also known as Luminal, is an anticonvulsant/hypnotic prescribed to treat seizures and insomnia by decreasing electrical activity in the brain. The drug may be administered orally or by injection. Blood concentration levels are monitored at regular intervals and also when breakthrough seizure activity or over sedation occurs, indicating possible high/low therapeutic blood levels. A blood sample is obtained by a separately reportable venipuncture. Blood serum is then tested using high performance liquid chromatography.

Phenytoin level

A blood test is performed to measure phenytoin total and phenytoin free levels. Phenytoin also known as Dilantin, Phenytek or Prompt, is an anticonvulsant prescribed to treat seizures and works by deceasing electrical activity in the brain. The drug may be administered orally or by injection. Phenytoin has a narrow therapeutic range and the patient should be monitored for both total and free phenytoin levels. Total phenytoin reflects the total serum concentration of the drug while free phenytoin levels reflect the unbound levels. Only the unbound levels are biologically active. Ninety (90) percent of the drug is typically highly bound and biologically inactive, but bound phenytoin is sensitive to displacement by other protein binding drugs which can elevate levels of free phenytoin in the blood. Blood concentration levels are monitored at regular intervals and also when breakthrough seizures occur, indicating possible low therapeutic levels. A blood sample is obtained by a separately reportable venipuncture. Blood serum is then tested using immunoassay.

Phosphatase (enzyme) level

Lab test for Alkaline Phosphatase

Phosphatase, alkaline; isoenzymes

Phosphate level

A blood or urine test is performed to measure inorganic phosphorus (phosphate) levels. Phosphate is an intracellular anion, found primarily in bone and soft tissue. It plays an important role in cellular energy (nerve and muscle function) and the building/repair of bone and teeth. Decreased levels are most often caused by malnutrition and lead to muscle and neurological dysfunction. Elevated levels may be due to kidney or parathyroid gland problems. A blood sample is obtained by separately reportable venipuncture. Serum/plasma is tested using quantitative spectrophotometry.

Phospholipid antibody (autoimmune antibody) measurement

Platelet count, automated test

Prealbumin (protein) level

A blood test is performed to measure prealbumin levels. Prealbumin, also referred to as transthyretin (TTR) is found in serum and cerebral spinal fluid (CSF). It is responsible for transporting thyroxin and retinol binding protein carried on retinol. The test may be ordered to detect protein-calorie malnutrition in chronically or critically ill individuals. Levels may be elevated with the use of high dose corticosteroids or non-steroidal anti-inflammatory drugs (NSAIDs), adrenal gland disorders, Hodgkin's disease, and kidney failure. Decreased levels may be caused by hyperthyroidism, liver disease, severe infection, inflammatory diseases, and certain digestive disorders. A blood sample is obtained by separately reportable venipuncture. Serum/plasma is tested using immunoturbidimetric method.

Pregnenolone (reproductive hormone) level

Primidone level

Progesterone (reproductive hormone) level

Prolactin (milk producing hormone) level

A blood test is performed to measure prolactin levels. Prolactin is a hormone produced by the pituitary gland. Normal variations in prolactin levels occur during the day and night. Normal elevations occur during pregnancy, lactation (breast feeding), and times of physical or emotional stress. Abnormal elevations can occur with kidney and liver disease, hypothyroidism, and pituitary gland tumors (prolactinomas). Decreased levels may result from pituitary gland damage. This test may be ordered to evaluate nipple discharge, infertility, and erectile dysfunction. This code may be used to report prolactin, prolactin macroadenoma (dilution study) for patients with prolactin secreting tumors, and thyroid releasing hormone stimulation of Prolactin at 0, 30, 60, 90 minutes. A blood sample is obtained by separately reportable venipuncture. Serum/plasma is tested using quantitative chemiluminescent immunoassay.

Protein C antigen (clotting inhibitor) measurement

Protein Measurement, Serum

A blood test is performed to measure protein levels in serum. This test is often performed in conjunction with total protein to detect pathophysiologic states such as inflammation, gammopathies, and dysproteinemias. There are more sensitive tests available to detect these and similar disorders. A blood sample is obtained by separately reportable venipuncture. Serum is tested using electrophoretic fractionation and quantitation.

