Type: W

Test 751

SuperUser Account — Tue, 16 Sep 2008 21:53:52 GMT

Test: White Blood Cell (WBC) Count
Number: 005025
CPT: 85048
Synonyms: Leukocyte Count ; WBC ; White Count
Specimen: Whole blood
Volume: 5 mL (dependent upon whether cells are badly distorted by excess anticoagulant)
Container: Lavender-top (EDTA) tube
Storage Instructions: Maintain specimen at room temperature up to 24 hours. Refrigerate up to 48 hours.
Causes for Rejection: Hemolysis; clotted specimen; tube not filled with minimum volume; improper labeling
Use: White cell enumeration; evaluate myelopoiesis, bacterial and viral infections, toxic metabolic processes; diagnose/evaluate leukemic states
Methodology: Automated cell counter

Test 1223

SuperUser Account — Tue, 16 Sep 2008 22:12:11 GMT

Test: White Blood Cells (WBC), Stool
Number: 008656
CPT: 89055
Synonyms: Fecal Leukocyte Stain ; Stool for White Cells ; WBC, Stool ; White Cells, Stool
Test Includes: Evaluation of fecal material for the presence of WBC by direct smear and stain. CPT coding for microbiology and virology procedures often cannot be determined before the culture is performed.
Specimen: Stool
Volume: 1 g
Container: Parasite (O & P) transport (PVA) vial only
Storage Instructions: Maintain specimen at room temperature.
Causes for Rejection: Quantity not sufficient for analysis; improper specimen transport device; improper labeling; unlabeled specimen or name discrepancy between specimen and request label; specimen received after prolonged delay
Use: Assist in the differential diagnosis of diarrheal disease
Limitations: Ten percent to 15% of stools that yield an invasive bacterial pathogen have an absence of fecal leukocytes. Fecal leukocytes are present in idiopathic inflammatory bowel disease.
Methodology: Simple stain
Additional Information: Conditions associated with marked fecal leukocytes, blood and mucus include diffuse antibiotic associated colitis, ulcerative colitis, shigellosis, salmonellosis, Campylobacter, and Yersinia infection. Salmonella typhi may evoke a monocyte response. Conditions associated with modest numbers of fecal leukocytes include early shigellosis involving small bowel, antibiotic associated colitis, and amebiasis. Conditions associated with an absence of fecal leukocytes include toxigenic bacterial infection, giardiasis, and viral infections. In a review the methylene blue stain for polymorpholeukocytes had a high sensitivity 85% and specificity 88% for bacterial diarrhea (Shigella, Salmonella, Campylobacter). Positive predictive value was 59%. Negative predicative value was 97%. Combined with a history of abrupt onset, greater than four stools per day and no vomiting before the onset of diarrhea the stool methylene blue stain for fecal polymorphonuclear leukocytes was a very effective presumptive diagnostic test for bacterial diarrhea.¹ A positive occult blood test may also be suggestive of acute bacterial diarrhea. Neither method is sufficiently sensitive or specific to preempt the use of culture.² Similar findings including a sensitivity of 81% and specificity 74% were observed when both tests were positive.³
Footnotes:

DeWitt TG, Humphrey KF, and McCarthy P, “Clinical Predictors of Acute Bacterial Diarrhea in Young Children,” Pediatrics, 1985, 76(4):551-6.
Paccagnini S, Fontana M, Ceriani R, et al, “Occult Blood and Faecal Leukocyte Tests in Acute Infectious Diarrhea in Children,” Lancet, 1987, 1(8530):442.
Seigel D, Cohen PT, Neighbor M, et al, “Predictive Value of Stool Examination in Acute Diarrhea,” Arch Pathol Lab Med, 1987, 111(8):715-8

References:

Bishop WP and Ulshen MH, “Bacterial Gastroenteritis,” Pediatr Clin North Am, 1988, 35(1):69-87 (review).

Harris JC, Dupont HL, and Hornick RB, “Fecal Leukocytes in Diarrheal Illness,” Ann Intern Med, 1972, 76(5):697-703.

