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Section-V

POWERCHART NAME

VALPROIC ACID (DEPAKENE) LEVEL

MERCY TEST NAME

VALPRO ACID

MERCY LAB CODE

VAL

Specimen:
  • 0.5 ml lithium heparin plasma from a PST tube.
  • Sodium Heparin, serum and EDTA plasma tubes are also accepted. 
  • Stable 48 hours refrigerated.
  • Collection time is not critical.
Comment: Peak reached 1-4 hours after oral dose. Indicate time last dose in comment.
Performed: Within 8 hours of receipt.  Available stat. 
Reference value:

Therapeutic range: 50-100 mcg/ml
Biopolar disorder therapeutic range:  50-125 mcg/ml

Method:   Emit Enzyme Immunoassay
CPT Code:  80164

 

POWERCHART NAME

VANCOMYCIN PEAK LEVEL

MERCY TEST NAME

VANCOMYCIN PEAK

MERCY LAB CODE

VNPK

Specimen: 
  • 0.5 ml lithium heparin plasma from a PST tube.
  • Serum, Sodium Heparin and EDTA plasma tubes are also acceptable. 
  • Stable 48 hours refrigerated
  • If receipt of specimen is delayed by >48 hours specimen can be frozen
Comment:  Consult Pharmacy to establish collection time.  Indicate time last dose in comment.
Performed: Within 8 hours of receipt.
Reference value: 25-40 mcg/mL
Method:  Emit Enzyme Immunoassay
CPT Code: 80202

 

POWERCHART NAME

VANCOMYCIN LEVEL INTERMEDIATE

MERCY TEST NAME

VANCOMYCIN INT

MERCY LAB CODE

VNI 

Specimen:
  • 0.5 ml lithium heparin plasma from a PST tube.
  • Serum, Sodium Heparin and EDTA plasma tubes are also acceptable. 
  • Stable 48 hours refrigerated
  • If receipt of specimen is delayed by >48 hours specimen can be frozen
Comment:  Consult Pharmacy to establish collection time.  Indicate time last dose in comment.
Performed: Within 8 hours of receipt.
Reference value: Therapeutic range: 18-25 mcg/ml
Method: Emit Enzyme Immunoassay
CPT Code: 80202

 

POWERCHART NAME

VANCOMYCIN TROUGH  LEVEL

MERCY TEST NAME

VANCOMYCIN TRGH

MERCY LAB CODE

VNTR

Specimen: 
  • 0.5 ml lithium heparin plasma from a PST tube.
  • Serum, Sodium Heparin and EDTA plasma tubes are also acceptable. 
  • Stable 48 hours refrigerated
  • If receipt of specimen is delayed by >48 hours specimen can be frozen
Comment: Consult Pharmacy to establish collection time.  Indicate time last dose in comment.
Performed: Within 8 hours of receipt.
Reference value:

Recommendation of Pharmacy and Therapeutic Committee

  • 10-15  mcg/ml  Trough target range for mild infections (UTI, skin and soft tissue).
  • 15-20  mcg/ml  Trough target range for severe and life threatening infections (bacteremia, pneumonia, meningitis, endocarditis, osteomyelitis, diskitis, abscess, and joint infection.
Method:  Emit Enzyme Immunoassay
CPT Code:  80202

 

TEST NAME

VANILLYMANDELIC ACID

See:  VMA (Vanillymandelic Acid) 24-Hour Urine

 

POWERCHART NAME

VAP (VERTICAL AUTO PROFILE) LIPID PROFILE

MERCY TEST NAME

VAP LIPID PROFILE*

MERCY LAB CODE

VAP

Specimen: 3 ml serum from a SST tube.  Refrigerate.
Coment: Specimen will be rejected if hemolyzed. 
Performed:   Test results will be sent to physician within 72 hours of specimen receipt at Atherotech Laboratories.
Reference value:  Included on report.
CPT Code:

84478 Triglycerides
83701 Lipoprotein Frac. Qnt.

 

TEST NAME

DERMAL, Herpes Simplex Virus & Varicella Zoster Virus, DNA Detection by PCR*

 

See: HSV AND VZOSTER VIRUS PCR

 

POWERCHART NAME

VARICELLA ZOSTER ANTIBODY IgG

MERCY TEST NAME

VARIC ZOST IgG*

MERCY LAB CODE

VZVG

Specimen: 1.0 ml serum from a SST or plain red top tube. (0.3 ml minimum) 
Comment:  Qualitative testing only.  Determines immunity status. For diagnosis of recent infection, testing of IgM and IgG antibodies are recommended. (VZGM)
Processing: 

Send specimen to Mercy lab FROZEN.