Protein measurement, body fluid

Blood test, clotting time

Prothrombin time (PT) measures how long it takes for blood to clot. Prothrombin, also called factor II, is one of the clotting factors made by the liver and adequate levels of vitamin K are needed for the liver to produce sufficient prothrombin. Prothrombin time is used to help identify the cause of abnormal bleeding or bruising; to check whether blood thinning medication, such as warfarin (Coumadin), is working; to check for low levels of blood clotting factors I, II, V, VII, and X; to check for low levels of vitamin K; to check liver function, to see how quickly the body is using up its clotting factors. The test is performed using electromagnetic mechanical clot detection. If prothrombin time is elevated and the patient is not on a blood thinning medication, a second prothrombin time using substitution plasma fractions, also referred to as a prothrombin time mixing study, may be performed. This is performed by mixing patient plasma with normal plasma using a 1:1 mix. The mixture is incubated and the clotting time is again measured. If the result does not correct, it may be indicative that the patient has an inhibitor, such as lupus anticoagulant. If the result does correct, the patient may have a coagulation factor deficiency.

Qualitative or semiquantitative detection test for helicobacter pylori in stool, multiple-step metho

Quantitation of therapeutic drug

Red blood count, automated test

An automated reticulocyte count is performed. Reticulocytes are new red blood cells (RBCs) that circulate in the peripheral blood for 1-2 days before losing sufficient RNA to become mature RBCs. A reticulocyte count may be performed when a blood test shows decreased RBCs and/or decreased hemoglobin or hematocrit measurements. The test can help determine if the bone marrow is responding to the body's need for RBCs. Indications for monitoring reticulocytes include vitamin B12 or folate deficiency, kidney disease, chemotherapy, bone marrow transplant, and treatment with erythropoietin or darbepoetin. A blood sample is obtained. A reticulocyte count is performed with an automated blood cell counting instrument. Automated reticulocyte count performed alone is reported. When automated reticulocyte count is performed with direct measurement of one or more cellular parameters, such as reticulocyte hemoglobin content (CHr), immature reticulocyte fraction (IRF), mean reticulocyte volume (MRV), or RNA content is reported. CHr measures the amount of hemoglobin in reticulocytes, which is an indicator of iron utilization for RBC production, and is used to diagnosis iron deficiency. IRF is used to determine whether reticulocytes are being released prematurely and to quantify the proportion of immature reticulocytes. Premature release occurs during periods of high demand for RBCs in chronic kidney disease, following chemotherapy or bone marrow transplant, or in patients with AIDs or malignant disease, as well as other conditions. IRF is calculated as a ratio of immature reticulocytes to the total number of reticulocytes (both immature and mature). MRV looks at the total volume of reticulocytes compared to total red blood cells and is used to evaluate iron utilization. RNA content is evaluated to determine the maturity of circulating reticulocytes.

Red blood cell sedimentation rate, to detect inflammation

Renin (kidney enzyme) level

Rheumatoid factor analysis

Rheumatoid factor level

Lab test for Rheumatoid Arthritis factor

Screening test for antibody to noninfectious agent

Screening test for compatible blood unit

Selenium (vitamin) level

Serotonin (hormone) level

Sirolimus level

Smear for Parasites

A stool sample is collected and observed under a microscope for signs of parasite or parasite eggs.

Smear for infectious agents

Somatomedin (growth factor) level

Special Stain for Microorganism; Gram or Glemsa Stain

A laboratory test is performed to identify bacteria, fungi, or cell types in pus, normally sterile body fluid(s), or aspirated material using Gram or Giemsa stain technique. Gram staining is a differential technique used to classify bacteria into gram positive (Gram +) or gram negative (Gram -) groups. Gram + bacteria have a thick layer of peptidoglycan in the cell wall which stains purple. Giemsa technique is used in cytogenetics for chromosome staining; in histopathology to detect trichomonas, some spirochetes, protozoans, malaria, and other parasites; and as a stain for peripheral blood and bone marrow to differentiate cells types such as erythrocytes, platelets, lymphocyte cytoplasm, monocyte cytoplasm, and leukocyte nuclear chromatin. A drop of suspended culture or cell material is applied in a thin layer to a slide using an inoculation hook and fixed with heat. The material is stained and the slide is examined under a microscope. The bacteria, fungi, or cells are identified, counted, and a written report of the findings is made.