Test 1766

SuperUser Account — Tue, 16 Sep 2008 22:38:30 GMT

Test: Wine Vinegar
Number: 060067
CPT: 86003
Specimen: Serum
Volume: 0.2 mL
Container: 10 mL red-top tube or 10 mL gel-barrier tube
Storage Instructions: Refrigerate
Methodology: Quantitative allergen-specific IgE test

Test 1767

SuperUser Account — Tue, 16 Sep 2008 22:38:33 GMT

Test: Wheat/Quack Grass
Number: 060069
CPT: 86003
Specimen: Serum
Volume: 0.2 mL
Container: 10 mL red-top tube or 10 mL gel-barrier tube
Storage Instructions: Refrigerate
Methodology: Quantitative allergen-specific IgE test

Test 1779

SuperUser Account — Tue, 16 Sep 2008 22:39:02 GMT

Test: Wheat Smut
Number: 060091
CPT: 86003
Specimen: Serum
Volume: 0.2 mL
Container: 10 mL red-top tube or 10 mL gel-barrier tube
Storage Instructions: Refrigerate
Methodology: Quantitative allergen-specific IgE test

Test 1825

SuperUser Account — Tue, 16 Sep 2008 22:41:25 GMT

Test: Whitefish
Number: 060574
CPT: 86003
Specimen: Serum
Volume: 0.2 mL
Container: Red-stopper tube or gel-barrier tube
Storage Instructions: Refrigerate
Methodology: Quantitative allergen-specific IgE test

Test 1845

SuperUser Account — Tue, 16 Sep 2008 22:42:15 GMT

Test: Willow, Pussy
Number: 061051
CPT: 86003
Specimen: Serum
Volume: 0.2 mL
Container: Red-stopper or gel-barrier tube
Storage Instructions: Refrigerate
Methodology: Quantitative allergen-specific IgE test

Test 1860

SuperUser Account — Tue, 16 Sep 2008 22:42:53 GMT

Test: Whey
Number: 061523
CPT: 86003
Specimen: Serum
Volume: 0.2 mL
Container: Red-stopper tube or gel-barrier tube
Storage Instructions: Refrigerate
Methodology: Quantitative allergen-specific IgE test

Test 1906

SuperUser Account — Tue, 16 Sep 2008 22:44:52 GMT

Test: Watermelon
Number: 066969
CPT: 86003
Specimen: Serum
Volume: 0.2 mL
Container: Red-stopper tube or gel-barrier tube
Storage Instructions: Refrigerate
Methodology: Quantitative allergen-specific IgE test

Test 1966

SuperUser Account — Tue, 16 Sep 2008 22:47:26 GMT

Test: White Bean
Number: 068197
CPT: 86003
Specimen: Serum
Volume: 0.2 mL
Container: Red-stopper or gel-barrier tube
Storage Instructions: Refrigerate
Methodology: Quantitative allergen-specific IgE test

Test 1994

SuperUser Account — Tue, 16 Sep 2008 22:48:39 GMT

Test: Wheat
Number: 068494
CPT: 86003
Specimen: Serum
Volume: 0.2 mL
Container: Red-stopper tube or gel-barrier tube
Storage Instructions: Refrigerate
Methodology: Quantitative allergen-specific IgE test

Test 2012

SuperUser Account — Tue, 16 Sep 2008 22:49:26 GMT

Test: Walnut Pollen
Number: 068759
CPT: 86003
Specimen: Serum
Volume: 0.2 mL
Container: Red-stopper or gel-barrier tube
Storage Instructions: Refrigerate
Methodology: Quantitative allergen-specific IgE test

Test 2013

SuperUser Account — Tue, 16 Sep 2008 22:49:29 GMT

Test: Willow, Black
Number: 068767
CPT: 86003
Specimen: Serum
Volume: 0.2 mL
Container: Red-stopper or gel-barrier tube
Storage Instructions: Refrigerate
Methodology: Quantitative allergen-specific IgE test