Inhouse Use Only: Test can be added on to a refrigerated sample within 48 hours of drawing.

Performed: Thursdays, 0800 cutoff
Reference value: Non-immune - presumed non-immune to VZV infection
Method:  EIA
CPT Code:  86787

 

POWERCHART NAME

VARICELLA ZOSTER ANTIBODY IgG IgM

MERCY TEST NAME

VARIC ZOST IgG IgM*

MERCY LAB CODE

VZGM

Specimen:  1 ml serum from a SST or plain red top tube.
Comment: Includes IgG and IgM results
Processing:  Send in screw-capped, round bottom, plastic vial, refrigerated to Mayo.  Mayo order code VZGM.
Performed: Test set up Monday through Saturday
Reference value: Included with Results
Method:  

IgG: Multiplex Flow Immunoassay (MFI)
IgM: Immunofluorescence Assay (IFA)

CPT Code:  86787 x2

 

TEST NAME

VARICELLA-ZOSTER VIRUS, MOLECULAR DETECTION, PCR

MERCY TEST NAME

MISC. GENERAL LAB

MERCY LAB CODE

CMIS

Specimen: Must indicate specimen source and specify for Varicella-Zoster Virus PCR Mayo test (LVZV) on requisition and specimen label
Fluid:
  • Spinal, body, amniotic, ocular
  • Submit 0.5 mL in sterile container
Misc.:
  • Dermal, eye, nasal, throat
  • Culture swab
Genital:
  • Cervix, vagina, urethra, anal/rectal, other genital sources
  • Culture swab
Respiratory:
  •  Bronchial washing, bronchoalveolar lavage, nasopharyngeal
  • 1.5 mL in sterile container
Tissue:
  •  Brain, colon, kidney, liver, lung, etc.
  • Submit fresh tissue in sterile container with 1 to 2 mL of sterile saline
  • Submit entire collection

 

POWERCHART NAME

NEUTROPHIL CYTOPLASM ANTIBODY VASCULITIS PANEL

MERCY TEST NAME

VASCULITIS ANCA PANEL*

MERCY LAB CODE

VAPNL

Specimen:  1.0 mL serum from a plain red top tube.
Processing: 
Send refrigerated to Mayo.  Mayo order code  VASC.
Performed: Monday through Saturday
Reference value:
Reference ranges included with results.
Method:  

Multiplex flow immunoassay.

CPT Code:  83516  Myeloperoxidase antibodies
83516  Proteinase 3 Antibodies
86255  Cytoplasmic Neutrophil Antibodies (ANCA) Screen - if appropriate
86256  Cytoplasmic Neutrophil Antibodies (ANCA) Titer - if appropriate.

 

TEST NAME

VDRL, serum

See:   SYPHL

 

POWERCHART NAME

VDRL CSF QUALITATIVE

MERCY TEST NAME

VDRL CSF*

MERCY LAB CODE

VDRC

Specimen: 0.5 ml spinal fluid in a CSF tube.
Processing:  Send frozen to Mayo.  Mayo order code VDSF.
Performed:  1-3 days.  Test set up Monday through Friday 12 p.m..
Reference value:  Included in report.
Method:    Flocculation/Agglutination
CPT Code: 86592

 

TEST NAME

Venous Blood Gas

See:   Blood Gas Analysis



 

POWERCHART NAME

CULTURE VIRUS NON-RESPIRATORY

MERCY TEST NAME

NON RESP VIRUS*

MERCY LAB CODE

VRSNR

Order:

Specify site when ordering.

Specimen:

Body Fluid or Cerebrospinal Fluid (CSF): Send 1.0 mL in a sterile screw-capped vial. Send to Mercy lab immediately.

Ocular or Rectal swabs: Collect sample on a Dacron-tipped swab with a plastic handle. Place swab in M5 transport media. Send to Mercy lab immediately.

Stool: 5 – 10 g of stool. Collect in a sterile screw-capped container. Send to Mercy lab immediately.

Tissue (Brain, Colon, Kidney, Liver): Place tissue in 1-2 mL of sterile saline in a sterile screw-capped container or use a M5 transporter. Send to Mercy lab immediately.

Urine (Acceptable for Mumps testing ONLY): Collect 0.5 mL of urine in a sterile screw-capped container. Send to Mercy lab immediately AND clearly indicate on order form and container label "mumps."
 