Special stain for microorganism; special stain for parasites

Stool Analysis for Blood

A fecal (stool) sample is obtained for colorectal neoplasm screening and tested for the presence of occult (hidden) blood by peroxidase activity. This test is also referred to as a fecal occult blood test (FOBT). Occult blood in a stool specimen is present in amounts too small to see with the naked eye, but becomes visible when chemical tests are performed. Guaiac is one type of chemical (reagent) test that can be performed to identify the presence of blood in the stool. If the test is performed in an office or hospital, the physician may obtain the sample during a rectal exam. If the test is performed at home, the patient is provided with a stool collection kit consisting of three cards or a single triple card. The patient obtains three consecutive stool specimens per the kit instructions. The stool specimens are then returned to the physician office or mailed to a laboratory. All three specimens are then tested using a chemical reagent for the presence of occult blood. A few drops of the chemical reagent are applied to each stool specimen. If blood is present, a color change will be detected on the card.

Stool analysis for blood

Stool calprotectin (protein) level

Stool lactoferrin (immune system protein) analysis

Surgical Pathology, High Complexity

Tissue removed during a surgical procedure, such as a biopsy, excision, or resection, is examined macroscopically (gross or visual examination) and then under a microscope. The cells, tissues, or organ are transported from the surgical suite to the pathologist. The pathologist first visually examines the specimen and notes any defining characteristics. The specimen is then prepared for microscopic evaluation. The physician carefully analyzes the specimens to help establish a diagnosis, identify the presence or absence of malignant neoplasm, identify the exact type malignancy if present, examine the margins of the specimen to determine whether or not the entire diseased area was removed. A written report of findings is then prepared and a copy sent to the treating physician. Pathology services are reported based on the type of tissue examined, whether or not the tissue is expected to be normal or diseased, the difficulty of the pathology exam, and the time required to complete the exam.

Pathology examination of tissue using a microscope, intermediate complexity

Tissue removed during a surgical procedure, such as a biopsy, excision, or resection, is examined macroscopically (gross or visual examination) and then under a microscope. The cells, tissues, or organ are transported from the surgical suite to the pathologist. The pathologist first visually examines the specimen and notes any defining characteristics. The specimen is then prepared for microscopic evaluation. The physician carefully analyzes the specimens to help establish a diagnosis, identify the presence or absence of malignant neoplasm, identify the exact type malignancy if present, examine the margins of the specimen to determine whether or not the entire diseased area was removed. A written report of findings is then prepared and a copy sent to the treating physician. Pathology services are reported based on the type of tissue examined, whether or not the tissue is expected to be normal or diseased, the difficulty of the pathology exam, and the time required to complete the exam.

Pathology examination of tissue using a microscope, moderately high complexity

Tissue removed during a surgical procedure, such as a biopsy, excision, or resection, is examined macroscopically (gross or visual examination) and then under a microscope. The cells, tissues, or organ are transported from the surgical suite to the pathologist. The pathologist first visually examines the specimen and notes any defining characteristics. The specimen is then prepared for microscopic evaluation. The physician carefully analyzes the specimens to help establish a diagnosis, identify the presence or absence of malignant neoplasm, identify the exact type malignancy if present, examine the margins of the specimen to determine whether or not the entire diseased area was removed. A written report of findings is then prepared and a copy sent to the treating physician. Pathology services are reported based on the type of tissue examined, whether or not the tissue is expected to be normal or diseased, the difficulty of the pathology exam, and the time required to complete the exam.