Test 2043

SuperUser Account — Tue, 16 Sep 2008 22:50:48 GMT

Test: Wormwood
Number: 069088
CPT: 86003
Specimen: Serum
Volume: 0.2 mL
Container: Red-stopper tube or gel-barrier tube
Storage Instructions: Refrigerate
Methodology: Quantitative allergen-specific IgE test

Test 2070

SuperUser Account — Tue, 16 Sep 2008 22:52:02 GMT

Test: Wasp, Paper
Number: 069435
CPT: 86003
Specimen: Serum
Volume: 0.2 mL
Container: Red-stopper tube or gel-barrier tube
Storage Instructions: Refrigerate
Methodology: Quantitative allergen-specific IgE test

Test 2078

SuperUser Account — Tue, 16 Sep 2008 22:52:23 GMT

Test: Whole Body: Mosquito
Number: 069567
CPT: 86003
Specimen: Serum
Volume: 0.2 mL
Container: Red-stopper tube or gel-barrier tube
Storage Instructions: Refrigerate
Methodology: Quantitative allergen-specific IgE test

Test 2089

SuperUser Account — Tue, 16 Sep 2008 22:52:52 GMT

Test: Wheat, Cultivated
Number: 069716
CPT: 86003
Specimen: Serum
Volume: 0.2 mL
Container: Red-stopper tube or gel-barrier tube
Storage Instructions: Refrigerate
Methodology: Quantitative allergen-specific IgE test

Test 2099

SuperUser Account — Tue, 16 Sep 2008 22:53:19 GMT

Test: Walnut
Number: 069823
CPT: 86003
Specimen: Serum
Volume: 0.2 mL
Container: Red-stopper tube or gel-barrier tube
Storage Instructions: Refrigerate
Methodology: Quantitative allergen-specific IgE test

Test 2173

SuperUser Account — Tue, 16 Sep 2008 22:57:34 GMT

Test: Warfarin (Coumadin®), Serum
Number: 071423
CPT: 82491
Synonyms: Coumadin® ; Sodium Warfarin
Specimen: Serum or plasma
Volume: 2 mL
Minimum Volume: 0.6 mL
Container: Red-top tube, lavender-top (EDTA) tube, or green-top (heparin) tube
Collection: Transfer separated serum or plasma to a plastic transport tube. Do not use a gel-barrier tube. The use of gel-barrier tubes is not recommended due to slow absorption of the drug by the gel. Depending on the specimen volume and storage time, the decrease in drug level due to absorption may be clinically significant.
Storage Instructions: Refrigerate
Causes for Rejection: Gel-barrier tube
Reference Interval: 2.0-5.0 μg/mL
Use: Warfarin is used for chronic oral anticoagulation in a variety of clinical settings. Management of warfarin therapy is usually by following the prothrombin time, rather than by measuring serum drug concentrations. Warfarin is subject to a bewildering number and variety of drug interactions, producing increased or decreased clinical effect of itself or other drugs. Many of these effects are due to changes in protein binding or hepatic metabolism. Reductions in dosage may be indicated for aging subjects treated for venous thromboembolic or coronary arterial disease, but not in those with peripheral vascular disease, deep vein thrombosis, or valvular heart disease.^1,2
Limitations: Assay measures sodium warfarin only
Methodology: High-pressure liquid chromatography (HPLC)
Additional Information: Warfarin is intermediate acting; a peak effect is achieved in 36-72 hours and the anticoagulant effect persists for 2-5 days. The drug is rapidly and completely absorbed from the gastrointestinal tract. The delay in achieving the peak effect results from the long half-lives of clotting factors II, IX, and X, whose levels must decline before maximal anticoagulation is reached. Warfarin is highly lipophilic and is 99% bound to albumin. Some tissue binding occurs, particularly in the liver. However, only the unbound drug is active and available for hydroxylation in the liver. Therefore, co-administered agents which either increase the free fraction (eg, salicylates) or activate liver enzymes (eg, St John´s wort) need to be monitored cautiously.³
Footnotes:

Montamat SC, Cusack BJ, and Vestal RE, “Management of Drug Therapy in the Elderly,” N Engl J Med, 1989, 321(5):303-9.
James AH, Britt RP, Raskino CL, et al, “Factors Affecting the Maintenance Dose of Warfarin,” J Clin Pathol, 1992, 45(8):704-6.
Williamson EM, “Drug Interactions Between Herbal and Prescription Medicines,” Drug Saf, 2003, 26(15):1075-92 (review)

References:

AMA, Division of Drugs and Toxicology, Drug Evaluations Subscription, Chicago, IL: American Medical Association, Spring 1992.