Dermal (any sort of skin lesion) and Oral (Acceptable for Enterovirus ONLY): Collect specimen on a Dacron-tipped swab with plastic handle.  Place swab in M5 viral transport media AND clearly indicated on order form and container label "Enterovirus" or "Hand, Foot and Mouth Disease."

Comments:

Blood, Bone marrow, Genital, and Respiratory specimens are not acceptable for viral culture.
Dermal or oral specimens for hand-foot-and-mouth disease or enterovirus must clearly indicate this on the order.

  1. Urine and Bone Marrow: specimens for CMV are not acceptable for viral culture. See Mayo test (LCMV) by Rapid PCR.
  2. Dermal (any sort of skin lesion): viral testing other than Enterovirus, must specify and order the following:
    For BOTH HSV-Herpes Simples Virus by PCR and VZV-Varicella-Zoster by PCR,  Mayo test (LHSVZ).
    For only VZV- Varicella-Zoster Virus by PCR, Mayo test (LVZV).
    For only  HSV-Herpes Simpex Virus by PCR, Mayo test (LHSV).
  3. Genital specimens: must order Mayo test (LHSV).
  4. Respiratory specimens: must order Mayo test (VRESP).
  5. Oral Specimens: viral tseting other than Enterovirus, must order Mayo test (LHSV).

RL Client Comments:

  • Write VIRUS CULTURE, NON-RESPIRATORY (Mayo order code-VIRNR) on order form. Indicate specimen source.
  • Send ALL specimens refrigerated to Mercy lab.

Processing:

Deliver to the lab immediately or refrigerate specimen. Send refrigerated to Mayo.  Mayo order code-VIRNR.

Performed:

Test setup daily, Final report 2 weeks.

Reference Value:

Included in report.
(If positive, virus is identified)

Method:

Cell culture

CPT Code:

87252 Tissue Culture Inoculation
87254 Shell vial (if appropriate)
87176 Homogenization, tissue (if appropriate)

 

POWERCHART NAME

CULTURE VIRUS RESPIRATORY

MERCY TEST NAME

RESP VIRUS*

MERCY LAB CODE

VRSRSP

Order:

Specify collection site when ordering.

Specimen:

Throat Swabs: Collect specimen on a routine culturette. Dacron-tipped swab with plastic handle is acceptable. Send culturette to Mercy lab immediately.

Sputum, Bronchoalveolar lavage, Bronchial washings, Tracheal aspirate or Secretions, Nasal washings: Collect 1.0 mL of specimen. Place specimen in a sterile screw-capped container. Send to Mercy lab immediately.

Tissue (Lung and others): Place the tissue specimen in 1-2 mL sterile saline in a sterile screw-capped container or use a M5 transporter (green cap). Send to Mercy lab immediately.

Mumps testing , swab specimens for Mumps must clearly indicate "MUMPS" on request form to insure proper handling and test setup.

Comments:

Oral specimen is not acceptable for respiratory viral culture (unless parotid gland, secretion or client requests enterovirus). Clients with oral specimens for suspected hand-foot-and-mouth disease or enterovirus must order Mayo test ( VIRNR)  Viral Culture, Non-Respiratory and clearly indicate enterovirus on order and specimen label.

RL Client Comments:

  1. Write VIRAL CULTURE, RESPIRATORY (Mayo order code-VRESP) on order form. Indicate specimen source.
  2. Send ALL specimens refrigerated to Mercy lab.

Processing:

Deliver to the lab immediately or refrigerate specimen. Send refrigerated to Mayo.  Mayo order code-VRESP.

Performed:

Test setup daily, Final report 2 weeks.

Reference Value:

Included in report.
If positive, virus is identified

Method:

Cell culture

CPT Code:

87252 Tissue Culture Inoculation
87254 Shell vial (if appropriate)
87176 Homogenization, tissue ( if appropriate)

 

POWERCHART NAME

VISCOSITY

MERCY TEST NAME

VISCOSITY SERUM*

MERCY LAB CODE

VSCT

Specimen:  1.5 ml serum from a red top tube.  Keep specimen at 37°C until after centrifugation and separation of cells.
Processing:  Send to Mayo.  Mayo  order code VISCS.
Performed:  1-3 days.  Test set up Monday through Friday; continuously until 2 p.m.
Reference value:  Included in report.
Method:  Sonoclot Coagulation Analyzer.
CPT Code: 85810

 

TEST NAME

VitagelTM  or   VitaPrepTM

Same Day Surgery, Holding, or Surgery will call the Lab to assist with the collection of a specimen in a special syringe provided by surgery, VitaPrepTM syringe.  The special syringe contains sodium citrate and is used to collect 10 cc of the patient's blood.   There is a special cap for the syringe and the syringe should be recapped following the specimen collection.   After collection, verify that the syringe is labeled with the patient's name and medical record number.  Then hand the syringe to nursing personnel and they are responsible for processing the specimen.  There is no Lab order for this blood draw.