Syphilis Detection Test

A test for syphilis is performed. Syphilis is a sexually-transmitted disease (STD) caused by the bacterium Treponema pallidum. During the primary stage, a sore called a chancre appears at the site where the syphilis bacterium entered the body. The chancre resolves without treatment in 3-6 weeks but the patient remains infected. Without treatment, the infection will progress to a secondary stage in which a skin rash and mucous membrane lesions appear. The most common site of the rash is the palms of the hands and soles of the feet. Other symptoms during the secondary stage include fever, swollen lymph nodes, sore throat, hair loss, headaches, weight loss, muscle aches, and fatigue. Symptoms of secondary syphilis also resolve spontaneously but the patient remains infected. The patient then enters the late or latent stage of the disease. Symptoms of this stage may not appear for 10-20 years. Symptoms of late stage syphilis include difficulty coordinating muscle movements, paralysis, numbness, gradual blindness, and dementia. These symptoms occur as the disease damages internal organs including the brain, nerves, eyes, heart, blood vessels, liver, bones, and joints. Of particular concern is undiagnosed syphilis infection during pregnancy as the infection can be passed to the baby in utero. This increases the risk of stillbirth or death shortly after birth. Untreated infants who survive often experience developmental delays or seizures. A qualitative syphilis test, such as the venereal disease research laboratory (VDRL) test, rapid plasma reagin (RPR) test, or automated reagin test (ART). The VDRL, RPR, ART are nontreponemal tests that measure antibody response to lipoidal antigen from T. pallidum and/or antibody interaction with host tissues. If a screening test is positive and the result is confirmed with a second confirmatory test, quantitative testing is then performed to determine disease activity and monitor response to treatment. Quantitative testing may be performed by enzyme linked immunosorbent assay (ELISA).

Tacrolimus Level

A blood test is performed to measure tacrolimus levels. Tacrolimus, also known as Prograf is an immunosuppressant drug that affects the ability of certain white blood cells in the body to recognize and respond to transplanted body organs such as kidney, liver, heart and lung. The drug is administered intravenously, either alone or in combination with other immunosuppressant drugs. Tacrolimus has a narrow therapeutic range and blood levels may be assessed daily at the start of therapy, taper to 1-2 times per week and finally to once every 1-2 months. For routine monitoring the specimen is collected as a trough level, immediately prior to a scheduled dose and at least 12 hours after the previous dose. A blood sample is obtained by a separately reportable venipuncture. Whole blood is then tested using liquid chromatography-tandem mass spectrometry. Prograf may be tested with chromatographic or immunoassay technique and the results will be somewhat different. Make note of the technique used when comparing results with previous levels.

Test for Influenza Virus

A quick test to detect influenza (Type A or B) by immunoassay with direct optical observation is performed. It is a rapid, qualitative test performed using lateral flow immunoassay. Influenza is an acute, highly contagious, viral upper respiratory infection. There are three types of influenza viruses delineated as Type A, B, or C with Type A being the most severe and prevalent type. Type B is generally less severe. Type C is the least common and is not associated with large human epidemics. Type A and B can both be detected by a rapid test. A nasal or nasopharyngeal swab is obtained. Alternatively nasal wash or aspirate may be used. The specimen is placed in a tube containting an extraction reagent that disrupts the virus particles in the specimen and exposes viral nucleoproteins. A test strip is then inserted into the tube. If the influenza virus being tested (Type A or B) is present, a line on the test strip will change color along with a control line.

Testosterone Level; Free

A blood test is performed to measure free testosterone levels. Testosterone is an androgen hormone secreted in the testes of men, ovaries of women, and the adrenal glands of both sexes. Testosterone helps promote protein synthesis and supports the growth of cells and tissue. This test is often performed in conjunction with sex hormone binding globulin. A blood sample is obtained by separately reportable venipuncture. Serum/plasma of adult males is tested using quantitative electrochemiluminescent immunoassay with the value derived from a mathematical expression using sex hormone binding globulin (SHBG). Serum/plasma of adult males may also be tested using quantitative equilibrium dialysis/high performance liquid chromatography-tandem mass spectrometry. Serum/plasma of children and adult females is tested using quantitative high performance liquid chromatography-tandem mass spectrometry/electrochemiluminescent immunoassay with the value also derived from a mathematical expression using sex hormone binding globulin (SHBG).

Testosterone (hormone) level

A urine test is performed to measure total testosterone level. Testosterone is an androgen hormone secreted in the testes of men, ovaries of women, and the adrenal glands of both sexes. Testosterone helps promote protein synthesis and supports the growth of cells and tissue. This test is often performed in conjunction with sex hormone binding globulin. A blood sample is obtained by separately reportable venipuncture. Serum/plasma of adult males is tested using quantitative electrochemiluminescent immunoassay with the value derived from a mathematical expression using sex hormone binding globulin (SHBG). Serum/plasma of adult males may also be tested using quantitative equilibrium dialysis/high performance liquid chromatography-tandem mass spectrometry. Serum/plasma of children and adult females is tested using quantitative high performance liquid chromatography-tandem mass spectrometry/electrochemiluminescent immunoassay with the value also derived from a mathematical expression using sex hormone binding globulin (SHBG).

