Chapter 4

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This chapter outlines commonly ordered blood chemistry, immunology, and serology tests and other common laboratory investigations. Normal values and a guide to the diagnosis of common abnormalities are provided. Additional tests are described in the following chapters: hematology, Chapter 5; urine studies, Chapter 6; microbiology, Chapter 7; and Blood Gases, Chapter 8. Increased or decreased values that are not clinically useful usually are not listed. Because each laboratory has its own set of normal reference intervals, the normal values given should be used only as a guide. Unless specified, values reflect normal levels in adults. The method of collection is included because laboratories have attempted to standardize collection methods; however, be aware that some labs may have other collection methods. Blood specimen tubes are listed in Chapter 13, Table 13–8.

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Most laboratories offer AMA-recommended “panel” tests, whereby multiple determinations are performed on a single sample. Although labs may vary, common chemistry panels include the following:

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  • AMA Electrolyte Panel: Sodium, potassium, chloride, CO2
  • AMA Basic Metabolic Panel: Calcium, CO2, chloride, creatinine, glucose, potassium, sodium, BUN
  • AMA Comprehensive Metabolic Panel: albumin, ALT, AST, total bilirubin, calcium, chloride, CO2, creatinine, glucose, alkaline phosphatase, potassium, total protein, sodium, BUN
  • AMA Renal Function Panel: Albumin, calcium, CO2, chloride, creatinine, glucose, phosphorus serum, potassium, sodium, BUN
  • AMA Hepatic Function Panel: Total protein, albumin, total bilirubin, direct bilirubin, alkaline phosphate, AST, ALT
  • AMA Lipid Panel: Cholesterol, HDL, LDL (calculated from cholesterol and hydroxycholesterol [HC]), triglycerides

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Other Common Panel Tests

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  • Chem-7 Panel/SMA-7: BUN, creatinine, electrolytes (Na, K, Cl, CO2), glucose
  • Health Screen-12/SMA-12:Albumin, alkaline phosphatase, AST (SGOT), bilirubin (total), calcium, cholesterol, creatinine, glucose, LDH, phosphate, protein (total), uric acid
  • Cardiac Enzymes: CK-MB (if total CK > 150 IU/L), troponin

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Every reimbursable laboratory test has an associated CPT code used for billing transactions. The CPT (Current Procedural Terminology) system was developed by and is a registered trademark of the American Medical Association (AMA). CPT codes have been incorporated as the standard code set for Medicare and Medicaid reimbursement. They also are used in the Health Insurance Portability and Accountability Act (HIPAA) and have been adopted by private insurance carriers and managed care companies.

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CPT codes are designated for services that are part of “contemporary medical practice and being performed by many physicians in clinical practice in multiple locations.” Each of the codes consists of a five-digit number that is associated with a text descriptor (eg, 82565, Creatinine; blood).

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To comply with government regulations as specified by the Centers for Medicare & Medicaid Services (CMS), clinical pathology laboratories require physicians who order tests to provide appropriate International Classification of Disease, Ninth Revision (ICD-9) diagnosis and procedure codes that in turn indicate which laboratory tests are reimbursable.

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• 7–10 am 10–50 ...

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