If other lab work is needed, draw the VitaPrepTM syringe last.

 

POWERCHART NAME

VITAMIN A (Retinol) LEVEL

MERCY TEST NAME

VITAMIN A*

MERCY LAB CODE

VITA

Specimen:  0.5 mL serum in amber vial.
Collection:
  • Specimen must be collected in a plain red top tube following an overnight (12-14 hr) fast.
  • Patient may not consume alcohol or injest any vitamin supplements for 24 hours prior to collection
  • Infants - draw prior to next feeding.
  • Protect specimen from light
Processing: 

Send serum refrigerated in an amber vial.   Mayo order code  VITA.

Cause for Rejection: Specimen collected in serum gel tubes are not accepted.
Performed: Monday through Friday; first shift
Method: Liquid Chromatography-Tandem mass Spectrometry (LC-MS/MS)
CPT Code: 84590

 

POWERCHART NAME

VITAMIN B1 (THIAMIN) WHOLE BLOOD

MERCY TEST NAME

THIAMIN VIT B1*

MERCY LAB CODE

VB1

Specimen:  4 mL Whole Blood from a EDTA tube following an overnight (12 hour) fast.  Immediately place specimen on wet ice and protect from light by wrapping specimen in aluminum foil.
Processing: 

Maintain specimen on wet ice and process within 4 hours of draw.  Process by transfering whole blood into amber vial to protect from light. Specimen must be frozen within 4 hours of collect time. Mayo TDP.

RL Clients:  If you do not have amber vial, specimen may be frozen in EDTA tube and tube wrapped in aluminum foil.

Cause for Rejection: Specimens other than whole blood.  Specimens not protected from light.
Performed: Monday through Friday.
Reference value:

Reference ranges included with result

Method: High-Performance Liquid Chromatography (HPLC) with Flourescence
CPT Code: 84425 Vitamin B1

 

POWERCHART NAME

VITAMIN B12 LEVEL

MERCY TEST NAME

VITAMIN B12

MERCY LAB CODE

B12

Specimen:  0.5 ml serum from a SST tube or heparin plasma from a PST tube. Aliquot specimen.
Comment: 

Collect before blood transfusion.

Intrinsic Factor (Mayo test IFBA) will be reflex ordered and charged on all specimens with a B12 less than 180 pg/mL

 

Cause for rejection: Hemolyzed specimen not acceptable.
Processing: 

Keep all SST and PST tubes upright.  Any inverted spun SST/PST tubes must be aliquoted and re-centrifuged. Stable 8 hours at room temperature.  Stable 24 hours refrigerated.  Freeze if testing is not completed within 24 hours of collection.

Regional Lab Clients:
  Send in separate aliquot tube, not SST tube. Freeze if not received at Mercy Medical Center - North Iowa Laboratory within 24 hours of collection.

NOTE:  Folate must be must be Frozen if specimen will not be analyzed within 8 hours of collection.

Performed: Within 8 hours of receipt.
Reference value:

Male & Female: 180-914 pg/mL
Indeterminate Range: 146 - 179 pg/mL
Deficient Rance: 0 - 145 pg/mL

Method: Competitive Binding Immunoassay Chemiluminescent
CPT Code: 82607 Vit B12

 

POWERCHART NAME

VITAMIN B12 AND FOLATE LEVEL

MERCY TEST NAME

VIT B12 FOLATE

MERCY LAB CODE

B12F

Specimen:  0.5 ml serum from a SST tube or heparin plasma from a PST tube.  Aliquot specimen. Specimen must be collected prior to blood transfusion.
Comment:

Collect before blood transfusion.   Folate should not be ordered for patients who have recently received a radioisotope, methotrexate, or other folic acid antagonist. If adequate amount of specimen and the result is below the reference range.

Folate reference range based on populations with folic acid fortification of foods.  Deficient folate concentrations are considered to be less than 4ng/mL.

Intrinsic Factor (Mayo test IFBA) will be reflex ordered and charged on all specimens with a B12 less than 180 pg/mL

Cause for rejection: Hemolyzed specimen not acceptable.
Processing:

Keep all SST/PST tubes upright.  Any inverted spun SST/PST tubes must be aliquoted and re-centrifuged. Stable 8 hours refrigerated. 
Freeze if testing is not completed within 8 hours of collection.

Regional Lab Clients:
   Freeze if not received at Mercy Medical Center - North Iowa Laboratory within 8 hours of collection.

Performed:  Within 8 hours of receipt.
Reference value:

Vitamin B12  Male & Female: 180 - 914 pg/mL
Folate  Male & Female:  5.9->24.8 ng/mL
Indeterminate Range B12: 146 - 179 pg/mL
Deficient Range B12: 0 - 145 pg/mL

Method:     Competitive Binding Immunoassay Chemiluminescent
CPT Code:

82607 Vit B12+
82746 Folate+

 

POWERCHART NAME

VITAMIN D 25 HYDROXY LEVEL

MERCY TEST NAME

VIT D, 25-HYDROXY*

MERCY LAB CODE

VD25H

Comment: Total 25-Hydroxyvitamin D (Sum of  D2 + D3)
Specimen: 

1 ml serum from SST gel or serum aliquoted from plain red tube.   Plasma from Na or Li heparin tubes also acceptable.
Minimum volume is 0.50 ml.

Processing:   Specimen is to be sent refrigerated. 
Performed: Daily
Reference Value:

10-24 ng/mL (mild to moderate deficiency)
25-80 ng/mL (optimum levels)
>80 ng/mL (toxicity possible)

Method: CMIA.
CPT Code:

82306 

 

POWERCHART NAME

VMA URINE

MERCY TEST NAME

VMA 24 UR*

MERCY LAB CODE

VVMA

Comment:

This assay is of most value when the specimen is collected during a hypertensive episode.  For children 14 years old and younger, Mayo order code VH (VMA and Homovanillic Acid, Pediatric uring) is the recommended test.

A single 24-hour urine collection may be used for CATECHOLAMINE FRACTIONATION, METANEPHRINES [METN24U] and VMA [VMA24UR].    The specimen must be kept refrigerated during collection.

Patient preparation:

Amoxicillin interferes.  Discontinue for 3 days prior to collection.
The drug Mandelamine interferes with the test procedure and should be discontinued 48 hours prior to collection of the specimen.

Specimen:

 Before start of collection, add 25 ml 50% acetic acid preservative to the container (15 ml 50% acetic acid for children Refrigerate during collection.

Reference Lab Adjust pH to 2.0-4.0 with 50% acetic acid.  Aliquot 20 ml and indicate the 24-hour volume.
Processing:

Separate aliquots must be submitted for Metanephrines and Catecholamines if collected with this specimen.  Identify which specimen is for VMA. Mayo order code  VMA.

Performed: 2 days.  Test set up Monday through Saturday.
Mercy lab Processing: Send 5 ml in a 13 ml urine tube to Mayo refrigerated.
Reference value:    Included on report.
Method: Liquid Chromatography-tandam mass spectrometry (LC-MS/MS)
CPT Code: 

84585 VMA UR+

 

POWERCHART NAME

FACTOR VIII VON WILLEBRAND ANTIGEN

MERCY TEST NAME

VON WILL FACT AG*

MERCY LAB CODE

VONW

Specimen: 1 ml plasma from blue top tube filled appropriately with amount of blood listed on the label.
Processing:

Centrifuge, remove plasma, spin plasma again, aliquot to a new plastic tube.  Freeze plasma in plastic vial.  Send frozen to Mayo. Order VonWillebrand Antigen  Mayo order code  VWAG..
Complete a “Mayo Additional Test Information Form
(Fill out the Coagulation portion of this form), or a “Coagulation Form” and send with the specimen. 
 

Double spin coagulation specimens to ensure that all platelets are removed:     1.  Centrifuge specimen.  Aliquot plasma (leaving some above the cells) to a plastic centrifuge tube.   2.  Centrifuge the aliquot tube.  Pipette plasma (leaving some above the bottom of the tube) to another plastic aliquot tube.   3.  Store plasma as required for the test ordered.

Performed: 3 days.  Test set up Monday through Saturday.
Reference value:  Included on report.
Method: Automated Latex Immunoassay (LIA)
CPT Code:  85246
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