Theophylline level

Thyroglobulin (thyroid protein) antibody measurement

Lab test for Thyroglobulin antibody

Thyroglobulin (thyroid related hormone) level

Thyroid hormone, T3 measurement - Total

A blood sample is tested to determine levels of total triiodothyronine (T3), free T3, or reverse T3. T3 is a hormone made by the thyroid gland that affects almost every metabolic process including body temperature, growth, and heart rate. T3 can either be produced by the thyroid or synthesized by the body from T4. Approximately 95% of T3 is bound to proteins in the blood and is inactive. The remaining 5% is free and active. T3 tests are used to help determine whether the thyroid is functioning properly, to diagnose hyperthyroidism, and to monitor patients with known thyroid disorders. In total T3, which reflects the amount of both bound and free T3, is measured. Total and free T3 are evaluated using electrochemiluminescent immunoassay. If the thyroid does not produce enough T3 or not enough is synthesized from T4, an inactive form of T3, referred to as reverse T3 or rT3, may be produced. Elevated levels of rT3 may be indicative of a thyroid disorder. Radioimmunoassay is used to evaluate rT3 levels.

Thyroid Hormone, T3 Measurement, Free

A blood sample is tested to determine levels of total triiodothyronine (T3), free T3, or reverse T3. T3 is a hormone made by the thyroid gland that affects almost every metabolic process including body temperature, growth, and heart rate. T3 can either be produced by the thyroid or synthesized by the body from T4. Approximately 95% of T3 is bound to proteins in the blood and is inactive. The remaining 5% is free and active. T3 tests are used to help determine whether the thyroid is functioning properly, to diagnose hyperthyroidism, and to monitor patients with known thyroid disorders. In total T3, which reflects the amount of both bound and free T3, is measured. Total and free T3 are evaluated using electrochemiluminescent immunoassay.

Blood test, thyroid stimulating hormone (TSH)

A blood test is performed to determine levels of thyroid stimulating hormone (TSH). TSH is produced in the pituitary and helps to regulate two other thyroid hormones, triiodothyronine (T3) and thyroxin (T4), which in turn help regulate the body's metabolic processes. TSH levels are tested to determine whether the thyroid is functioning properly. Patients with symptoms of weight gain, tiredness, dry skin, constipation, or menstrual irregularities may have an underactive thyroid (hypothyroidism). Patients with symptoms of weight loss, rapid heart rate, nervousness, diarrhea, feeling of being too hot, or menstrual irregularities may have an overactive thyroid (hypothyroidism). TSH levels are also periodically tested in individuals on thyroid medications. The test is performed by electrochemiluminescent immunoassay.

Thyroid hormone, T3 measurement

Thyroid stimulating immune globulins (thyroid related protein) level

Thyroxine (thyroid chemical) measurement - Free Thyroxine

A blood sample is obtained and levels of total thyroxin, thyroxine requiring elution as for testing in neonates or free thyroxine are evaluated. Thyroxine, also referred to as T4, is tested to determine whether the thyroid is functioning properly and is used to aid in the diagnosis of overactive (hyperthyroidism) or underactive (hypothyroidism) thyroid function. In free thyroxine levels are tested. Free thyroxine is the amount of active thyroxine in the blood. Free thyroxine levels are considered to be a more accurate indicator of thyroid function. All thyroxine tests use electrochemiluminescent immunoassay methodology.

Thyroxine (thyroid chemical) measurement - Total

A blood sample is obtained and levels of total thyroxin (84436), thyroxine requiring elution as for testing in neonates (84437), or free thyroxine (84439) are evaluated. Thyroxine, also referred to as T4, is tested to determine whether the thyroid is functioning properly and is used to aid in the diagnosis of overactive (hyperthyroidism) or underactive (hypothyroidism) thyroid function. In 84436, total thyroxine levels are evaluated. Total thyroxine measures the total amount of both bound and unbound (free) thyroxine in the blood. All thyroxine tests use electrochemiluminescent immunoassay methodology. *

Tissue culture inoculation for virus isolation

Topiramate level

Total protein level, blood

A blood test is performed to measure total protein levels. Total protein is often reported as a ratio of albumin to globulin (A/G ratio), and normal results will show albumin slightly greater than globulin. The test may be used to monitor nutritional status or diagnose kidney and liver disease. Elevated levels can indicate chronic inflammation, viral hepatitis, HIV infection, and multiple myeloma. Levels that are decreased may result from malnutrition or malabsorption syndromes such as celiac disease or inflammatory bowel disease. A blood sample is obtained by separately reportable venipuncture. Serum, plasma, or whole blood may be tested using quantitative spectrophotometry.