Mosby´s Drug Consult, St Louis, MO: Elsevier Mosby, 2006.

Test 2985

SuperUser Account — Wed, 17 Sep 2008 00:02:02 GMT

Test: West Nile Virus (WNV) Antibody, Serum
Number: 138842
CPT: 86788; 86789
Synonyms: West Nile Virus, IgG and IgM; West Nile Virus, Serology; WNV Antibody
Specimen: Serum
Volume: 1.0 mL
Minimum Volume: 0.5 mL
Container: Red-top tube or gel-barrier tube
Storage Instructions: Refrigerate
Causes for Rejection: Gross contamination; severe hemolysis; icteric serum; lipemic serum; quantity not sufficient for analysis
Reference Interval: Negative
Use: Support a diagnosis of West Nile virus infection
Methodology: Enzyme immunoassay (EIA)
References:

Tardei G, Ruta S, Chitu V, et al, “Evaluation of Immunoglobulin M (IgM) and IgG Enzyme Immunoassays in Serologic Diagnosis of West Nile Virus Infection,” J Clin Microbiol, 2000, 38(6):2232-9.

Test 2995

SuperUser Account — Wed, 17 Sep 2008 00:02:56 GMT

Test: West Nile Virus (WNV) Antibody, Cerebrospinal Fluid
Number: 138966
CPT: 86788; 86789
Synonyms: West Nile Virus, IgG and IgM; West Nile Virus, Serology; WNV Antibody
Specimen: Cerebrospinal fluid
Volume: 0.5 mL
Minimum Volume: 0.1 mL
Container: Sterile container
Collection: Do not centrifuge cerebrospinal fluid.
Storage Instructions: Refrigerate
Causes for Rejection: Gross contamination; severe hemolysis; quantity not sufficient for analysis
Reference Interval: Negative
Use: Support a diagnosis of West Nile virus infection
Methodology: Enzyme immunoassay (EIA)
References:

Tardei G, Ruta S, Chitu V, et al, “Evaluation of Immunoglobulin M (IgM) and IgG Enzyme Immunoassays in Serologic Diagnosis of West Nile Virus Infection,” J Clin Microbiol, 2000, 38(6):2232-9.

Test 3298

SuperUser Account — Wed, 17 Sep 2008 00:31:53 GMT

Test: Western Equine Encephalitis Virus Antibodies, IgG
Number: 162040
CPT: 86654
Specimen: Serum
Volume: 0.4 mL
Minimum Volume: 0.2 mL
Container: Red-top tube or gel-barrier tube
Storage Instructions: Maintain specimen at room temperature.
Reference Interval: Negative
Methodology: Indirect fluorescent antibody (IFA)
Additional Information: Symptoms of this arbovirus infection include fever, aseptic meningitis, and meningoencephalitis. Disease is usually most severe in children. Diagnosis is best established by detecting specific IgM antibody, particularly in CSF.

Test 3312

SuperUser Account — Wed, 17 Sep 2008 00:33:09 GMT

Test: Western Equine Encephalitis Virus Antibodies, IgM
Number: 162347
CPT: 86654
Specimen: Serum
Volume: 0.4 mL
Minimum Volume: 0.2 mL
Container: Red-top tube or gel-barrier tube
Storage Instructions: Maintain specimen at room temperature.
Causes for Rejection: Heat inactivation; gross bacterial contamination
Reference Interval: Negative
Methodology: Indirect fluorescent antibody (IFA)
Additional Information: Symptoms of this arbovirus infection include fever, aseptic meningitis, and meningoencephalitis. Disease is usually most severe in children. Diagnosis is best established by detecting specific IgM antibody, particularly in CSF.

Test 3637

SuperUser Account — Wed, 17 Sep 2008 01:06:31 GMT

Test: Wet Prep
Number: 180901
CPT: 87210
Test Includes: Clue cell exam; Trichomonas exam; yeast exam
Special Instructions: Store uninoculated InPouch™ TV test kits at room temperature.
Specimen: Vaginal swab, sedimented first-void male urine, semen, prostatic fluid, or male urethral swab
Volume: Swab or 1-2 drops of fluid or sedimented urine
Container: InPouch™ TV transported at room temperature (for as long as 48 hours)
Collection: Specimens are inoculated directly into the culture media with the exception of urine specimens which are first centrifuged at 500xg and the sediment used for inocula. Collect specimens using a cotton swab. To avoid leakage, first move the medium at the top of the InPouch downward to the middle of the upper chamber. Tear off plastic above the white closure. In order to admit the swab, open the InPouch by pulling the closure tape´s middle tabs apart. Insert swab into upper chamber medium of the InPouch TV and elute specimen by rubbing swab between the InPouch TV walls. Remove the swab and discard. Liquid specimens are added directly to the upper chamber medium of the InPouch TV. When specimen inoculation is completed, squeeze the top of the InPouch closed, then roll down three rolls and fold tabs over. Keep InPouch in an upright position.
Storage Instructions: Maintain specimen at room temperature for up to 48 hours; if held longer than 48 hours, incubation at 37°C is required. Do not refrigerate.
Causes for Rejection: Received in the laboratory greater than 48 hours without incubation; expired product; specimen refrigerated; any transport except InPouch TV
Reference Interval: Negative for clue cells, Trichomonas, or yeast
Use: For the presumptive diagnosis of Trichomonas vaginalis infection.
Methodology: Microscopic evaluation
References:

BioMed Diagnostics, www.biomed1.com.

Test 3638

SuperUser Account — Wed, 17 Sep 2008 01:06:38 GMT

Test: Wet Prep With Reflex to Trichomonas Culture
Number: 180919
CPT: 87210
Test Includes: Clue cell exam; Trichomonas exam; yeast exam; reflex to culture if negative for Trichomonas
Special Instructions: Store uninoculated InPouch™ TV test kits at room temperature. If reflex testing is performed, additional charge(s)/CPT code(s) will apply.
Specimen: Vaginal swab, sedimented first-void male urine, semen, prostatic fluid, or male urethral swab
Volume: Swab or 1-2 drops of fluid or sedimented urine
Container: InPouch™ TV transported at room temperature (up to 48 hours).
Collection: Specimens are inoculated directly into the culture media with the exception of urine specimens which are first centrifuged at 500xg and the sediment used for inocula. Collect specimens using a cotton swab. To avoid leakage, first move the medium at the top of the InPouch downward to the middle of the upper chamber. Tear off plastic above the white closure. In order to admit the swab, open the InPouch by pulling the closure tape´s middle tabs apart. Insert swab into upper chamber medium of the InPouch TV and elute specimen by rubbing swab between the InPouch TV walls. Remove the swab and discard. Liquid specimens are added directly to the upper chamber medium of the InPouch TV. When specimen inoculation is completed, squeeze the top of the InPouch closed, then roll down three rolls and fold tabs over. Keep InPouch in an upright position.
Storage Instructions: Maintain specimen at room temperature for up to 48 hours; if held longer than 48 hours, incubation at 37°C is required. Do not refrigerate.
Causes for Rejection: Received in the laboratory greater than 48 hours without incubation; expired product; specimen refrigerated; any transport except InPouch TV
Reference Interval: Negative for clue cells, Trichomonas, or yeast
Use: For the presumptive diagnosis of Trichomonas vaginalis infection.
Methodology: Microscopic evaluation with reflex to culture if negative
References:

BioMed Diagnostics, www.biomed1.com.