Total Protein Level, Body Fluid

A test is performed on body fluids other than blood or urine, such as cerebral spinal fluid or synovial fluid, in order to measure total protein levels. Elevated protein levels in cerebral spinal fluid (CSF) may be caused by tumors, bleeding, inflammation, or injury in the brain or central nervous system. A decrease in protein levels may result from a rapid turnover/replacement of cerebral spinal fluid. An elevated level of total protein in synovial fluid is most often caused by inflammation. CSF is obtained by separately reportable lumbar puncture (spinal tap), while synovial fluid is obtained by arthrocentesis from the affected joint. All body fluids are tested using reflectance spectrophotometry.

Transferrin (iron binding protein) level

Triglycerides level

A test is performed on blood or body fluids to measure triglyceride levels. Triglycerides contain glycerol and 3 fatty acid molecules and are a component of very low density lipoproteins (VLDL) found in blood and chylomicrons (cholesterol, protein, triglycerides) found in lymphatic fluid. They provide an energy source during metabolism and carry any unused dietary fats or calories to the liver and fat cells where they can be stored. Elevated levels may reflect recent carbohydrate and/or fat consumption. Blood samples should be obtained with the patient fasting for 12 hours. A blood sample is obtained by separately reportable venipuncture. Body (lymphatic) fluid is obtained by needle aspiration or incision/drainage of pooled fluid. Serum/plasma and body fluids are tested using quantitative enzymatic methods.

Troponin (protein) analysis

A blood test is performed to measure troponin levels. Troponins are regulatory proteins that facilitate contraction of skeletal and smooth muscle by forming calcium bonds. Troponin T binds to tropomyosin to form a complex. Troponin I binds to actin and holds the Troponin T-tropomyosin complex together. Elevation of troponins, coupled with cardiac symptoms such as chest pain are considered diagnostic for cardiac injury. This test is commonly ordered in the Emergency Department when a patient presents with possible myocardial infarction, and is then repeated at 6 hour intervals. It may be ordered with other tests that assess cardiac biomarkers such as CK, CK-MB, and myoglobin. A blood sample is obtained by separately reportable venipuncture. Serum/plasma is tested for Troponin T using quantitative electrochemiluminescent immunoassay. Serum is tested for Troponin I using chemiluminescent immunoassay.

Urea nitrogen level to assess kidney function

A blood sample is obtained to measure total (quantitative) urea nitrogen (BUN) level. Urea is a waste product produced in the liver by the breakdown of protein from a sequence of chemical reactions referred to as the urea or Krebs-Henseleit cycle. Urea then enters the bloodstream, is taken up by the kidneys and excreted in the urine. Blood BUN is measured to evaluate renal function, to monitor patients with renal disease, and to evaluate effectiveness of dialysis. BUN may also be measured in patients with acute or chronic illnesses that affect renal function. BUN is measured using spectrophotometry.

Uric acid level, blood

A blood test is performed to measure uric acid levels. Uric acid forms from the natural breakdown of body cells and the food we ingest. Uric acid is normally filtered by the kidneys and excreted in urine. Elevated blood levels may result from kidney disease, certain cancers and/or cancer therapies, hemolytic or sickle cell anemia, heart failure, cirrhosis, lead poisoning, and low levels of thyroid or parathyroid hormones. Levels may be decreased in Wilson's disease, poor dietary intake of protein, and with the use of certain drugs. A blood sample is obtained by separately reportable venipuncture. Serum/plasma is tested using quantitative spectrophotometry.

Uric acid level

Urinalysis, Automated Test

A urinalysis is performed by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, and/or urobilinogen. Urinalysis can quickly screen for conditions that do not immediately produce symptoms such as diabetes mellitus, kidney disease, or urinary tract infection. A dip stick allows qualitative and semi-quantitative analysis using a paper or plastic stick with color strips for each agent being tested. The stick is dipped in the urine specimen and the color strips are then compared to a color chart to determine the presence or absence and/or a rough estimate of the concentration of each agent tested. Reagent tablets use an absorbent mat with a few drops of urine placed on the mat followed by a reagent tablet. A drop of distilled, deionized water is then placed on the tablet and the color change is observed. Bilirubin is a byproduct of the breakdown of red blood cells by the liver. Normally bilirubin is excreted through the bowel, but in patients with liver disease, bilirubin is filtered by the kidneys and excreted in the urine. Glucose is a sugar that is normally filtered by the glomerulus and excreted only in small quantities in the urine. Excess sugar in the urine (glycosuria) is indicative of diabetes mellitus. The peroxidase activity of erythrocytes is used to detect hemoglobin in the urine which may be indicative of hematuria, myoglobinuria, or hemoglobinuria. Ketones in the urine are the result of diabetic ketoacidosis or calorie deprivation (starvation). A leukocyte esterase test identifies the presence of white blood cells in the urine. The presence of nitrites in the urine is indicative of bacteria. The pH identifies the acid-base levels in the urine. The presence of excessive amounts of protein (proteinuria) may be indicative of nephrotic syndrome. Specific gravity measures urine density and is indicative of the kidneys' ability to concentrate and dilute urine. Following dip stick or reagent testing, the urine sample may be examined under a microscope. The urine sample is placed in a test tube and centrifuged. The sediment is resuspended. A drop of the resuspended sediment is then placed on a glass slide, cover-slipped, and examined under a microscope for crystals, casts, squamous cells, blood (white, red) cells, and bacteria.

Urine microalbumin (protein) level

A test on urine is used to measure microalbumin levels and is routinely performed annually on diabetic patients with stable blood glucose levels to assess for early onset nephropathy. The quantitative test, which measures the actual amount of microalbumin present in the urine, may be performed on a random urine sample, with a notation of total volume and voiding time, or a 24-hour urine sample using immunoturbidimetric technique. The semi-quantitative test identifies the presence of elevated microalbumin levels in the urine within a general range and involves a chemical dipstick placed into the urine sample which reacts and changes color when albumin is present.

Urine osmolality (concentration) measurement

Osmolality of blood or urine is tested. Osmolality refers to the number of solutes present in blood (plasma or serum) or urine. Osmotically active particles include sodium, chloride, potassium, urea, and glucose. Osmolality is tested using freezing point methodology or vapor pressure osmometer. The higher the concentration of solutes, the lower the freezing point as compared to water. A random urine specimen is obtained. Urine osmolality is tested to help evaluate fluid balance or to assess kidney function as demonstrated by the ability to produce and concentrate urine. Often both urine and blood osmolality is measured to determine the ratio of urine osmolality to serum osmolality.

Urine potassium level

A urine test is performed to measure potassium levels. Potassium is a chemical element essential for proper functioning of the heart, kidneys, intestine, muscles, and nerves. Levels may be elevated in kidney disease, Cushing's syndrome, hyperaldosteronism, eating disorders, diabetic/metabolic acidosis, hypomagnesemia, and with the use of certain diuretics. Decreased levels may be caused by adrenal gland insufficiency, hypoaldosteronism, and medications such as beta blockers, lithium, and NSAIDs. A 24-hour or random urine sample is obtained. Urine is tested using quantitative ion-selective electrode.

Urine sodium level

A urine sample is obtained to measure sodium level. Sodium is a positively charged electrolyte that works in conjunction with other electrolytes, such as potassium, chloride, and carbon dioxide (CO2), to regulate fluid in the body and maintain proper acid-base balance. Sodium is an essential mineral in the body, necessary for maintaining normal metabolic processes, fluid levels, and vascular pressure. Sodium level is used to screen for and monitor elevated blood sodium (hypernatremia), low blood sodium (hyponatremia), and electrolyte imbalances. Sodium may be monitored in patients on certain medications, such as diuretics, that can cause electrolyte imbalance. Sodium is measured by ion-selective electrode (ISE) methodology.

Urine albumin (protein) level

Urine calcium level

Urine phosphate level

Valproic acid level

A laboratory test is performed to measure valproic acid (dipropylacetic acid, depakote). Valproic acid is an anticonvulsant that may be used to treat seizure disorders, manic phase of bipolar disorders, and migraine headaches. The drug works by changing certain chemicals neurotransmitters in the brain. The test for total valproic acid can be used to monitor drug therapy, assess patient compliance, and evaluate for potential toxicity. The test for free valproic acid may be used to evaluate the cause of toxicity when the total valproic acid concentration is within the normal range. Free valproic acid may be elevated in patients with an altered or unpredictable protein binding capacity. A blood sample is obtained by separately reportable venipuncture just prior to medication administration to obtain the trough level. Serum/plasma is tested for total valproic acid using fluorescence polarization immunoassay and for free valproic acid using quantitative enzyme multiplied immunoassay.

Vancomycin (antibiotic) level

A blood test is performed to measure vancomycin levels at random, peak and trough times. Vancomycin, also known as Vancocin is a glycopeptide antibiotic prescribed to treat severe or serious bacterial infections. For systemic infections it is administered by intravenous infusion. For intestinal infections such as colitis or clostridium difficile it is taken orally. Blood level monitoring is necessary because the drug has the potential to cause auditory toxicity. A random sample may be drawn any time, peak and trough levels are time dependant and are usually drawn 24 hours after initiating therapy and every 2-3 days thereafter. A trough level is drawn 10 minutes prior to intravenous infusion. A peak level is drawn 1-2 hours after intravenous infusion is complete. A blood sample is obtained by separately reportable venipuncture. Blood serum is then tested using fluorescence polarization immunoassay.

Vitamin A level

Vitamin B-2 (riboflavin) level

Vitamin D-3 Level

Blood levels of 25-hydroxyvitamin D are used to primarily to determine whether a deficiency of Vitamin D or abnormal metabolism of calcium is the cause of bone weakness or malformation. Vitamin D is a fat soluble vitamin that is absorbed from the intestine like fat, and 25-hydroxyvitamin D levels are also evaluated in individuals with conditions or diseases that interfere with fat absorption, such as cystic fibrosis, Crohn's disease, or in patients who have undergone gastric bypass surgery. A blood sample is obtained. Levels of 25-hydroxyvitamin D3 and 25-hydroxyvitamin D2 are evaluated using chemiluminescent immunoassay. The test results may be the sum of Vitamin D3 and D2 or the results may include fractions of D3 and D2 as well as the sum of these values.

Vitamin E level

Vitamin K level

Zonisamide level

Administration of vaccine

Audiology exam - hearing test

Comprehensive hearing test

Application of mechanical traction to 1 or more areas

Application of medication through skin using electrical current, each 15 minutes

Application of on-body injector (includes cannula insertion) for timed subcutaneous injection

Application of whirlpool therapy to 1 or more areas

Attempt to Restart Heart and Lungs

Cardiopulmonary resuscitation (CPR) is a manual attempt at restarting a patient's heart and lungs when cardiopulmonary arrest occurs. Typically led by a health care provided certified in CPR, the lungs are filled with air by holding the nose and breathing through the mouth or performed with a ventilating bag. Chest compressions are also performed at intervals, alternating with the air in the lungs. A defibrillator may be used to shock the heart into starting.

Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin)

Catheter insertion of stents in major coronary artery or branch, accessed through the skin

Demonstration and/or evaluation of manual maneuvers to chest wall to assist movement of lung secreti

Determination of lung volumes using gas dilution or washout

Eardrum testing using ear probe

Ear drum sound and pressure procedure, also known as Tympanometry

Evaluation and insertion of catheters for creation of complete heart block

Evaluation and insertion of catheters for recording, pacing, and attempted induction of abnormal hea

Evaluation and insertion of catheters for recording, pacing, and treatment of abnormal heart rhythm

Evaluation of heart function using tilt table

External shock to heart to regulate heart beat

Fluoroscopic and video recorded motion evaluation of swallowing function

Haemophilus influenza type B vaccine (HiB), 4 dose schedule

Hearing assessment of abnormal sounds

Heart rhythm analysis, interpretation and report of 48-hour EKG

Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle