Reference Lab

TEST NAME ABDOMINAL FLUID CYTOLOGY See: Cytology Section Peritoneal Fluid
POWERCHART
ABO + RH(D) BLOOD TYPING
NAME
MERCY TEST NAME ABO GROUP/RH TYPE MERCY LAB CODE ABRX
Includes: Includes ABO group and Rh type. ABO and Rh are not ordered separately.
Included In: Type & Screen, Crossmatch, Prenatal Profile, Cord Blood Routine, and RHIG Evaluation.
Specimen: o Preferred in house: One 6 ml pink (EDTA) top tube.
o Preferred reference lab; One 6 ml pink (EDTA) top tube.
o Also acceptable: purple top (EDTA) whole blood in original tube.
Stability: 3 days refrigerated.
Performed: Within 8 hours of receipt. Available stat.
Method: Serological
CPT Code: o ABO+ 86900
RH+ 86901
TEST NAME ABG (ARTERIAL BLOOD GASES) Done by Cardio-Vascular & Pulmonary. For capillary
gases see
COLLECTION CHARGE CAPILLARY BLOOD GASES.

POWERCHART ACETAMINOPHEN (TYLENOL) LEVEL
NAME
MERCY TEST NAME ACETAMINOPHEN MERCY LAB CODE ACMN
Specimen: 0.5 ml serum
Specimens may be stored for up to 8 hours at 20-25 °C or stored frozen for up to 45 days at
Stability
-20°C
Therapeutic 10-20 mcg/mL

Range: Refer to the Acetaminophen Concentration Nomogram in the special help section of the LTI.
Method The Atellica CH Acetaminophen (Acet) assay is based on the conversion of acetaminophen by
Description: acyl amidohydrolase to produce p-aminophenol is then converted to a colored complex
produced by reacting with 8-hydroxyquinoline-5-sulfonic acid.
CPT Code: 80143

POWERCHART ACETYLCHOLINE RECEPTOR BINDING ANTIBODY
NAME
MERCY TEST ACET RECP BNDG* MERCY LAB CODE ACHRBA

NAME
Specimen: 2 ml serum from a no additive serum tube or a Serum Separator Tube (SST).
Stability: 28 days refrigerated: 72 hours ambient, frozen OK
Processing: Send refrigerated to Mayo. Mayo order code (ARBI).
Performed: Report available in 3 to 6 days.
Reference value: Included in report
Method: Radioimmunoassay (RIA)
CPT Code: 86041
POWERCHART ACTH Adrenocorticotropic

NAME
MERCY TEST ACTH* MERCY LAB ACTH

NAME CODE
Comment: Morning (0600 – 1030) specimens are desirable.

For the 12 hours before specimen collection do not take multivitamins or dietary supplements
containing biotin (vitamin B7), which is commonly found in hair, skin and nail supplements
and multivitamins.
Specimen: o Draw 5 ml blood into pre-chilled purple top (EDTA) tubes.

o Tubes MUST be ice-cooled before collection.
o Immediately place tubes in ice after collection.
o Immediately separate plasma in refrigerated centrifuge and freeze immediately
Cause for
Severe hemolysis is unacceptable.
rejection:
Processing: Send 1.0 ml plasma frozen to Mayo. Mayo order code (ACTH).
Performed: 4 days. Test set up Monday through Saturday.
Reference value: Included in report.
Method: Electrochemiluminescence Immunoassay
CPT Code: 82024
POWERCHART AFB CULTURE OTHER

NAME
MERCY TEST ACID FAST CLT/SMR* MERCY LAB AFBCLT

NAME CODE
Comment: Specify collection site when ordering.
Specimen: Submit each specimen in a sterile container with a tight-fitting lid.
o Body fluids: Minimum of 5 ml specimen. 60 ml preferred.

o Bronchus washings/brushings: Minimum of 5 ml bronchus washings/brushings.
o Cerebrospinal fluid: 1 ml CSF minimum in a sterile plastic screw cap tube.
o Gastric washings: 1 ml specimen minimum.
o Sputum: Minimum of 5 ml specimen. A first morning specimen is recommended.
o Stool: Submit a pea size sample. No preservative.
o Tissue: Submit a pea size sample. Can be placed in a small amount of saline to
prevent drying out.
o Urine: Minimum of 50 ml of urine. The first morning specimen is recommended.
o Bone Marrow: Send using lithium heparin tubes.
Cause for
Serum is submitted for testing.
rejection:
Processing: o Send to the laboratory immediately after collection.

o Specimens are referred to Mayo Medical Laboratories, Rochester, MN for an AFB
smear and culture.
RL Client
o Write AFB Culture/Smear on the order form. Indicate the specimen source.
Comments:
o Send specimens refrigerated to Mercy lab.
Performed: Smear: Monday through Sunday. Mayo will contact Mercy Lab if positive.
Final: 42 days for negative results. Mayo will notify Mercy Lab if culture is positive prior to 8
weeks.
o If tissue is submitted for testing, an additional charge will be assessed for

processing.
o If a bacteremia due to mycobacterium is suspected, see BLOOD CULTURE/ACID FAST
ORGANISMS
Reference values: AFB smear: No acid-fast organisms seen.
If the smear is positive: Mycobacterium tuberculosis, Amplified Direct
Test is available at an additional charge.
AFB culture: No acid-fast organisms isolated.

If the culture is positive for Mycobacterium: Antimicrobial Susceptibility testing is available at
an additional charge. This testing has to be requested by the ordering location or provider.
Method: AFB smear: Auramine-Rhodamine Stain
AFB culture: Automated Detection plus 7H10-11 agar
Identification of AFB isolates by rapid methods: Nucleic Acid Probes, DNA Sequencing and
Real-Time PCR, when appropriate.
CPT Code: 87206- Smear

87116- Culture, Mycobacterium
87150 - Microbial Probe, Fungus Ident (if appropriate)
87153 - Mycobacteria Ident by Sequencing (if appropriate)
87176- Tissue Processing (if appropriate) 87015 - Mycobacteria Culture, Concentration (if
appropriate)
POWERCHART AG RATIO (Albumin Globulin Ratio)

NAME
MERCY TEST NAME AG RATIO MERCY LAB CODE AG
Stability: N/A
Comment: AG Ratio is a calculation and not orderable by itself. Included in CMPL, GHP, HFPL, NUTP,
DPNL

Reference range: 1.0-2.3
Method
Calculation
Description:
CPT Code: N/A
POWERCHART ALBUMIN LEVEL

NAME
MERCY TEST NAME ALBUMIN MERCY LAB ALB

CODE
Specimens may be stored for up to 3 days at 2-8°C or stored frozen for up to 30 days at -
Stability:
20°C.
Comment: Do not use hemolyzed samples
Performed: Within 8 hours of receipt. Available Stat.
Reference Range: 0 - 30 days 2.9 - 5.5 g/dl

1 - 3 months: 2.8 - 5.0 g/dl
4 - 11 months: 3.9 - 5.1 g/dl
1 - 59 years: 3.5 - 5.0 g/dl
60 - 79 years: 3.2 - 4.8 g/dl
> 79 years: 3.1 - 4.6 g/dl
Method The Atellica CH Albumin BCP (AlbP) assay is an adaptation of the bromocresol purple (BCP)
Description: dye-binding method
CPT Code: 82040
POWERCHART ALCOHOL (ETHANOL) LEVEL

NAME
MERCY TEST NAME ALCOHOL ETHYL BLD MERCY LAB CODE ALCO
Specimens must be stored in capped or sealed containers. Specimens may be stored for up
Stability: to 2 days at room temperature. Serum may be stored for up to 2 weeks at 2-8°C or
indefinitely when stored frozen at -20oC or indefinitely when stored frozen at -20oC or below.
Comment: Laboratory personnel will not draw legal alcohols, if a legal issue is involved, refer to Nursing
Supervisor.
Reference Range: <10 mg/dL

Method: The Atellica CH Ethyl Alcohol (ETOH) assay is based on an enzymatic reaction. Reagent 1
contains the buffering system. Reagent 2 contains alcohol dehydrogenase (ADH), the
coenzyme nicotinamide adenine dinucleotide (NAD), buffer, acetaldehyde. During this
reaction, NAD is reduced to NADH.
CPT Code: 82077
POWERCHART ALDOLASE
NAME
MERCY TEST NAME ALDOLASE* MERCY LAB CODE ALDL
Specimen: 1 ml serum from a no additive serum tube. (0.5 ml minimum)

Cause for
Hemolysis, lipemia, and icterus
rejection:
Processing: Send refrigerated to Mayo. Frozen acceptable.
Mayo test order code ALS
Performed: 1-3 days. Test set up Monday through Saturday.
Reference value: Included with test results.
Method: Photometric
CPT Code: 82085
POWERCHART ALDOSTERONE LEVEL

NAME
MERCY TEST NAME ALDOSTERONE* MERCY LAB CODE ALDS
Specimen: o 1.2 ml serum from a Serum Separator Tube (SST) or a no additive serum tube. 0.6
ml minimum.
o Collect at 0800. 8 a.m. draw time (after the patient is active for 2 hours) is
recommended; preferably no later than 10 a.m. This is the preferred time because
of normal range but will accept other times.
o Specify specimen source as multiple specimens may be collected during a
procedure
Processing: Send frozen to Mayo. Refrigerated and ambient acceptable. Mayo order code (ALDS).
Performed: Monday - Friday
Reference value: Included with report
Method: Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS)

CPT Code: 82088
POWERCHART ALDOSTERONE 24 HOUR URINE

NAME
MERCY TEST NAME ALDOSTERONE, 24UR* MERCY LAB CODE ALDOU
Includes: Aldosterone, Urine Collection Duration, Urine Volume

Comment: o Add 25 ml of 50% Acetic Acid as preservative at start of collection.
o Children
o Keep Refrigerated.
o Addition of preservative may occur within 4 hours of completion of collection.
Cause for
pH of aliquot is outside of the range of 2.0 – 4.0.
Rejection:
Processing: o 10 ml in a 13 ml aliquot tube from a measured 24 -hour specimen. 1 ml minimum.
o Record 24-hour volume on aliquot.
o Send refrigerated. Frozen acceptable. Ambient acceptable with preservative. Mayo
order code (ALDU).
Performed: Monday, Thursday; 3 p.m.
Reference Value: Included with test results.
Method: Liquid Chromatography/Tandem Mass Spectrometry (LC-MS/MS)
CPT Code: 82088
POWERCHART ALKALINE PHOSPHATASE

NAME
MERCY TEST NAME ALK PHOS MERCY LAB CODE ALKP
Specimens may be stored for up to 8 hours at 25°C or for up to 7 days at 2–8°C or stored
Stability:
frozen for up to 6 months at -20°C or colder.
Comment: Avoid repeated freezing and thawing.
Reference Range: Female: Male:

4 yrs. 169-372 units/L 4 yrs 149-369 units/L
13 yrs 120-449 units/L 13 yrs 182-587 units/L
17-23 yrs 52-144 units/L 17 yrs 69-311 units/L
24-45 yrs 37-98 units/L 18 yrs 52-222 units/L
46-50 yrs 39-100 units/L >19 yrs 45-115 units/L
51-55 yrs 41-108 units/L
56-60 yrs 46-118 units/L
61-65 yrs 55-142 units/L
Method The Atellica CH Alkaline Phosphatase, concentrated (ALP_2c) assay is based on the primary
Description: reference procedure for the measurement of catalytic activity of alkaline phosphatase at
37°C as described by the International Federation of Clinical Chemistry (IFCC).
CPT Code: 84075
POWERCHART ALKALINE PHOSPHATASE BONE SPECIFIC

NAME
MERCY TEST NAME BONE ALK PHOS* MERCY LAB CODE BALP
Specimen: 0.6 ml serum from a Serum Separator Tube (SST) or a no additive serum tube. 0.5 ml
minimum
Cause for Hemolyzed and/or Lipemic specimens are unacceptable.
Rejection:
Processing: Send refrigerated to Mayo. Frozen acceptable.
Mayo test order code BAP.
Performed: 1 - 3 day(s). Test performed Monday through Friday 5 a.m.-midnight, Saturday 6 a.m.- 6 p.m.
Method: Immunoenzymatic Assay
CPT Code: 84080 Bone Alkaline Phosphatase
POWERCHART ALKALINE PHOSPHATASE ISOENZYMES

NAME
MERCY TEST NAME ALK PHOSPH ISO MERCY LAB CODE ALKI
Includes: Total Alkaline Phosphatase; Bone, Intestine and Liver Isoenzymes.

Specimen: o 1.0 ml serum from a Serum Separator Tube (SST) or a no additive serum tube.
Send two 0.5 ml aliquots of serum frozen in plastic vials.
o Minimum: 0.5 ml divided into 2 tubes each containing 0.25 ml.
Cause for
Hemolyzed specimens are unacceptable.
Rejection:
Processing: Send frozen to Mayo. Refrigerated acceptable. Mayo (ALKI).
Performed: 2-4 days. Test performed Monday through Friday.

Reference value: Included with report.
Method: Photometric, P-Nitrophenyl Phosphate
Electrophoresis, Densitometry
CPT Code: 84080 Alk Phos Isoenzymes

84075 Alk Phos Total
TEST NAME ALLERGEN MULTIPLE SCREEN*
MERCY TEST MISC GENERAL LAB MERCY LAB CODE CMIS

NAME
Comment: The multiple allergen screen is a very sensitive first-order test for allergic disease.
Also includes Immunoglobulin E testing.
Send 1 miscellaneous chemistry order for each multiple allergen screen requested, putting
allergen screen name in comment field.
(Example: you would need 1 order for major molds allergen screen, another order for dairy
allergen screen, etc...)
Please contact the Lab if you need help to determine which allergen screen is appropriate or
need to know what specific allergens are being tested in a particular allergen screen.
Mayo offers the following multiple allergen screens:

Geographical area panels for trees, grasses, and weeds. Seasonal recommendations are
provided by Mayo. Food panels include dairy, fish, grains, meats, nuts, seafood.
Other significant allergen groups including molds, household, epithelia groupings.
Specimen: 0.5 ml serum (enough for 1 multiple allergen screen) from a SST tube.
Minimum volume calculation: (0.05ul x # of allergens) + 0.25 ul
Processing: o See Mayo catalog or Special Helps section of Lab Test Index for special instructions
for specific Mayo ordering numbers for each allergen group.
o Mayo requests that each allergen screen is to have its own Mayo number.
o Send a separate vial of serum for each allergen screen ordered.
o Send refrigerated to Mayo.
POWERCHART RAST ALLERGEN

NAME
MERCY TEST NAME ALLERGEN IGE* MERCY LAB CODE ALRG
Comment: This test is useful principally to confirm the Allergen specificity in patients with clinically
documented allergic disease.
Please note:
This test is for a specific allergen requested. (Such as alfalfa grass or corn grass or birch tree,
etc.) If the doctor is looking to see if the patient is allergic to grasses or trees, etc., then an
allergen multiple screens should be ordered. Call Lab for help in ordering.
Send 1 order per specific allergen requested. Designate specific allergen to be tested. Refer
to Special Helps Section of the Lab Test Index for a complete list of allergens available
for testing and their corresponding test order codes.
Specimen: 0.5 ml serum from a Serum Separator Tube (SST) or no additive serum tube
Processing: o See Mayo catalog, special instructions for specific Mayo ordering numbers for each
allergen.
o Send refrigerated to Mayo.
o Mercy Lab staff will order on Mayo Access.
Performed: 1 day. Test set up Monday through Friday.
Method: Fluorescence Enzyme Immunoassay (FEIA)
CPT Code: 86003
MERCY TEST ALLERGY FOOD PED 6* MERCY LAB CODE ALRG6

NAME
Comment: This profile includes, egg whites, milk, cod fish, wheat, peanut, and soybean.
Specimen: 1.5 ml serum from a Serum Separator Tube (SST) or no additive serum tube.
Processing: Send refrigerated to Mayo.
Mayo test order code (PR207).
Performed: 1-5 days. Test set up Monday through Friday.
CPT Code: 86003 x6
MERCY TEST ALLERGY FOOD 12* MERCY LAB CODE ALRG12

NAME
Comment: This profile includes, egg whites, milk, cod fish, wheat, peanut, soybean, melon, tomato,
banana, baker's yeast, egg yolk and apple.
Mayo test order code (PR350).
CPT Code: 86003 x12
MERCY TEST ALLERGY PROFILE 15* MERCY LAB CODE ALRG15

NAME
Comment: This profile includes cat epithelium, dog epithelium, house dust mites DP, house dust mites
DF, Alternaria tenuis, giant ragweed, short ragweed, timothy grass, silver birch, mugwort,
epicoccum purpurascens, corn pollen, box elder/maple, oak and Johnson grass.
Mayo test order code (PR894)
CPT Code: 86003 x15
TEST NAME ALLERGEN PROFILE 138 MERCY LAB CODE PR138
Comment: This profile includes English Plantain, Epicoccum purpurascens, Firebush (Kochia),
Helminthosporium halodes, Lamb's Quarter, Mugwort
Mayo test order code (PR138)
CPT Code: 86003 x7
POWERCHART ALPHA FETOPROTEIN MATERNAL

NAME
MERCY TEST NAME SINGLE MARKER AFP* MERCY LAB CODE SMAFP
Specimen: 1 ml serum from a Serum Separator Tube (SST) (Preferred) or no additive serum tube also
acceptable. Spin down immediately
Comment: o To be run between the 15th and 22nd gestational week.
o The Mayo information form must be completed and sent with the
patient/specimen.
o Forms available from the Laboratory or from the intranet LTI - Special Helps
Section. AFP Form.
o Do not collect specimen after amniocentesis as this could affect results.
Processing: o 1.0 ml serum refrigerated to Mayo. Frozen and ambient also acceptable.
o Mayo test order code (MAFP1).
o Must send the Mayo AFP form with the specimen.
Performed: 1-3 days Monday through Friday
Reference value: Included with test results
Methods: Two-Site Immunoenzymatic (Sandwich) Assay
CPT Code: 82105 – AFP
POWERCHART ALPHA FETOPROTEIN QUAD TEST

NAME
MERCY TEST QUAD SCRN 2ND TRI* MERCY LAB CODE QUADM
NAME
Specimen: 1 ml serum from a Serum Separator Tube (SST) (Preferred) or no additive serum tube. Spin
down immediately.
Comment: o Do not collect specimen after amniocentesis as this could affect results.
o To be run between the 15th and 22nd gestational week.
o Assessments for trisomy 21 (Down Syndrome) and Trisomy 18 (Edwards syndrome)
are only available between 14 weeks and 22 weeks.
oThe Mayo information form must be completed and sent with the
patient/specimen. Forms available from the Laboratory or from the intranet LTI -
Special Helps Section. AFP Form.
o Initial or repeat testing is determined in the laboratory at the time of report and will
be reported accordingly. To be considered a repeat test for the patient, the testing
must be within the same pregnancy and trimester, with interpretable results for the
same test, and both tests are performed at Mayo Clinic.
Processing: o 1.0 ml serum refrigerated (Preferred) to Mayo. Frozen and ambient also
acceptable.
o Mayo test order code (QUAD1).
o Must send the Mayo AFP form with the specimen.
Performed: 1-4 days, Monday through Friday
CPT Code: 81511
POWERCHART ALPHA FETOPROTEIN TUMOR MARKER

NAME
MERCY TEST AFP TUMOR MARKER MERCY LAB CODE AFPT

NAME

Specimens that are tightly capped may be stored at room temp for less than 8 hours or
Stability: refrigerated at 2–8°C. Freeze samples at ≤ -20°C if the assay is not completed within 48 hours.
Freeze samples only 1 time and mix thoroughly after thawing.
Comment: Keep tubes capped at all times. Do not use specimens that have been stored at room
temperature for longer than 8 hours.
Reference
0.0-9.0 ng/mL
Range:
Method The Atellica IM AFP assay is a 2-site sandwich immunoassay using direct chemiluminescent
Description: technology
CPT Code: 82105
POWERCHART ALPHA-1 ANTITRYPSIN

NAME
MERCY TEST ALPHA1 ANTITRYP* MERCY LAB CODE ALPA

NAME
Specimen: 1 ml serum from a Serum Separator Tube (SST) or a no additive serum tube
Processing: Send refrigerated to Mayo. Frozen or ambient acceptable.
Mayo test order code AAT
Note: **Included in Alpha-1 Antitrypsin Phenotype testing Mercy Lab Code ALAN, do not order both.
Performed: Test set up Monday through Saturday.
Method: Rate Nephelometry
CPT Code: 82103
POWERCHART ALPHA-1 ANTITRYPSIN PHENOTYPE

NAME
MERCY TEST NAME ALPH1 ANTITRYP PHEN* MERCY LAB CODE ALAN
Specimen: 1.25 ml serum a no additive serum tube. Serum from a SST is also acceptable.
Processing: Send refrigerated to Mayo. Frozen or ambient acceptable.
Mayo test order code A1APP
Note: **Do not order ALPHA - Alpha-1 Antitrypsin in addition to this order, it would be a duplicate.
Alpha-1 Antitrypsin is included in this ALAN - Alpha-1 Antitrypsin Phenotype testing.
Performed: 2-6 Days; Monday through Friday.
Method: Isoelectric Focusing: Nephelometry
CPT Code: 82103 - Alpha-1 Antitrypsin
82104 - Alpha-1 Antitrypsin Phenotype
POWERCHART ALT/SGPT
NAME
MERCY TEST NAME ALT MERCY LAB CODE ALT

Separated specimens may be stored for up to 7 days at 2–8°C or stored frozen for up to 30
Stability:
days at -20°C or colder.
Comment: Avoid repeating freezing and thawing. Venipuncture should occur prior to Sulfasalazine
administration due to the potential for falsely depressed results.
Reference Range: 10-49 Units/L
Method The Atellica CH Alanine Aminotransferase (ALT) assay is based on a reaction initiated by the
Description: addition of α-Ketoglutarate as a second reagent. The concentration of reduced nicotinamide
adenine dinucleotide (NADH) is measured.
CPT Code: 84460
POWERCHART ALUMINUM LEVEL

NAME
MERCY TEST NAME ALUMINUM SERUM* MERCY LAB CODE ALUM
Specimen: o 1.2 ml serum from a navy blue top no additive trace metal tube. 0.3 ml minimum.
o Always draw this tube first if multiple tubes are being drawn.
o Use alcohol, not iodine to cleanse venipuncture site.
o If a syringe is needed, use only Mayo blue-labeled metal-free polypropylene
syringe.
Cause for
The use of other tubes is unacceptable.
rejection:
Processing: o Allow to clot well.
o After centrifugation, pour (DO NOT use transfer pipette or wooden sticks) serum
into blue-labeled 5ml Mayo metal-free, screw-capped polypropylene vial.
o Send refrigerated to Mayo. Ambient and frozen also acceptable.
o Mayo test order code AL
o If specimen will be stored more than 48 hours, send frozen.
Performed: 1-5 days. Wednesday, Friday, 5 p.m.
Method: Dynamic Reaction Cell-Inductively Coupled Plasma-Mass Spectrometry

CPT Code: 82108
POWERCHART AMIKACIN LEVEL PEAK

NAME
MERCY TEST NAME AMIKACIN PEAK* MERCY LAB AMIKP

CODE
Specimen: o 0.5 ml serum from a Serum Separator Tube (SST) or no additive serum tube.
o Specimen should be drawn 30 to 60 minutes after last dose. Spin specimen down
within 2 hours of draw. Send serum specimen in a plastic vial
Mayo Test
Mayo order code (PAMIK).
number/Code:
RL Comment: Send specimen refrigerated to Mercy Lab. Frozen and Ambient specimens are acceptable.
Processing: Send 0.5 ml serum refrigerated to Mayo.
Performed: 1 day. Monday through Sunday; continuously

Reference: Included with results.
Method: Kinetic interaction of microparticles in solution (KIMS).
CPT Code: 80150
POWERCHART AMIKACIN LEVEL

NAME
MERCY TEST NAME AMIKACIN RANDOM* MERCY LAB AMIKR

CODE
Specimen: o 0.5 ml of serum from a Serum Separator Tube (SST) or no additive serum tube.
o Spin specimen down within 2 hours of draw. Send serum specimen in a plastic vial.
Mayo Test
Mayo order code (RAMIK).
number/Code:
RL Comment: Send specimen refrigerated to Mercy Lab. Frozen and ambient specimens are acceptable.

CPT Code: 80150
POWERCHART AMIKACIN LEVEL TROUGH
NAME
MERCY TEST NAME AMIKACIN TROUGH* MERCY LAB CODE AMIKT
Specimen: o 0.5 ml of serum from a Serum Separator Tube (SST) or no additive serum tube.
o Draw blood immediately before next scheduled dose. Spin specimen down within
2 hours of draw. Send serum specimen in a plastic vial.
Mayo Test
Mayo order code (TAMIK).
number/Code:
RL Comment: Send specimen refrigerated to Mercy Lab. Frozen and ambient specimens are acceptable.

CPT Code: 80150
TEST NAME AMINOPHYLLINE See: Theophylline
POWERCHART AMIODARONE LEVEL

NAME
MERCY TEST NAME AMIODARONE* MERCY LAB CODE AMDR

Specimen: o 1.5 ml serum from no additive serum tube.
o Gel tube not acceptable (Serum Separator Tube, SST).
o Draw blood no sooner than 12 hours (trough value) after last dose or immediately
before next scheduled dose.
o Centrifuge within 2 hours of draw and aliquot to remove serum from spun RBC's
Comment: Indicate time last dose in comment.
Processing: Send 1.5 ml serum refrigerated to Mayo. Frozen acceptable.
Mayo test code (AMIO).
Performed: 2-5 days. Test set up Monday through Saturday; 4 p.m.

Reference value: Included with results
Method: Liquid Chromatography Mass Spectrometry (LC - MS/MS)
CPT Code: 80151
POWERCHART AMITRIPTYLINE + NORTRIPTYLINE LEVEL

NAME
MERCY TEST NAME AMITRIP NORTRP* MERCY LAB CODE AMNP
Specimen: o 1 ml serum in a no additive serum tube.

o Collect 12 hours after last dose.
o Spin down within 2 hours of draw.
Cause for
Serum from SST tubes.
rejection:
Comment: Indicate time of last dose in comment field.
Alias: Elavil or Pamilar
Processing: o Centrifuge and remove serum within 2 hours after collection.
o Send refrigerated to Mayo. Ambient or frozen also acceptable. Mayo order code
(AMTRP).
Performed: 2 days. Test set up Monday through Friday.
Reference Value: Included with results.
Method: Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS).
CPT Code: 80335/G0480
POWERCHART AMMONIA LEVEL

NAME
MERCY TEST NAME AMMONIA MERCY LAB CODE AMM
Specimen: 0.5 ml plasma from a lithium heparin green top tube. The tube should be completely filled
and placed on ice and centrifuged without delay.
Comment: Serum samples will be rejected. Hemolyzed samples will be rejected. Lipemic or icteric
samples my yield invalid results. Venipuncture should occur prior to Sulphapyridine
administration due to the potential for falsely depressed results.
Venipuncture should occur prior to Sulfasalazine administration due to the
potential for falsely elevated results.
Stability:
Separated specimens may be stored for up to 2 hours at 2–8°C. The tube should be
completely filled, stored tightly capped on ice and centrifuged without delay.
Samples should be analyzed within 30 minutes of centrifugation. Concentrations may more
than double in plasma when stored at room temperature for 6 hours.
Reference Range: 0-14 days 64-107 μmol/L

15-30 days 56-92 μmol/L
> 1 month 16-53 μmol/L
Method The Atellica CH Amm assay is an enzymatic assay that uses glutamate dehydrogenase
Description: (GLDH) and a stabilized NADPH analog. Ammonia reacts with α-ketoglutarate and reduced
cofactor to form L-glutamate and the cofactor. The reaction is catalyzed by glutamate
dehydrogenase.
CPT Code: 82140
TEST NAME AMPHETAMINES See: Drug Abuse Random Urine
MERCY TEST AMPHETAMINES UR* CONFIRMATION MERCY LAB CODE UAMPHT

NAME
Specimen: 20 ml random urine specimen in a 60 mL urine bottle, no preservative
Processing: Send refrigerated to Mayo - Mayo order code (AMPHU).

Performed: Monday - Thursday, Sunday
Method: Liquid Chromatography-Mass Spectrometry (LC-MS/MS).
CPT Code: G0480
POWERCHART AMYLASE
NAME
MERCY TEST NAME AMYLASE MERCY LAB CODE AMY
Stability:
Separated serum specimens may be stored for up to 8 days at room temperature or up to
31 days at 2–8°C6 or stored frozen for at least 1 year at -20°C.
Reference Range: 29-103 U/L
Method The Atellica CH AMY_2 assay uses ethylidene blocked.

Description:
p-nitrophenyl-maltoheptaoside as substrate. The indicator enzyme α-glucosidase, used to
release p-nitrophenol (PNP), is also employed in the assay. The terminal glucose of the
substrate is chemically blocked, preventing cleavage by the indicator enzymes.
CPT Code: 82150

POWERCHART AMYLASE BODY FLUID
NAME
MERCY TEST NAME AMYLASE BF MERCY LAB FAMY

CODE
Specimen: 0.5 ml body fluid
Stability: Specimens may be stored for up to 8 days at room temperature or for up to 31 days at 2–
8°C6 or stored frozen for at least 1 year at -20°C.
Comment: Indicate source in comment field.
Reference Range: No reference range has been established
Method The Atellica CH AMY_2 assay uses ethylidene blocked p-nitrophenyl- maltoheptaoside as
Description: substrate. The indicator enzyme α-glucosidase, used to release p-nitrophenol (PNP), is also
employed in the assay. The terminal glucose of the substrate is chemically blocked,
preventing cleavage by the indicator enzymes.
CPT Code: 82150

POWERCHART AMYLASE ISOENZYMES
NAME
MERCY TEST NAME AMYLASE ISOENZYMES* MERCY LAB CODE AMISO
Specimen: 1 mL serum from a Serum Separator Tube (SST)(Preferred) or no additive serum tube.
Serum gel tubes should be centrifuge within 2 hours of collection. Red-top tubes should be
centrifuged and the serum aliquoted into a plastic vial within 2 hours of collection.
Processing: Send refrigerated (preferred) to Mayo. Ambient or frozen is also acceptable. Mayo order
code (AMISO).
Performed: 1-3 days. Monday through Sunday.
Reference value: Reference ranges included with report.
Method: AMYSE, AMYPA: Colorimetric Rate Reaction; AMYSA: Calculation
CPT Code: 82150 X 2
TEST NAME AMYLASE 12 - HOUR URINE See: Amylase 24-Hour Urine

POWERCHART AMYLASE 24 HOUR URINE
NAME
MERCY TEST NAME AMYLASE 24UR MERCY LAB CODE VAMY
Specimen: o 5 ml from a 24-hour or 12-hour urine collection.

o No preservative needed.
o Refrigerate during collection.
Comment: o A 24-hour collection is the preferred specimen.
o Note in comment if a 12-hour collection is submitted.
o If less than a 12-hour collection, order Amylase Quantitative Urine.
Processing: Aliquot 5 ml and indicate total 24-hour volume. Refrigerate.
Performed:
Within 8 hours of receipt.
Reference value: 120-648 U/24 Hours
Method: Enzymatic Rate
CPT Code: 82150
POWERCHART AMYLASE QUANTITATIVE URINE

NAME
MERCY TEST NAME AMYLASE QUANTITATIVE URINE MERCY LAB CODE XAMY
Specimen: 5 ml urine
Stability: Urine amylase is unstable in acidic urine. Adjust urine to a pH ≥ 7 before storage. Adjusted
urine specimens may be stored for up to 10 days at room temperature6 or for up to 31 days
at 2–8°C.
Comment: Includes Volume (mls) Amylase (U/L)

Collection duration (hours) Calculated Amylase (U/HR)
Reference Value: 5-27 U/hour
Method: The Atellica CH AMY_2 assay uses ethylidene blocked p-nitrophenyl- maltoheptaoside as
substrate. The indicator enzyme α-glucosidase, used to release p-nitrophenol (PNP), is also
CPT Code: 82150
POWERCHART AMYLASE RANDOM URINE

NAME
MERCY TEST NAME AMYLASE R UR MERCY LAB CODE UAMY
Specimen: 5 ml urine
Stability: Adjusted urine specimens may be stored for up to 10 days at room temperature6 or for up
to 31 days at 2–8°C.
Comment: Urine amylase is unstable in acidic urine. Adjust urine to a pH ≥ 7 before storage.
Reference Range: 20-1,500 units/L
Method The Atellica CH AMY_2 assay uses ethylidene blocked p-nitrophenyl-maltoheptaoside as

Description: substrate. The indicator enzyme α-glucosidase, used to release p-nitrophenol (PNP), is also
CPT Code: 82150
TEST NAME ANAEROBIC CULTURE + SMEAR
MERCY TEST ANAEROBIC CLT/GS MERCY LAB CODE ANER

NAME
Order: Specify collection site when ordering.
Specimen: DO NOT USE AEROBIC TRANSPORTER!

A Port-A-Cul Cary Blair tube or Port-A-Cul anaerobic transport vial should be used. Both
transport systems contain an indicator which will turn purple when oxygen is present. DO NOT
USE the transporter if the indicator is purple prior to opening the transporter.
Swab specimens: Embed swab deeply into Port-A-Cul Cary Blair tube and cap tightly. Two
swabs from the same specimen site should be submitted in one transport tube.
Fluid or pus aspirates: Inject specimen into Port-A-Cul vials. DO NOT inject air into vial.
ACCEPTABLE specimens for anaerobic culture:

o Exudates or aspirated pus from deep wounds/abscesses
o Surgical specimens
o Normally sterile body fluids
o Transtracheal aspirates
o Suprapubic urine from:
o Percutaneous bladder aspiration
o Nephrostomy tubes
o Suprapubic catheter
o Genital specimens ONLY as follows:
Cul de sac aspiration

o
o Culdocentesis
o Nasal Sinus (Aspirate)
o Bartholin’s gland inflammation/secretions
o Bronchoscopy secretions (protected specimen brush)
UNACCEPTABLE specimens for anaerobic culture:
o Superficial wounds
o Specimens contaminated with intestinal flora -such as intestinal contents, colostomy
sites, drainage from a pilonidal sinus, or bowel perforations.
o Feces/rectal swabs
o Throat/nasopharyngeal/Endotracheal Swab or Tracheostomy secretions
o Sputum/Bronchoalveolar lavage/Bronchoalveolar wash
o Vaginal/cervical swabs
o Midstream or catheterized urine specimens
o Female: Vaginal/cervical/perineal
o Male: Urethral swabs/prostrate or seminal fluid
Comments: o Specimens will be processed according to site. Only predominant anaerobes will be
reported from cultures contaminated with oral, genital, or intestinal flora.
o Identification to genus and species will only be performed on isolates from blood, CSF
and other normally sterile body fluids.
o Anaerobic susceptibility testing will not be performed. Anaerobic isolates may be
referred to Mayo Laboratories, Rochester, MN for susceptibility testing upon special
request. Contact the Mercy Microbiology Lab for information.
RL Client
o Write ANAEROBIC CULTURE on the order form. Indicate the specimen source.
Comments:
o Send anaerobic transporters at room temperature to Mercy lab.
Performed: Gram stain: Within 8 hours of receipt.
Preliminary report: 2 - 4 days
Final report: 7 days
Reference values: No anaerobes isolated (applies to normally sterile body sites). Varies with site of collection.
Method: Standard culture techniques.

CPT Code: 87205 Gram Stain
87075 Anaerobic Clt
POWERCHART ANGIOTENSIN 1CONVERTING ENZYME (ACE)

NAME
MERCY TEST NAME ANGIOTENS CONV* MERCY LAB CODE ANGV
Patient
Patient must be fasting.
preparation:
Cause for Hemolyzed specimens are unacceptable.
rejection: The use of ACE-inhibiting antihypertensive drugs will cause decreased values.
Mayo test code (ACE).
Reference Value: Included with report
Method: Spectrophotometry
CPT Code: 82164
TEST NAME ANION GAP
Stability: Specimens may be stored for up to 7 days at 2–8°C or stored frozen for up to 30 days at -
20°C.
Comment: Anion gap is a calculation and is not orderable by itself. Included in METB, CMPL, LYTE, GHP,
RPNL, NUTP, TPNL
Reference value: 6 - 16 mmol/L
Method
Calculation
Description:
CPT Code: N/A
TESTNAME ANTIBODY IDENTIFICATION
Comment: To be ordered by Lab only.
Regional Lab Clients: Order Antibody Screen. An antibody identification will be ordered and
charged only if screen is positive. Please see Special Helps Section for further information.
Specimen: Two (2) 6 ml pink top tunes. Refrigerate.

May also be done on an eluate from the patient's red cells or from cord blood red cells.
Cause for
Serum
rejection:
Performed: Within 24 hours of receipt.
Method: Serological
CPT Code: 86870
POWERCHART ANTIBODY SCREEN
NAME
MERCY TEST NAME ANTIBODY SC MERCY LAB CODE ABSN
Specimen: One 6ml pink top tube. Refrigerate.

Included in: Crossmatch, RHIG Evaluation, Type & Screen, or may be ordered separately.
Cause for
Serum
rejection:
Comment: o If RHIG is to be given, RHIG Lot # must be ordered also.
o If antibody screen is positive, Lab will order and charge for an Antibody
Identification.
Reference value: Negative
Method: Serological
CPT Code: 86850
POWERCHART ANTIBODY TITRATION

NAME
MERCY TEST NAME ANTIBODY TITER MERCY LAB CODE ABTT
Specimen: 1-6 ml pink top tube. All tubes must be labeled with the patient's name, date, and medical
record number. Refrigerate.
Cause for
SST tube is unacceptable.
rejection:
Comment: o Blood Bank will order and charge for an Antibody Screen, and if positive, order and
charge for an Antibody Identification if one has not been done within the previous
72 hours.
o Titer will be performed by LifeServe Blood Center if Titer is indicated.
Mercy Medical Center-North Iowa Blood Bank Staff will order and perform an antibody
screen using both solid phase and LIS method. If solid phase antibody screen is positive,
antibody ID will be performed at MMC-NI. After the initial testing is performed at MMC-NI,
the specimen will be forwarded to LifeServe Blood Center if titer is indicated.
Performed: Monday--Friday 1300 cutoff

Method: Serological
CPT Code: 886850/86870/86886(x2)
POWERCHART ANTI ENA ANTIBODY

NAME
MERCY TEST NAME AB EXTRCT NUCLR AG* MERCY LAB CODE ENAE
Specimen: 0.5 ml serum from a no additive serum tube or a Serum Separator Tube (SST) is acceptable.
Processing: Send refrigerated to Mayo. Frozen is acceptable. Mayo order code (ENAE).
Performed: 1-2 days. Monday through Saturday; 4 P.M.
Reference Value: Included in report
Method: Multiplex Flow Immunoassay
CPT Code: 86235 x6
TEST NAME ANTIMULLERIAN HORMONE
MERCY TEST ANTIMULLERIAN HORM* MERCY LAB CODE AMH

NAME
Patient For 12 hours before specimen collection do not take multivitamins or dietary supplements
Preparation: containing biotin (Vitamin B7), which is commonly found in hair, skin, and nail supplements
and multivitamins
Processing: Send refrigerated to Mayo. Ambient and Frozen are also acceptable.
Mayo order code (AMH1).
Performed: Report available in 1-3 days.
Method: Electro chemiluminescent Immunoassay (ECLIA)
CPT Code: 82166
TEST NAME ANTINUCLEAR ANTIBODY SCREEN
MERCY TEST ANTINUCLEAR AB* MERCY LAB CODE ANA2S

NAME
Processing: Send refrigerated to Mayo. Ambient and Frozen are also acceptable.
Mayo order code (ANA2).
Performed: 1 day. Testing performed Monday through Saturday.
Method: Enzyme-Linked Immunosorbent Assay (ELISA)
CPT Code: 86038
TEST NAME ANTINUCLEAR AB HEP-2 SUBSTRATE
MERCY TEST ANA HEP2 SUBSTRATE* (ANA titer) MERCY LAB CODE ANAH2
NAME
Processing: Send refrigerated to Mayo. Frozen is also acceptable.
Mayo order code (NAIFA).
Performed: 1 day. Testing performed Monday through Saturday
Reference value: Included with results
Method: Indirect Immunofluorescence
CPT Code: 86039
TEST NAME ANTIGEN TYPING
MERCY TEST MISC IMMUNOHEM MERCY LAB CODE MISI

NAME
Specimen: One 6 ml pink top tube or a purple top tube. Red Cells are needed for testing.
Comment: o Order Miscellaneous Immunohematology. Enter specific antigen to be tested in
comment.
o Reference Lab Clients: Mark OTHER on requisition form. Write antigen typing and
the specific antigen(s) to be tested.
Processing: Centrifuge. Refrigerate specimen.
Method: Serological
CPT Code: 86905
POWERCHART ANTI SMITH ANTIBODY

NAME
MERCY TEST NAME SM AB IGG* MERCY LAB CODE SMB
Specimen: 0.5 mL serum from a Serum Separator Tube (SST) or no additive serum tube.
Processing: Send refrigerated to Mayo. Mayo order code (SM)
Performed: 1-2 days. Monday through Saturday; 4 p.m.
CPT Code: 86235
POWERCHART SMOOTH MUSCLE ANTIBODIES

NAME
MERCY TEST NAME ANTI SMOOTH MUS AB* MERCY LAB CODE SMAB
Processing: Send refrigerated to Mayo. Ambient and frozen also acceptable. Mayo order code (SMAS).
CPT Code: 86015 Screen
86015 If Appropriate
POWERCHART ANTITHROMBIN III ACTIVITY
NAME
MERCY TEST NAME ANTITHROMBIN ACTIV* MERCY LAB CODE ATTFB
Specimen: 1.0 mL platelet-poor plasma light-blue citrate tube
Processing: Spin down, remove plasma, and spin plasma again and place 1.0 mL platelet poor plasma in
plastic aliquot vial. Freeze immediately.
Double-centrifuged specimen is critical for accurate results as platelet contamination

may cause spurious results. Coagulation Consultation Patient Information Sheet must be
sent with specimen. Send frozen. Mayo order code (ATTF).
Performed: 1-3 days. Monday through Friday
Reference Value: Included in Report
Method: Chromogenic Assay
CPT Code: 85300
POWERCHART ANTITHROMBIN III ANTIGEN

NAME
MERCY TEST NAME ANTITHROMBIN AG* MERCY LAB ATTI

CODE
Specimen: Draw a blue top tube (sodium citrate) filled appropriately with amount of blood listed on
label. Draw enough citrated whole blood to spin down and aliquot 1.0 mL platelet poor
plasma.
Note: Patient should not be receiving Coumadin or heparin.

Test should not be ordered with a Thrombophilia Profile (AATHR) because of duplication of
testing.
Refer to Mayo lab test index for special processing instructions.
Processing Spin down, remove plasma, and spin plasma again. Remove plasma and place 1.0 mL
Instructions: platelet poor plasma in plastic aliquot vial. Freeze specimens immediately at < or = -40
degrees C, if possible. Label specimens as plasma.
Double-centrifuged specimen is critical for accurate results. Coagulation Consultation Patient

Information Sheet must be sent with specimen.
Shipping
Send plasma frozen. Mayo order code (ATTI).
Instructions:
Performed: 4 days. Monday through Friday.
Method: Automated Latex Immunoassay (LIA)
CPT Code: 85301

TEST NAME ASCITES FLUID CYTOLOGY See: Cytology Section Peritoneal Fluid
POWERCHART ASO (Antistreptolysin O Quantitative)

NAME
MERCY TEST NAME ASO MERCY LAB CODE ASO
Specimens are stable when separated for up to 2 days at 2–8°C or stored frozen for up to 6
Stability:
months at -20°C or colder.
Reference Range: 0-250 IU/ML
Method The Atellica CH ASO_2 assay measures ASO antibodies in serum or plasma by a latex-
Description: enhanced immunoturbidimetric method.
CPT Code: 86060

POWERCHART ASPERGILLUS ANTIGEN EIA
NAME
MERCY TEST NAME ASPERGILLUS AG* MERCY LAB CODE ASPAG
Specimen: 1.5 ml serum in am Serum Separator Tube (SST) **DO NOT ALIQUOT**
Processing: DO NOT ALIQUOT Send serum in original tube, send refrigerated to Mayo. Mayo test order
code: ASPAG
Performed: 1-3 days. Monday through Friday 9-4, Sunday 8
Method: Enzyme Immunoassay (EIA)
CPT Code: 87305
POWERCHART AST/SGOT
NAME
MERCY TEST NAME AST MERCY LAB CODE AST
Separated specimens may be stored for up to 3 days at 20–25°C or for up to 7 days at 2–8°C
Stability:
or stored frozen for up to 30 days at -20°C or colder.
Comment: Hemolyzed serum is unacceptable.

Reference Range: <34 units/L
Method The concentration of reduced nicotinamide adenine dinucleotide (NADH) is measured, and
Description: the rate of absorbance decrease is proportional to the AST activity.
CPT Code: 84450
POWERCHART AUTOIMMUNE LIVER DISEASE PANEL

NAME
MERCY TEST NAME AUTO IMM LIVER PNL* MERCY LAB CODE ALDP
Comment: Duplicate testing if ordered with MTAB (Mayo AMA) or SMAB (Mayo SMAS)
Processing Send refrigerated to Mayo. Mayo order code (ALDG2).
Performed: 3-4 days, Monday through Saturday.
Method: AMA: Enzyme Immunoassay (EIA) NAIFA, SMAS, SMAT: Indirect Immunofluorescence
CPT Code: 86381

86039
86015
86015 (if appropriate)
POWERCHART CULTURE IDENTIFICATION BACTERIAL

NAME
MERCY TEST NAME BACTERIAL ID RL MERCY LAB CODE MCID
Specimen: Submit each organism to be identified on a separate plate. Colonies should be well
isolated.
Comment: o 1 organism should be submitted PER request.

o Write MCID on the order form. Indicate the specimen source.
o A Reference Bacterial Examination form should be submitted with each order.
Send this form with the order form.
o On the Reference Bacterial Examination form, indicate if susceptibility testing is
needed. Susceptibilities will be performed at an additional charge.
o A copy of the Reference Bacteria Form is also located in the "Forms" section.
Processing: Seal the culture plate and send at room temperature to Mercy lab.
Method: Standard culture techniques
CPT Code: 87077

MERCY TEST BARBITURATES UR* CONFIRMATION MERCY LAB CODE UBARBT
NAME
Specimen: 20 ml random urine specimen in 60 mL urine bottle, no preservative
Processing: Send to Mayo Refrigerated, Mayo order code (BARBU).

Method: Gas Chromatography - Mass Spectrometry (GC - MS) Confirmation and Quantification
CPT Code: 80345 / G0480 (if appropriate)
TEST NAME BARR BODY SMEAR See: Cytology Section Barr Body Smear
POWERCHART BARTONELLA ANTIBODY PANEL IGG IGM

NAME
TEST NAME BARTONELLA AB PNL* MERCY LAB CODE BARTO
Specimen: 0.5 mL serum from a Serum Separator tube (SST) or no additive serum tube
Stability: 30 days refrigerated (preferred), 30 days frozen.
Performed: 1-3 days, Monday through Saturday; 9 a.m.
Method: Immunofluorescence Assay (IFA) technique using antigen substrate slides consisting of 2
separates cell cultures infected with Bartonella henselae or Bartonella Quintana.
CPT Code: 86611 x 4
POWERCHART (BMP) BASIC METABOLIC PANEL
NAME
TEST NAME BASIC METABOLIC PNL MERCY LAB CODE METB
Specimen: 0.5 mL serum
Stability: Specimen may be stored for up to 7 days at 2-8 °C or frozen for up to 30 days at -20°C.
Comment: Includes Anion Gap, BUN, BUN/Creatinine Ratio, Calcium, Chloride, CO2, Creatinine, eGFR,
Potassium, Sodium, Glucose
Reference value: See individual test entry.
Method: See individual test entry.
CPT Code: 80048
POWERCHART BCR ABL QUANT PCR

NAME
MERCY TEST NAME BCRAB MRNA DETECT (BCR ABL P210 MRNA MERCY LAB CODE BCRAB
DETECTION)
Submit only 1 of the following:
Specimen: o
o 10 mL whole blood from lavender top tube (EDTA)
o 3 mL bone marrow from lavender top tube (EDTA)
Send to Mayo lab refrigerated. Specify on requisition specimen type. Order Mayo test (BCRAB).
Process:
Specimen must arrive at Mayo within 72 hours of collection.
Method: Quantitative Reverse Transcription-Polymerase Chain Reaction (RT-PCR) using GeneXpert
CPT Code: 81206
POWERCHART BETA 2 GLYCOPROTEIN I IGA ANTIBODY

NAME
MERCY TEST NAME BETA 2 GP1 AB IGA* MERCY LAB CODE AB2GP
Specimen: 0.5 ml serum from a Serum Separator tube (SST) or no additive serum tube.
Processing: Send refrigerated to Mayo, Frozen is acceptable. Mayo order (AB2GP).
Performed: 3 - 5 days, Monday, Wednesday, Friday
Method: Enzyme-Linked immunosorbent Assay (ELISA)
CPT Code: 86146
POWERCHART BETA 2 GLYCOPROTEIN I IGG ANTIBODY

NAME
MERCY TEST NAME BETA 2 GLYCOPRT AB* MERCY LAB CODE GB2GP
Processing: Send refrigerated to Mayo, Frozen is acceptable. Mayo order (GB2GP).
Performed: Monday through Saturday; 8 a. m.
CPT Code: 86146
POWERCHART BETA 2 GLYCOPROTEIN I IGG IGM

NAME
MERCY TEST NAME BETA2 GPI IGG IGM* MERCY LAB CODE B2GMG
Processing: Send refrigerated to Mayo, Frozen is acceptable. Mayo order code (B2GMG).
Performed: 1-6 days. Monday through Saturday; 8 a. m.
CPT Code: 86146 x2
POWERCHART BETA-2 MICROGLOBULIN

NAME
MERCY TEST NAME BETA 2 MICROGLBN* MERCY LAB CODE B2MG
Processing: Send refrigerated to Mayo, ambient or frozen. Mayo order code (B2M).
Performed: Monday - Saturday, 3 PM
Method: Nephelometry
CPT Code: 82232
POWERCHART BETA-2 TRANSFERRIN: Detection of Spinal Fluid in Other Body Fluid

NAME
MERCY TEST NAME General Miscellaneous MERCY LAB CODE CMIS
Order General Miscellaneous Lab, specify in comment: Mayo order code (BETA2) Beta-2
Transferrin, and source of specimen.
0.5 ml body fluid such as ear or nasal fluid, or other fluid. Indicate specimen type.
Specimen:
NOTE: Although results may be obtainable on smaller specimens (perhaps as little as 0.05ml,
depending on the protein concentrations and percentage of spinal fluid in the specimen),
Reliable results are best obtained with an adequate specimen volume.
Processing: Send frozen to Mayo. Mayo test code (BETA2).

Performed: Monday - Saturday, 1 PM
Method: Electrophoresis/Immunofixation-Peroxidase Antisera/Dimethylformamide visualization
CPT Code: 86335
POWERCHART Beta Hydroxybutyrate Level
NAME
MERCY TEST NAME Beta Hydroxybutyrate Level MERCY LAB CODE BHOB
Alias ACETONE (KETONES) QUALITATIVE SERUM
Stability: 7 days refrigerated
Reference value: 0.020-0.270 pg/mL
Method: Enzymatic quantitation of B-hydroxybutyrate by B-hydroxybutyrate dehydrogenase
CPT Code: 82010
POWERCHART BILE ACIDS TOTAL

NAME
MERCY TEST NAME BILE ACIDS TOTAL* MERCY LAB CODE BILEA
Specimen: 0.5 mL serum from a Serum Separator tube (SST) or no additive serum tube
*Patient must be fasting 8 hours minimum. Do not order on patients receiving bile
acid therapy.
Processing: Serum gel tubes should be centrifuged within 2 hours of collection. Red top tubes should be
centrifuged and aliquoted within 2 hours of collection. Send to
Mayo refrigerated. Frozen is acceptable. Mayo code (BILEA)
Performed: 1-2 days. Monday through Sunday; continuously

Reference value: Included in reports.
Method: Enzymatic
CPT Code: 82239
POWERCHART BILI DIRECT

NAME
MERCY TEST NAME BILI DIRECT MERCY LAB CODE BID
Stability: Specimen should be stored at 4°C and analyzed within 5 days. Specimens may be stored
frozen for up to 3 months at -70°C with no light exposure.
Comment: Bilirubin is extremely photosensitive. Care should be taken to protect sample from both
daylight and fluorescent light to avoid photodegradation.

Reference value: 0-14 days: 0.0-0.6 mg/dl
15 days-<1 month: 0.0-0.3 mg/dl
≥1 month: 0.0-0.5 mg/dl
Method: The Atellica CH Direct Bilirubin_2 (DBIL_2) assay is based on a chemical oxidation method
using vanadate as an oxidizing agent.
CPT Code: 82248 Bili, Direct
POWERCHART BILIRUBIN TOTAL AND DIRECT

NAME
MERCY TEST NAME BILI PNL MERCY LAB CODE BILI
daylight and fluorescent light to avoid photodegradation. Panel includes total bilirubin,
direct bilirubin, and indirect bilirubin.
Reference value: Total: 0-1 days: 2.0-6.0 mg/dl
2-5 days: 6.0-10.0 mg/dl
6 days- <1 month: 4.0-8.0 mg/dl
≥1 month: 0.3-1.2 mg/dl
Direct: 0-14 days: 0.0-0.6 mg/dl
≥1 month: 0.0-0.5 mg/dl
Indirect: 0-1 day: 1.4-6.0 mg/dl
2-5 days: 5.4-10.0 mg/dl
6-14 days: 3.4-8.0 mg/dl
15-30 days: 3.7-8.0 mg/dl

>30 days: 0.0-1.2 mg/dl
Method: The Atellica CH Bilirubin assay is based on a chemical oxidation method using vanadate as
an oxidizing agent.
CPT Code: 82247 Bili, Total
82248 Bili, Direct
POWERCHART BILIRUBIN TOTAL

NAME
MERCY TEST NAME BILI TOTAL MERCY LAB CODE BIT
daylight and fluorescent light to avoid photodegradation. Panel includes total bilirubin,
direct bilirubin, and indirect bilirubin.
Reference value: 0-1 days: 2.0-6.0 mg/dl

2-5 days: 6.0-10.0 mg/dl
≥1 month: 0.3-1.2 mg/dl
Method: The Atellica CH Total Bilirubin_2 (TBil_2) assay is based on a chemical oxidation method
using vanadate as an oxidizing agent.
CPT Code: 82247
POWERCHART BK VIRUS QUANTITATIVE PCR

NAME
MERCY TEST NAME BK VIRUS PCR QUANT MERCY LAB CODE QBK
Specimen: 1.5 mL plasma from EDTA tube. Centrifuge within 2 hours of collection and removed plasma.
Stability: 84 days frozen (preferred), 6 days refrigerated
Processing: Send frozen to Mayo. Mayo order code (PBKQN).

If a Tacrolimus is ordered at same time a separate tube is required.
Performed: 2 days. Monday through Saturday

Reference value: Included in reports.
Method: Real-Time Polymerase Chain Reaction (rtPCR)
CPT Code: 87799
POWERCHART BLASTOMYCES AB (ID)
NAME
MERCY TEST NAME BLASTOMYCES Ab* MERCY LAB CODE BLAST
Specimen: 1 mL serum from a Serum Separator Tube (SST) (Preferred). Serum from a no additive
serum tube is also acceptable. Centrifuge within 2 hours of collection. For red-top tubes,
immediately aliquot serum into a plastic vial. For serum gel tubes, aliquot serum into a
plastic vial within 24 hours of collection.
Processing: Send refrigerated to Mayo. Frozen is also acceptable. Mayo order code (BLAST).
Performed: 1-3 days. Monday through Friday.
If result is equivocal or positive, Blastomyces antibody by immunodiffusion will be

performed at an additional charge.
CPT Code: 86612
POWERCHART BLEEDING DIATHESIS LIMITED PROFIL

NAME
MERCY TEST NAME BLEEDING DIATH PRF* MERCY LAB CODE BDIAL
5 ml platelet-poor plasma (from light-blue top, citrate tube).
Specimen: Patient should not be receiving Coumadin or heparin.
Draw enough citrated whole blood to spin down and aliquot 5.0 mL platelet poor plasma in
5 plastic aliquot vials. Spin down, remove plasma,
and spin plasma again. Remove plasma and place in plastic aliquot vials. Freeze immediately
at < or = -40 degrees C, if possible. Label
Processing:
specimens as plasma.
Double-centrifuged specimen is critical for accurate results. Coagulation Consultation

Patient Information Sheet must be sent with specimen.
Shipping
Send plasma frozen. Mayo code (ALBLD).
Instructions:
Performed: 7-21 days. Test run Monday - Friday.
Clot-Based Assay, Prothrombin Time Clot-Based Assay, Activated Partial Thromboplastin

Method:
Time-Based Clotting Assay, Activated Partial Thromboplastin Time (APTT) Mixing Test,
Ristocetin Induced Agglutination of Washed Normal Platelets, Automated Latex
Immunoassay, Immunoturbidimetric, Clauss Methodology, Latex Particle Enhanced
Immunoassay
CPT codes for Bleeding Diathesis Limited Profile:
Coagulation factor VIII assay – 85240, von Willebrand factor antigen – 85246
Factor IX – 85250, Clot solubility factor XIII – 85291
D-dimer – 85379, Fibrinogen – 85384
von Willebrand factor activity – 85397, PT – 85610
Thrombin Time – 85670, APTT - 85730
If indicated, the following reflex tests will be ordered by Mayo at an additional cost:
Factor II - 85210
Factor V - 85220
CPT Code:
Factor VII - 85230
Ristocetin cofactor - 85245
Von Willebrand factor multitimer - 85247
Factor X - 85260
Factor XI - 85270
Factor XII – 85280, Plasminogen Activity - 85420
Bethesda units – 85335, PAI-1 Ag - 85415
Platelet neutralization for lupus inhibitor – 85597, Chromogenic FVIII,P-85130
Reptilase time – 85635, Chromogenic IX,P - 85130
APTT mix 1:1 – 85732, Antithrombin Antigen -85301
Factor V Inhibitor screen – 85335, Antithrombin Activity - 85300
Factor VIII Inhibitor screen – 85335, PT-Fribrinogen - 85385
Factor IX Inhibitor screen – 85335, Soluble Fibrin Monomer - 85366
Alpha-2 Plasmin Inhibitor - 85410, HEX LA,P - 85598
PTT mix 1:1 – 85611, DRVVT - 85613
DRVVT mix – 85613, DRVVT - 85613
POWERCHART BLOOD CULTURE

NAME
MERCY TEST NAME BLOOD CLT MERCY LAB CODE BLC
Order: If yeast or fungus is suspected, see Blood Culture/Fungus. If Mycobacteremia (AFB/TB) is

suspected, see Blood Culture/Acid Fast Organisms.
Specimen: Specimens must be collected using sterile techniques.
o Cleanse site with Chlorhexidine Chloroprep device, according to procedure.

o Remove & discard the plastic cover(s) from the culture bottle.
o Disinfect the rubber septum of each bottle with a 70% alcohol pad.
o Do not touch venipuncture site, after it has been cleansed. Draw the blood
according to the lab's protocol.
o For syringe draws only: Place a new transfer safety device on the syringe. Put
blood into blood culture bottles, using the following procedure:
Pediatric (<13yrs): Inject 1-4 ml whole blood into the BacTec FX Pediatric blood culture vial
(pink lid) Avoid injecting air into the bottle. Invert to mix. Patients > 13 yrs old: Draw 20 ml
blood. Inject 10 ml blood into the aerobic bottle (blue lid) and 10 ml of whole blood into the
anaerobic bottle (purple) Avoid injecting air into the bottles. Invert to mix.
Comments: o A minimum of two sets of blood cultures within a 24-hour period is
recommended.
o Culture is tested daily by continuous monitoring technology.
o Culture detects both aerobic and anaerobic bacteria.
o The aerobic and pediatric bottles contain resin beads which will aid in the recovery
of organisms if antimicrobial therapy was initiated before the culture was
obtained.
o ALL POSITIVE BLOOD CULTURE RESULTS WILL BE PHONED TO THE PHYSICIAN,
NURSING PERSONNEL OR ORDERING LOCATION RESPONSIBLE FOR THE PATIENT.
o Susceptibility testing will routinely be performed on ALL aerobic isolates.
(EXCEPT diphtheroids, Bacillus species, Viridians Streptococcus and Micrococcus
species).
RL Client o Mark BLOOD CULTURE on the order form. Indicate the specific draw site on the
Comments: form (Line draw, Rt arm, etc.).
o Blood cultures drawn using Mercy lab’s bottles (Bactec FX) should be left at room
temperature until the Mercy courier picks up the samples. DO NOT PLACE THE
BOTTLES IN ANY INCUBATOR AT YOUR LAB.
o Send the blood culture bottles at room temperature to Mercy lab, the same day
they are drawn (preferred). If there is a delay in sending the blood culture bottles,
the delay should not exceed 36 hours.
Performed: Preliminary report: Daily Final report: 5 days
Reference value: No growth
Method: Automated Continuous Monitoring Technology
CPT Code: 87040

MERCY TEST BLOOD CULTURE ID MERCY LAB CODE BLCID
NAME
Specimen: The specimen submitted should be the positive blood culture bottle.
o This order is to be user ONLY by Reference Lab clients that have a positive blood
culture, at their facility, which requires further workup at Mercy Lab.
o Do not submit any media plates if this order is used. The actual blood culture
bottle should be submitted.
Comment:
o Fax the white Reference Lab Examination sheet that indicates specifics about the
specimen. The Mercy Microbiology fax number is found at the top of the form.
o Please place the Blood Culture ID labels on the neck of the bottle to alert Mercy
staff of the ID only.
Performed: Daily.
Method: Routine culture method.
CPT Code: 87040
TEST NAME BLOOD CULTURE/ACID FAST ORGANISMS*
MERCY TEST MISC MICROBIOLOGY MERCY LAB CODE MISM

NAME
Order: Order Miscellaneous microbiology. Specify Mayo code: CTBBL MYCOBACTERIAL CULTURE,
BLOOD in comment
Specimen: Draw 10 ml heparinized (green top tubes) whole blood using aseptic technique. Invert tubes
to mix.
Processing: Specimens need to be processed immediately upon being drawn. SPECIMENS MUST ARRIVE
AT MAYO LAB WITHIN 72 HOURS OF BEING DRAWN
RL Client o Write MYCOBACTERIAL CULTURE, BLOOD (Mayo order code CTBBL) on order form.
Comments: o Send the specimen to Mayo Lab within 72 hours of drawing the specimen.
o Send the heparinized green top vacutainer tubes to Mercy lab at room
temperature or refrigerated.
Performed: Monday through Sunday; Continuously

Method: Continuously Monitored Automated Broth Culture Instrument with Conventional Methods
for Identification of Mycobacteria
CPT Code: 87116 (Additional CPT codes may be added if the culture is positive).
POWERCHART BLOOD CULTURE FUNGUS

NAME
MERCY TEST NAME BLOOD CLT/FUNGUS MERCY LAB CODE BLF
Comment: See beginning of section for ordering help and codes.
Specimen: Patients 6 yrs of age and older: 10 ml whole blood drawn into Isolator 10 tube. Short
samples decrease the already low number of organisms.
Patients 5 years of age and under: 1.5 ml whole blood drawn into pediatric Isolator tube.
Specimens are to be collected using the following instructions:

oDisinfect the stopper of Isolator tube with alcohol.
o Cleanse and disinfect the venipuncture site and maintain aseptic technique.
o Collect blood sample with the patient's arm in a downward position. (1.5 ml for
patient 5 yrs and under) (10 ml for patients over 5 years.)
o Gently invert the tube 8 to 10 times immediately after collection. Incomplete
mixing causes small clots to form. Clotted samples are unacceptable and must be
redrawn.
o Transport promptly to the lab.
o 1.5 ml Isolator tubes need to be processed on the same shift the sample was
drawn. 10 ml Isolator tubes need to be processed within 16 hours of being drawn.
RL Client o Write in Blood Culture/Fungus on RL order form. Indicate source on order form.
Comments: o Send specimen the same day it is drawn. Send specimen at room temperature:
Samples drawn in the 1.5 Isolator tube need to be processed immediately.
Samples drawn in the 10 ml Isolator tube need to be processed within 16 hours of
the sample being drawn
Performed: Preliminary report: 5 days Final report: 4 weeks
Reference value: No fungus isolated. Positives will have fungus identified.
Method Lysis centrifugation and standard culture techniques.
CPT Code: 87103
TEST NAME BLOOD GAS ANALYSIS Arterial Blood Gases are collected and performed by
Cardio-Vascular & Pulmonary. Capillary Blood
Gases see: COLLECTION CAPILLARY CHARGE BLOOD
GASES
Venous Blood Gases:

Powerchart user selects Blood Gas Venous Order Set
(MC) from the Powerchart order dictionary. "Venous
Blood" is defaulted in for the user as the "additional
instructions/comments."
The Powerchart paper order sheet prints to the printer

in Cardiovascular Pulmonary (CVP). The Venous Blood
comment is visible for them.
Draw in green Heparin no gel tube, 4.0 mL.
The order CVBG-collect venous blood gas, appears on

the collection handheld device. This will be the
notification to the lab that a venous blood gas has been
ordered and needs to be collected. Lab will go to the
patient and if CVP is not there will call switchboard to
reach CVP. Lab will enter as the result to CVBG who
they handed the specimen off to in CVP.
Outpatient Draw Station- Order CVBG for venous blood

gas collections. Label will print at designated printer for
ordering location. Call switchboard to reach CVP and
make arrangements to hand specimen off to CVP for
testing. Result the CVBG test via function ME and
worksheet BEDS with the name of the CV&P tech
spoken to, the date and time the specimen was tubed,
and where the specimen was tubed.
POWERCHART BLOOD PARASITES (MALARIA SMEAR)

NAME
MERCY TEST NAME BLOOD PARASITES (MALARIA SMEAR) MERCY LAB CODE MAL
Specimen: Non-anticoagulated venous blood or peripheral blood from finger or earlobe preferred.
Prepare 3 thick and 3 thin smears on separate slides. EDTA blood can be used and should
also be sent with the slides.
Prepare slides as follows:

THIN SMEARS: Prepare at least 3 thin blood smears with a feathered edge in the same
manner as for a differential and then fixed in alcohol.
THICK SMEARS: Place a drop of blood on a slide. Using the corner of a clean slide spread the
blood in a circle about 20 times until the size of a quarter by literally scratching the blood
onto the carries slide. Prepare at least 2 slides. This technique allows the blood to dry quickly
and adhere well to the slide. If proper thickness is achieved, ordinary print should barely be
visible through the wet center.
Allow both thick and thin films to air dry without heating. The thick smear must dry 8-10
hours before staining.
Comment: Collection available stat. Collection time is determined by the fever pattern. Consult the
Microbiology Department. If the smear is considered positive, it will be referred to Mayo for
identification and will incur extra charges.
Performed: Within 24-72 hours of receipt.
Reference value: No malaria or blood parasites seen.
Method: Microscopy, Giemsa/Wright-stained smears.
CPT Code: 87207
POWERCHART BLOOD PATCH COLLECTION

NAME
MERCY TEST NAME BLOOD PATCH COLL MERCY LAB CODE PTCH
Specimen: Specimen is collected for use in conjunction with anesthesia procedure.
PROCEDURE (FOUND IN PHLEBOTOMY PROCEDURE MANUAL, #29)
The floors will call the lab and ask that a phlebotomist come to the patient’s room to assist
the Anesthesiologist in the blood drawing for the epidural blood patch.
Comment:
o The floor will place an order on the Powerchart system the test name is Blood
Patch Collection.
o This is a “sterile procedure”. Anesthesia staff will explain the procedure to the
patient while the Phlebotomist is putting on the gown, gloves, and mask.
o With the patient lying on their side, the Phlebotomist will stand in front of the
patient. The patient’s arm is to be extended toward you.
o As the doctor is preparing the site on the patients back, the Phlebotomist will
prepare the arm site to perform the venipuncture, using chloraprep to cleanse,
allow to air dry. The doctor provides a sterile 20cc syringe. The Phlebotomist will
provide a 20g sterile needle or a 21g sterile butterfly.
o When the doctor is in the epidural cavity of the spine, they will say, “Okay, draw”.
The Phlebotomist will quickly draw 20 cc of blood from the vein, keeping a sterile
field, and hand the syringe to the doctor.
o The doctor will inject the blood into the spinal cavity of the patient.
o Place a gauze and paper tape over the venipuncture site and return to the lab.
o Use function CLVS to verify the collect time in Sunquest. For the phlebotomy
workload code, use PA, comma then enter the length of time the procedure took.
DO NOT add a collect charge.
o In function ME, use worksheet PHL, type in PATC and accept.
Performed: Available stat

Method: Venipuncture
CPT Code: G0001
POWERCHART BNP (B-TYPE NATRIUREIC PEPTIDE)

NAME
MERCY TEST NAME BNP MERCY LAB CODE BNP
Specimen: 1 mL EDTA plasma collected in a plastic blood collection tube.
Stability: If plasma samples are not tested within 24 hours, store samples in plastic tubes and freeze
at ≤ -20°C. Do not store in a frost-free freezer.
Samples may undergo up to 4 freeze-thaw cycles without degradation.
Samples are stable for up to 9 months when stored at ≤ -20°C.
Mix samples thoroughly after thawing and store at 2-8°C until use.
Samples should be tested within 8 hours after thawing.
Comment: After centrifugation, store separated plasma samples at 2-8°C until testing.
For optimal recovery of BNP values, it is suggested that plasma samples be tested within 24
hours. The average percentage of BNP recovery in EDTA plasma after 24-hour-storage at 2-
8°C was 91%. It is recommended not to store EDTA-plasma at room temperature.
Reference Range: 0-100 pg/mL
Method The Atellica IM BNP assay is a fully automated 2-site sandwich immunoassay using direct
Description: chemiluminescent technology which uses constant amounts of 2 monoclonal antibodies.
CPT Code: 83880
POWERCHART BODY FLUID FOR CRYSTALS

NAME
MERCY TEST NAME BODY FL CRYSTALS MERCY LAB CODE BCRY
Specimen: Put 1 ml body fluid in a plain red top tube. Refrigerate.

Cause for
EDTA (purple top tube) is not acceptable.
rejection:
Comment: Indicate specimen source in comment.
Method: Microscopic examination using polarized filter.
CPT Code: 89060
POWERCHART BODY FLUID CULTURE +SUSECEPTIBILITY + SMEAR DIRECT

NAME
MERCY TEST NAME BODY FLD CLT/GS MERCY LAB CODE FLDC
Order: Specify site when ordering.
Specimen: Collect aseptically by needle aspiration or surgical procedure. Submit all specimens in a
sterile syringe with the needle discarded or sterile screw top container or tube.
Specimen stability: All listed specimens are stable <24 hours, room temperature
EXCEPT Pericardial. Pericardial samples are stable <24 hours refrigerated.
o Bone marrow: 1.5 ml placed in a Wampole Isolator tube (available from lab)
o CSF fluid: 1 ml minimum, placed in sterile screw capped tube. Do not refrigerate.
o Joint: 1 ml aspirate
o Pericardial: 1 ml aspirate
o Peritoneal: 1-2 ml aspirate
o Pleural: 5-10 ml aspirate
o Thoracic: 5-10 ml aspirate
Cause for Fluid injected into a CULTURETTTE is unacceptable. A SWAB SPECIMEN IS NOT
rejection: ADEQUATE.
Comments: o Recovery of microorganisms from these sites is dependent on the volume of

specimen received.
o ALL POSITIVE GRAM STAINS, on the above listed sterile body sites, will be phoned
to the Provider, nursing personnel or ordering location responsible for the patient.
o Positive CSF Cultures will be phoned to the Provider, nursing personnel or ordering
location responsible for the patient.
o Susceptibility testing will be performed on significant isolates.
RL Comments: o Write BODY FLUID CULTURE on order form. Include source on the form.
If ordering in the computer, use order code FLDC.
Gram Stain will be performed next day by 1st shift UNLESS ordered to be called STAT with a
specific phone number indicated.
Performed: Gram stain: Within 8 hours of receipt, unless ordered STAT Preliminary reports: Days 1 and 2
Reference value: No growth (applies to normally sterile sites).
CPT Code: 87205 Gram stain 87070 Body Fld Clt
POWERCHART BODY FLUID DIFF

NAME
MERCY TEST NAME BODY FLUID DIFF MERCY LAB CODE BFCC
Comment: o Body Fluid Differential is included in Cell Count Body Fluid.

o To be ordered by Regional Hospitals when they are doing the cell counts at their
facility and want to refer the differential to Mercy.
Specimens: Send 2 cytocentrifuge prepared slides, unstained or 1.0 ml of body fluid may be sent
refrigerated, and Mercy will prepare the slides.
Method: Microscopic exam of Wright’s-stained smear.
CPT Code: NA
POWERCHART BONE MARROW COLLECTION

NAME
MERCY TEST NAME BONE MARROW CL AS MERCY LAB CODE BM
Comment: Not available stat. Nursing service must also fill out a yellow Surgical Specimen Slip and
a white bone marrow history form to include patient history and clinical diagnosis.
Available Monday through Friday, 0700-1500. If a bone marrow examination is needed
outside these hours, special arrangements may be made by contacting the Laboratory. Send
Lab a message of all bone marrows scheduled (include date and time). Nursing Service is
to schedule with:
o Cancer Center for patients seen by the Cancer Center physicians.

o ER for all other patients.
Reference Lab Clients:

o Please completely fill out the pink Pathology Specimen Form, include patient
history and clinical diagnosis.
o Send a copy of your CBC results and 2 peripheral smear slides. Order Diff Manual
and a Cell Morphology. Send 2 unstained slides. Fix 1 by dipping in Methanol for 10
seconds. CBC results must be included. OR send a purple top tube. Order a CBC
with Manual Diff and a Cell Morphology. Mercy Lab will do a CBC and prepare the
slides.
o Send 8 unstained bone marrow slides.
o MERCY LAB: Do not order BM in Misys.
Specimen: Procedure will include collection of the following: 6 smears for Wright's Stain, smear for Iron
Stain, CBC and Cell Morphology, 2 peripheral smears, Bone Marrow Clot and Biopsy. Lab will
order the CBC if one has not been done within the previous 24 hours.
Performed: 2--4 days

Reference value: Descriptive report will be sent.
Microscopic examination of Wright stained and Iron-stained smears. Clot and core biopsy
Method:
also examined microscopically.
CPT Code: 85097
POWERCHART BREATH ALCOHOL

NAME
MERCY TEST NAME BREATH ALCOHOL TESTING MERCY LAB CODE BATHW
Comment: o Patient must have identification and should be accompanied by designated

person.
o Post accident should be performed within 2 hours.
Performed: Monday - Friday 1630-0800. Performed by Healthworks from 0800-1630. Saturday and
Sunday, available 24 hours.
Method: Fuel cell sensor.
TEST NAME BRONCHIAL BRUSH/WASH See: Cytology Section Bronchial

CYTOLOGY
POWERCHART BRONCHIAL QUALITATIVE + SMEAR DIRECT OTHER

NAME
MERCY TEST NAME BRONCH QAL CLT/GS MERCY LAB CODE BQAL
Order: Specify from which bronchus the specimen is collected when ordering.
Specimen: Minimum of 5 ml of bronchus washings collected through the inner chamber of the
bronchoscope. Submit in a sterile plastic container with a tight-fitting lid.
Comments: o Only significant respiratory isolates will be reported.

RL Comments: o Write QUALITATIVE BRONCHUS CULTURE on the order form. Indicate the specimen
source on form.
o Send at room temperature.
Performed: Gram stain: 1st shift RL: Next day.
1st shift Preliminary report: 1 day
Reference value: Normal flora of the upper respiratory tract.
CPT Code: 87205 Gram Stain 87070 Bronch Clt
POWERCHART BRONCHIAL QUANTITATIVE + SMEAR DIRECT OTHER

NAME
MERCY TEST NAME BRONCH QNT CLT/GS MERCY LAB CODE BQNT
Order: Specify from which bronchus the specimen is collected from.
To be ordered ONLY on Protected Brush Bronch Specimens (PSB). (Other Bronch sources
should be ordered as a QUAL culture).
Specimen: 1 ml protected specimen brushings (PSB) placed in 1 ml normal saline. Submit in a sterile
plastic container with a tight-fitting lid. Quantity of saline added is critical for accurate
quantitation.
Comments: o Includes quantitation in colony forming units (CFU/ml).

RL Client o Write QUANTITATIVE BRONCHUS CULTURE on order form. Indicate source on the
Comments: form.
o To be ordered ONLY on Protected Brush Bronch Specimens
o Send specimen(s) at room temperature to Mercy lab.
Performed: Gram stain: 1st shift RL: Next day, 1st shift Preliminary report: 1-day Final report: 2 days
Reference value: No growth or Scant Normal flora of the upper respiratory tract.
CPT Code: 87205 Gram Stain+ 87070 Bronch Clt+
TEST NAME BUCCAL SMEAR See: Cytology Section Barr Body Smear
POWERCHART BULLOUS PEMPHIGOID AG 180 AND 230 IGG

NAME
MERCY TEST NAME BULLOUS PEMPH IGG* MERCY LAB CODE BP
Specimen: 1 ml serum from a no additive serum tube

Processing: Send to Mayo Refrigerated, Ambient and Frozen are acceptable. Mayo order code (BPAB).
Performed: Once or twice weekly.
Method: Enzyme-Linked Immunosorbent Assay (ELISA).
CPT Code: 83516 x 2
POWERCHART BUN
NAME
MERCY TEST NAME BUN MERCY LAB CODE BUN
Specimen: 0.5 mL of serum
Stability: Separated blood urea nitrogen is stable in separated serum or plasma and may be stored
for up to 3-5 days at room temperature or for up to 7 days at 4°C or stored frozen
indefinitely at -20°C.
Comment: Blood samples from some patients with monoclonal gammopathies may produce falsely
elevated results.
Reference Range: 0-2 years: 4-15 mg/dl

3-16 years: 9-18 mg/dl
17-64 years: 8-22 mg/dl
≥ 65 years: 10-28 mg/dl
Method Urea is hydrolyzed in the presence of water and urease to produce ammonia and carbon
Description: dioxide. The ammonia reacts with 2-oxoglutarate in the presence of glutamate
dehydrogenase and reduced nicotinamide adenine dinucleotide (NADH). The oxidation of
NADH to oxidized nicotinamide adenine dinucleotide (NAD).
CPT Code: 84520

TEST NAME BUN/CREATININE RATIO
Stability: Separated serum may be stored for up to 3-5 days at room temperature or for up to 7 days
at 4°C or stored frozen indefinitely at -20°C.
Comment: BUN/Creatinine Ratio is a calculation and not orderable by itself. Included in the METB,
CMPL, GHP, RPNL, NUTP, OPNL, DPNL, ATPN, TPNL.
Reference Range: 10-20
Method Calculation
Description:
CPT Code: N/A
POWERCHART BUN Post Dialysis

NAME
MERCY TEST NAME BUN POST DIALYSIS MERCY LAB CODE BUNP

Stability: Separated blood urea nitrogen is stable in separated serum or plasma and may be stored
for up to 3-5 days at room temperature or for up to 7 days at 4°C or stored frozen
Comment: To be ordered by Dialysis only.
Blood samples from some patients with monoclonal gammopathies may produce falsely
elevated results.
Reference Range: 0-2 years: 4-15 mg/dl

3-16 years: 9-18 mg/dl
17-64 years: 8-22 mg/dl
≥ 65 years: 10-28 mg/dl
Method Urea is hydrolyzed in the presence of water and urease to produce ammonia and carbon
Description: dioxide. The ammonia reacts with 2-oxoglutarate in the presence of glutamate
dehydrogenase and reduced nicotinamide adenine dinucleotide (NADH). The oxidation of
NADH to oxidized nicotinamide adenine dinucleotide (NAD).
CPT Code: 84520
POWERCHART BUPRENORPHINE
NAME
MERCY TEST NAME MISCELLANOUS GENERAL LAB Designate: Mayo order MERCY LAB CODE CMIS
code - BUPM
POWERCHART C3 COMPLEMENT
NAME
MERCY TEST NAME C3 COMPLEMENT MERCY LAB CODE C3
Stability: Specimens may be stored for up to 3 days at 2–8°C or stored frozen for up to 3 weeks at -
20°C.
Reference Range: 87-200 mg/dL
Method The Atellica CH Complement C3 (C3) assay measures the concentration of complement C3 in
Description: serum using an immunoturbidimetric assay. The complements are part of a complex
biological system, which works in conjunction with antibody and other factors to protect the
body from invasion of pathogens. When activated by either the classical or alternate
pathway, complements act on biological membranes and may cause cell death. The human
complements consist of several distinct plasma proteins, such as complement C3 and
complement C4.
CPT Code: 86160

POWERCHART C4 COMPLEMENT
NAME
MERCY TEST NAME C4 COMPLEMENT MERCY LAB CODE C4
Stability: Specimens may be stored for up to 3 days at 2–8°C or stored frozen for up to 3 weeks at -
20°C.
Reference Range: 19-25 mg/dl
Method The Atellica CH Complement C4 (C4) assay measures the concentration of complement C4 in
Description: serum using an immunoturbidimetric assay. The complements are part of a complex
biological system, which works in conjunction with antibody and other factors to protect the
body from invasion of pathogens. When activated by either the classical or alternate
pathway, complements act on biological membranes and may cause cell death. The human
complements consist of several distinct plasma proteins, such as complement C3 and
complement C4.
CPT Code: 86160

POWERCHART CA 125
NAME
MERCY TEST NAME CA 125 MERCY LAB CODE CA125
Stability: Tightly cap and refrigerate specimens at 2–8°C if the assay is not completed within 8
hours. Freeze samples at ≤ -20°C if the sample is not assayed within 24 hours. Thoroughly
mix thawed samples before using.
Comment: Do not interpret levels of CA 125 as absolute evidence of the presence or the absence of
malignant disease. Before treatment, patients with confirmed ovarian carcinoma frequently
have levels of CA 125 within the range observed in healthy individuals. Elevated levels of CA
125 can be observed in patients with nonmalignant disease. Measurements of CA 125
should always be used in conjunction with other diagnostic procedures, including
information from the patient’s clinical evaluation.
The concentration of CA 125 in a given specimen determined with assays from different
manufacturers can vary due to differences in assay methods, calibration, and reagent
specificity. CA 125 determined with different manufacturers’ assays will vary depending on
the method of standardization and antibody specificity. Therefore, it is important to use
assay specific values to evaluate quality control results.
CA 125II assay testing is not recommended as a screening procedure to diagnose cancer in

the general population.
Do not use samples that contain fluorescein. Evidence suggests that patients undergoing
retinal fluorescein angiography can retain amounts of fluorescein in the body for up to 72
hours post-treatment. In the cases of patients with renal insufficiency, including many
diabetics, retention could be longer. Such samples can produce either falsely elevated or
falsely depressed values when tested with this assay and should not be tested.
Patient samples may contain heterophilic antibodies that could react in immunoassays to
give falsely elevated or depressed results. This assay is designed to minimize interference
from heterophilic antibodies.
Reference Range: 0-35 units/mL
Method The Atellica IM CA 125II assay is a 2-site sandwich immunoassay using direct
Description: chemiluminometric technology, which uses 2 mouse monoclonal antibodies specific for CA
125. The first antibody is directed toward the M11 antigenic domain and is labeled with
acridinium ester. The second antibody is directed toward the OC 125 antigenic domain and
is labeled with fluorescein. The immunocomplex formed with CA 125 is captured with
mouse monoclonal anti-fluorescein antibody coupled to paramagnetic particles in the Solid
Phase.
CPT Code: 86304
TEST NAME CA15-3
MERCY TEST CA 15-3 MERCY LAB CODE CA153B

NAME
Specimen: 0.5 ml of serum
hours. Freeze samples at ≤ -20°C if the sample is not assayed within 24 hours. Mix
thoroughly after thawing.
Comment: Do not use samples that have been stored at room temperature for longer than 8 hours.
Do not use the Atellica IM CA 15‑3 assay as a screening test or for diagnosis. Normal
levels of CA 15‑3 do not always preclude the presence of disease.
Processing: Stable 8 hours at room temp or 48 hours refrigerated. Freeze if analysis will be delayed
>48 hours.
Reference
0-31.3 units/mL
Range:
Method The Atellica IM CA 15‑3 assay is a fully automated, 2-step sandwich immunoassay using
Description: direct chemiluminescent technology.
CPT Code: 86300
TEST NAME CA19-9
MERCY TEST NAME CA 19-9 MERCY LAB CA199

CODE
Stability: Tightly cap and refrigerate specimens at 2°–8°C if the assay is not completed within 8
hours. Freeze samples at ≤ -20°C if the sample is not assayed within 48 hours.
Freeze samples only 1 time and mix thoroughly after thawing
This device is not indicated for screening or the early detection of pancreatic cancer or as a
diagnostic tool to confirm the presence or absence of malignant pancreatic disease. Do not
predict disease recurrence solely on levels of Atellica IM CA 19‑9. Normal levels of Atellica IM
CA 19‑9 do not always preclude the presence of disease.
Performed: Within 8 hours of receipt, 7 days a week.
Reference value: 0-35 units/mL
Method The Atellica IM CA 19-9 assay is a 2-step sandwich immunoassay using direct
Description: chemiluminescent technology that uses a single monoclonal antibody, 1116-NS-19-9, for
both the Solid Phase and Lite Reagent.
CPT Code: 86301
TEST NAME CA 27.29
MERCY TEST NAME CA 2729* MERCY LAB C2729

CODE

Processing: Centrifuge and aliquot serum into a plastic vial within 2 hours of collection. Send refrigerated
to Mayo. Mayo order code (C2729).
Cause for
Specimens that have not been aliquoted will be canceled.
Rejection:
Reference: Included in report.
Method: Chemiluminometric Immunoassay
CPT Code: 86300
POWERCHART CALCITONIN
NAME
MERCY TEST NAME CALCITONIN* MERCY LAB CODE CLCN
Caution: This test is not useful for evaluating calcium metabolic diseases.
Note: Patient preparation: 12 HOURS before this blood test do not take vitamins or dietary
supplements containing
biotin or vitamin B7, which are commonly found in hair, skin, and nail supplements and
vitamins.
Place specimen on ice immediately after collection
Processing: Refrigerate specimen during centrifugation and immediately transfer serum to plastic
vial. Send frozen to Mayo. Mayo order code (CATN).
CPT code: 82308
POWERCHART CALCIUM TOTAL

NAME
MERCY TEST NAME CALCIUM MERCY LAB CODE CA
Stability: Separated serum/plasma specimens may be stored for up to 8 hours when stored at room
temperature or for at least 2 days at 4°C or stored frozen for at least 6 months at -20°C.
Performed: Within 8 hours or receipt. Available Stat.
Reference Range: 0-10 days: 7.6-10.4 mg/dL
11 days- ≤ 2 years: 9.0-11.0 mg/dL
2-12 years: 8.8-10.8 mg/dL
≤ 13 years: 8.6-10.3 mg/dL
Method Calcium ions form a colored complex with Arsenazo III. The amount of calcium present in
Description: the sample is directly proportional to the intensity of the colored complex formed.
CPT Code: 82310

POWERCHART CALCIUM IONIZED
NAME
MERCY TEST NAME CALCIUM IONIZED MERCY LAB CODE CAI
Alias: o Calcium Free

Specimen: o 0.5 ml whole blood from lithium heparin green top tube.
o Keep the tube capped until analysis.
o For single ionized calcium orders, completely fill a separate tube.
o Deliver to the Lab within one hour.
o Reference Lab Clients - If not delivered to lab within one hour refrigerate and
send on ice. Preferred specimen is a dark green tube. If not available, a light
green tube may be used if tape is placed over the cap with DO NOT SPIN
indicated on it.
Stability: 12 hours if capped and refrigerated and sent on ice.
Cause for Hemolyzed specimens or specimens other than unopened green top tubes, except for
rejection: capillary specimens in green top microtainers tubes.

Reference value: Cord blood: 1.30 - 1.60 mmol/L
< 1 day: 1.21 - 1.46 mmol/L
1 - 2 days: 1.10 - 1.36 mmol/L
3 - 4 days: 1.15 - 1.42 mmol/L
5 days - 11 months: 1.22 - 1.48 mmol/L
1 - 17 years: 1.20 - 1.38 mmol/L
> 17 years: 1.16 - 1.32 mmol/L
Method: Ion selective electrode direct

CPT Code: 82330
POWERCHART CALCIUM 24 HOUR URINE

NAME
MERCY TEST NAME CALCIUM 24UR MERCY LAB CODE VCAL
Specimen: 5 mL of preserved urine
Stability: Urine specimens should be collected in a bottle containing 10 mL of 6 M HCl per 24-hour
specimen to prevent calcium salt precipitation.
Performed: Within 8 hours or receipt. Available Stat.
Reference 100-300 mg/24 Hours

Range:
Method Calcium ions form a colored complex with Arsenazo III. The amount of calcium present in the
Description: sample is directly proportional to the intensity of the colored complex formed.
CPT Code: 82340

POWERCHART CALCIUM RANDOM URINE
NAME
MERCY TEST NAME CALCIUM R UR MERCY LAB CODE UCAL
Specimen: 5 mL of random urine

Stability: Urine specimens should be collected in a bottle containing 10 mL of 6 M HCl per 24-hour
specimen to prevent calcium salt precipitation.
Performed: Within 8 hours of receipt. Available Stat

Reference Range: 1.00-32.00 mg/dL
Method: Calcium ions form a colored complex with Arsenazo III. The amount of calcium present in
the sample is directly proportiona to the intensity of the colored complex formed.
CPT Code: 82310
TEST NAME CALCIUM/CREATININE RATIO
Comment: Order Calcium Random Urine and Creatinine Random Urine.

This is a calculation which is done by the physician/nursing service.
Calcium/Creatinine Ratio = Calcium Random Urine (mg/dl)

Creatinine Random Urine (mg/dl)
Specimen: 5 ml random urine. Refrigerate.

**NOTE** If the urine calcium/creatinine ratio is greater than 0.18, one source recommends
quantifying with 24-hour urine.
POWERCHART CALPROTECTIN STOOL
NAME
MERCY TEST NAME CALPROTECTIN* MERCY LAB CALPR

CODE
Specimen: 5 g fresh random fecal specimen in a stool container. No preservative.

Separate specimens must be submitted when multiple tests are ordered. Specimens
must be split prior to transport.
Additional Info Testing cannot be added on to a previously collected specimen.
Processing: If specimen is sent refrigerated, send immediately after collection. If specimen cannot be
sent immediately, freeze and send frozen (preferred). Send frozen to Mayo. Mayo order
code (CALPR).
Performed: 3-5 days, Monday through Friday
Method: Enzyme-linked Immunosorbent Assay (ELISA)
CPT code: 83993
POWERCHART CARBAMAZEPINE (TEGRETOL) LEVEL

NAME
MERCY TEST NAME CARBAMAZEPINE MERCY LAB CODE CAR

Alias: Carbatrol or Tegretol
Stability: Specimens may be stored for up to 8 hours at 25°C or for up to 2 days at 2-8°C or stored
frozen for up to 30 days at -20°C.
Therapeutic range: 4-12 mcg/mL
Method The methodology for Carb involves a homogeneous particle-enhanced turbidimetric

Description: inhibition immunoassay (PETINIA) technique which uses a synthetic particle-carbamazepine
conjugate (PR) and carbamazepine-specific, monoclonal antibody (Ab).
CPT Code: 80156
POWERCHART CARBON DIOXIDE LEVEL

NAME
MERCY TEST NAME CO2 MERCY TEST CO2

CODE
Alias: Bicarb or HC03

Specimen: 0.5 ml from a serum
Stability:
20°C
Reference Range: 20- 34 mmol/L
Method The Atellica CH CO2_c assay is based on phosphoenolpyruvate carboxylase (PEPC) catalyzed
Description: reaction followed by an indicator reaction
CPT Code: 82374
POWERCHART CARBONMONOXIDE SATURATION ARTERIAL

NAME
TEST NAME CARBOXYHGB, ARTERIAL MERCY TEST COSATA

CODE
Specimen: Arterial Whole Blood collected in a Heparinized syringe. Minimum volume of 1 ml.
o The tube must be walked to its destination. Do NOT send through the tube
station.
Comment: Respiratory or RN will call lab 87256 to come pick up Arterial specimen that Respiratory is
collecting.
Rejection Criteria: Air in the sample, clotted, hemolyzed, unlabeled specimens
Performed: Within 10 minutes of specimen collection.
Reference value: 0-3%
Method: ABL80 CO-OX Flex

CPT Code: 82375
POWERCHART CARBONMONOXIDE SATURATION VENOUS

NAME
MERCY TEST NAME CARBOXYHGB, VENOUS MERCY TEST CODE COSATV
Specimen:
Venous Whole Blood collected in a Lithium Heparin tube. Minimum volume 1 ml. Lab may collect.
o The tube must be walked to its destination. Do NOT send through the tube station.
o Testing can be done no matter how old the specimen is. There are no time restrictions for
this test.
o This tube may not be used for other testing.
o Do not open the tube until analysis.
o Serum specimens, SST, and purple top EDTA tubes are unacceptable.
o
Reference Lab Send specimen on ice.
Clients:
Rejection Criteria: Clotted, hemolyzed, unlabeled specimens.
Reference value: 0-3%

CPT Code: 82375
POWERCHART CARDIAC ENZYMES (CK, LD, AST)
NAME
MERCY TEST NAME CARDIAC ENZYME MERCY LAB CODE CENZ
Stability: Specimens may be stored for up to 3 days at 20-25°C or for up to 7 days at 2-8°C or stored
frozen for up to 30 days at -20°C or colder
Comment: Panel includes CK, AST, and LD. Hemolyzed specimens are not acceptable.
Reference Range: Refer to individual tests
Method Refer to individual tests
Description:
CPT Code: 82550 CK

84450 AST
83625 LD
POWERCHART CARDIOLIPIN ANTIBODIES

NAME
MERCY TEST NAME CARDIOLIPIN ATBY* MERCY LAB CODE CRLA
Processing: Send refrigerated to Mayo. Frozen acceptable. Mayo order code (CLPMG).
Performed: 1-2 days. Monday - Saturday; 4 p.m.
Reference Value: Included in report.
86147 x 2
CPT Code:
POWERCHART CARDIOLIPIN ANTIBODY IGA

NAME
MERCY TEST NAME CARDIOLIPIN AB IGA* MERCY LAB ACLIP

CODE
Specimen: 0.5 mL of serum from a Serum Separator Tube (SST) or no additive serum tube.
Processing: Send refrigerated (preferred) to Mayo. Frozen is also acceptable. Mayo order code (ACLIP).
Performed: Monday, Wednesday, Friday; Report available 3-5 days from receipt.
86147
CPT Code:
POWERCHART
CATECHOLAMINE FRACTIONATION URINE
NAME
MERCY TEST NAME CATECH FR 24UR* (alternate name Catecholamine MERCY TEST
CTCH
Fractionation, Free) CODE
Comment:
o A single 24-hour urine collection may be used for CATECHOLAMINE
FRACTIONATION, METANEPHRINES [METN24U] and VMA [VMA24UR].
o The specimen must be kept refrigerated during collection.
Patient o This assay is of most value when the specimen is collected during a hypertensive
preparation: episode.
o Discontinue any epinephrine, norepinephrine, or dopamine injections/infusions at
least 12 hours before specimen collections, UNLESS drug monitoring is the goal.
o Discontinue drugs that release or hinder metabolism of epinephrine,
norepinephrine or dopamine for at least 1 week before obtaining the specimen. If
this is not possible for medical reasons, contact Mayo laboratory to discuss
whether a shorter drug-withdrawal period may be acceptable.
o Do not perform the test on patients withdrawing from legal or illegal drugs known
to cause rebound plasma catecholamine release during withdrawal.
Cautions: o Many alterations in physiologic and pathologic states can profoundly affect
catecholamine concentrations.
o Any environmental factors that may increase endogenous catecholamine
production should be avoided. These include noise, stress, discomfort, body
position, and the consumption of food, caffeinated beverages, and nicotine.
Caffeine and nicotine effects are short term, a few minutes to hours only.
o Other substances and drugs that may affect the results include:
Substances that result in increased release or diminished metabolism of
endogenous catecholamines
Monoamine oxidase inhibitors (MOLs)-a class of anti-depressants with marked
effects on catecholamine levels, particularly if the patient consumes tyrosine rich
foods, such as nuts, bananas , or cheese.
Catecholamine reuptake inhibitors including cocaine and synthetic cocaine
derivatives, such as many local anesthetics, which also can be antiarrhythmic drugs
(e.g., lidocaine)
Some anesthetic gases, particularly halothane.
Withdrawal from sedative drugs, medical or recreational.
Vasodilatin drugs (e.g., calcium antagonists, alpha-blockers)
Tricyclic antidepressants usually exert a negligible effect.
o Substances that reduce or increase plasma volume acutely (e.g., diuretics,
radiographic contrast media, synthetic antidiuretic hormone {e.g., desmopressin 1-
deamino-8-d-arginine vasopressin: DDAVP})
Specimen: o Before start of collection, add 25 ml 50% acetic acid preservative to the container
(15 ml 50% acetic acid for children
o Collect for 24 hours.
o RL Clients, please call Mercy Lab to have a jug prepared with preservative.
Reference Lab: Adjust pH to 2.0-4.0 with 50% acetic acid. Aliquot 20 ml and indicate the 24-hour volume.
Processing: o Separate aliquots must be submitted for Metanephrines and VMA if collected with
this specimen.
o Identify which specimen is for Catecholamine Fractionation.
Mercy lab o 2 ml in a 10 ml urine tube. Mayo order code (CATU).
Processing: o Send refrigerated to Mayo. Frozen acceptable. Ambient with preservative
acceptable.
Method: High Performance Liquid Chromatography (HPLC)
CPT Code: 82384
POWERCHART CATHETER TIP CULTURE

NAME
MERCY TEST NAME CATHETER TIP CLT MERCY LAB CODE CTC
Order: Specify site of insertion (subclavian, peripherally inserted central catheter, etc.)
Specimen: 2 inches of Blood Catheter Tip.
o Aseptically remove the catheter tip from the patient.

o Using sterile scissors, cut the catheter 2 inches from the tip.
o Only submit 2 inches of the blood catheter tip.
o Aseptically place catheter tip in a sterile PLASTIC CONTAINER with a tight-fitting
lid. DO NOT send the catheter tip in a Culturette device.
o Specimen should be sent to Mercy lab at room temperature.
Cause for Foley Tip catheters will not be accepted.
rejection:
Comments: oQuantitation will be reported for each isolate. >15 colony forming units (CFU) is
considered significant.
Reference value: No growth
Performed: Preliminary report: 1 day

CPT Code: 87070
POWERCHART CBC
NAME
MERCY TEST CBC MERCY LAB CBC

NAME CODE
Includes: WBC HCT

RBC
MCV HGB PLATELETS
MCH
RDW MCHC NUCLEATED RBC
MPV
No differential included.
Comment: Cell morphology will be ordered and charged if established criteria/diagnosis are met.
Specimen: 1 purple top (EDTA) tube.
Stability: 24 hours room temp, or 48 hours refrigerated.
Reference value: Included with test results. Complete listing in Special Helps section of Lab Test Index.
Method: Automated cell counter.
CPT Code: 85027
POWERCHART CBC with DIFFERENTIAL

NAME
MERCY TEST NAME CBC with Diff MERCY LAB CODE CBCAD
Includes: WBC RBC HGB HCT

MCV MCH MCHC PLATELETS
RDW MPV Automated NUCLEATED RBC
Differential
(Includes absolute
cell counts)
Manual differential (includes only absolute segmented neutrophil and bands, lymphs,
monocytes, eosinophils and basophils count) is done if indicated by test results.
Specimen: Draw 1 purple top (EDTA) tube.
Stability: 24 hours at either room temp or 48 hours refrigerated.
CPT Code: 85025
POWERCHART CBC with MANUAL DIFFERENTIAL
NAME
MERCY TEST NAME CBC Diff MANUAL MERCY LAB CODE CBCD
Includes: WBC RBC HGB HCT

MCV MCH MCHC PLATELETS
RDW MPV Manual Differential NUCLEATED RBC
(Includes only
absolute
segmented
neutrophil, band,
lymphocytes,
monocytes,
eosinophils and
basophil count).
Specimen: Draw 1 purple top (EDTA) tube.

Comment: To be ordered only when physician orders are CBC with Manual diff.
Cell morphology will be ordered and charged if established criteria/diagnosis are met.
Stability; 24 hours at either room temp or 48 hours refrigerated.

Method: Automated cell counter and microscopic exam of Wright-stained smear.
CPT Code: 85027 CBC
85007 Manual Differential
POWERCHART
CD4
NAME
MERCY TEST NAME CD4 T-CELL COUNT* MERCY LAB CODE CD4A
Includes: CD3, CD4, CD8 and CD45 Lymphocytes, CD4/CD8 Ratio
Note: Draw specimens as close to shipping time as possible

Specimen: o 3 mL whole blood EDTA lavender tube, ambient temperature
o Send specimen in original tube, DO NOT ALIQUOT
o Send specimens to Mayo within 24 hours of collection
Processing: Send specimens ambient to Mayo Medical Laboratories, Mayo order code (TCD4).
Performed: Monday – Sunday
Reference Value: Age-related reference values will be provided on the report
Method: Flow Cytometry, Single Platform (CD3, CD4, CD8, CD45)

CPT Code: 86359
86360
POWERCHART CEA
NAME
MERCY TEST NAME CEA* MERCY LAB CODE CEA

Stability: Tightly cap and refrigerate specimens at 2-8°C if the assay is not completed within 8 hours.
Freeze samples at ≤20°C if the sample is not assayed within 48 hours. Freeze samples only
1 time and mix thoroughly after thawing.
Do not interpret levels of CEA as absolute evidence of the presence or the absence of
malignant disease. Measurements of CEA should always be used in conjunction with other
diagnostic procedures, including information from the patient’s clinical evaluation.
Reference Range: 0.25 ng/mL
Method The Atellica IM CEA assay is a 2-site sandwich immunoassay using direct chemiluminometric
Description: technology which uses constant amounts of 2 antibodies.
CPT Code: 82378
TEST NAME CELIAC DISEASE PROFILE Order: IgA and TISTA
Patient Fasting is recommended to avoid lipemia which may interfere with the test.
Preparation:
Specimen: 0.5 ml serum for IgA and 1.0 ml serum for TISTA from a Serum Separator Tube (SST) or no
additive serum tube. Send refrigerated
Cause for
Hemolysis or gross lipemia
Rejection:
Comment: TISTA is a new assay that performs the Tissue Transglutaminase and deamidated Gliadin
simultaneously for IgA. There is no need for a separate order for the tTG and deamidated
gliadin. Ordering the TISTA will cover for both assays, simultaneously, but will be reported as
one result for IgA and one result for IgG
Processing: IgA can be refrigerated for up to 21 days. Send TISTA refrigerated to Mayo. (Mayo order
code (TSTGP) Frozen is acceptable for both.
Performed: IgA-Within 8 hours of receipt
TISTA-Monday thru Saturday at Mayo
Reference Value: Included with the report
Method: IgA-Immunoturbidimetric
TISTA-EIA
CPT Code: 82784-IgA
83516x2-TISTA
POWERCHART CELL COUNT BODY FLUID

NAME
MERCY TEST NAME CELL COUNT BF MERCY LAB CODE BFCC
Includes: WBC Differential RBC (All fluids except synovial fluids)

Description of color, clarity, and source
Specimen: o 1-2 ml body fluid immediately placed in a purple top tube by nursing personnel
after collection.
o Invert tube several times.
o Tubes are available from the Laboratory.
o Pleural and peritoneal fluids in purple top tubes are stable up to 48 hours
Stability:
refrigerated.
o Synovial fluids should be examined within 2 hours of collection. If synovial fluid
examination will be delayed > 2 hours, refrigerate specimen in purple top tube.
Comment: Indicate specimen source in comment field.
Method: Hemacytometer counting chamber and microscopic exam of Wright-stained smear.
CPT Code: 89050 Cell Count
or
89051 Cell Count with Differential
POWERCHART CELL COUNT CSF

NAME
MERCY TEST NAME CELL COUNT CSF MERCY LAB CODE CCSF
Includes: RBC WBC Differential if indicated

Specimen: 1 ml CSF. Deliver to the Laboratory within 15 minutes of collection.
Stability: 1 hour room temp
Comment: Specimen must be transported in a screw top container.
Processing: Must be tested within 1 hour of collection.
Reference value: WBC: 0-1 month 0 - 30 /mcl
>1 month 0 - 5 /mcl
WBC DIFFERENTIAL Neutrophil Lymphocyte Monocyte

0 - 11 months: 0-8% 5-35% 50-90%
1 year - adult: 0-6% 40-80% 15-45%
RBC: 0/mcl
Method: Hemacytometer counting chamber.

Microscopic exam of Wright-stained smear if >5 WBC/mcl.
CPT Code: 89050 Cell Count

or
89051 Cell Count with Differential
POWERCHART
CELL MORPHOLOGY
NAME
MERCY TEST NAME CELL MORPHOLOGY MERCY LAB CODE CM
Comment: o Order a CBC with DIFFERENTIAL

o Indicate in comment if previous specimen is to be used.
o Lab will order and charge for a cell morphology on any patient meeting established
Laboratory guidelines.
o If pathologist review is needed on a body fluid specimen, please order Cytology.
Send specimen (and slide if available) for Cytology. See the Cytology Section for
fluid preservation.
Alias: Slide review for Pathologists or Peripheral Blood Smear.
Specimen: Blood smear prepared from a purple top tube.
Regional Lab Clients - Send a purple top tube (ALWAYS), two unstained slides, patient's
demographic sheet and either:
o Copy of your CBC results that include the CBC normal ranges for that patient's age
and sex. Order Diff Manual and a Cell Morphology. Send completed Cell
Morphology Information form.
OR
o Order a CBC with DIFFERENTIAL and a Cell Morphology. Mercy Lab will do a CBC
with differential.
o Send completed Cell Morphology Information form.
o 36 hours room temp or refrigerated.
Stability: o If a manual diff or slide review was already done on the specimen, CM may be
added anytime because the slide is already prepared.
Performed: 2 days
Results: Descriptive report is sent.
Method: Pathologist evaluation of Wright-stained smears.
CPT Code: 85060
POWERCHART CENTROMERE ANTIBODY IGG

NAME
MERCY TEST NAME CENTROMERE IGG AB* MERCY LAB CENTR

CODE
Specimen: 0.5 ml serum from a serum separator tube (SST)

Send refrigerated to Mayo. Frozen is also acceptable.
Processing:
Mayo order code (CMA).

CPT Code: 83516
POWERCHART CERULOPLASMIN
NAME
MERCY TEST CERULOPLASMIN* MERCY LAB CRLPSM

NAME CODE
Alias Name(s): Copper Oxidase
Specimen: 1 ml serum from a Serum Separator Tube (SST) or no additive serum tube.
4 hour fasting specimen is preferred, non-fasting is acceptable

Performed: 3 days. Test Performed by Mayo Monday through Friday continuously.
Processing: Send to Mayo refrigerated. Mayo order code CERS
Method: Nephelometric Assay
CPT code: 82390
POWERCHART CHLAMYDIA PNEUMONIAE BY PCR*

NAME
MERCY TEST NAME CHLAMYDIA PNEUMONIAE BY PCR* MERCY LAB CODE MISM
Specimen: o Bronchial Wash/Lavage

o Collect 1 mL in a sterile leak-proof container.
o Sputum
o Collect 1 mL in a sterile plastic container.
o Respiratory specimen (throat or Nasopharyngeal)
Collect specimen on a plastic shafted swab and place in M4 transport
o
media.
RL Client o Write CHLAMYDIA PNEUMONIAE PCR on order form. Indicate the specimen source
Comments: on order form.
o Send specimen refrigerated to Mercy lab.
Days Performed: Specimen referred M-F to UHL, Iowa City for testing
Method: Real-Time PCR
Reference Value: Not Detected
CPT Code: 87486
TEST NAME Chlamydia trachomatis, Miscellaneous Sites, by Nucleic Acid Amplification

(OTHER SITES not genital or urine) *
MERCY TEST MISCELLANEOUS GENERAL LAB Designate: Mayo order MERCY LAB CODE CMIS
NAME code - MCRNA
Specimen: Swab specimen collected using the APTIMA Collection Vaginal Swab (the APTIMA Unisex
Swab can also be used). Collection kits are available from Mercy Lab.
Mayo approved: The following sites are approved for Chlamydia testing at Mayo Med Labs, ONLY (Mercy Lab
is not approved to do testing on these sites):
Sites: o Rectal/anal
o Ocular (corneal/conjunctiva)
o Oral/throat
o Pelvic wash, cul-de-sac fluid (this source requires the APTIMA specimen transfer
tube T652, available from Mercy lab).
NOTE: If provider wants both Chlamydia and GC testing done on rectal, ocular, oral or
pelvic, a separate order will have to
be placed for each test.
Cause for o Transport tubes that are received without collection swabs inside.
rejection: o Transport tubes that have expired.
o Transport tubes received with a swab different from the one provided in the
collection kit.
o Sources other than those listed above.
Comment: In the case of suspected child abuse, culture is the only recommended procedure.
See: Chlamydia Trachomatis Culture listed below
RL Client o If ordering the test at your facility, order a CMIS and put in comment the test is for
Comments: MCRNA and include the source (rectal, ocular, oral, pelvic). If you will order using a
requisition, write CMIS on the order form and indicate the testing is for MCRNA
and include the source (rectal, ocular, oral, pelvic).
o Send the APTIMA transporter refrigerated to Mercy lab.
Processing: Refrigerate sample after collection and sent to Mayo Med Labs refrigerated. Mayo order
MCRNA (C. trach, Misc., Amplified RNA)
POWERCHART CHLORIDE LEVEL

NAME
MERCY TEST NAME CHLORIDE MERCY LAB CODE CL

Stability: Serum may be stored for up to 7 days at 2-8°C or stored frozen for up to 30 days at -20°C.
Thawed or frozen specimens which are turbid must be clarified by centrifugation prior to
Comment: testing
Reference
97 - 109 mmol/L
range:
Method The methods for measurement of electrolytes include flame photometry, spectrophotometry
Description: and direct or indirect ion selective electrode potentiometry. The A-LYTE Na, K, and Cl assays
are indirect Integrated Multisensor Technology (IMT). There are four electrodes used to
measure electrolytes. Three of these electrodes are ion-selective for sodium, potassium, and
chloride. A reference electrode is also incorporated in the multisensor.
CPT Code: 82435
POWERCHART CHLORIDE 24 HOUR URINE

NAME
MERCY TEST NAME CHLORIDE 24HR UR MERCY LAB CODE VCL
Specimen: 5 mL unpreserved urine from a 24-hours urine collection that was refrigerated during
collection.
Stability: Twenty-four-hour collection should be made without addition of preservatives and stored
refrigerated at 2-8°C or frozen for delayed analysis.
Comment: Indicate volume of urine collection
Performed:
Within 8 hours of receipt. Available Stat.
Reference Range: 110-250 mmol/L/24 Hours
Method: The A‑LYTE Na, K, and Cl assays use indirect Integrated Multisensor Technology (IMT). There
are four electrodes used to measure electrolytes. Three of these electrodes are ion-selective
for sodium, potassium, and chloride. A reference electrode is also incorporated in the
multisensor.
CPT Code: 82436
POWERCHART CHLORIDE RANDOM URINE

NAME
MERCY TEST NAME CHLORIDE RAND UR MERCY LAB CODE UCL
Specimen: 5 mL random urine.

Stability: Urine collection should be made without addition of preservatives and stored refrigerated at
2-8°C or frozen for delayed analysis.
Reference Range: 20.0-330.0 mmol/L
Method: The A-LYTE Na, K, and Cl assays use indirect Integrated Multisensor Technology (IMT). There are
four electrodes used to measure electrolytes. Three of these electrodes are ion-selective
for sodium, potassium, and chloride. A reference electrode is also incorporated in the multi-
Sensor.
CPT Code: 82436
POWERCHART CHOLESTEROL
NAME
MERCY TEST NAME CHOLESTEROL MERCY LAB CODE CHOL

Stability: Specimens may be stored for up to 8 hours at 25°C or for up to 2 days at 2-8°C or for longer
storage, specimens may be frozen at -20°C or colder
Method The Atellica CH Cholesterol_2 (Chol_2) assay is based on enzymatic method using cholesterol
Description: esterase and cholesterol oxidase conversion followed by a Trinder endpoint.
CPT Code: 82465
TEST NAME CHOLINESTERASE MERCY LAB CODE See: Pseudocholinesterase, Total

Acetylcholinesterase RBC
Note: If only cholinesterase is written, please clarify with provider as to whether it is

pseudocholinesterase or acetylcholinesterase RBC.
POWERCHART CHROMOGRANIN A
NAME
MERCY TEST NAME CHROMOGRANIN A* MERCY LAB CODE CGA
Comment: Proton pump inhibitor drugs should be discontinued at least 2 weeks before collection.
Processing: Send specimen frozen to Mayo. Mayo order code (CGAK).
Performed: Monday through Saturday.

Reference value: Included in the report.
Method: Automated Immunofluorescent Assay
CPT Code: 86316
POWERCHART CHROMOSOME HEMATOLOGIC BLOOD

NAME
MERCY TEST NAME CHRM ANLYS BLD* MERCY LAB CODE CHRB
Comment: This test is not appropriate for detecting constitutional/congenital chromosome

abnormalities.
Specimen: 5-10 ml whole blood collected in yellow top (ACD) (Preferred), Sodium heparin,
o
EDTA tubes
Processing: o Send WHOLE BLOOD. DO NOT CENTRIFUGE.
o Send ambient to Mayo. DO NOT FREEZE. Refrigerated also acceptable. Mayo Code
(CHRHB) for Chromosome Analysis, Hematologic Disorders, Blood.
o Mercy Lab staff will order on Mayo Access
o Reason for referral will need to be entered on Mayo Access when ordering.
Performed: Monday – Friday 9-11 days
Reference value: An interpretive report will be provided.
Method: Cell culture without mitogens followed by chromosome analysis.
CPT Code: 88237, 88291- Tissue culture for neoplastic disorders; bone marrow, blood, Interpretation
and report
88264 w/ modifier 52-Chromosome analysis with less than 20 cells (if appropriate)
88264-Chromosome analysis with 20 to 25 cells (if appropriate)
88264,88285- Chromosome analysis with greater than 25 cells (if appropriate)
88283-Additional specialized banding technique (if appropriate)
POWERCHART CHROMOSOME CONGENITAL BLOOD

NAME
MERCY TEST NAME CHRM CONGENITAL BLOOD* MERCY LAB CODE CHRC
Specimen: o Blood: 5 ml whole blood collected in SODIUM HEPARIN tubes. 2 ml minimum.

o Cord Blood: whole blood collected in sodium heparin tube. Send as much as
possible. Please label as cord blood.
o Other anticoagulants may be harmful to the viability of the cells.
Processing: o Send WHOLE BLOOD. DO NOT CENTRIFUGE.
o Put Genetics Request information under internal notes on the Mayo system.
o Send ambient to Mayo. Refrigerated acceptable. DO NOT FREEZE. Mayo Code
(CHRCB).
Performed: 10 days. Monday through Sunday.
Reference values: 46, XX or 46, XY. No apparent chromosome abnormality. An interpretive report will be
provided.
Method: Cell culture with mitogens followed by chromosome analysis
CPT Code: 88230 - Tissue culture for chromosome analysis (if appropriate)
88262 - With modifier 52 (if appropriate)
88291
88280
88283 - (if appropriate)
POWERCHART CHROMOSOME STUDY BONE MARROW

NAME
MERCY TEST NAME CHRM ANLYS BM* MERCY LAB CODE BMC
Specimen: o 2-3 ml of bone marrow placed in yellow top (ACD), sodium heparin, or EDTA tubes
Comment: o Complete the Hematopathology portion of Mayo Connect Additional Test
Information form.
o Send a copy of CBC and/or bone marrow report.
o Chromosome analysis is not recommended for plasma cell neoplasms due to
limited clinical utility; therefore effective 12/7/2020, Mayo will cancel the BMC
(Mayo CHRBM) if ordered concurrently with a plasma cell FISH tests such as Mayo's
PCPDS, MSMRT or MFCF
Processing: o See Mayo Test Catalog for complete instructions.
o Send ambient to Mayo. Refrigerated acceptable. Mayo CHRBM
Cause for
Specimen sent frozen will be rejected.
Rejection:
Performed: 9-11 days. Samples processed Monday through Sunday
Reference value: Interpretation included with test results.
Method: Cell culture without mitogens followed by chromosome analysis.
CPT Code: 88237, 88291-Tissue culture for neoplastic disorders; bone marrow, blood, interpretation,
and report
88264 w/ modifier 52-Chromosome analysis with less than 20 cells (if appropriate)
88264-Chromosome analysis with 20 to 25 cells (if appropriate)
88264, 88285-Chromosome analysis with greater than 25 cells (if appropriate)
88283-Additional specialized banding technique (if appropriate)
POWERCHART CITRATE EXCRETION 24 HR URINE

NAME
MERCY TEST NAME CITRATE EXCRT 24UR* MERCY LAB CODE CITRAT
Patient Any drug that causes alkalemia or acidemia may be expected to alter citrate excretion and
preparation: should be avoided, if possible. The patient must avoid laxative use for 24-hour collection
period.
o 24-hour urine collection.

o Add 5 mL of diazolidinyl urea (Germall) as a preservative at start of collection OR
Specimen:
refrigerate specimen during and after collection.
Processing: o Transfer 4 ml urine to 5 mL plastic tube. Mix well before aliquot is taken.
o Indicate total 24-hour volume.
o Send refrigerated to Mayo. Mayo order code (CITR).
Performed: Results 1 day. Monday through Saturday.
Method: Enzymatic
CPT Code: 82507
POWERCHART CK (CREATINE KINASE)

NAME
MERCY TEST NAME CK MERCY LAB CODE CK

Specimens may be stored for up to 4 hours at 25°C or for up to 5 days at 2-8°C or stored
Stability:
frozen for up to 2 months at -20°C.
Comment: Do not use hemolyzed samples, as they may cause significant interference with this assay.
Reference Range: Male:49-397 units/L

Female:38-234 units/L
Method The Atellica CH CK_L assay is an adaptation of the IFCC Reference Method. Creatine Kinase
Description: reacts with creatine phosphate and adenosine diphosphate (ADP) to form adenosine
triphosphate (ATP), which is coupled to the hexokinase-G6PD (glucose-6-phosphate
dehydrogenase) reaction, generating NADPH (reduced nicotinamide adenine dinucleotide
phosphate).
CPT Code: 82550
POWERCHART CK-MB TOTAL
NAME
MERCY TEST NAME CKMB MERCY LAB CODE CKMB
Tightly cap and refrigerate specimens at 2-8°C if the assay is not completed within 4 hours.
Stability: Freeze samples at ≤20°C if the sample is not assayed within 48 hours. Freeze samples only
Reference Range: 0-4.99 ng/mL

Method The Atellica IM CKMB assay is a 2-site sandwich immunoassay using direct
Description: chemiluminescent technology, which uses constant amounts of 2 antibodies
CPT Code: 82553
POWERCHART CLOSTRIDIUM DIFFICILE (MOLECULAR)

NAME
MERCY TEST NAME CLOSTRIDIUM DIFFICILE TOXIN GENE MERCY LAB CDIFFM
CODE
Test stool for C. difficile on all patients with clinically significant diarrhea AND history of
recent antibiotic use or exposure to C. difficile.
Specimen: FRESH SPECIMEN ONLY:
2 grams of fresh stool submitted in a tight-fitting lid container, refrigerated.
Refrigerated (2-8 C) stools are stable for 5 days.

Room temperature stools (never refrigerated) are stable for 24 hours.
The sample should NOT be frozen at any time after collection.
Consider C. Difficile testing as an alternative to routine microbiologic studies for INPATIENTS

that have been hospitalized for more than 3 days.
Cause for o Formed stools are not indicative of Clostridium difficile associated disease
Rejection: and will not be test.
o Specimens collected within 24 hours of barium or bismuth enema.
o Specimens contaminated with toilet water or urine.
o Specimens that are sent frozen
Comment: o Patient should be passing 3 or more liquid or soft stool that conforms to the container per 24
hours to be tested for Clostridium difficile.
o Not to be used for children
o Not to be used as a "test of cure," as this test will also detect non-viable organisms that persist
after treatment.
o Useful as an aid in diagnosis of antibiotic associated pseudomembranous colitis.
o Collect samples at least 24 hours post barium or bismuth enema.
o All positive results will have reflex C. diff antigen and toxin testing to determine carrier state vs
active infection. See CTOXAT section for further details.
RL Comments: o Mark CLOSTRIDIUM DIFFICILE on the order form.
o Fresh stool should be refrigerated immediately. Send stool to Mercy lab
refrigerated. A refrigerated stool is stable for 5 days.
o The sample should NOT be frozen after collection
Performed: Daily
Reference value: Negative for Toxigenic Clostridium Difficile
Method: Amplified DNA
CPT Code: 87493
POWERCHART
NAME
MERCY TEST NAME CLOSTRIDIUM DIFFICLE TOXIN AND ANTIGEN MERCY LAB CTOXR
CODE
Specimen: Frozen or preserved stool specimen
Comment: To be used only be our regional hospital Community Works sites or for regional hospital
correlation purposes. These order / results are not available within Cerner Powerchart. This
is NOT PCR or molecular testing.
For all other testing purposes, see Clostridium difficile molecular / CDIFFM.
Performed: Daily
Reference value: Negative for Clostridium difficile toxin

Negative for Clostridium difficile antigen
Method: Enzyme Immunoassay
CPT Code: 87324 & 8744

POWERCHART ACT (ACTIVATED CLOTTING TIME) POCT for Docking Purposes
NAME
MERCY TEST NAME ACTIVATED CLOTTING TIME MERCY LAB CODE ACTLT
Specimen: o 0.5 ml whole blood in non-siliconized syringe.

o Test must be performed at bedside immediately after blood specimen is collected.
Processing: This is only an order to collect and will be resulted with “performed” once collected. The
result will be generated from POCT testing at the bedside and will generate a second
order. The result will be found Activated Clotting Time (ACT) POCT (Upload) in Cerner
Powerchart.
Performed: Immediately after specimen collection. Available STAT.
Reference value: 74 - 125 seconds
Method: iStat instrument
CPT Code: 85347
POWERCHART CLOZAPINE NORCLOZAPINE LEVELS

NAME
MERCY TEST NAME CLOZAPINE* MERCY LAB CLZ

CODE
Specimen: 1 ml serum from a no additive serum tube

Processing: Send refrigerated to Mayo. Mayo order code (CLZ).
Performed: Monday through Friday
Reference value: Included on the report
Method: Liquid Chromatography - Tandem Mass Spectrometry (LC - MS/MS)
CPT Code: 80159
POWERCHART CARBON DIOXIDE LEVEL

NAME
MERCY TEST NAME CO2 MERCY LAB CODE CO2

Stability;
20°C.
Reference Range: 20-34 mmol/L
Method The Atellica CH CO2_c assay is based on a phosphoenolpyruvate carboxylase (PEPC)
Description: catalyzed reaction followed by an indicator reaction.
CPT Code: 82374
POWERCHART COCCIDIOIDES ANTIBODY

NAME
MERCY TEST NAME COCCIDIOIDES AB* MERCY LAB CODE COCD
Specimen: 2 mL Serum from a Serum Separator Tube (SST) or no additive serum tube
Processing: Send refrigerated to Mayo. Mayo code -(COXIS)
Comment: If this initial Coccidioides Antibody testing is positive then additional reflex testing (Mayo
code - RSCOC) Coccidioides Antibody by Complement Fixation, and Immunodiffusion (IgG,
IgM) will be performed at an additional charge.
Performed: Monday - Friday, Sunday 9 am

CPT Code: 86635 Coccidioides Antibody
86635 Coccidioides CF (If applicable)
86635 Coccidioides IgG (If applicable)
86635 Coccidioides IgM (If applicable)
MERCY TEST COCAINE UR* CONFIRMATION MERCY LAB CODE UCOKE

NAME
Specimen: 20 ml random urine specimen in a 60 mL urine bottle, no preservative
Processing: Send refrigerated to Mayo. Mayo order code (COKEU).

Method: Gas Chromatography - Mass Spectrometry (GC - MS) Confirmation and Quantification
CPT Code: G0480 / 80353
POWERCHART COLD AGGLUTININ SCREEN

NAME
MERCY TEST NAME COLD AGGLUT MERCY LAB CODE COLD

Specimen: o Preferred specimen: 1 ml plasma from pink top tube. Draw a separate tube if
ordered with Type & Screen or Crossmatch.
o Also acceptable: EDTA plasma from purple top tube or serum from plain red top
tube.
Cause for
SST is unacceptable. Hemolyzed specimens are unacceptable.
rejection:
Processing: o Incubate pink EDTA tube in a 37-degree water bath for 10-15 minutes.
o Centrifuge 10 minutes at room temperature.
o Remove plasma immediately.
o Refrigerate plasma/serum if not tested immediately.
o Reference Lab Clients: Follow above procedure, then remove aliquot and freeze
immediately.
Performed: Daily with 2000 cutoff. Available stat
Reference value: 0 - 15
Method: Hemagglutination at 4°C.
CPT Code: 86157
POWERCHART COLLECTION CAPILLARY BLOOD GASES

NAME
MERCY TEST NAME COLLECT CHG CBG MERCY LAB CODE CCBG
Specimen: o The patient’s heel or finger must be warmed prior to specimen collection.
o Refer to Phlebotomy Procedure Manual for complete specimen collection
instructions.
Comment: o Available stat.
o Included in the capillary venous blood gas order set.
o Outpatients-order CBGCVP for the blood gas test along with the CCBG for collect
charge.
o Lab collects and testing performed by CV&P.
o This can NOT be used for venous collections.
Method: Heel stick, Fingerstick
CPT Code: 36416
POWERCHART COLLECTION DONOR CANDIDATE

NAME
MERCY TEST NAME COLLECT CHG DONOR MERCY LAB CODE MDONOR
Specimen: o Collect tubes are in kit.

Comment: o Patient is registered in the HealthQuest system by outpatient registration staff and
instructed to go to the laboratory on the second floor.
o Client services order MDONOR.
o Service is done at no charge to the patient.
o No additional processing charges or collection charge is added.
POWERCHART COMPLEMENT C1q

NAME
MERCY TEST NAME COMPLEMENT C1Q* MERCY LAB CODE C1Q
Specimen: 1 mL serum from a red no additive serum tube

Processing: Send refrigerated to Mayo. Mayo order code (C1Q)
Method: Nephelometry
CPT Code: 86160
POWERCHART COMPLEMENT TOTAL (CH50)

NAME
MERCY TEST NAME COMPLEMENT TTL* MERCY LAB CODE CMPT
Specimen: 1 ml serum from a no additive serum tube or Serum Separator Tube (SST).
Stability: Immediately after drawing the specimen, place the tube on wet ice.
Processing: o Separate from clot and freeze immediately.
o Send frozen to Mayo. Mayo order code (COM).
Performed: 2 days. Test set up Monday through Friday; 3 p.m..
Method: Automated Liposome Lysis Assay
CPT Code: 86162
POWERCHART COMPREHENSIVE METABOLIC PANEL

NAME
MERCY TEST NAME COMP METABOLIC PNL MERCY LAB CODE CMPL
Specimen: 1 ml of serum
Stability: Specimens may be stored for up to 3 days at 2-8°C or stored frozen for up to 60 days at -
20°C.
Avoid hemolyzed samples for potassium. Hemolyzed samples may give incorrect elevated
Comment:
potassium. Panel includes Glucose, BUN, Creatinine, BUN/Creatinine Ratio, eGFR, Total
Bilirubin, Total Protein, Albumin, A/G Ratio, Calcium, Alkaline Phosphatase, AST, ALT, Sodium,
Potassium, Chloride, CO2, Anion Gap
Reference Range: See individual test entry.
Method
See individual test entry.
Description:
CPT Code: 80053
POWERCHART CONNECTIVE TISSUE DISEASE CASCADE (Replaces ANA Screen)

NAME
MERCY TEST NAME CONN TIS DIS CASC* MERCY LAB CODE CTDC
Alias: ANA (ANTINUCLEAR ANTIBODY SCREEN), Antinuclear Antibodies, Autoimmunity Panel,

Specimen: 1 ml serum from a Serum Separator Tube (SST) or no additive serum tube. Testing includes
Antinuclear Antibodies (ANA) and Cyclic Citrullinated Peptide (CCP) IgG Antibody.
If antinuclear antibodies are > or =3.0 U, then antibodies to double-stranded DNA (dsDNA),
extractable nuclear antigen evaluation, ribosome P, and centromere are performed at an
Comment: additional charge. If result from dsDNA test is borderline, then dsDNA antibody by Crithidia
IFA will be performed at an additional charge.
Processing: Send refrigerated to Mayo. Mayo order code (CTDC).

Performed 3-4 days. Monday through Saturday
CPT Code: 86038
86200
POWERCHART COOMBS DIRECT

NAME
MERCY TEST NAME COOMBS DIRECT (DAT (DIRECT ANTIGLOBULIN TEST) MERCY LAB CODE CMBS
Comment: For newborns: Order a Cord Blood Routine whenever a Direct Coombs is needed if the cord
blood is available, and this is the initial Direct Coombs order.
Specimen: One 6 ml pink top tube or purple top tube. Do not spin. Refrigerate.
Method: Serological
CPT Code: 86880
POWERCHART COPPER LEVEL

NAME
MERCY TEST NAME COPPER* MERCY LAB CODE COPP
Specimen: o Draw before any other tubes are drawn. 0.8 ml serum from Navy blue monoject-
no additive, trace element blood collection tube.
Cause for
The use of other tubes is unacceptable.
rejection:
Processing: o Allow to clot well (for at least 30 minutes before spinning). Then centrifuge the
specimen to separate serum from the cellular fraction. Serum must be removed
from the cells within 4 hours of specimen collection. Pour serum into a
Mayo Metal FREE vial. Do NOT use a transfer pipet or wooden sticks. Avoid
hemolysis.
o Send to Mayo refrigerated. Ambient acceptable. Mayo order code (CUS1).
Performed: 1-3 days. Monday through Saturday.
Method: Dynamic Reaction Cell Inductively Coupled Plasma Mass Spectrometry (DRC-ICP-MS)
CPT Code: 82525
POWERCHART CORD BLOOD STUDIES

NAME
MERCYONE TEST CORD BLD ROUTINE MERCY LAB CODE CRDB

NAME
Specimen: o 5-10 ml whole blood collected from the umbilical cord. Blood is to be placed in
a red top tube and purple top tube. Refrigerate.
o NOTE: Tubes must be labeled with baby's identification, mother's FULL name, date
and time of delivery.
Comment: o Enter mother's FULL name in comment field.
o Includes ABO Group/RH Type and Direct Coombs (DAT).
o If the Direct Coombs is positive, Lab will order and charge for a CBC, Cell
Morphology, Bilirubin from the cord blood and Antibody ID from the eluate.
Reference value: Direct Coombs: NEGATIVE

Method: Serological
CPT Code: 86900 ABO
86901 RH
86880 Direct Coombs
POWERCHART
CORONAVIRUS (COVID-19/SARS-CoV-2) POCT
NAME
MERCY TEST NAME COVID 19 SARS COV2 MERCY LAB CODE COV19P
Specimen: Two Nasal Swab in Sterile conical tube, each collected from both nares.
Request ID NOW Covid collection kit from Lab.
Performed: Daily, available stat
Reference value: NEGATIVE
Method: NAAT PCR Methodology on Abbott ID Now instrumentation
CPT Code:
87635
POWERCHART
CORONAVIRUS, FLU A/B, RSV Panel
NAME
MERCY TEST NAME COVID, FLU A/B, RSV MERCY LAB CODE
CEPH41
Specimen: Nasopharyngeal swab specimen is collected and placed into a viral transport tube containing
3 mL transport medium. The specimen is briefly mixed by rapidly inverting the collection
tube 5 times (Preferred).
Nasal swab placed in 3 mL of viral transport media.
Mid-Turbinate Swab placed in 3 mL of viral transport media.
Nasal Wash/Aspirate.
Includes: SARS-CoV-2, Influenza A virus, Influenza B virus and RSV.
Comment: No age restriction for RSV testing.
Processing: Nasal Wash/Aspirate-using a clean 300 uL transfer pipette (supplied), transfer 600 uL of the
sample (two draws using the same transfer pipette) into the 3 mL transport medium tube
then cap the tube.
Performed: Daily, available stat.
Reference value: Sars_CoV-2 NEGATIVE

Influenza A NEGATIVE
Influenza B NEGATIVE
RSV NEGATIVE
Method: Rapid Multiplexed real-time RT-PCR Methodology on Cephid Xpert instrument.
CPT Code:
U0241
POWERCHART
NAME Coronavirus and Influenza A/B Panel (COVID AND FLU A/B AG) **For Clinic Use Only***
MERCY TEST
MERCY LAB CODE
NAME COVID AND FLU A/B AG SARFLU
POWERCHART
NAME SARS CoV2 COVID Coronavirus Antibody IgG
MERCY TEST
MERCY LAB CODE
NAME SAR COVID 2 IGG AB COR2G

Separated samples are stable for up to 7 days at room temperature, and for up to 14 days
at 2–8°C. Thawed frozen specimens must be clarified by centrifugation prior to testing. Do
Stability:
not store in a frost-free freezer. Avoid more than 4 freeze-thaw cycles. Freeze samples,
devoid of red blood cells, at ≤ -20°C for longer storage.
• This assay has not been evaluated with fingerstick specimens.
Comment:
• Samples should only be tested from individuals who are 15 days or more post
symptom onset.
Performed: Monday through Sunday Cut off 0900 and 1900
Reference Range: 0.00-1.00 Index
The Atellica IM SARS-CoV-2 IgG (sCOVG) assay is a chemiluminescent immunoassay
Method
intended for qualitative and semi-quantitative detection of IgG antibodies to SARS-CoV-2 in
Description:
human serum and plasma (lithium heparin) using the Atellica IM Analyzer.
CPT Code: 86769
POWERCHART
NAME Coronavirus (COVID-19/SARS-CoV-2) Antigen POCT
MERCY TEST
MERCY LAB CODE
NAME COVID19 AG POCT COVAGP
Specimen: Nasal swab provided by lab

Send to lab immediately for testing
Do not place swab back in original paper package
This test is to be ordered if hospitalized patient is being transferred to a nursing
Comment:
home. MUST BE ORDERED AS STAT IN POWERCHART.
Performed: Daily, available stat
CPT Code: 87811
POWERCHART CORTISOL Total

NAME
MERCY TEST NAME CORTISOL Total MERCY LAB CODE CORT

Stability: Tightly cap and refrigerate specimens at 2–8°C if the assay is not completed within 8 hours.
Freeze samples at ≤ -20°C if the assay is not completed within 48 hours.
The performance of the assay has not been established with neonatal specimens.
Reference Range: AM Reference range 6.7-22.6 mcg/dL
PM Reference range 2.0-14.0 mcg/dL
Method The Atellica IM Cor is a competitive immunoassay using direct chemiluminescent
Description: technology.
CPT Code: 82533
POWERCHART Cortisol Challenge

NAME
MERCY TEST NAME CORTISOL ACTH RES MERCY LAB CODE CORT 3 orders
3 separate specimens, requiring 3 separate CORT orders, one prior to and two following
injection of 0.25 mg Cortrosyn, given IV bolus, at times specified by Nursing Service.
o Baseline: Collect prior to injection

2. 30 minutes following injection
3. 60 minutes following injection
Nursing service will obtain Cortrosyn from Pharmacy.
Comment: Mercy lab clients: Testing is done in the Mercy Cancer Center. Ordering clinic will fill out
form OMH-146, following the directions on the form for the information required. Fax order
and accompanying information to Mercy First Call at 641-428-6140, who will fax the
information to Mercy's Cancer Center. Mercy Cancer Center will schedule the appointment
and call the patient with instructions.
Performed: Within 8 hours of receipt
Reference Range: Expected values during ACTH stimulation: over twice (usually 2-3 times) reference a.m. level.
Method The Atellica IM Cor assay is a competitive immunoassay using direct chemiluminescent
Description: technology
CPT Code: 82533x3
POWERCHART CORTISOL WITH CORTISONE FREE 24-HOUR URINE

NAME
MERCY TEST NAME CORTSL/CORTSNE 24U* MERCY LAB CODE CRTF
Specimen: o Collect a 24-hour urine specimen.

o At start of collection, add 25 ml of 50% acetic acid preservative. (15 ml 50% acetic
acid for children)
Processing: o Aliquot 5 ml and indicate total volume.
o Send refrigerated in 10 ml urine tube to Mayo. Frozen acceptable. Mayo order
code (COCOU).
o Click on 24-hour urine preservative chart for other acceptable temperatures and
additives.
Reference value: Included with results.
CAUTIONS:
o Acute stress (including hospitalization and surgery), alcoholism, depression, and

many drugs (ex: exogenous cortisone, anticonvulsants), can obliterate normal
diurnal variation, affect response to suppression/stimulation tests, and cause
elevated baseline levels.
o Renal disease (decreased clearance) may cause falsely low values.
o Values may be elevated to twice normal in pregnancy.
Method: Liquid Chromatography/Tandem Mass Spectrometry (LC/MS/MS)
CPT Code: 82542
82530
POWERCHART C-PEPTIDE
NAME
MERCY TEST NAME C-PEPTIDE MERCY LAB CODE CPEPT
Specimen: 1 mL of serum
Stability: Do not use samples that have been stored at room temperature for longer than 8 hours.
Separate serum from the red blood cells before storage at 2–8°C or -20°C. Tightly cap and
refrigerate specimens at 2–8°C if the assay is not completed within 8 hours. Freeze samples
at ≤ -20°C if the assay is not completed within 24 hours. Freeze samples only 1 time and mix
thoroughly after thawing.
Reference Range: Female: 0.730-4.370 ng/mL
Male: 0.81-3.85 ng/mL
Method The Atellica IM CpS assay is a 2-site sandwich immunoassay using direct chemiluminescent
Description: technology which uses constant amounts of 2 antibodies
CPT Code: 84681
POWERCHART CREATININE
NAME
MERCY TEST NAME CREATININE (CREAT AND GFR) MERCY LAB CODE CREAT

Stability: Separated serum and plasma specimens may be stored for up to 2 days at 2–8°C or stored
frozen at or below -20°C.
Comment: eGFR estimated Glomerular Filtration Rate is calculated and reported with creatinine
Performed: Within 8 hours of receipt. Available stat
Reference Range: Male: 0.7-1.3 mg/dl
Female: 0.6-1.2 mg/dl
Method Description: The Atellica CH Enzymatic Creatinine_2 (ECre_2) assay is based on the enzymatic reaction.
CPT Code: 82565
POWERCHART Creatinine Body Fluid

NAME
MERCY TEST NAME CREATININE BODY FL MERCY LAB CODE FCREA
Specimen: 0.5 mL body fluid
Stability: Specimens may be stored for up to 2 days at 2–8°C or stored frozen at or below -20°C.
Reference Range: No reference range established
Method
The Atellica CH Enzymatic Creatinine_2 (ECre_2) assay is based on the enzymatic reaction.
Description:
CPT Code: 82570
POWERCHART Creatinine 24 HOUR URINE. Not available in Powerchart orders

NAME
MERCY TEST NAME CREAT 24UR MERCY LAB CODE VCRT
Specimen: 5 mL of unpreserved urine from a 24-hour urine specimen that was refrigerated during
collection.
Stability: Urine specimens may be stored for up to 4 days at 2-8°C or stored frozen at or below -20°C.
Comment: Includes volume (ml/24 hours) and calculated creatinine (g/24 hours)
Reference Range: Creatinine Male Female
0.8-2.8 0.8-2.8 g/24 hrs.
g/24 hrs.
Method The Atellica CH Enzymatic Creatinine_2 (ECre_2) assay is based on the enzymatic reaction.
Description:
CPT Code: 82570
POWERCHART CREATININE CLEARANCE 24 HOUR URINE

NAME
MERCY TEST NAME CREAT CL 24UR MERCY LAB CODE VCCL

5 mL of unpreserved urine from a 24-hour urine specimen that was refrigerated during
collection.
Stability: Urine specimens may be stored for up to 4 days at 2–8°C or stored frozen at or below -20°C
Comment: o Outpatients and Inpatient, Mercy Laboratory will order the appropriate serum
creatinine (CRTMM) if a serum creatinine has not been completed within 48 hours.
This will be done at no additional charge. The patient needs to have blood drawn
when the container is picked up or delivered. In order to avoid possible duplication,
the serum creatinine is not to be ordered by the physician office, the hospital floor or
admitting.
o Regional Lab Clients, send 0.5 ml serum for the creatinine at the same time that the
urine specimen is sent. This enables analysis of both specimens by the same method
for accuracy.
Mercy Laboratory will order the serum creatinine at no charge. Do not order a single
creatinine on the requisition.
Includes Volume (ml/24 hours) Raw Creatinine (mg/dl) and Calc. Creatinine (g/24 hours)
Creatinine Clearance (ml/min)

Reference value: Creatinine Male Female
0.8 - 2.8 g/24hrs 0.8 - 2.8 g/24hrs
Creatinine Age Male Female
clearance < 41 Yrs: 71 - 137 71 - 128 ml/minute
41 - 50 Yrs: 71 - 131 71 - 122 ml/minute
51 - 60 Yrs: 71 - 125 71 - 116 ml/minute
70 - 110 ml/minute
61 - 70 Yrs: 71 - 119 64 - 104 ml/minute
>70 Yrs: 71 - 113
Method
The Atellica CH Enzymatic Creatinine_2 (ECre_2) assay is based on the enzymatic reaction.
Description:
CPT Code: 82575
POWERCHART CREATININE RANDOM URINE

NAME
MERCY TEST NAME CREAT R UR MERCY LAB CODE UCRT
Specimen: 5 ml random urine.

Stability: Urine specimens may be stored for up to 4 days at 2–8°C or stored frozen at or below -20°C.
Method The Atellica CH Enzymatic Creatinine_2 (ECre_2) assay is based on the enzymatic reaction.
Description:
CPT Code: 82570
POWERCHART TRANSFUSION ORDER SET CROSSMATCH

NAME
MERCY TEST NAME CROSSMATCH (Type and Cross) MERCY LAB CODE XMI
Includes: ABO Group/RH Type, Antibody Screen, and compatibility testing.

Comment: o A Type & Screen is included in a crossmatch order. Do NOT order separately.
o Irradiation or CMV negative blood, see step 2.
o For PAT patients: If surgery is scheduled for more than two days from the date the
specimen is drawn, order a Type & Screen instead of a crossmatch. A crossmatch
will need to be ordered and done when the patient is admitted.
o A hemoglobin must be ordered if one has not been performed at Mercy Medical
Center-North Iowa Laboratory within one week prior to transfusion
for outpatients.
o Indicate number of units to be crossmatched in units ordered field. Packed cells

will be processed for all crossmatches.
o If irradiation or CMV negative blood is needed, indicate so in the comment field for
each order. It is not sufficient to send a message to cover all orders. Prestorage
leuko-reduced red cells (CMV safe) will be provided if CMV negative is ordered. Call
the Lab when irradiated blood is ordered as
special arrangements may be necessary.
Specimen: o Preferred specimen: One 6 ml pink top tube.

o Also acceptable: purple top tube.
o Refrigerate.
o SST is unacceptable.
All patients drawn for possible blood product transfusion MUST be correctly identified
and MUST BE WEARING an armband with their FULL NAME and MEDICAL RECORD
NUMBER before the patient is drawn.
A check mark MUST be put by the Medical Record number on the tubes drawn for a
Crossmatch by the person drawing the specimen indicating the phlebotomist has
matched the medical record number on the Specimen with the medical record
number on the Patient Armband and it is identical along with the name and other
pertinent information. Date, time, and initials of the individual collecting the specimen
must be on the tube.
FOR OUTPATIENT AND PRE-SURGICAL PATIENTS:

All the above guidelines must be followed The PATIENT is also to be informed to leave
the armband on and if the armband is removed, they will need to be redrawn and
testing repeated. **Qualified staff may remove the armband and replace it with
another armband after careful matching.
Processing: Regional Lab Clients: Crossmatch verification by transfusing facility is recommended for all
units crossmatched at Mercy.
Method: Serological
CPT Code: 86900 ABO+
86901 RH+
86850 Antibody Sc
86920 Unit Compatibility (1 for each unit ordered)
For each unit issued: P9021 Packed Red Cells (Proc)*
POWERCHART CRP (C-Reactive Protein)

NAME
MERCY TEST NAME CRP MERCY LAB CODE CRP

Stability: Specimens may be stored for up to 3 days at 4–8°C or stored frozen for up to 6 months at -
20°C or colder.
Reference Range: 0.0-0.9 mg/dl
Method The Atellica CH C-Reactive Protein_2 (CRP_2) assay measures CRP in serum by a latex-
Description: enhanced immunoturbidimetric assay.
CPT Code: 86140
POWERCHART CRP HIGH SENSITIVITY (CARDIAC)

NAME
MERCY TEST NAME CRP SENS (CARDIAC) MERCY LAB CODE HSCRP

Stability: Specimens may be stored for up to 3 days at 4–8°C or stored frozen for up to 6 months at -
20°C.15 Avoid repetitive freezing and thawing of specimens. Centrifuge samples containing
precipitates before performing the assay
Method The Atellica CH High Sensitivity C-Reactive Protein (hsCRP) latex reagent is a suspension of
Description: uniform polystyrene latex particles coated with anti-CRP antibody.
CPT Code: 86141

POWERCHART CRYOGLOBULIN
NAME
MERCY TEST NAME CRYOGLOBULIN* (CRYOGLOBULIN AND MERCY LAB CODE CRYG
CRYOFIBRINOGEN PANEL)
Specimen: 5 ml serum from a no additive serum tube plus 1 ml EDTA plasma. Minimum 3 ml serum
and 0.5 ml plasma. Testing requires both specimens.
Processing: o Deliver to Lab immediately!
o Keep specimens at 370C, 98.60F until delivered, by holding tubes in hands, may
wrap tubes in a heel warmer. Place plasma and serum in appropriately labeled
plastic vials and mark each corresponding aliquot as serum or plasma.
o Regional Lab Clients: Keep specimens at 370C, 98.60F until the plasma and serum
are removed from the cells. It is very important that the specimen remain at 37
degrees C until after separation of plasma/serum from red cells. Place plasma and
serum in appropriately labeled plastic vials and mark each corresponding
aliquot as serum or plasma.
o Send refrigerated. Frozen acceptable. Mayo order code (CRGSP).
Cause for
A SST tube is not acceptable.
rejection:
Method: Quantitative and Qualitative typing. Precipitation at 1°C. Includes cryofibrinogen.
CPT Code: 82595 Cryoglobulin +*
82585 Cryofibrinogen +*
86334/Immunofixation (if appropriate)

Notes: If cryoglobulin has a result other than negative, then Mayo order code IMFXC
"immunofixation cryoglobulin" will be performed at an additional charge. Positive
cryoglobulins of >=0.1 ml of precipitate will be typed once.
POWERCHART TRANSFUSION ORDER SET CRYOPRECIPITATE FOR INFUSION

NAME
MERCY TEST NAME CRYO FOR INFUS MERCY LAB CODE CRYO
Comment: o Indicate number of units desired.

o An order of 1 will be filled with a pre-pooled product equivalent to 5 individual cryo
units.
o Cryoprecipitate contains factor VIII and fibrinogen.
Specimen: No specimen needed.
Performed: Allow 30 minutes thawing time. Available stat.
Method: Thawed and pooled.
CPT Code: 86927 Cryoprecipitate (1 for each unit)
86595 Cryoprecipitate Pool (Admin) (1 for each pool)
P9012 Cryoprecipitate (Proc)* (1 for each unit)
POWERCHART FIBRIN GLUE ORDER SET CRYOPRECIPITATE NOT FOR INFUSION

NAME
MERCY TEST NAME CRYO NOT FOR INFUS MERCY LAB CODE CRYX
Comment: o To be ordered by Nursing Service at the same time an order is placed to Pharmacy
for Fibrin Glue.
o One order of Cryoprecipitate is necessary for each unit of Fibrin Glue requested.
o Used in the preparation of Fibrin Glue, a topical hemostatic agent used in surgery.
Specimen: None needed
Processing: Group specific cryoprecipitate is not needed.
Performed: Allow 10-30 minutes thawing time. Available stat.
Method: Thawed.
CPT Code: P9012 Cryoprecipitate (Proc)* (1 for each unit ordered)
POWERCHART CRYPTOCOCCAL CULTURE + DIRECT SMEAR CSF

NAME
MERCY TEST NAME CRYPTO CLT/GS MERCY LAB CODE CRYP
Specimen: o 1 ml CSF minimum. Submit in sterile plastic screw cap tube.

o DO NOT refrigerate specimen.
RL Client o Write CRYPTOCOCCAL CULTURE on order form. Indicate source (CSF).
Comments: o Send specimen at room temperature to Mercy lab.
Performed: Direct gram Stain: Daily 1600 cutoff

Preliminary report:1 and 2 weeks
Final report: 3 weeks
Reference value: Direct Gram stain: No yeast seen.

Culture: No Cryptococcus neoformans isolated.
Method: Culture: Standard culture techniques

87102 Yeast Clt
POWERCHART CRYPTOCOCCUS ANTIGEN SCREEN

NAME
MERCY TEST NAME CRYPTOCOCCUS AG* MERCY LAB CODE CRYPA
Specimen: 1 mL serum from a Serum Separator Tube (SST) or no additive serum tube
Processing: Send Refrigerated to Mayo, Mayo code - (SLFA)
If this initial Cryptococcus Antigen testing is positive, then additional reflex testing (Mayo
Comment: code - SLFAT) Cryptococcus Antigen Titer by Later Flow Assay (LFA) will be performed at an
additional charge.
1-2 days. Monday through Friday: 11 a.m.
Performed:
Saturday, Sunday; 1 p.m.
Included in report
Reference value:
Method: Lateral Flow Assay
87899 Cryptococcus Ag Screen
CPT Code:
87899 Cryptococcus Ag Titer (if applicable)
POWERCHART CSF CYTOLOGY

NAME
MERCY TEST NAME CSF CYTOLOGY SPEC MERCY LAB CODE

Comment: All CSF Cytology specimens must be accompanied by the manual CSF Cytology requisition
form which includes patient history, etc.
Specimen: 1 ml CSF. Deliver to Lab immediately.
Processing: After Chemistry testing is completed, take specimen to Cytology, preserve properly, and
place in the Cytology refrigerator.
POWERCHART DIFFERENTIAL CSF

NAME
MERCY TEST NAME CSF DIFF MERCY LAB CODE CSFD
Comment: o CSF Differential is included in Cell Count CSF if ≥ 6 WBC/mcl are present.
o To be ordered by Regional Hospitals when they are doing the cell counts at their
facility and want to refer the differential to Mercy.
Specimen: o Send 2 cytocentrifuge prepared slides, unstained.
o If a cytocentrifuge is not available, mix 1 drop of 22% albumin with 3-5 drops of
CSF. Place a drop on the slide and allow to air dry, do not spread.
Stability: 1 hour room temp
Cause for o Up to 40% of cells in CSF lyse within 1 hour after collection.
rejection: o It is not acceptable to send CSF fluid.
Reference values: Age Neutrophil Lymphocyte Monocyte
0 - 1 year 0 - 8% 5 - 35% 50 - 90%
> 1 year 0 - 6% 40 - 80% 15 - 45%
Method: Microscopic exam of Wright-stained smear.
CPT Code: NA
POWERCHART CS (Cardiac Surgery) PANEL
NAME
MERCY TEST NAME CS PANEL MERCY LAB CODE CSPL
Comment: Orderable only by Cardiac Surgery Personnel. Used for specimens collected outside of the
open-heart surgery suite (OR10).
Includes: Hemogram Glucose Ionized calcium
Potassium Sodium
Specimen: 2 ml whole blood from purple top tube AND 0.5 ml whole blood from green top (lithium
heparin) tube without gel.
Reference value: See individual test entry
Method: o Sodium, Potassium, Ionized calcium by direct ion selective electrode
potentiometry.
o Glucose by amperometrically.
o Hemogram by automated cell counter.
CPT Code: 85027 Hemogram
82947 Glucose
84132 Potassium
84295 Sodium
82330 Calcium, Ionized
POWERCHART Cardiac Surgery Perfusion Perform

NAME
Comment: Order only for specimens being performed while patient is in the open-heart surgery suite
(OR10). Order is in the Surgery Express ORDER set.
Includes: Blood Gas Glucose Ionized calcium
Potassium Sodium Hematocrit and calculated Hemoglobin
Reference value: Included with results. Varies based on type of specimen.

Method: Direct electrochemical
CPT Code: 82947 Glucose

84132 Potassium
82330 Calcium, Ionized
85014 Hematocrit
82805 Blood Gas w/ O2 Sat
MISM Mayo - CULTURE TB or AFB BLOOD CULTURE/ACID FAST ORGANISMS

CTBBL
POWERCHART CUTANEOUS IMMUNOFLUOR-BIOPSY

NAME
MERCY TEST NAME CUTAN IMMU BIOP* MERCY LAB CODE CUTBX
Specimen: 4 MM punch biopsy of recent lesion and small portion of normal tissue placed into Mayo's
special transport media.
Comment: If a specimen is to be sent to pathology in addition to a specimen sent for Mayo testing, fill
out both the pink Pathology /Dermatology Request Form and the Mayo Additional test
Information form. Include patient's age, sex, diagnosis, biopsy site, sun exposure of
specimen (exposed, unexposed) and involvement of specimen (perilesional, involved,
uninvolved).
Processing: Send Ambient (Frozen and refrigerated specimens are acceptable) to Mayo with request
form. Mayo order code (CIB).
Performed: 1-3 days. Test set up Monday through Friday
Method: Direct Immunofluorescence staining of cryostat prepared skin biopsy sections for IgG, IgM,
IgA, C3, and Fibrinogen deposition.
CPT Code: 88346
88350 x5
POWERCHART CUTANEOUS IMMUNOFLUOR-SEROLOGY

NAME
MERCY TEST NAME CUTAN IMMU IGG* MERCY LAB CODE CUT
Specimen: 2 ml serum from a SST or plain red top tube. Minimum 0.5 ml.
Processing; Send refrigerated to Mayo in a screw cap plastic vial. Ambient or frozen acceptable. Mayo
order code (CIFS).
Performed: 2-7 days. Test set up Monday through Friday; 7 a.m.-5 p.m.
Method: Detection of IgG anti-intercellular substance (ICS) and anti-basement membrane zone (BMZ)
antibodies by indirect immunofluorescence technique using Rhesus monkey esophagus
substrate and human NaCl split-skin substrate. Serum is tested for presence and titer of
antibodies. Titer is obtained on monkey esophagus substrate, and pattern of BMZ
fluorescence is determined on split-skin substrate.
CPT Code: 88346

88350
POWERCHART CYCLIC CITRULLINATED PEPTIDE ANTIBODY IgG

NAME
MERCY TEST NAME CCP ANTIBODIES MERCY LAB CODE CCPAB
Specimen: 1.0 ml serum from a SST.

Processing: Stable 22 hours room temp, or 7 days refrigerated. If >7 days freeze.
Cause for
Gross Hemolysis
rejection:
Reference range: 0.0-4.99 U/mL
Method: Chemiluminescent microparticle immunoassay.
CPT 86200
POWERCHART CYCLOSPORA STAIN

NAME
MERCY TEST NAME CYCLOSPORIN STAIN (stool specimen required) MERCY LAB CODE CYSTN
Specimen: Submit only 1 of the following specimens:

Preserved stool:
o Transfer enough stool specimen to bring the liquid level up to the fill line indicated
on the ECOFIX
preservative. DO NOT OVERFILL.
o Mix thoroughly. Pieces should be pea size or less.
o Send ambient.
Unpreserved stool:
o 5-10 gm of feces submitted in clean container with tight fitting lid.

o Send refrigerated within 3 days of collection.
Comments: Patient should avoid use of anti-diarrheal medication (i.e., Loperamide or Pepto-Bismol)
The presence of barium will interfere with this test.
Processing: Ambient transport for preserved specimen. Refrigerated ok.

Refrigerated transport for unpreserved specimen. Mayo order code (CYCL).
Performed: 2-4 days. Test set up at Mayo Monday through Saturday.

Method: Safranin stain.
CPT Code: 87015-Concentration
87207-Stain
POWERCHART CYCLOSPORIN LEVEL

NAME
MERCY TEST NAME CYCLOSPORIN* MERCY LAB CODE CYCL
Comment: o Occasionally patients will come in with orders to have their Cyclosporin sent to
another reference Lab.
o Follow the instructions the patient presents for specimen collection and
transportation.
o These patients have a “processing charge” ordered.
o Please include time and date of last dose.
Specimen: 3 ml EDTA (purple top) whole blood. Minimum 1 ml. Do not spin down.
Processing: Send refrigerated to Mayo. Send specimen in original collection tube. Mayo order code
(CYSPR).
Performed: 1 day. Test set up at Mayo Monday through Sunday.
Method: High Performance Liquid Chromatography/Tandem Mass Spectrometry (Hplc-ms/ms)
CPT Code: 80158
TEST NAME CYSTATIN C WTIH ESTIMATED GFR
MERCY TEST CYSTATIN C EGFR* MERCY LAB CSTCE

NAME CODE
Performed: 1-3 days. Test set up Monday through Sunday.
Processing: Centrifuge and aliquot serum into a plastic vial within 2 hours of collection. Send
refrigerated to Mayo. Mayo order code (CSTCE).
Method: Immunoturbidimetric
CPT Code: 82610
POWERCHART CYSTIC FIBROSIS MUTATION PANEL

NAME
MERCY TEST NAME CYSTIC FIB MUT ANL* MERCY LAB CODE CFMA
Specimen: 3 mL whole blood lavender top (EDTA) or yellow top (ACD)
Patient A previous bone marrow transplant from an allogenic donor will interfere with testing. Call
Preparation: 800-533-1710 for instructions for testing patients who have received a bone marrow
transplant.
Processing: Send specimen in original tube. Do NOT aliquot.
Specimen must arrive to Mayo labs within 96 hours of collection. Specimens can only
be sent Monday through Thursday.
Send to Mayo ambient. Frozen and refrigerated also acceptable. Mayo order code (CFMP).
Additional To ensure minimum volume and concentration of DNA is met, the preferred volume of
Information: blood must be submitted. Testing may be cancelled if DNA requirements are inadequate.
Performed: 14-42 days. Thursday and Sunday
Method: Targeted Genotyping Array
CPT Code: 81220

81222
TEST NAME CYTOKINE PANEL 13
MERCY TEST NAME CYTOKINE PANEL 13* MERCY LAB CODE FCYTP
Specimen: 1 mL serum from a serum gel tube. Plain red top tube is acceptable.
Processing: Spin down within 2 hours and send 1 mL of serum Frozen to Mayo. Mayo order code
(FCYTP).
Performed: 1-8 days, performed Monday, Wednesday, Friday
Method: Quantitative Multiplex Bead Assay
CPT Code: 83520 x 12
83529
POWERCHART CYTOMEGALOVIRUS (CMB) ANTIBODY IgG & IgM
NAME
MERCY TEST NAME CMV AB, IGG/IGM QN * MERCY LAB CODE CMVGM
Specimen: 1 ml of serum from a plain red-top or SST tube.

Cause for
Hemolysis and Lipemia.
rejection:
Processing: Send refrigerated to Mayo. Frozen acceptable. Mayo order code (CMVP).
Performed: Within 3 days from order. Monday through Saturday.
Method: Multiplex Flow Immunoassay (MFI)
CPT Code: IgG 86644

IgM 86645
POWERCHART CYTOMEGALOVIRUS DNA DETECT AND QUANT

NAME
MERCY TEST NAME CYTOMEGALOVIRUS DNA* MERCY LAB CODE CMVQU
Specimen: 1.2 mL of plasma from purple top (EDTA).

Spin down and remove plasma from cells within 6 hours of collection.
Processing: Send frozen to Mayo. Mayo order code (CMVQN).

Performed: Monday through Saturday; 7 am - 4 pm
Reference Included in report.

Value:
Method: CMVQN: Reverse Transcription Polymerase Chain Reaction (RT-PCR)
CPT Code: 87497
TEST NAME CYTOMEGALOVIRUS PCR (CMV PCR)
MERCY TEST CYTOMEGALOVIRUS PCR* MERCY LAB CODE CMVPCR

NAME
Specimen: Must indicate specimen source. Submit only 1 of the following specimens:
Body fluid (Spinal, pleural, peritoneal, ascites, pericardial, amniotic, or ocular) – 0.5 mL of
fluid in a sterile, screwcap, 5-mL aliquot tube (preferred) or sterile container. Do not
centrifuge. Send to Mayo in Sarstedt Aliquot Tube (T914) or sterile container.
Respiratory (Bronchial washing, bronchoalveolar lavage, nasopharyngeal aspirate or

washing, sputum, or tracheal aspirate) – 1.5 mL of fluid in a sterile, screwcap, 5-mL aliquot
tube (preferred) or sterile container. Do not centrifuge. Send to Mayo in a Sarstedt Aliquot
Tube, 5 mL (T914).
Genital swab (Cervix, vaginal urethra, anal/rectal, or other genital sources) – Culturette (BBL
Culture Swab) (T092). Send swab to Mayo in multimicrobe media (M4-RT, M4 or M5).
Swab (Dermal, eye, nasal, saliva, or throat) – Culturette (BBL Culture Swab) (T092). Send
swab to Mayo in multimicrobe media (M4-RT, M4 or M5).
Tissue (Brain, colon, kidney, liver, lung, etc.) - Whole collection in a Multimicrobe media (M4-
RT) (T605) (Preferred) or Sterile container with 1–2 mL of sterile saline. Submit only fresh
tissue.
Urine – 1 mL of a random urine in a sterile container.
Bone Marrow – 0.5 mL of bone marrow in an EDTA tube. Send bone marrow in original
tube. Do not aliquot.
Cautions: A negative result does not eliminate the possibility of cytomegalovirus (CMV) infection.
This assay is only to be used for patients with a clinical history and symptoms consistent
with CMV infection and must be interpreted in the context of the clinic picture.
Processing: Send refrigerated (preferred) to Mayo. Frozen is also acceptable. Mayo order code (CMVPV).
Method: Real-Time Polymerase Chain Reaction (PCR)/DNA Probe Hybridization
CPT Code: 87496

POWERCHART NEUTROPHIL CYTOPLASM ANTIBODY ID
NAME
MERCY TEST NAME CYTOPLASMIC NEUT AB* MERCY LAB CODE ANCA
Specimen: 0.5 ml serum from a SST tube or plain red top tube. Minimum 0.4 ml.
Processing: Send refrigerated to Mayo. Frozen is acceptable. Mayo order code ANCA.
Performed: 3 – 4 days. Monday through Saturday.
Reference Values: Included with test results.
CPT Code: 86036 x2 Screen
86256 Titer (if appropriate)
POWERCHART D-DIMER
NAME
MERCY TEST NAME D-DIMER TEST MERCY LAB CODE DDIMER
Specimen: Draw a blue top tube (3.2% citrate) filled appropriately with amount of blood listed on label.
Stability: 4 hours room temp, freeze if > 4 hours, good for 4 weeks frozen.
Cause for
Improperly filled tubes will NOT be tested. Avoid gross hemolysis.
rejection:
Processing: Processing:In-house patients: Centrifuge immediately. Test within 4 hours of collection.
If testing will be delayed longer than 4 hours. Double spin coagulation specimens to ensure that
all platelets are removed and freeze.:
o Centrifuge specimen. Aliquot plasma (leaving some above the cells) to a plastic
centrifuge tube.
o Centrifuge the aliquot tube. Pipette plasma (leaving some above the bottom of the
tube) to another plastic aliquot tube.
o Store plasma in freezer. Label aliquot vial "CITRATED PLASMA."
Regional Lab Clients:
o Centrifuge immediately.
o Aliquot specimen (leaving some above the cells) to a plastic centrifuge tube.
o Send refrigerated if testing can be performed within 4 hours of collection.
o If testing will not be performed within 4 hours freeze specimen and send frozen.
o Label aliquot vial "CITRATED PLASMA."

Reference value: 0-500 ng/mL FEU
The cutoff for suspected DVT or PE is 500 ng/mL FEU.
Elevated levels of DDIMER are found in clinical conditions such as DVT, PE, and DIC. DDIMER
levels also rise during normal pregnancy, but very high levels are associated with
complications.
Method: Turbidimetric method on IL ACL TOP500.

CPT Code: 85379
TEST NAME DEPAKEN or DEPAKOTE See: Valproic Acid
POWERCHART DERMATOLOGY CHEMISTRY PANEL

NAME
MERCY TEST NAME DERM PANEL (Accutane Panel) MERCY LAB CODE ATPN
Stability:
Specimens may be stored for up to 2 days at 2–8°C or stored frozen at or below -20°C.
Comment: Includes Alk Phos, ALT, AST, BUN, BUN/Creat ratios, Cholesterol, Creatinine, eGFR, Glucose,
Total Protein, Triglyceride.
Performed: Within 8 hours or receipt. Available stat.

Method
Description:
CPT Code: See individual test entry.
POWERCHART DERMATOPHYTE CULTURE

NAME
MERCY TEST DERMATOPHYTE MERCY LAB CODE DERMCT

NAME CLT
Specimen: o Skin scrapings, hair or nail clippings.

o Culture media will be inoculated directly by the dermatology office.
Comment: o Label DTM agar with the patient’s name, date, and time of collection, and source.
o Do not cover agar slant with label.
Processing: o Specimen to be collected in dermatology office and inoculated directly to DTM agar.
o The specimen should be sent at room temperature to Mercy lab.
Performed: Positive cultures reported when detected.

Negative Cultures reported after 30-35 days
Method: Plated to Mycobiotic Agar
CPT Code: 87101

Additional identification panels reflex ordered as appropriate.
POWERCHART DHEA-S (DEHYDROEPIANDROSTERONE SULFATE)
NAME
MERCY TEST NAME DHEAS BATTERY MERCY LAB CODE DHEASB
Stability: Tightly cap and refrigerate specimens at 2–8°C for no longer than 6 days if the assay is not
completed within 4 hours. If longer storage is necessary, freeze samples at ≤ -20°C for up to
1 month. Do not store in a frost-free freezer. Freeze samples only 1 time and mix thoroughly
after thawing.
Comment: Test samples as soon as possible after collecting. Do not use samples stored at room
temperature for no longer than 4 hours.
Reference Age (Years) Female Male

Range: 18-21 51-321 24-537
21-30 18-391 85-690
31-40 23-366 106-464
41-50 19-231 70-495
51-60 8-188 38-313
61-70 12-133 24-244
>70 7-177 5-253
Reference ranges have not been established for
children under 18 years of age.
Method: The Atellica IM DHEAS assay is a quantitative competitive immunoassay that uses direct
chemiluminescent technology.
CPT Code: 82627
POWERCHART DIALYSIS CHEMISTRY PANEL

NAME
MERCY TEST NAME DIALYSIS PANEL MERCY LAB CODE DPNL
Specimen: 1 ml serum
Stability: Specimens may be stored for up to 2 days at 2–8°C or stored frozen at or below -20°C
Comment: For use by Dialysis Unit only. Includes A/G Ratio, Albumin, Alkaline Phosphatase
AST(SGOT), BUN, BUN/Creatinine Ratio, Calcium, CO2, Creatinine, eGFR, LDH, Phosphorus,
Potassium, Sodium, and Total Protein
Reference Range: See individual test entry
Method
See individual test entry
Description:
CPT Code: See individual test entry
TEST NAME DIAPHRAGM WASHINGS See: Cytology Section Peritoneal Fluid

POWERCHART DIAZEPAM AND NORDIAZEPAM LEVEL
NAME
MERCY TEST NAME DIAZEP NORDIAZ* MERCY LAB CODE DIAN
Specimen: 0.5 ml serum from a no additive serum tube

Processing: Separate from cells. Send refrigerated to Mayo. Ambient or frozen acceptable. Mayo order
code (DIA).
Performed: Tuesday 11 AM
Reference values: Included with test results

CPT Code: G0480 / 80346
POWERCHART DIC PANEL

NAME
MERCY TEST NAME DIC PANEL MERCY LAB CODE DICPNL
Includes: Fibrinogen D-Dimer

Protime/INR Thrombin Time
PTT
Specimen: 2 Blue top tubes (3.2% Citrate) filled appropriately with amount of blood listed on label.
Stability: 4 hours room temp, freeze if >4 hours, good for 4 weeks frozen.
Cause for
Gross hemolysis. Improperly filled tubes will not be tested.
rejection:
Processing: o Centrifuge immediately.
o Separate plasma within 2 hours of collection.
o Double spin and freeze plasma if testing delayed longer than 4 hours.
o Label frozen vial “Citrated Plasma.”
Preformed: Within 8 hours of receipt. Available stat.
Method: Photo-optical clot detection
CPT Code: 85380 D-Dimer
85610 PT
85384 Fibrinogen
85730 PTT
POWERCHART DIFFERENTIAL
NAME
MERCY TEST NAME DIFFERENTIAL MANUAL MERCY LAB CODE DIFF
Specimen: Purple top tube adequately filled and mixed immediately.

Stability: 4 hours room temp, 36 hours refrigerated.
Comment: o Includes differential count of white cells and morphology of red cells.
o May be performed on a CBC specimen which was ordered and reported within the
previous 36 hours.
o Indicate in comment if previous days specimen is to be used.
o Please send a copy of the CBC results from your instrument.
Reference value: Included with test results. See Special Helps section for complete listing.
Method: Microscopy, Wright-stained smear.
CPT Code: 85007
POWERCHART DIGOXIN LEVEL
NAME
MERCY TEST NAME DIGOXIN MERCY LAB CODE DIG

Stability: Separated specimens may be stored for up to 8 hours at 20–25°C or for up to 7 days at 2–
8°C or stored frozen for up to 6 months at -20°C or colder.
Do not use hemolyzed samples.
Comment:
Alias: Lanoxin
Reference Range: Therapeutic range: 0.8-2.0 ng/ml
Method The Atellica CH Digoxin (Dgn) assay measures digoxin in serum by a latex-enhanced
Description: immunoturbidimetric method.
CPT Code: 80162
POWERCHART LDL CHOLESTEROL DIRECT

NAME
MERCY TEST NAME DIRECT LDL CHOL (Low Density Liopro MERCY LAB CODE DLDL

Stability: Specimens are stable for up to 5 days at 2–8°C.9. Specimens may be frozen for up to 14
days at ≤ -20°C.9 Do not store in a frost‑free freezer. Thoroughly mix thawed specimens and
centrifuge before using.
Comment: Venipuncture should occur prior to metamizole (sulpyrine) administration due to the
potential for falsely depressed results.
The National Cholesterol Education Program of the National Heart, Lung, and Blood Institute
has announced the following guidelines:
Optimal: <100mg/dl
Near Optimal: 100-129mg/dl
Borderline high: 130-159mg/dl
High: 160-189mg/dl
Very High: ≥190mg/dl
Method The Atellica CH LDLC assay is a homogeneous assay for directly measuring LDL-C levels in
Description: serum
CPT Code: 83721
POWERCHART DONOR COLLECTION

NAME
MERCY TEST NAME COLLECT CHG DONOR MERCY LAB CODE MDONOR
Comment: o When a potential bone marrow, tissue, or organ donor comes to the lab to be
drawn for compatibility, we will do the collection at no charge to the donor.
o DO NOT add a collect charge or a processing charge.
o The test code "MDONOR" is ordered simply to track that the patient did have a
specimen drawn, but there is no charge associated with the test.
o Patient may bring in their own kit, or kit may be located in processing department.
o Process and send out kit as instructed.
POWERCHART DOXEPIN (SINEQUAN) LEVEL
NAME
MERCY TEST NAME DOXEPIN NORDOXEPIN* MERCY LAB CODE DXPN
Specimen: o 1 ml serum from a no additive serum tube.

o Collect immediately before next scheduled dose (minimum 12 hours after last
dose.)
o Spin down within 2 hours of draw. If serum is not removed within this time, TCA
levels may be falsely elevated due to drug release from red blood cells.
Cause for
Hemolysis is NOT acceptable. Serum gel tube is NOT acceptable.
rejection:
Processing: o Centrifuge within 2 hours of collection.
o Send refrigerated to Mayo. Frozen or ambient acceptable. Mayo order code
(DXPIN).
CPT Code: 80335/G0480
POWERCHART COLLECTION DRUG SCREEN HEALTH WORKS

NAME
MERCY TEST NAME DRUG ABUSE TESTING FOR EMPLOYMENT, PRE- CCDAHW
EMPLOYMENT, POST-ACCIDENT, CDL (Commercial
Driver's License), NON-CDL
Comment: o Employers each have specific procedures. Certain industries are mandated by DOT
regulations. Chain-of-custody available.
o Refer Healthworks clients to Healthworks at Mercy, Chelsea Creek, 8:00 AM to 5:00
PM. 1-800-622-6352 or 421-5244.
o After hours, Laboratory support services staff will collect the urine specimens.
Clients are to register in patient registration or through ER.
o An Employer representative must accompany the employee and the employee
must have a photo ID. (Exception: Post accident or out of area).
o The Lab will refrigerate the sealed package in a locked box and secure paperwork.
POWERCHART DRUG OF ABUSE OVERDOSE PANEL URINE

NAME
MERCY TEST NAME URINE OVERDOSE PNL MERCY LAB CODE ODDRUG
Comment: Performed at Mercy in Mason City. No chain of custody is kept.

Regional Lab Clients: Refer to Drug Abuse with Chain of Custody for legal actions.
Screens for: Screens for these types of drugs:
AMP Amphetamine 500ng/mL OPI Opiates (Morphine) 100 ng/mL
(d-Amphetamine)
BAR Barbiturates 200ng/mL OXY Oxycodone 100 ng/mL
(Butalbital) (Oxycodone)
BZO Benzodiazepines 150 ng/mL PCP Phencyclidine 25 ng/mL
(Nordiazepam) (Phencyclidine)
BUP Buprenorphine 10 ng/mL PPX Propoxyphene 300 ng/mL
(Buprenorphine) (Norpropoxyphene)
COC Cocaine 150 ng/mL THC Cannabinoids 50 ng/mL
(Benzoylecgonine) (11-nor-9-carboxy-Δ9-THC
MAMP Methamphetamine 500 ng/mL TCA Tricyclic Antidepressants (Desipramine) 300 ng/mL
(d-Methamphetamine)
MTD Methadone 200 ng/mL
(Methadone)
Screening test for medical decisions, not for legal chain of custody. Should not be used
for drug compliance testing. Please refer to DRUG ABUSE WITH CHAIN OF
CUSTODY (Regional Lab Clients)
Comment: If urine alcohol is needed, refer to Alcohol Ethyl Urine.
Specimen: 10 ml urine. No preservative.
2 days refrigerated, freeze if > 2 days.
Stability:
Performed: Available stat. Performed at Mercy Laboratory.
Method: Homogeneous Enzyme Immunoassay

CPT Code: 80306
POWERCHART DRUG OF ABUSE SCREEN URINE

NAME
MERCY TEST NAME DRUG AB R UR MERCY LAB CODE DRUG
Specimen: 5 mL of unpreserved urine.

Stability: Specimens may be stored for up to 7 days at 25°C8 or for up to 30 days at 2–8°C8 or stored
Comment: Not used for Chain of Custody testing.
Screens for these types of drugs:
1. Amphetamine cutoff: 500 ng/mL

2. Barbiturate cutoff: 200 ng/mL
3. Benzodiazepine cutoff: 200 ng/mL
4. Cocaine cutoff: 150 ng/mL
5. Opiates cutoff: 300 ng/mL
6. Cannabinoid cutoff: 50 ng/mL
Performed: Screening test done within 8 hours of receipt. Available stat.
Reference Range: None detected
Method The Atellica CH Am, Bnz, Thc, Coc, Op, and Brb assay is a homogeneous enzyme
Description: immunoassay technique used for the analysis of specific compounds in human urine.
CPT Code: 80307
TEST NAME DRUG ABUSE WITH CHAIN OF CUSTODY (Regional Lab Clients)
Comment: Regional Lab clients need to order the collection kit directly from MEDTOX. Regional Lab
clients are responsible for the collection process, chain of custody, mailing kit, billing, and
reporting.
MEDTOX Laboratories
402 West County Road D
St. Paul, MN 55112
Phone number: 800-832-3244.
CLIA ID# 24D0665278
TEST NAME DRUG SCREEN AUTOPSY*
Specimen: Urine, Blood, Vitreous fluid, Gastric fluid, or Tissue.

Comment: Ordered by Lab personnel on autopsy specimens as directed by pathologist or pathology
assistant.
Processing: Performed at Mercy Medical Center – North Iowa, send to Mayo, send to Medtox, send to
Aegis Analytical Lab, or as indicated on the Mercy Drug Screen Autopsy form.
Refer To: Drug Abuse Random Urine performed at Mercy North Iowa
DGS - Drug Screen Blood, Mayo order code DSS
OTCU - OTC/Rx Drug Screen Urine Mayo order code PDSU.
POWERCHART DRUG SCREEN COMPREHENSIVE SERUM

NAME
MERCY TEST NAME DRUG SCN BLOOD* MERCY LAB CODE DGS
Comments: Detection and identification of prescription or over the counter drugs frequently found in
drug overdose or used with a suicidal intent.
Qualitatively identifying drugs present in the specimen; quantifications of identified drugs,

when available, may be performed upon client request.
This test is NOT intended for therapeutic drug monitoring or compliance testing.
This test is NOT intended for use in employment-related testing.
This test is NOT useful for drugs of abuse or illicit drug testing, including benzodiazepines,
opioids, barbiturates, cocaine, amphetamine type stimulants.
Specimen: 2.75 mL serum from no additive serum tube. Serum from a Serum Separator Tube (SST)
is NOT acceptable.
Centrifuge and aliquot serum into plastic vial within 2 hours of collection.
Processing: Send refrigerated (Preferred) to Mayo. Ambient or frozen is also acceptable. Mayo order
code (DSS).
Performed: 3 days. Monday through Sunday.
Method: Gas Chromatography-Mass Spectrometry (GC-MS)
CPT Code: 80307
POWERCHART DRUG SCREEN URINE PRESCRIPTION - OTC

NAME
MERCY TEST NAME OTC/Rx Drug Urine* MERCY LAB CODE OTCU
Comment: This test is limited to prescription and OTC drugs. Drugs of abuse testing will need to be
ordered separately if desired.
This test looks for a broad spectrum of prescription and over-the-counter drugs. It is
designed to detect drugs that have toxic effects. It is intended to help physicians manage an
apparent overdose of an intoxicated patient, to determine if a specific set of symptoms
might be due to the presence of drugs, or to evaluate a patient who might be abusing these
drugs intermittently. This test does not test for all possible drugs.
Specimen: 5 mL random urine in a Sarstedt Aliquot Tube (preferred) or plastic urine container. No
preservative.
Processing: Send refrigerated (preferred) to Mayo. Frozen is also acceptable. Mayo order code (PDSU).
Method: Gas Chromatography-Mass Spectrometry (GC-MS)
CPT Code: 80307
POWERCHART QUICK DRUG SCREEN CHAIN OF CUSTODY - ORDERABLE ONLY BY LAB

NAME
MERCY TEST NAME DRUG SCRN COC QUICK MERCY LAB CODE QDRUG
Comment Refer clients to Healthworks at Mercy, Chelsea Creek, 8:00 AM to 5:00 PM. 1-800-622-6352 or
428-5244.
After hours, Laboratory support services staff will collect the urine specimens using the
chain of custody and perform the Quick Drug screen testing. Employers each have specific
procedures. When Larson Manufacturing employees present to the lab the Quick Drug kit
11+4 is to be used. When Curries/Graham Manufacturing employees present to the lab the
CRLSTAT kit is used. An Employer representative must accompany the employee. The forms
and kits for this testing are kept on site in the draw station room off of the lab waiting room.
Order the test CCDAHW and QDRUG and result as “TCOM” test completed. See specific
procedure for the handling of the paperwork.
CPT Code: 80307
TEST NAME DNA DOUBLE STRANDED AB
MERCY TEST NAME DSDNA AB REF IGG* MERCY LAB ADNAR

CODE
Specimen: 0.3 ml serum from a serum separator tube (SST)

Mayo order code (ADNA1).
Performed: 4 days. Test set up Monday through Saturday
Method: ADNAR: Enzyme-Linked Immunosorbent Assay (ELISA)
CPT Code: 86225
POWERCHART EAR CULTURE

NAME
MERCY TEST NAME EAR CLT/GS MERCY EARC

LAB CODE
Collect sample on a routine Culturette. Cleanse the external canal. Collect exudate or
Specimen:
scrapings of ear canal.
Comments: Susceptibility testing will be performed on significant isolates.

o Haemophilus, Neisseria, & Streptococcus pneumoniae will be screened for
penicillin resistance only.
o This order is for INTERNAL ear samples only. If the EXTERNAL portion of the ear is
to be cultured, order as a wound culture.
RL Client o Write EAR CULTURE on the order form.

Comments: o Send specimen at room temperature to Mercy lab.
Processing: Send at room temperature.
Gram Stain: Within 8 hours of receipt

Performed: Preliminary report: 1,2,3,4 days
Final report:5 days
Reference value: No growth (commensal skin flora may be present).
87070 Culture
CPT Code:
87205 Gram Stain
POWERCHART ELECTROLYTE PANEL

NAME
MERCY TEST NAME ELECTROLYTES MERCY LAB CODE LYTE

Stability: Specimens may be stored for up to 2 days at 2–8°C or stored frozen at or below -20°C.
Includes Anion Gap, Chloride, CO2, Potassium and Sodium. Hemolyzed specimens not
Comment:
acceptable.
Reference Range: Please see individual test entries
Method Refer to individual test entries.

Description:
CPT Code: 80551
POWERCHART ENDOMYSIAL IgA AUTOANTIBODY

NAME
MERCY TEST NAME ENDOMYSIAL ATBY* MERCY LAB CODE ENDA
Specimen: 2 ml serum from a Serum Separator Tube (SST) or no additive serum tube
Comment: Useful for the diagnosis of dermatitis herpetiformis and celiac disease and for monitoring
adherence to gluten-free diet in patients with dermatitis herpetiformis and celiac disease.
Note: If Endomysial Antibodies (IgA), Serum is positive or indeterminate, Mayo (EMAT) /Endomysial
(IgA) Titer, Serum will be performed at an additional charge.
Processing: Send refrigerated to Mayo. Ambient or frozen acceptable. Mayo order code (EMA).
Performed: 2-7 days. Test set up at Mayo Monday through Friday; 7 a.m.-5 p.m.
Reference value: Report includes presence and titer of circulating anti-endomysia antibodies. Negative in
normal individuals, also negative in dermatitis herpetiformis or celiac disease patients
adhering to gluten-free diet.
Method: Indirect Immunofluorescence (EMA)
CPT Code: 86231
86231 titer (if appropriate)
POWERCHART
ENTEROVIRUS RNA DETECTOR
NAME
MERCY TEST NAME ENTEROVIRUS BY PCR* MERCY LAB CODE ENTRPC
Spinal Fluid: 0.5 mL collected in a sterile screw-capped container. DO NOT CENTRIFUGE.

Specimen:
Note: If ordering for other specimen type than CSF, order as CMIS-Mayo code LENT. Must specify
specimen type and source.
Processing: Send refrigerated to Mayo. Frozen is also acceptable. Mayo order code (LENT).
Method: Real-Time Polymerase Chain Reaction (PCR)/RNA Probe Hybridization
CPT Code: 87498
POWERCHART SMEAR FOR EOSINOPHIL URINE

NAME
MERCY TEST NAME EOSINOPHIL URINE MERCY LAB CODE EOUA

Specimen: 10 ml random urine. Deliver to Lab within 1 hour of collection. Refrigerate.
Reference Lab Clients: Refrigerate for transport
Stability: 8 hours refrigerated.

Reference value: None seen
< 1 % may indicate urinary tract infection
1 - 5% is not a good predictor of Acute Interstitial Nephritis
> 5 % may be a valuable predictor of Acute Interstitial Nephritis and may indicate Chronic
Urinary Tract infection.
Method: Microscopy, Wright-stained smear.
CPT Code: 87205
POWERCHART EPSTEIN BARR VIRUS PANEL

NAME
MERCY TEST NAME EPSTEIN BARR AB QL (qualitative) MERCY LAB CODE EBVA
Comment: Includes VCA IgG Ab, VCA IgM Ab, EBNA IgG Ab, and Interpretation. Testing is qualitative. If
quantitative test is required, specimen will need to be sent to Mayo.
Specimen: 1 ml serum from a Serum Separator Tube (SST).
Processing: Specimens can be sent refrigerated. Frozen is acceptable. Mayo order code (SEBV)
Cause for
Grossly hemolyzed, lipemic, or icteric samples.
rejection:
Performed: 2-14 days. Monday through Friday; Continuous 9 a.m. – 6 p.m.
Sunday; 6 a.m.

CPT Code: 86665 x2-VCA, IgG and IgM
86664 EBNA
POWERCHART EPSTEIN BARR VIRUS DNA PCR QUANT PLASMA

NAME
MERCY TEST NAME EBV DNA DET QNT* MERCY LAB EBVQN
CODE
Specimen: 1.5 mL EDTA plasma from EDTA tube.

Centrifuge with 2 hours of collection. Aliquot plasma into a plastic vial.
Processing: Send specimen frozen on dry ice only. If shipment will be delayed for more than 24 hours,
freeze plasma at -20 to -80 degrees C (up to 84 days) until shipment on dry ice. Refrigerated
is also acceptable. Mayo order code (EBVQN).
Method: Real-Time Polymerase Chain Reaction (RT-PCR)
CPT Code: 87799

POWERCHART ERYTHROPOIETIN LEVEL
NAME
MERCY TEST NAME ERYTHROPOIETIN* MERCY LAB EPO

CODE

Comment: Morning samples taken between 7:30 am and 12:00 noon have been recommended.
Reference Range: Included with report.
Method
Description: Two site immunoenzymatic (sandwich) assay.
CPT Code: 82668
POWERCHART ESTRADIOL LEVEL

NAME
MERCY TEST NAME ESTRADIOL MERCY LAB ESTD

CODE

Keep samples frozen for no more than 6 months. Do not store in a frost-free freezer.
Reference Rang: Male: 0 - 47 pg/mL
Female: Estradiol Expected Values

for Ovulating non-pregnant females
based on the hLH peak as Day 0.
Day –6 to –8 Mid-Follicular 27-122 pg/mL
Day –1 Peri-Ovulatory 95-433 pg/mL
Day +6 to +8 Mid-Luteal 49-291 pg/mL
Post-Menopausal Female <15-40 pg/mL
Method
The Atellica IM eE2 assay uses a competitive assay format
Description:
CPT Code: 82670
TEST NAME ESTROGEN/PROGESTERONE RECEPTOR ASSAY QUANTITATIVE (PARAFFIN BLOCK)
MERCY TEST ERA/PRA BLOCK MERCY LAB CODE EPRB

NAME
Comment: Ordered on paraffin block. Routinely ordered on breast carcinoma.
Processing: Paraffin Block

Performed: Test set up Tuesday and Friday.
Reference value: Included with pathology report.
Method: Labeled-Streptavidin Biotin Immunoperoxidase stain.
CPT Code: 88342 X2 Immunocytochem+ X2
TEST NAME ETHOSUXIMIDE (ZARONTIN) LEVEL
MERCY TEST ETHOSUXIMIDE* MERCY LAB CODE ETX

NAME
Specimen: 0.5 ml of serum from Serum Separator Tube (SST).

Processing: Send refrigerated. Ambient or frozen acceptable. Mayo order code (ETX).
Performed: 1 day. Test set up Monday through Saturday
Method: Enzyme-Multiplied Immunoassay Technique (EMIT)

CPT Code: 80168
TEST NAME EVEROLIMUS LEVEL
MERCY TEST EVEROLIMUS* MERCY LAB CODE EVROL

NAME
Specimen: 3.0 ml of whole blood lavender top (EDTA) tube.

Processing: Send refrigerated. Ambient or frozen are acceptable. DO NOT centrifuge. Send in original
tube. Mayo order code (EVROL)
Performed: 1-2 days. Monday through Sunday; 1 p.m.

CPT Code: 80169
POWERCHART EYE CULTURE OTHER
NAME
MERCY TEST EYE CLT/GS MERCY LAB CODE EYEC

NAME
Order: Indicate which eye when ordering. See beginning of section for ordering help and codes.
Specimen: o Conjunctivitis:
Touch the involved area with a sterile swab moistened with sterile saline. Ideally,
inoculate directly to the appropriate media (Contact Microbiology). However, the
specimen may be transported on a routine Culturette to the lab.
o Corneal scrapings:
The cornea may be anesthetized with 0.5% proparacaine hydrochloride, but better
results are obtained if the scrapings are collected without the use of a topical
anesthetic. A topical anesthetic may have an antimicrobial effect. Scrape the base
and margin of the ulcer. Inoculate these scrapings directly to the appropriate
media.
Comment: o Deliver to Lab immediately. The organisms involved in eye infections are often
fastidious in nature.
o This order is for INTERNAL eye specimens only. If an external eye culture is
needed, order as a wound culture.
RL Client o Write EYE CULTURE on the order form. Indicate which eye was cultured.
Comments: o Send the specimen room temperature to Mercy lab.
Performed: Gram Stain: Within 8 hours of receipt
Preliminary reports: Days 1 & 2
Reference value: No growth (commensal skin flora may be present)
CPT Code: 87070 Culture+

87205 Gram Stain+
POWERCHART FACTOR V LEIDEN F5 LEVEL

NAME
MERCY TEST F5 LEIDEN R506Q MU* MERCY LAB CODE FACTV

NAME
Patient Preparation: A previous bone marrow transplant from an allogenic donor will interfere with testing. Call 800-
533-1710 for instructions for testing patients who have received a bone marrow transplant.
Specimen: 3 mL whole blood in EDTA (Preferred). Yellow top (ACD solution B) and sodium citrate also
acceptable. Invert several times to mix blood.
Processing: Send ambient in original tube. DO NOT ALIQUOT. Mayo order code F5DNA.
Coagulation Consultation Patient Information Sheet must be sent with specimen.
Performed: 3-5 days, Weekly.
Method: Polymerase Chain Reaction/Fluorescence Monitoring
CPT Value: 81241
POWERCHART FACTOR VIII LEVEL
NAME
MERCY TEST NAME COG FAC VIII ASSAY* MERCY LAB CODE F8A
Specimen: o Draw 2 blue top tubes filled appropriately with the amount of blood listed on the
label.
o Avoid gross hemolysis.
o Patient must NOT be receiving coumadin or heparin therapy.
Processing: Double centrifuge specimen, place 1 mL double spun platelet poor plasma into vial. Freeze
specimen immediately. Send FROZEN to Mayo. Mayo code - F8A
Performed: 1-3 Days, performed Monday through Friday
Method: Activated Partial Thromboplastin Clot-Based Assay
CPT Code: 85240
POWERCHART FACTOR Xa
NAME
MERCY TEST NAME FACTOR X A MERCY LAB FTENA

CODE
Specimen: Draw a blue top tube filled appropriately with amount of blood listed on the label.
Stability: 4 hours refrigerated, freeze if >4 hours.
Comment: Used to monitor dose of Low Molecular Weight Heparin. To monitor unfractionated Heparin
dose, order HEPARIN UNFRAC.
Cause for
Improperly filled tubes will NOT be tested. Gross Hemolysis unacceptable.
Rejection:
Processing: Double spin and freeze plasma if testing not done within 4 hours of collection.
Label vial “citrated plasma”.
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: Available stat. Performed within 8 hours of receipt.

Reference Value: Peak levels (4 hours post dose) are recognized as the best measures of safety and efficacy.
Desired levels are as follows:
o For prevention of venous thromboembolism (VTE) (DVT & PE) a peak Factor X A
drawn 4 hours post SQ injection range is 0.1 - 0.2 U/ml.
o Treatment levels recommended are 0.4 - 1.1 U/ml for twice daily dosing or 1.0 - 2.0
U/ml for once daily dosing.
NOTE: Levels >0.8 - 1.0 U/ml may be associated with increased risk of bleeding.
Method: Chromogenic Substrate

CPT Code: 85520
POWERCHART FACTOR X ACTIVITY

NAME
MERCY TEST NAME MERCY LAB CODE FXCH

CHROMOGEN FACTOR X*
Specimen: o Draw a blue top tube filled appropriately with the amount of blood listed on the
label.
o Avoid gross hemolysis.
o Patient must NOT be receiving coumadin or heparin therapy.
Processing: Double centrifuge specimen, place 1 mL double spun platelet poor plasma into vial. Freeze
specimen immediately. Send FROZEN to Mayo. Mayo code- (FXCH), Coagulation Factor X
Chromogenic Activity Assay, Plasma.
Performed: 1-3 Days, performed Monday through Friday
Method: Chromogenic
CPT Code: 85260
POWERCHART FAT QUALITATIVE FECES
NAME
MERCY TEST NAME FAT FECES QUALITATIVE MERCY LAB CODE FFQ
Specimen: o 2 gm random stool specimen.

o Submit in a clean container with a tight-fitting lid.
o Deliver to Lab within 6 hours of collection.
Processing: Refrigerate.
Reference Lab Clients: Refrigerate. Specimen must be delivered to lab within 72 hours of
collection.
Performed: As received.
Reference value: Negative. Descriptive report if positive for fat
Method:
Sudan red stain, microscopic examination.
CPT Code: 82705
POWERCHART FAT QUANTITATIVE FECES

NAME
MERCY TEST NAME FAT FECES QNT* MERCY LAB CODE FTFC
Patient
Patient should be on a controlled diet, 100-150 grams fat per day during collection.
Preparation:
Specimen: o 48- or 72-hour stool specimen collected in a special container obtained from the
Lab.
o 48- or 72-hour specimen preferred, but a 24 hour or random specimen will be
accepted.
o Refrigerate the specimen during and after collection (portable refrigerator
available from the Lab for inpatients).
o 5 grams of stool specimen is required for testing. Continue collection until 5 grams
collected.
Comment: o Must indicate length of collection period in comment.
o Barium in the stool will interfere with the test.
o It is essential that laxatives (particularly mineral oil and castor oil) are NOT used
during the collection period.
o Synthetic fat substitutes such as Olestra interfere with test procedure.
o Wait a minimum of 48 hours following a barium procedure before beginning
specimen collection.
Processing: o Send entire specimen in container that is no more than three-fourths full.
o Indicate length of collection period.
o Send frozen to Mayo. Mayo order code FATF.
Performed: 3 days. Test set up Monday through Friday.
Reference Value: Included with report.
Method: Nuclear Magnetic Resonance Spectroscopy (NMR).
CPT Code: 82710
Comment: o To be ordered on MISYS when a test result is to be faxed or called to a location in
addition to the normal reporting location.
Include the fax telephone number, mailing address, to whom the report should be directed,
and for which tests.
POWERCHART FEBRILE AGGLUTININ
NAME
MERCY TEST NAME FEBRIL AGGLUTS* MERCY LAB CODE MISM
Includes: Brucella Ab (Total), Tularemia Ab (Total) and Leptospira Igm Ab

Specimen: 2 ml serum from a Serum Separator Tube (SST) or no additive serum tube. Refrigerate
Cause for
Hemolysis.
rejection:
Comment: Reference Lab Clients: Mark “Other” and specify Febrile Agglutinins
Processing: Send to University Hygienic Lab, Iowa City.
Performed: 7 days.
Method: Microagglutination, Tube Agglutination and EIA
CPT Code: 86622 (Brucella), 86668 (Tularemia), 86720 (Leptospira)
POWERCHART FELBAMATE (FELBATOL) LEVEL

NAME
MERCY TEST NAME FELBAMATE* MERCY LAB FELBA

CODE
Specimen: 1 ml serum from a no additive serum tube (Preferred). Also acceptable Serum Separator
Tube (SST).
Draw blood immediately before next scheduled dose. Centrifuge and aliquot serum into
plastic vial within 2 hours of collection.
Processing: Send refrigerated (Preferred) to Mayo. Ambient or frozen also acceptable. Mayo code
(FELBA).
Performed: 1-3 days. Monday, Wednesday, Friday.
CPT Code: 80167
POWERCHART FERRITIN LEVEL

NAME
MERCY TEST NAME FERRITIN MERCY LAB FRR

CODE
Tightly cap and refrigerate specimens at 2–8°C if the assay is not completed within 8 hours.
Freeze samples at ≤ -20°C if the sample is not assayed within 48 hours.
Stability:
Freeze samples only 1 time and mix thoroughly after thawing. The handling and storage
information provided here is based on data.
Serum ferritin values are elevated in the presence of the following conditions and do not
reflect actual body iron stores:
– inflammation
– significant tissue destruction
– liver disease
– malignancies such as acute leukemia and Hodgkin’s disease
– therapy with iron supplements

Reference Range: 0-1 month: 25-200 ng/ml
1-2 months: 200-600 ng/ml
2-5 months: 50-200 ng/ml
6 months- 14 years: 10-140 ng/ml
Adult male: 24-336 ng/ml
Adult female: 11- 307 ng/ml
Method The Atellica IM Fer assay is a 2-site sandwich immunoassay using direct chemiluminescent
Description: technology, which uses constant amounts of 2 anti-ferritin antibodies.
CPT Code: 82728
POWERCHART SEMEN ANALYSIS FERTILITY

NAME
MERCY TEST NAME FERTILITY TEST SEMEN MERCY LAB CODE SMNFER
Note: To be ordered for Reference Lab Clients only.

Specimen: o Semen – Total Ejaculate.
o Patient should have 2-7 days of sexual abstinence at the time of semen collection
for accurate results.
o Mayo kit (supply T178) must be obtained prior to collection from Mercy Laboratory
Causes for Specimen will be rejected if: not the total ejaculate, specimen not sent in preservative, or if
Rejection: specimen is received at Mayo >24 hours from collection
Processing: o Send at ambient temperature to Mayo order code (SEMB).

o Specimen must arrive within 24 hours of collection.
o Send specimen Monday through Thursday ONLY, and NOT the day before a
holiday.
o Specimen should be collected and packaged as close to shipping time as possible.
o Measure and observe semen volume, viscosity, pH, appearance (color), and
number of days of sexual abstinence and document on
o Place specimen in preservative (preservative is stored refrigerated until specimen
is added)
Performed: Monday through Friday; 3 p.m.
1-4 days.

Method: Parameters of test done per The World Health Organization (WHO) Laboratory Manual
CPT Code: 89322 Semen Analysis with Strict Morphology
POWERCHART FETAL FIBRONECTIN

NAME
MERCY TEST NAME FETAL FIBRONECTIN MERCY LAB CODE FFNT
Specimen: Specimen Collection Kit may be obtained from the Lab. This kit is the only acceptable
collection system available.
Specimen Collection Precautions and Warnings:
o Specimens for Fetal Fibronectin should be collected prior to culture specimens.

Collection of vaginal specimens for culture requires aggressive collection
techniques which may abrade the cervical or vaginal mucosa.
Cellular debris may potentially interfere with sample preparation.
o Specimens should be obtained prior to digital cervical examination or vaginal
probe ultrasound exam as manipulation of the cervix may cause the release of
fetal fibronectin.
o Patient specimens should not be tested if the patient has had sexual intercourse
within 24 hours prior to the sampling time because semen and/or sperm may
increase the possibility of the test giving a false positive result.
o Care must be taken not to contaminate the swab or cervicovaginal secretions with
lubricants, soaps, or disinfectants.
o Patient using Tafazal, a vaginal cream used for yeast infection, should wait 24
hours before collecting a specimen.
o Rupture of membranes should be ruled out prior to specimen collection since fetal
fibronectin is found in both amniotic fluid and the fetal membranes.
o Specimens should not be obtained from patients with suspected or known
placental abruption or placenta previa.
o Not intended for use in patients with cancers of the reproductive tract.
o Not intended for use in patients with moderate or gross bleeding
Specimen Collection Instructions are included in the collection kit.
Regional Lab: Send specimen on ice or refrigerated.

Performed: Within 8 hours of receipt. Available STAT
Method: Solid Phase Immunoassay, Optional Reflectance
CPT Code: 82731
POWERCHART FETAL MATERNAL ERYTHROCYTES
NAME
MERCY TEST FETAL/MAT ERYTH MERCY FME

NAME LAB
CODE
Vaginal bleed specimen: Screens for fetal bleed.

Specimen: 2 slides prepared at bedside or submit swabs to the Lab.
Whole blood specimen:
Specimen: 2 ml whole blood from purple (EDTA) top tube. Refrigerate.
Stability: 2 weeks refrigerated but should be processed as soon as possible.
o May be ordered before delivery to determine if fetal bleed has occurred.
Comment: o Ordered by Lab when Fetal/Maternal Screen is positive.
Processing: Store specimen refrigerated. Test within 24 hours of collection.

Performed: Daily. Available stat.
Method: Keilhauer Betke stain, microscopic examination.
CPT Code: 85460
POWERCHART FETAL SCREEN

NAME
MERCY TEST NAME FETAL/MAT SCREEN MERCY LAB CODE FETS
Specimen: One 6 ml Pink top tube. Refrigerate.

Comment: o Test will be ordered by Lab when RHIG workup tests indicate that the patient is
eligible to receive Rh immune globulin.
o The Lab will order a Fetal/Maternal Ratio when the Fetal Screen is positive.
o Test may also be ordered by outside clients.
NOTE: Test can be done only when maternal blood type is known to be Rh negative and fetal
blood type is Rh positive. If Rh type of fetus is unknown, order Fetal/Maternal Erythrocyte
Ratio.
Performed: Within 24 hours of collection.

Reference value: Negative (Indicates
Method: Serological
CPT Code: 85461
POWERCHART FIBRINOGEN ACTIVITY

NAME
MERCY TEST NAME FIBRINOGEN MERCY LAB CODE FIBR
Specimen: o Draw 1 blue top tube filled appropriately with amount of blood listed on label.
o 1 ml plasma needed.
o Avoid hemolysis.
Other: Improperly filled tubes will NOT be tested.
Processing: o Centrifuge and separate plasma within 2 hours.
o Store in refrigerator up to 4 hours.
o Double spin and freeze plasma if storage will be longer than 4 hours.
o Label vial "CITRATED PLASMA".

Reference value: 145-450 mg/dL
Method: Clauss, photo optical clot detection.
CPT Code: 85384
POWERCHART
LIVER FIBROSIS FIBRO TEST ACTITEST PANEL
NAME
FIBROTEST ACTITEST* MERCY LAB FIBRO

MERCY TEST NAME
CODE
Specimen: 3 mL serum from a Serum Separator Tube, no additive serum tube acceptable.
Centrifuge and aliquot serum into an amber vial within 2 hours of collection. It must
be protected from light.
Cause for
Rejection: Specimen not protected from light.
Processing: Centrifuge and aliquot serum into an amber vial or wrap the aliquot tube in foil within 2
hours of collection. Send refrigerated. Mayo (FIBRO).
Performed:
2 days, HAPTF, A2MF: Monday through Saturday
ALTF, GGTF, TBILF: Monday through Sunday
APOAF: Monday through Saturday
Reference Value:
Included in Report
Method:
INTF: Algorithm and Interpretation provided through BioPredictive
APOAF: Automated Turbidimetric Immunoassay
A2MF, HAPTF: Nephelometry
ALTF:Photometric Rate, L-Alanine with Pyridoxal-5-Phosphate
GGTG:Photometric Rate
TBILF:Photometric, Diazonium Salt (DPD)
81596
CPT Code:
POWERCHART FOLATE SERUM

NAME
MERCY TEST NAME FOLATE MERCY LAB CODE FOL

Freeze serum samples at ≤ -20°C if the assay is not completed within 48 hours. Freeze serum
Stability: samples only 1 time and mix thoroughly after thawing. Frozen specimens can remain frozen
for up to 30 days. Do not store in a frost-free freezer. If serum samples will be stored for
longer than 30 days, then they must be frozen at ≤ -80°C.
Comment: Hemolysis significantly increases folate values in serum due to the high folate
concentrations found in red blood cells.
Methotrexate and leucovorin interfere with folate measurement because these drugs cross-
react with folate binding proteins.
Performed:
Within 8 hours of receipt. Available stat.
Reference Range: >12.19 ng/mL

Method The Atellica IM Fol assay is a competitive immunoassay using direct chemiluminescent
CPT Code: 82746
TEST NAME FOLIC ACID RBC / FOLATE RBC See: FOLATE SERUM
Comment: Recommended Alternate testing: Folate Serum
True folate deficiency in the current era of FDA-mandated folic acid supplementation is
exceedingly rare. There is no evidence to support routine ordering of RBC or serum folate,
but serum folate concentrations provide equivalent clinical information to RBC folate in the
assessment and diagnosis of folate deficiency. Based on these statistics, and because serum
folate provides equivocal results to RBC folate in almost all clinical scenarios, routine
ordering of RBC folate is no longer warranted.
Furthermore, investigation of megaloblastic anemia should preferentially be initiated with

vitamin B12 testing instead of folate due to the low incidence of modern folate deficiency. In
the absence of B12 deficiency, it is more cost effective to simply supplement with folic acid
rather than routinely test and monitor a patient's folate status, similar to other nutritional
deficiencies such as vitamin D.
Information provided by Mayo Medical laboratories.
POWERCHART FRACTIONAL EXCRETION SODIUM

NAME
MERCY LAB CODE

MERCY TEST NAME FRACT EXCRET SODIUM VFES
Specimen: Random urine specimen plus 1 ml serum. Blood specimen must be collected within 1 hour
of urine specimen.
Stability: Sodium in serum and urine may be stored for up to 7 days at 2–8°C or stored frozen for up
to 30 days at -20°C.
Comment: Includes random urine sodium, random urine creatinine, and Fractional Excretion Sodium
Interpretation.
Lab will place an order for a SERUM Sodium and SERUM Creatinine when the urine
specimen is received in the Lab.
Reference Range: Interpretation table is included with results. Calculations are based on Urine Sodium, Urine
Creatinine, Serum Sodium and Serum Creatinine.
Method Refer to individual test entry
Description:
CPT Code: 84300 Sodium Ur+
82570 Creat R UR
POWERCHART
CHROMOSOME STUDY FRAGILE X
NAME
FRAG X MOL ANLYS* FXMA
MERCY TEST NAME MERCY LAB CODE
Specimen: 2.5 ml EDTA whole blood from purple top tubes or a yellow ACD tube. Minimum 1 ml. Draw
as much as possible, as Mayo preserves some for more testing, and also for repeat testing.
NOTE: Amniotic fluid and chorionic villus may also be tested. DO NOT collect these
specimens before consultation with Mayo Medical Laboratories. Complete collection
instructions are found in the Mayo catalog. Call the Lab for a copy of these instructions.
Comment: Useful for documentation of carrier status and prenatal diagnosis for fragile X syndrome.
Prior consultation with a medical geneticist is recommended.
Processing: o Send whole blood at room temperature. DO NOT CENTRIFUGE!

o Samples should arrive at Mayo within 72 hours of collection.
o Reason for referral and relevant clinical and family information must be submitted
with specimen.
o Complete a Molecular Genetics Information sheet and Genetics request form and
send with specimen.
o Send at room temperature ONLY. Mayo order code (FXS).
Performed: 4 days. Test set up Monday, Wednesday; 10 a.m.
Method: Polymerase Chain Reaction (PCR)-Based Assays.
CPT Code: 81243
POWERCHART FROZEN PLASMA ORDER SET
NAME
MERCY TEST NAME FFP FOR INFUS MERCY LAB CODE TFFP
Specimen: EDTA plasma in a pink or purple top tube. MRN must be check marked.
Use: Usage is indicated in the treatment of clotting factor deficiencies.
Comment: o Use one order for up to 6 units.
o In Powerchart, if plasma is needed "STAT", in the "Transfusion Priority" drop
down select "STAT".
o In Powerchart, if plasma is needed for a FUTURE DATE and TIME, in the
"Transfusion Priority" drop down select "TIMED" and select future date and time to
when you want the infusion.
o If blood type has not been ordered for the episode, order "ABO+Rh(D) Blood
Typing."
o Indicate number of units in the units ordered field.
o Allow 6 minutes thawing time for each unit ordered of FFP.
o If FFP is for routine use, the process to receive a unit is to send the "Blood Product
Request" slip when the unit is ready to be transfused. When the request form is
received the product will be thawed and the blood bank will call the requesting
location to tell them the product is ready to be picked up.
o During Massive Transfusion or Emergency Release, units will automatically be
thawed according to orders.
Processing: Give group specific or compatible disregarding Rh. Refer to procedure if specific group is
unavailable.
Performed: Available stat.

Method: Thawed
CPT Code: 86927 FFP (Admin) (1 for each unit)
P9017 FFP (Proc)* (1 for each unit)
TEST NAME FROZEN SECTION TISSUE EXAMINATION
Includes: Tissue Exam Gross and Microscopic.

Comment: Complete manual Pathology Specimen requisition form and Frozen Section Consultation
requisition.
Pre-op diagnosis, patient history, and specimen source must be included.
When sending breast biopsy for frozen section, please forward appropriate mammogram.
Specimen: Tissue specimen, fresh, without formalin.
Reference Lab Clients: Fresh tissue specimen (no formalin) must be kept on ice and
transported to Mercy Histology Lab immediately. Notify the Histology Lab (641-428-7486)
that the specimen is coming.
Performed: Pathologist report will be called to the physician within 15 minutes of receipt.
Reference Lab Clients: Pathologist report will be called and faxed.
Reference value: Interpretation will be provided.

Method: Pathologist microscopic evaluation
CPT Code: 88331 Frozen/Consult
88332 Frozen Additional
POWERCHART FRUCTOSAMINE LEVEL
NAME
MERCY TEST NAME FRUCTOSAMINE, SERUM* MERCY LAB CODE FRUCT

Processing: Send Refrigerated to Mayo. Ambient or Frozen also acceptable. Mayo Code (FRUCT).
Performed: Daily
Reference Value: Reference Ranges included in report

Method: Colorimetric rate reaction
CPT Code: 82985
POWERCHART FSH LEVEL (FOLLICLE STIMULATING HORMONE LEVEL)

NAME
MERCY TEST NAME FSH MERCY LAB CODE FSH

hours. Freeze samples at ≤ -20°C if the sample is not assayed within 48 hours. Freeze
samples only 1 time and mix thoroughly after thawing.
Comment: Do not use samples that have been stored at room temperature for > 8 hours.
Reference Range: Male 1-7 days <3.0 mIU/mL

8-15 days <1.4
6 days to 3 years <2.5
4-6 years <6.7
Puberty onset occurs for boys at 7-8 years <4.1
a median age of 11.5 (+/- 2) 9-10 years <4.5
years. For boys, there is no 11 years 0.4-8.9
proven relationship between 12 years 0.5-10.5
puberty onset and body weight 13 years 0.7-10.8
or ethnic origin. Progression 14 years 0.5-10.5
through tanner stages is 15 years 0.4-18.5
variable. Tanner stage V (adult) 16 years <9.7
should be reached by age 18. 17 years 2.2-12.3
Tanner Stage I <3.7
Tanner Stage II <12.2
Tanner Stage III 1.2-11.4
Tanner Stage IV 0.3- 8.2
Tanner Stage V 1.1-12.9
1-7 days <3.4

Female 8-15 days <1.0
16 days- 6 years <3.3
7-8 years <11.0
Puberty onset (transition from 9-10 years 0.4-6.9
Tanner stage I to Tanner stage II) 11 years 0.4-9.0
occurs for girls at a median age 12 years 1.0-17.2
of 10.5 (+/- 2) years. Progression 13 years 1.8-9.9
through Tanner stages is 14-16 years 0.9-12.4
variable. Tanner stage V (adult) 17 years 1.2-9.6
should be reached by age 18. >/= 18 years Premenopausal
Follicular: 3.9-8.8
Mid Cycle: 4.5-22.5
Luteal: 1.8-5.1
Postmenopausal: 16.7-113.6
Tanner Stage I 0.4-6.7

Tanner Stage II 0.5-8.7
Tanner Stage III 1.2-11.4
Tanner Stage IV 0.7-12.8
Method The Atellica IM FSH assay is a 2-site sandwich immunoassay using direct chemiluminescent
Description: technology, which uses constant amounts of 2 antibodies that have specificity for the
intact FSH molecule.
CPT Code: 83001
POWERCHART FUNGITELL TEST

NAME
MERCY TEST NAME FUNGITELL* MERCY LAB CODE FUNGS
Specimen: 1 ml serum in a Serum Separator Tube (SST). **DO NOT ALIQUOT**

Processing: Centrifuge specimen within 2 hours of collection **DO NOT ALIQUOT** Ship serum gel tube
refrigerated to Mayo. Mayo code: (SFUNG)
Alias: (1,3) Beta-D glucan FORWARD
Performed: 1 day, Monday through Friday, 9 a.m.
Reference Value: Reference Ranges included in report

Method: Protease Zymogen-Based Colorimetric Assay Based on the Limulus Amebocyte Lysate (LAL)
Pathway
CPT Code: 87449
POWERCHART CULTURE FUNGUS + SMEAR DIRECT ORDER SET

NAME
MERCY TEST NAME FUNGUS CLT/GS MERCY LAB CODE FUNG
Specimen: To prevent aerosolization, specimens must be submitted in a sterile container with a

tight-fitting screw top lid. Culturette must be capped snugly. Submit according to the
following guidelines:
o Body fluid: 5 ml minimum. Collect in sterile screw-capped vial.

o Bone marrow aspirate: 1.5 ml in small Wampole Isolator tube.
o Bone marrow biopsy: Transport in a sterile screw-capped container with 1 ml
sterile normal saline.
o Bronchus washings/brushings: 5 ml minimum. Collect in sterile screw-capped vial.
o Corneal scraping or donor cornea: Ophthalmologist is to collect and plate. Contact
Microbiology for media.
o Ear: Collect sample on a routine Culturette.
o Hair: Collect hair and base of shaft in screw-capped vial.
o Nail cuttings: Submit cuttings in a screw-capped vial.
o Skin scrapings: Submit scrapings in a sterile screw-capped container.
o Sputum: 5 ml minimum. Collect in a screw-capped vial.
o Stool: Freshly passed specimen. Submit specimen in a screw-capped vial.
o Tissue: Place tissue in 1-2 mL sterile saline in a screw-capped vial.
o Urine: 25-50 ml of clean catch, first morning specimen. Submit urine in a sterile
screw-capped vial. Catheterized and suprapubic specimens are also acceptable.
RL Client
o Write FUNGUS CULTURE on order form. Indicate specimen source.
Comments:
o Send specimens at room temperature to Mercy lab.
Performed: Direct preparation: 1 day
Preliminary report: 2,3 weeks
Final report: 4 weeks
Reference value: Direct exam: No yeast or hyphal elements seen.

Culture: No fungus isolated.
CPT Codes: 87205 Gram Stain

87102 Fungus Clt
TEST NAME CULTURE IDENTIFICATION FUNGUS
MERCY TEST FUNGAL ID MERCY LAB CODE FNID

NAME
Specimen: Submit each yeast or fungus to be identified on a separate plate. 1 yeast or fungus per
request.
RL Client o Write FUNGAL IDENTFICATION on the order form. Indicate the source of the
Comments: specimen.
o Send the culture plates sealed and at room temperature to Mercy lab.
Method: Standard Culture Techniques.
CPT Code: 87102
FUNGAL SURVEY, FUNGAL ANTIBODY PANEL - Discontinued 05/06/14 by Mayo Laboratories. Please refer to
the April 2014 Lab Links for more details. The following tests can be ordered individually.
o Histoplasma Antibody Screen, Mercy code HSTAB
o Blastomyces Antibody, Mayo code BLAST
o Cryptococcus Antigen, Mayo code SLFA
o Coccidioides Antibody, Mayo code COXIS
POWERCHART GABAPENTIN (NEURONTIN) LEVEL

NAME
MERCY TEST NAME GABAPENTIN* MERCY LAB CODE GABP

Specimen: o 1.0 ml serum from a no additive serum tube.
o Draw immediately before next scheduled dose.
o Spin within 2 hours of collection.
Processing: Send refrigerated to Mayo. Ambient or frozen acceptable. Mayo order code (GABA).
Performed: 2-3 days. Set up Tuesday through Saturday 12 A.M.
Saturday at 4 P.M.

CPT Code: 80171
POWERCHART G6PD QUANTITATIVE (GLUCOSE-6-PHOSPHATE DEHYDROGENASE)

NAME
MERCY TEST NAME G6PD* MERCY LAB CODE G6PD
Specimen: 6.0 ml whole blood drawn in EDTA tube or yellow top (ACD solution A) tube.
Do not spin down.
Processing: Send refrigerated to Mayo. Mayo order code (G6PD1).
Do not transfer blood to other containers/send in original tube.
Do not allow specimen to freeze.
Use bubble wrap to protect specimen.
Performed: Test set up at Mayo Monday through Sunday.
Reference value: Included with the report.
Method: Kinetic Spectrophotometry (KS)
CPT Code: 82955
POWERCHART GALECTIN 3 LEVEL
NAME
MERCY TEST NAME GALECTIN-3* MERCY LAB CODE GAL3
Specimen: 1.0 ml serum from a no additive serum tube.

Processing: Send FROZEN to Mayo, Mayo order code GAL3.
Performed: 8 days. Performed Monday at 9 A.M.
Reference value: >17 years is <=22.1 ng/mL
CPT Code: 82777
POWERCHART GAMMA GLUTAMYL TRANSFERASE (GGT)

NAME
MERCY TEST NAME GAMMA GT MERCY LAB CODE GGT
Specimen: 0.5 ml Serum

Specimens may be stored for up to 7 days at 25°C or for up to 7 days at 2–8°C or stored
Stability:
Reference Rang: Female:<38 units/L
Male:<73 units/L
Method The Atellica CH Gamma-Glutamyl Transferase (GGT) assay is based on the reaction with
Description: synthetic substrate (L-γ-glutamyl-3-carboxy-4-nitroanilide), glycylglycine acts as an acceptor
for the γ-glutamyl residue and 5-Amino-2-Nitrobenzoate (ANB) is liberated.
CPT Code: 82977
POWERCHART GASTRIN LEVEL

NAME
MERCY TEST NAME GASTRIN* MERCY LAB CODE GSTR
Patient
Patient must be fasting.
preparation:
Processing: Send frozen to Mayo. Mayo order code GAST.
Performed: 3 days. Test set up Monday through Friday;5 a.m.-12 a.m., Saturday; 6a.m.-6 p.m.
Method: Automated Chemiluminescent Immunometric Assay.
CPT Code: 82941
POWERCHART GASTROCCULT® BODY FLUID

NAME
MERCY TEST NAME GASTROCCULT® BODY FLD MERCY LAB CODE GASO
Specimen: 1 ml gastric aspirate obtained by nasogastric intubation or vomitus. Nursing Service is to

collect in specimen container with tight fitting lid and send to the Lab for testing.
Comment: Specimen must arrive in the laboratory within 2 hours of collect time. Indicate source in
comment field (Nasogastric or specific site).
Processing: Testing performed using Gastroccult® blood slides. DO NOT use Hemoccult® slides as those
are for fecal material only.
Method: Guaiac paper test
CPT Code: 82271
MERCY TEST NAME GASTROINTESTINAL PATHOGEN PANEL PCR, FECES MERCY LAB CODE CMIS
Specimen: Fresh stool placed in an orange-topped Cary Blair stool preservative. Enough stool should be
added to the preservative vial to bring the level of the preservative fluid up to the red line,
on the preservative container.
o It is NOT recommended that the following tests be concomitantly ordered if this

test is ordered as this is considered duplicate testing: Vibrio culture, rotavirus
antigen, adenovirus, giardia antigen, cryptosporidium antigen, Cyclospora stain,
stool culture, Shiga toxin, or clostridium difficile toxin.
o Mayo test code - GIP
Stability: Specimen must be received by MAYO Medical Labs within 96 hours of collection.
Performed: Monday through Sunday; continuously at Mayo Medical Labs
Reference value: Negative (for all targets)
Method: Multiplex PCR FilmArray
CPT Code: 87507
POWERCHART GC & Chlamydia PCR

NAME
MERCY TEST NAME GC & Chlamydia PCR MERCY LAB CODE GCCM
Specimen: Urine: First void urine specimens must be transferred from the collection cup to the Xpert
CT/NG Urine Transport Reagent Tube (Yellow Cap) immediately (preferred) or within 24
hours of collection when kept at Room Temperature or within 8 days of collection when
stored at 2–8°C.
Urine specimens in Xpert CT/NG Urine Transport Reagent Tubes should be kept between 2°C
and 30°C during transport and can be stored for up to 3 days at this temperature.
Urine Specimen Collection:
o Collect the specimen in a sterile, preservative-free specimen collection cup.

o The patient should collect the first 20–60 mL of voided urine (the first part of the
stream - not midstream) into a urine collection cup.
o Cap and label the urine collection cup with patient identification and date/time
collected.
Vaginal/Endocervical: Collect using only the Xpert Swab Specimen Collection Kit (Pink Cap).
Swab samples in Xpert Swab Transport Reagent are stable up to 60 days at 2–30°C.
Cause for
Rejections o Improperly collected samples.
Comment: In the case of suspected child abuse, culture is the only recommended procedure. See: GC
Culture.
Results are directly dependent on specimen quality. Inadequate or improperly collected

specimens may give false negative results.
Processing Store at 2-30 °C
Performed: Performed daily. Available STAT.
Reference value: Chlamydia trachomatis & Neisseria gonorrhoeae Not Detected
Method: DNA Extraction
CPT Code: 87491 Chlamydia

87591 GC
TEST NAME GC (Neisseria gonorrhea, Miscellaneous Sites, by Nucleic Acid Amplification)

(OTHER SITES not genital or urine) *
MERCY TEST MISCELLANEOUS GENERAL LAB MERCY LAB CODE CMIS

NAME
Specimen: Swab specimen collected using the APTIMA Collection Vaginal Swab (the APTIMA Unisex
Swab can also be used). Collection kits are available from Mercy lab.
Mayo Approved The following sites are approved for GC testing at Mayo Med Labs, ONLY (Mercy Lab is not
Sites: approved to do testing on these sites
o Rectal/anal
o Ocular (corneal/conjunctiva)
o Oral/throat
o Pelvic wash, cul-de-sac fluid (this source requires the APTIMA specimen transfer
tube T652, available from Mercy lab).
NOTE: If provider wants both Chlamydia and GC testing done on a rectal, ocular, oral
or pelvic, a separate order will have to be placed for each test.
Comment: o In the case of suspected child abuse, culture is the only recommended procedure.
See GC culture.
RL Client o If ordering the test at your facility, order a CMIS and put in comment the test is for
Comments: MGRNA and include the source (rectal, ocular, oral). If you will order using a
requisition, write CMIS on the order form and indicate the testing is for MGRNA
and include the source (rectal, ocular, oral).
o Send the APTIMA transporter refrigerated to Mercy lab.
Cause for o Transport tubes that are received without collection swabs inside.
rejection: o Transport tubes that have expired.
o Transport tubes received with a swab different from the one provided in the
collection kit.
o Sources other than those listed above.
Processing: Refrigerate sample after collection and send to Mayo Med Labs refrigerated. Mayo order
code MGRNA (N. gonorr, Misc., Amplified RNA)
POWERCHART GENERAL HEALTH PANEL

NAME
MERCY TEST NAME GENERAL HEALTH PANEL MERCY LAB CODE GHP
Specimen: o 2.0 mL serum

o Lavender top (EDTA) tube
o Serum: Specimens may be stored for up to 2 days at 2–8°C or stored frozen at or

Stability:
below -20°C.
o EDTA tube: 36 hours room temperature or refrigerated.
Comment: Includes: CBC with automated differential, Comprehensive Metabolic Panel, TSH
Grossly hemolyzed specimens are not acceptable.
EDTA tube must be received at Mercy within 36 hours of collection.

Reference range: See individual test entry.
CPT Code: 80050
POWERCHART GENITAL CULTURE

NAME
MERCY TEST NAME GENITAL LOW CLT MERCY LAB CODE GENL
Order: Indicate site when ordering.

This culture will NOT determine the presence of Neisseria gonorrhoeae. For presence
of N. gonorrhoeae, see GC culture.
Specimen: Vulva, Vagina, Cervix, or Urethra. Submit in a double Culturette.
Comment: o This culture screens for the presence of Group B Beta Streptococcus,
Staphylococcus aureus, Gardnerella vaginalis, and a predominance of yeast.
o Susceptibility testing will routinely be performed on significant isolates of
Staphylococcus aureus.
RL Comments: Write Genital Tract Lower Culture on RL order form. Indicate Collection site. Send specimen
at Room temp.
Performed: Gram Stain: 1st shift

Reference value: Normal flora of the lower genital tract.
CPT Code: 87070 Culture

87205 Stain
POWERCHART GENTAMICIN LEVEL

NAME
MERCY TEST NAME GENTAMICIN INT MERCY LAB CODE GNI

Specimens may be stored for up to 8 hours at room temperature or for up to 2 days at
Stability:
2–8°Cor stored frozen for up to 30 days at -20°C.
Comment: Indicate time last dose in comment. Consult Pharmacy to establish collection time.
Therapeutic
2-7 mcg/ml
values:
Method The methodology for Atellica CH Gent involves a homogeneous particle-enhanced
Description: turbidimetric inhibition immunoassay (PETINIA) technique which uses a synthetic
particlegentamicin conjugate (PR) and gentamicin-specific monoclonal antibody (Ab).
CPT Code: 80170
POWERCHART GENTAMICIN PEAK LEVEL

NAME
MERCY TEST NAME GENTAMICIN PEAK MERCY LAB CODE GNPK

Stability:
Comment: Indicate time last dose in comment. Consult Pharmacy to establish collection time.
Therapeutic range: 5-10 mcg/ml
CPT Code: 80170
POWERCHART GENTAMICIN TROUGH LEVEL

NAME
MERCY TEST NAME GENTAMICIN TRGH MERCY LAB CODE GNTR

Stability:
Comment: Specimen must not be hemolyzed, lipemic or icteric.
Therapeutic range: <1.0 mcg/mL
CPT Code: 80170
POWERCHART eGFR estimated Glomerular Filtration Rate

NAME
MERCY TEST NAME eGFR estimated Glomerular Filtration Rate MERCY LAB
CODE
Stability: Separated serum and plasma specimens may be stored for up to 2 days at 2–8°C or stored
frozen at or below -20°C.
Comment: eGFR is a calculation and not orderable by itself. eGFR is reported with every creatinine test
ordered.
Reference Range: ≥ 60 mL/min/1.73m2
eGFR will not calculate if the patient is under age 18 or if the patient sex is not specified as male or female.
Method: The Laboratory is using the Chronic Kidney Disease Epidemiology Collaboration (2021 CKD-EPI)
eGFRcr = 142 x min (Scr/κ, 1) α x max (Scr/κ, 1)-1.200 x 0.9938Age x 1.012 [if female]
Scr = standardized serum creatinine in mg/dL

κ = 0.7 (females) or 0.9 (males)
α = -0.241 (female) or -0.302 (male)
min (Scr/κ, 1) is the minimum of Scr/κ or 1.0.
max (Scr/κ, 1) is the maximum of Scr/κ or 1.0.
Age (years)
CPT Code: NA
POWERCHART GIARDIA + CRYPTOSPORIDIUM ANTIGEN

NAME
MERCY TEST NAME GIARDIA/CRYP RAPID MERCY LAB CODE GLCP
Specimen: 2 grams fresh feces. Collect sample in a container with a tight-fitting lid. Deliver to Mercy lab
as soon after collection as possible. Testing needs to occur within 72 hours of collection.
Transport refrigerated.
Fresh stool specimens can also be frozen, after collection, if testing cannot be performed
within 72 hours of collection. Frozen samples are stable for 90 days. Transport frozen.
This method can also be tested with the ParaPak C&S (orange lid) preservative. Testing
needs to occur within 72 hours of collection. Transport at room temperature if a stool
culture is also ordered on this same C&S vial.
Cause for
o Specimens collected within 7 days of barium or bismuth enema are not acceptable.
rejection:
o Specimens should not be contaminated with toilet water or urine.
Comment: Detects Giardia and Cryptosporidium antigens. Tests are not available separately.
RL Comments:
o Mark GIARDIA/CRYP RAPID STOOL on the order form.
Performed: Daily 1500 cutoff.
*Not more than one specimen in 24 hr. period.
Method: Rapid immunoassay.
Reference value: Not detected.
CPT Code: 87328 Cryptosporidium

87329 Giardia
POWERCHART Global Hemostasis TEG

NAME
MERCY TEST NAME TEG GH MERCY LAB CODE GHEMO
Specimen: Properly filled blue top sodium citrate tube

Stability: 4 hours room temp
Reference Value:
Method: Whole Blood Hemostasis System

CPT Code: 85347, 85384 & 85576
POWERCHART Global Hemostasis with Lysis TEG

NAME
MERCY TEST NAME G HEMOSTASIS LYSIS MERCY LAB CODE GHLYS
Specimen: Properly filled blue top sodium citrate tube

Reference Value:

CPT Code: 85347, 85384 & 85576
POWERCHART GLOMERULAR BASEMENT MEMBRANE ANTIBODY IgG AB

NAME
MERCY TEST NAME G BASE MEMBRAN IGG* MERCY LAB CODE GBM
Cause for
Hemolysis, Lipemia
Rejection:
Processing: Send refrigerated to Mayo. Frozen acceptable. Mayo order code GBM.
Performed: Monday – Friday, Sunday;11a.m.
Method: Multiplex flow immunoassay
CPT Code: 83516
POWERCHART GLUCOSE LEVEL
NAME
MERCY TEST NAME GLUCOSE MERCY LAB CODE GLUC

Stability: 72 hours at 4°C; variable stability is observed with longer storage conditions.
Comment: Glycolysis decreases serum glucose by approximately 5% to 7% per hour in normal.
uncentrifuged, coagulated blood at room temperature.
Reference Value: 0-2 days: 40-60 mg/dl
3 days- ≤ 1YEAR: 60-100 mg/dl
1 year-6 years: 70-130 mg/dl
≥ 7 years: 70-110 mg/dl
Method
The Atellica CH Glucose Hexokinase_3 (GluH_3) assay uses a two-component reagent
Description:
CPT Code: 82947
POWERCHART GLUCOSE LEVEL RAPID

NAME
MERCY TEST NAME GLUCOSE (GLUCOSE DONE BY LAB ON WHOLE BLOOD) MERCY LAB CODE GLUCR
Specimen: 1 mL whole blood collected in a dark green sodium heparin tube

Stability: 8 hours room temperature, 48 hours refrigerated
Reference value: 0-2 days: 40-60 mg/dl
3 days-11 months: 60-100 mg/dl
1 year-6 years: 70-130 mg/dl
>6 years: 70-110 mg/dl
Method: Glucose Oxide Enzyme, Electrode
CPT Code: 82947
POWERCHART GLUCOSE BODY FLUID

NAME
MERCY TEST NAME GLUCOSE BF MERCY LAB CODE FGLU
Specimen: 1 ml body fluid in plain red top tube

Stability: Stable up to 72 hours at 4°C.
Comment: Indicate specimen source in comment.
Reference Range:
No established reference range available
Method
The Atellica CH Glucose Hexokinase_3 (GluH_3) assay uses a two-component reagent.
Description:
CPT Code: 82945
POWERCHART GLUCOSE CSF

NAME
MERCY TEST NAME GLUCOSE CSF MERCY LAB CODE CGLU

Specimen: 0.5 ml spinal fluid. Hemolyzed specimens should not be used.
Stability: CSF may be contaminated with bacteria or other cells and should be analyzed immediately
for glucose. If a delay in measurement is unavoidable, the sample should be centrifuged and
stored at 4°C or -20°C.
Comment: Specimen must be transported in a screw top container.
Reference Range: 1-13 days: 40-60 mg/dl
>13 days: 40-70 mg/dl
Method
The Atellica CH Glucose Hexokinase_3 (GluH_3) assay uses a two-component reagent.
Description:
CPT Code: 82945
POWERCHART GLUCOSE TOLERANCE GESTATIONAL

NAME
MERCY TEST NAME GLUCOSE GEST MERCY LAB CODE GLUG
Specimen: Preferred in house: 0.5 ml lithium heparin plasma.

Collect specimen 60 minutes after the administration of 50 G glucose. A venous specimen is
preferred.
Stability: Stable at 72 hours at 4°C
Comment: Perform between 24- and 28-weeks’ gestation on all pregnant women not identified as
having glucose intolerance. Screening is performed without regard to the time of day or last
meal.
Test available:
Performed: Outpatient Drawing/Core Lab – Monday-Friday 0800-1700
Core Lab – Saturday and Sunday 0800 - -1200
Within 8 hours of receipt.

Method
Description:
CPT Code: 82950
POWERCHART FOR GLUCOSE TOLERANCE 2 HOUR order the following

NAME
GLUCOSE TOLERANCE FASTING, GLUCOSE TOLERANCE 1 HOUR, and GLUCOSE
TOLERANCE 2 HOUR
MERCY TEST GLUC TOL 2HR (ORDER FASTING, 1 HOUR AND 2 MERCY LAB CODE GLUC0T
NAME HOUR TESTS) (FASTING)
GLUC1T (1
HOUR)
GLUC2T (2
HOUR)
Specimen: 0.5 ml lithium heparin plasma from a PST tube.

o A fasting specimen will be tested before administration of the glucose solution.
o If the fasting glucose level is 135 mg/dl or less, the Glucose Drink will be given to the
patient.
o If the fasting level is >/=136 mg/dl, the Glucose Tolerance Test will be canceled, and
the provider's office will be notified.
Comment: Test available Monday through Saturday, 0645 - 1200.

Call Lab for special ordering instructions if 1/2-hour collections are necessary.
Patient preparation:
o Patient should have a regular diet with adequate carbohydrates for three days
before test.
Excessive amounts of sugars should be avoided. Reducing diets are not satisfactory.
o Patient should maintain normal activities with no excessive vigorous exercise.
o Patient should not be acutely ill. Test should not be performed during acute medical
or surgical stress and not for several months after an acute myocardial infarction.
o Patient should be fasting for at least 8 hours. Moderate amounts of water are
permissible.
o Discontinue medications as directed by physician.
o Patient should remain seated and should not smoke throughout the test.
o No other tests or procedures should be scheduled during a Glucose Tolerance Test.
Outpatients having tolerance testing in the Laboratory should be prepared to stay
in the Laboratory waiting area for the duration of the test.
Pediatric patients: The amount of glucose given to pediatric patients is by weight for
patients 25-95 lbs. See Policy in PolicyStat for details.
Performed: Monday through Saturday 1200 cutoff

Reference Range: Non-pregnant Men and Women
Fasting: 70-110 mg/dl
1 hour: 120-170 mg/dl
2 hours: 70-120 mg/dl
Pregnancy Normal Ranges

1 hour: Less than 180 mg/dl
2 hours: Less than 155 mg/dl
Method
Description
CPT Code: 82951
POWERCHART FOR GLUCOSE TOLERANCE 3 HOUR order the following

NAME
GLUCOSE TOLERANCE FASTING, GLUCOSE TOLERANCE 1 HOUR, GLUCOSE TOLERANCE 2
HOUR, and GLUCOSE TOLERANCE 3 HOUR
MERCY TEST GLUCOSE TOL 3HR (ORDER FASTING, 1 HOUR, 2 HOUR, AND 3 MERCY LAB GLUC0T
NAME HOUR TESTS) CODE (FASTING)
GLUC1T
(1 HOUR)
GLUC2T
(2 HOUR)
GLUC3T
(3 HOUR)
Specimen: 6ml lithium heparin plasma from a PST tube.

o A fasting specimen will be tested before administration of the glucose solution.
o If the fasting glucose level is 135 mg/dl or less, the Glucose Drink will be given to the
patient.
o If the fasting level is >/=136 mg/dl, the Glucose Tolerance Test will be canceled, and
the provider's office will be notified.
Comment: Test available Monday through Saturday, 0645 - 1200.

Call Lab for special ordering instructions if 1/2-hour collections are necessary.
Patient preparation:
o Patient should have a regular diet with adequate carbohydrates for three days before test.
Excessive amounts of sugars should be avoided. Reducing diets are not satisfactory.
o Patient should maintain normal activities with no excessive vigorous exercise.
o Patient should not be acutely ill. Test should not be performed during acute medical or
surgical stress and not for several months after an acute myocardial infarction.
o Patient should be fasting for at least 8 hours. Moderate amounts of water are permissible.
o Discontinue medications as directed by physician.
o Patient should remain seated and should not smoke throughout the test.
o No other tests or procedures should be scheduled during a Glucose Tolerance Test.
Outpatients having tolerance testing in the Laboratory should be prepared to stay in the
Laboratory waiting area for the duration of the test.
Pediatric patients: The amount of glucose given to pediatric patients is by weight for
patients 25-95 lbs. See Policy in PolicyStat for details.
Performed: Monday through Saturday 1200 cutoff
Reference Non-pregnant Men and Women

Range: Fasting: 70-110 mg/dl
1 hour: 120-170 mg/dl
Pregnancy Normal Ranges

1 hour: Less than 180 mg/dl
CPT Code: 82951
POWERCHART GLUCOSE 24 HR Urine

NAME
MERCY TEST NAME GLUCOSE 24HR UR MERCY LAB CODE VGLU
Specimen: 5 ml refrigerated, unpreserved urine from a 24- hour collection.
Stability Urine should be stored at 4°C during collection. Urine samples may lose as much as 40% of
their glucose after 24 hours at room temperature.
Reference Range: No established reference range available
Method
Description: The Atellica CH Glucose Hexokinase_3 (GluH_3) assay uses a two-component reagent.
CPT Code: 82945
POWERCHART GLUCOSE Random Urine

NAME
MERCY TEST NAME Misc. General Lab (CMIS) Designate: test name GLUCOSE MERCY LAB CODE CMIS
RANDOM URINE in comment
POWERCHART GLUTAMIC ACID DECARBOXYLASE AUTOANTIBODIES
NAME
MERCY TEST NAME GAD65 ANTBY* MERCY LAB CODE GAD
Test included: This included testing for Glutamic Acid Decarboxylase Autoantibodies, Mayo order (GD65S)
NOTE* If physician ordered both Glutamic Acid Decarboxylase Autoantibodies (Mayo GD65S)
and Islet Antigen 2 Antibody (Mayo IA2) See: I2GAD
Specimen: 1.0 ml serum from a no additive serum tube or a Serum Separator Tube (SST).
Processing: Send refrigerated to Mayo. Mayo order code (GD65S) Frozen acceptable. Ambient
Performed: 2-6 days, Sunday thru Thursday; 10 PM
CPT Code: 86341
POWERCHART GRAM STAIN

NAME
MERCY TEST NAME GRAM STAIN DIRECT MERCY LAB CODE GRAM

A gram stain is already included in a Body Fluid Culture, Respiratory Culture, Wound Culture,
and an Anaerobic Culture.
Specimen: o Fluid specimens: Submit in a sterile screw top container.

o Other specimens: Submit in a sterile plastic container with a tight-fitting lid or
submit on a routine Culturette.
o Any source can be submitted for a gram stain.
Comment: o This test is used as the screening test for yeast in vaginal specimens when
specifically noted on the order.
o This test is used as the screening test for Gardnerella vaginalis.

RL Comment: o Write Gram Stain on RL order form. Indicate source/site.
o Send specimen at Room Temp
RL: Next day, 1st shift unless ordered STAT with a specific phone number indicated
Reference value: Varies by site of collection.
Method: Direct microscopy of stained slide.
CPT Code: 87205
POWERCHART GROUP B STREP CULTURE

NAME
MERCY TEST NAME GRP B STREP CLT MERCY LAB CODE GBOB
Order: Place only 1 order for Culturette (sites). Specify the source(s) when ordering (i.e.: vag-rect).
Specimen: Both vaginal and rectal specimens are recommended.

Preferred Specimen: Separate Culturette from each site, labeled with specimen source. One
double Culturette with rectal/vag swab is acceptable.
Comment: o Culture screens for Group B Streptococcus only and is recommended for screening
obstetric patients for carrier status.
o Do not order if patient has a Penicillin Allergy. See GBOBS.
RL Comments: o Mark GROUP B STREP CULTURE (OBSTETRICS) on RL order form. Only 1 order is
needed for both specimens. Write collection site(s) on source line.
o Send specimen at room temp.
Reference value: No Group B Streptococcus isolated.
CPT Code: 87081
POWERCHART GROUP B STREP CULTURE W SENSITIVITY

NAME
MERCY TEST NAME GRP B STREP CLT/SENS MERCY LAB CODE GBOBS
Order: Place only 1 order for Culturette (sites). Specify the source(s) when ordering (i.e.: vag-rect).
Specimen: Both vaginal and rectal specimens are recommended.

Preferred Specimen: Separate Culturette from each site, labeled with specimen source. One
double Culturette with rectal/vag swab is acceptable.
Comment: o Culture screens for Group B Streptococcus only and is recommended for screening
obstetric patients for carrier status with Penicillin Allergy
o Do not order if patient does not have a Penicillin Allergy
RL Comments: o Mark GROUP B STREP CULTURE (OBSTETRICS) on RL order form and indicate MIC is
needed. Only 1 order is needed for both specimens. Write collection site(s) on
source line.
o Send specimen at room temp.
Reference value: No Group B Streptococcus isolated.
CPT Code: 87081
POWERCHART GROWTH HORMONE (HGH) LEVEL

NAME
MERCY TEST NAME GROWTH HORMONE* MERCY LAB CODE GRTH
Patient
Patient must be fasting. (Overnight – 8 hours)
preparation:
Specimen: 0.6 ml serum from a SST or plain red top tube. Minimum 0.5 ml.
Processing: Send refrigerated to Mayo. Frozen acceptable. Mayo order code HGH.
Performed: 1- 3 days. Monday through Friday 5 a.m. - 12 a.m., Saturday 6 a.m.- 6 p.m.
Method: Immunoenzymatic immunoassay
CPT Code: 83003
POWERCHART HAPTOGLOBIN
NAME
MERCY TEST NAME HAPTOGLOBIN MERCY LAB CODE HAPT

Stability: Specimens may be stored frozen for up to 14 days at -20°C.
Comment: Do not use hemolyzed samples.
Method The Atellica CH Haptoglobin (Hapt) assay is based upon the reaction between antibody and
Description: haptoglobin in a serum sample.
CPT Code: 83010
POWERCHART HCG QUANTITATIVE

NAME
MERCY TEST NAME HCG QUANT SERUM MERCY LAB CODE HCGQ

Stability: Freeze samples at ≤ -20°C if the sample is not assayed within 48 hours. Freeze samples only
This test may be used for detecting pregnancy by the first day of the missed menstrual
period.
All in vitro assays can generate erroneous results, both clinically false positive results (test
results suggesting a condition that is absent) and clinically false negative results (test results
failing to identify a condition that is present).
Reference Range: Male: 0-3 IU/L
Non-Pregnant Female 18-39 years: 0-1 IU/L

Non-Pregnant Female over 39 years: 0-3 IU/L
Peri- and post-menopausal female: 0-12 IU/L.
Post-menopausal HCG originates from the pituitary gland.
Gestational age:
1 week: 5 - 50 IU/L
1-2 weeks: 50 - 500 IU/L
2-3 weeks: 100 - 5,000 IU/L
3-4 weeks: 500 - 10,000 IU/L
4-5 weeks: 1,000 - 50,000 IU/L
5-6 weeks: 10,000 - 100,000 IU/L
6-8 weeks: 15,000 - 200,000 IU/L
8-12 weeks: 10,000 - 100,000 IU/L
3rd trimester: 5,000 - 50,000 IU/L
During the first six weeks of pregnancy, serum HCG concentrations have a doubling time of
approximately 2 days. A maximum is reached by the second to third month and followed by
a decrease to as low as 5000 by the third trimester (6-9 months). Following delivery, HCG
concentrations rapidly decrease and usually return to normal within several days post-
partum.
Method The Atellica IM ThCG assay is a 2-site sandwich immunoassay using direct chemiluminescent
Description: technology, which uses constant amounts of 2 antibodies.
CPT Code: 84702
POWERCHART HCG (HUMAN CHORIONIC GONADOTROPIN) TUMOR MARKER

NAME
MERCY TEST HCG TUMOR MARKER* MERCY LAB CODE HCGM

NAME
Note: Patient Preparation: For 12 hours before specimen collection, do not take multivitamins or
dietary supplements containing biotin (vitamin B7), which is commonly found in hair, skin,
and nail supplements and multivitamins.
Processing: Send to Mayo refrigerated. Frozen acceptable. Mayo order code (BHCG).
Performed: 1-3 days. Test set up Monday through Saturday Varies
CPT Code: 84702
POWERCHART HDL CHOLESTEROL

NAME
MERCY TEST NAME HDL CHOL (High Density Lioprotein) MERCY LAB CODE HDL

Stability: Specimens are stable for up to 8 days at 2–8°C. Specimens may be frozen for up to 30 days
at ≤ -20°C.
Reference Range: Reference intervals for healthy adults was established by the National Cholesterol Education
Program (NCEP):
Low: <40mg/dl
Acceptable: 40-59 mg/dl
Optimal: ≥60 mg/dl
Method The Atellica® CH HDL Cholesterol (HDLC) assay is a two-reagent format and depends on the
Description: Accelerator Selective Detergent methodology.
CPT Code: 83718
POWERCHART HELICOBACTER PYLORI FECES / H. PYLORI FECES
NAME
MERCY TEST NAME H. PYLORI FECES MERCY LAB CODE HPSTL
Specimen: 5 grams FRESH stool.

Cause for Very mucoid stool; or a watery, diarrheal specimen; stool in transport media, swab or
rejection: preservative.
Processing: Send refrigerated specimen in screw capped plastic container. Refrigerated specimen
acceptable <72 hrs. Freeze for longer storage.
Comment: This is a qualitative not a quantitative test. Positive results indicate presence of Helicobacter
pylori antigen in the stool. Negative result indicates absence of detectable antigen but does
not eliminate the possibility of infection due to Helicobacter pylori. Falsely negative results
may be obtained within 2 weeks of treatment with antimicrobials, bismuth, or proton pump
inhibitors. A negative test result in such a situation should be followed up with a repeat at
least 2 weeks after discontinuing therapy.
Performed: Daily, cutoff 0900 & 1300
Reference Value: Negative
CPT Code: 87338
TEST NAME HELICOBACTER SCREEN
MERCY TEST HELICOBACTER SCN

NAME
Order: Use pink Pathology Specimen Form for ordering. Write on request form "Look for
Helicobacter".
Specimen: Gastric mucosal biopsy, 2-3 mm in diameter.
oBiopsy should be from normal looking tissue.

o Patients should not have taken antibiotics or bismuth salts for at least 3 weeks
prior to endoscopy/ biopsy.
o Place specimen in 10% formalin.
Processing: Send to Lab immediately.
Method: Histological stain
Reference value: No Helicobacter identified.
Performed: 1 week
CPT Code: 87072
POWERCHART HEMATOCRIT
NAME
MERCY TEST NAME HEMATOCRIT MERCY LAB CODE HCTX

Processing: 24 hours room temperature or 48 hours refrigerated.
CPT Code: 85014
POWERCHART OCCULT BLOOD FECAL DIAGNOSTIC

NAME OCCULT BLOOD FECAL
MERCY TEST NAME HEMOCCULT®, DIAGNOST MERCY LAB CODE HEMC

HEMOCCULT®, SCREEN NHOS
Comment: o Current card is Beckman Coulter Hemoccult® green/yellow card.

o The Diagnostic order should be placed if the patient has documented symptoms.
o The Screening order should be placed if the testing is being performed in the
absence of documentation.
o This is for stool specimens only. See GASTROCCULT® BODY FLUID for all other
body fluids.
o If using the Beckman Counter Hemoccult® ICT blue card SEE: Occult Blood
Fecal ICT Screen
Patient o Patients should be placed on the Special Diagnostic Diet starting at least 48 hours
preparation: prior to and continuing through the test period. This diet can increase the accuracy
of the test results.
o Patients on unrestricted diets who test positive on one or more of the initial 3
slides is recommended to be retested after being placed on the special diet.
Specimen: o Fresh, unpreserved stool specimen
o NOTE: Fecal samples should not be collected if hematuria or obvious rectal
bleeding, such as from hemorrhoids, is present. Pre-menopausal women should
not collect fecal samples during or in the 3 days following a menstrual period.
o Collect a small fecal sample on one end of the applicator stick (may use tongue
depressor) Apply a small thin smear inside box A. Use the other end of the
applicator to obtain a second sample from a different area of the stool. Apply a
thin smear inside box B and close the cover.
o The test slide MUST be labeled with patient first and last name, date, and time of
collection.
Card Appearance Test Name Mercy Lab
Code
Hemoccult®, Diagnostic HEMC
Hemoccult®, Screening NHOS
(Must decide at ordering time whether testing

is being done as screening or as diagnostic)
Occult Blood Fecal ICT Screen OBFS
See: Occult Blood Fecal ICT Screen

Performed: Within 8 hours of receipt. Available stat. Must be received in laboratory within 14 days of
collection.
Method: Guaiac paper test
CPT Code: 82272
POWERCHART HEMOCHROMATOSIS GENOTYPE

NAME
MERCY TEST NAME HFE GENE ANALYSIS* MERCY LAB CODE HHEMO
Specimen: 2.5 mL whole blood in lavender top (EDTA) or yellow top (ACD).
Processing: Send ambient to Mayo. Mayo order code (HFET)
Performed: 6 - 7 days. Monday through Friday
Method: Droplet Digital Polymerase Chain Reaction (ddPCR)
CPT Code: 81256
POWERCHART HEMOGLOBIN
NAME
MERCY TEST NAME HEMOGLOBIN MERCY LAB CODE HGBX

Stability; 24 hours room temperature or 48 hours refrigerated.
Method: Automated Cell counter.
CPT Code: 85018
POWERCHART HEMOGLOBIN POST DIALYSIS

NAME
MERCY TEST NAME HGB POST DIALYSIS MERCY LAB CODE HGBXPD

Comment: To be ordered by Dialysis only.
Stability: 24 hours room temperature or 48 hours refrigerated.
CPT Code: 85018
POWERCHART HEMOGLOBIN A1C

NAME
MERCY TEST NAME HEMOGLOBIN A1C MERCY LAB CODE GLYCO
Specimen: 0. 5 ml EDTA whole blood from purple top tube or 1 full purple capillary tube.
Stability: Specimens may be stored for up to 48 hours at room temperature,8 for up to 7 days at 2–
8°C, or stored frozen for up to 21 months (with one freeze-thaw) at -70°C.
Also included is a calculated mean blood glucose.
Comment:
Performed:
Reference Range: 4.0-5.6%
Method The Atellica CH A1c_E assay consists of two separate measurements: glycated hemoglobin
Description: (A1c_E) and total hemoglobin (tHb_E). The two measurements are used to determine the
%HbA1c (NGSP units) or the hemoglobin A1c_E/tHb_E ratio in mmol/mol (IFCC units). The
individual concentration values of A1c_E and tHb_E generated by this assay are used only for
calculating the %HbA1c or A1c_E/tHb_E ratio.
CPT Code: 83036
POWERCHART HEMOGLOBIN ELECTROPHORESIS

NAME
MERCY TEST NAME HEMOGLBN ELECT* MERCY LAB CODE HGBE
Specimen: 10 ml EDTA whole blood from a EDTA tube. ACD (solution B) or sodium heparin is also
acceptable.
Comment: Include recent transfusion information.
Include most recent complete blood cell count results.
Metabolic Hematology Patient Information (T810) is strongly recommended. Testing

may proceed without this information, however if the information requested is received, any
pertinent reported clinical features and data will drive the focus of the evaluation and be
considered in the interpretation.
The laboratory has extensive experience in hemoglobin variant identification and many
cases can be confidently classified without molecular testing. However, molecular
confirmation is always available, subject to sufficient sample quantity (e.g., multiplex ligation-
dependent probe amplification testing requires at least 2 mLs of sample in addition to
protein testing requirements). If no molecular testing or specific molecular tests are desired,
utilize the appropriate check boxes on the form. If the form or other communication is not
received, the reviewing hematopathologist will select appropriate tests to sufficiently explain
the protein findings which may or may not include molecular testing.
Processing: o Send refrigerated to Mayo. Mayo order code HBEL1.

o DO NOT allow to freeze.
o Use bubble wrap to protect specimen.
o Do NOT transfer specimen to other containers.
o Include recent transfusion information and most recent complete blood cell count
results.
o Patient's age is required.
o Please complete a Thalassemia/Hemoglobinopathy Information Sheet and forward
with specimen.
Method: Capillary Electrophoresis (HGBCE)
Cation Exchange/High-Performance Liquid Chromatography (HPLC)
Isoelectric Focusing (IEF)
Mass Spectrometry (MASS)
Flow Cytometry (HPFH)
Isopropanol and Heat Stability (UNHB)
CPT Code: 83020-Quantitation by electrophoresis
83021-Quantitation by HPLC
POWERCHART HEMOGLOBIN S SCREEN

NAME
MERCY TEST NAME HEMOGLBN S SCN* (Sickle Cell) MERCY LAB CODE HGBS
Specimen: 1 ml EDTA whole blood from EDTA tube.

Cause for Specimen cannot be FROZEN!
rejection:
Processing: o Include recent transfusion information in the Mayo computer system.
o Send refrigerated to Mayo. Mayo -order code (SDEX).
Method: Hemoglobin S Solubility
CPT Code: 85660
POWERCHART HEMOGRAM WITH PLATELET COUNT
NAME
MERCY TEST NAME HEMOGRAM PLATELET CT MERCY LAB CODE See: CBC
POWERCHART HEMOQUANT FECES

NAME
MERCY TEST NAME HEMOQUANT, FECES* MERCY LAB CODE HMQF
Patient o Patient should be instructed to refrain from red meat and aspirin for 3 days prior
preparation: to specimen collection.
o IMPORTANT: Note on order whether patient has complied with instructions.
Specimen: o 1 gram of feces from a single defecation is to be collected using a spoon-like
sampler from the kit supplied by the Laboratory.
o Place sample in screw-capped tube.
Processing: o Send refrigerated to Mayo.
o Mayo code order code (HQ).
Performed: Test set up Monday through Saturday
Method: Fluorescence Quantitation.
CPT Code: 84126
POWERCHART HEMOSIDERIN QUALITATIVE URINE

NAME
MERCY TEST NAME HEMOSDRIN R UR* MERCY LAB CODE HMDR
Specimen: o 13 ml random urine in a 60 mL urine bottle.

o No preservative.
Processing: Send refrigerated to Mayo. Frozen acceptable. Mayo order code (UHSD1).
Performed: 1 day. Test set up Monday through Sunday.

Method: Rous method
Dipstick
Microscopy
CPT Code: 83070
POWERCHART HEPARIN UNFRACTIONATED LEVEL

NAME
MERCY TEST NAME HEPARIN UNFRAC MERCY LAB CODE HEPR
Specimen: Draw a blue top tube filled appropriately with amount of blood listed on label.
Stability: 8 hours refrigerated, double spin and freeze if >8 hours.
Comment: o Used to monitor dose of unfractionated Heparin.
o To monitor low molecular weight heparin, order Factor X A.
Cause for o Improperly filled tubes will NOT be tested.
rejection: o Gross hemolysis unacceptable.
Processing: o Centrifuge within 30 minutes.
o Separate plasma within 2 hours and analyze within 8 hours.
o Double spin and freeze plasma if testing not done within 8 hours of collection.
o Label vial "Citrated Plasma".
Performed: Available stat. Performed within 8 hours of receipt except for special studies to establish
therapeutic PTT ranges.
Reference value: 0.3-0.7 u/ml
Method: Chromogenic Substrate
CPT Code: 85520
TEST NAME HEPARIN INDUCED THROMBOCYTOPENIA SCREEN
MERCY TEST MERCY LAB CODE

HIT SCREEN (DONE AT MERCY) HITSCR
NAME
Specimen: o 0.5 mls plasma from a properly filled blue top tube.
o Remove plasma by a double spin method and freeze if testing will not be
performed within 2 hours of draw time.
o
Performed: Same shift, Sunday through Saturday. Available stat.
Method: Particle ImmunoFiltration Assay (PIFA)
CPT Code: 86022
TEST NAME HEPARIN PF4 ANTIBODY

MERCY TEST MERCY LAB CODE
HEPARIN PF4 AB HITPF4
NAME

Processing: Send frozen to Mayo. Mayo order (HITIG)
Performed: 1-3 days. Monday through Sunday
Reference value: Included with Mayo report.
CPT Code: 86022
POWERCHART HEPATIC FUNCTION PANEL

NAME
MERCY TEST NAME HEPATIC (Liver) FUNCTION PNL MERCY LAB HFPL
CODE
Stability: Specimens may be stored for up to 8 hours at 25°C or for up to 7 days at 2–8°C or stored
frozen for up to 6 months at -20°C or colder.
Comment: Includes: Albumin, Alkaline Phosphatase, ALT, AST, Total Bilirubin, Direct Bilirubin, Indirect
Bilirubin, Total Protein, and A/G Ratio
Reference value: See individual test entry
Method: See individual test entry
CPT Code: 80076
POWERCHART HEPATITIS A IgM ANTIBODY
NAME
MERCY TEST NAME HEPATITIS A IgM AB MERCY LAB CODE HAVMAB
Specimen: 1 ml serum from a Serum Separator Tube (SST). Centrifuge within 2 hours of collection.
Stability: 8 hours room temp, or 48 hours refrigerated. Freeze if >48 hours.
Included in: Hepatitis Acute Panel or may be ordered separately.
Cause for The following samples are unacceptable and will not be tested; heat treated, hemolyzed,
rejection: cadaveric specimens, body fluid other than serum or plasma.
Reference value: Non-Reactive
Method: Chemiluminescent Microparticle Immunoassay

CPT Code: 86709
POWERCHART HEPATITIS A ANTIBODY TOTAL

NAME
MERCY TEST NAME HEPATITIS A TOTAL AB MERCY LAB CODE HAVG

Processing: Stability: 12 hours room temp, or 7 days refrigerated. Freeze if >7 days.
Reference value: Non-Reactive. Reactive specimens will have Hepatitis A IgM Antibody (HAVMAB)performed at
an additional charge.
Method: Chemiluminescence Immunoassay

CPT Code: 86708
POWERCHART HEPATITIS A ANTIBODY IGG

NAME
MERCY TEST NAME HEP A IGG AB* MERCY LAB CODE HAIGG
Specimen: 1.0 mL serum from a Serum Separator Tube (SST). Centrifuge within 2 hours of collection
and aliquot into plastic vial.
Processing: Send refrigerated to Mayo. Mayo order code (HAIGG).
Method: Chemiluminescent Microparticle Immunoassay (CMIA)
CPT Code: 86708

POWERCHART HEPATITIS ACUTE PANEL
NAME
MERCY TEST NAME HEPATITIS ACUTE MERCY LAB CODE HPACUT
Includes: Hepatitis B Surface Antigen, Hepatitis B Core IgM Antibody, Hepatitis C Antibody, Hepatitis A
Antibody IgM

Stability: Refrigerate if not tested immediately. 48 hours refrigerated, freeze if >48 hours.
Cause for The following samples are unacceptable and will not be tested; heat treated,
rejection: hemolyzed, heparinized, cadaveric specimens, body fluids other than serum and plasma.
Comment: o If Hepatitis B Surface antigen is Reactive, specimen will be forwarded to Mayo

Medical Laboratories for additional testing. Mayo code HBAG, HBGNT if
appropriate.
o If Hepatitis C is Reactive, Confirmatory Hepatitis C RNA, Mayo HCVQU will be
performed and charged.
Reference value: Hepatitis B Surface Antigen - Non-Reactive
Hepatitis A Antibody, IgM Antibody - Non-Reactive
Hepatitis B Core, IgM Antibody - Non-Reactive
Hepatitis C Antibody - Non-Reactive

CPT Code: 80074 Acute profile
87340 HBAG (if appropriate)
87341 HBGNT (if appropriate)
87522 HCVQU (if appropriate)
POWERCHART HEPATITIS CHRONIC PROFILE SCREENING

NAME
MERCY TEST NAME HEPATIT CH SCREEN MERCY LAB CODE HPCHRS
86706Includes: Hepatitis B Surface Antigen, Hepatitis B Surface Antibody, Hepatitis C Antibody, Hepatitis B
Core Total Antibody
Specimen: 4 ml serum from a Serum Separator Tube (SST)

Stability: Refrigerate if not tested immediately. 3 days refrigerated or freeze if > 3 days.
Comment o If Hepatitis B Surface antigen is reactive, specimen will be forwarded to Mayo

Medical laboratories for additional testing Mayo code HBAG, HBGNT if
appropriate.
o If Hepatitis C is reactive, Confirmatory hepatitis C virus, Mayo test HCVQU
(Hepatitis C RNA) will be performed and charged.
Hepatitis B Core Total Antibody - Non-Reactive
Hepatitis B Surface Antibody - Reactive - Indicates immunity or exposure of HBV, Non-
Reactive - No immunity to HBV

CPT Code: G0499 - HBSA
87341 - HBGNT (if appropriate)
G0472 - HCVAB
87522 - HCVRNA (if appropriate)
G0499 - HBCTAB
86705 - HBCMAB (if appropriate)
G0499 - HPBSAB
POWERCHART HEPATITIS CHRONIC ACUTE

NAME
MERCY TEST NAME HEPATITIS CHRONIC ACUTE MERCY LAB CODE HPCHAC
Includes: Hepatitis B Surface Antigen, Hepatitis B Core IgM Antibody, Hepatitis C Antibody, Hepatitis A
Antibody IgM, Hepatitis B Surface Antibody, Hepatitis B Core Total Antibody

Stability: Refrigerate if not tested immediately. 48 hours refrigerated, freeze if >48 hours.
rejection: hemolyzed, heparinized, cadaveric specimens, body fluids other than serum and plasma.
Comment: o If Hepatitis B Surface antigen is Reactive, specimen will be forwarded to Mayo

Medical Laboratories for additional testing. Mayo code HBAG, HBGNT if
appropriate.
o If Hepatitis C is Reactive, Confirmatory Hepatitis C RNA, Mayo HCVQU will be
Hepatitis A Antibody, IgM Antibody - Non-Reactive
Hepatitis B Core, IgM Antibody - Non-Reactive
Hepatitis B Surface Antibody - Reactive

CPT Code: 80074 Acute Profile
G9499 HBSA
G0499 HBCTAB
G0499 HPBSAB
87340 HBAG (if appropriate)
87341 HPGNT (if appropriate)
87522 HCVQU (if appropriate)
POWERCHART HEPATITIS B CORE TOTAL ANTIBODY

NAME
MERCY TEST NAME Hepatitis B Core Total Antibody MERCY LAB CODE HBCTAB
Specimen: 0.5 ml serum from a Serum Separator Tube (SST).

Stability: 12 hours room temp, 3 days refrigerated, or freeze if >3 days.
Included in: Hepatitis Chronic Profile or is available separately.
Reference value: Not Detected
Comment: If Hepatitis B Core Total Antibody is detected, Hepatitis B Core, IgM Antibody will be
CPT Code: 86704- HBCTAB
86705-HBCMAB (if appropriate)
POWERCHART HEPATITIS B VIRUS DNA (PCR) QUANTITATIVE

NAME
MERCY TEST HEP B VIRUS DNA* MERCY LAB HBVQ

NAME CODE
Specimen: 1.5 mL serum from a Serum Separator Tube (SST). Centrifuge within 2 hours of collection
and aliquot into plastic vial.
Processing: Send frozen to Mayo. Mayo order code (HBVQN).
Performed: 3 days, Monday through Saturday
Method: Real-Time Polymerase Chain Reaction (RT-PCR)
CPT Code: 87517
POWERCHART HEPATITIS BE ANTIBODY

NAME
MERCY TEST HEP BE AB* MERCY LAB HEAB
NAME CODE
Patient Preparation: For 24 hours before specimen collection, do not take multivitamins or dietary supplements
containing biotin (Vitamin B7), which is commonly found in hair, skin and nail supplements and
multivitamins.
Specimen: 1 mL serum from a Serum Separator Tube (SST). Centrifuge within 2 hours of collection and
aliquot serum into a plastic vial.
Processing: Send frozen to Mayo. Mayo order code (HEAB).
CPT Code: 86707
POWERCHART HEPATITIS BE ANTIGEN

NAME
MERCY TEST HEP BE AG* MERCY LAB EAG
NAME CODE
containing Biotin (Vitamin B7), which is commonly found in hair, skin and nail supplements and
multivitamins.
Specimen: 1 mL serum from a Serum Separator Tube (SST) or plain, no additive serum tube. Centrifuge
within 2 hours of collection and aliquot into plastic vial.
Processing: Send frozen (preferred) to Mayo. Mayo order code (EAG).
CPT Code: 87350
POWERCHART HEPATITIS Be ANTIGEN AND ANTIBODY

NAME
MERCY TEST HEP BE AG AB* MERCY LAB HEAG
NAME CODE
containing biotin (Vitamin B7), which is commonly found in hair, skin and nail supplements and
multivitamins.
Specimen: 1.5 mL serum from a Serum Separator Tube (SST). Centrifuge within 2 hours of collection and
aliquot serum into a plastic vial.
Processing: Send frozen to Mayo. Mayo order code (HEAG).
CPT Code: 87350
86707
POWERCHART HEPATITIS CHRONIC PROFILE

NAME
MERCY TEST NAME HEPATIT CH UK* MERCY LAB CODE HPCHRN
86706 Includes: Hepatitis B Surface Antigen, Hepatitis B Surface Antibody, Hepatitis C Antibody, Hepatitis B
Core Total Antibody

Stability: Refrigerate if not tested immediately. 3 days refrigerated or freeze if > 3 days.
Comment o If Hepatitis B Surface antigen is detected, specimen will be forwarded to Mayo

Medical laboratories for additional testing Mayo code HBAG, HBGNT if appropriate.
o If Hepatitis C is detected, Confirmatory hepatitis C virus, Mayo test HCVQU
(Hepatitis C RNA) will be performed and charged.
Hepatitis B Surface Antibody - Reactive - Indicates immunity or exposure of HBV, Non-
Reactive - No immunity to HBV

CPT Code: 87340 - HBSA
87341 - HBGNT (if appropriate)
86803 - HCVAB
87522 - HCVRNA (if appropriate)
86704 - HBCTAB
86705 - HBCMAB (if appropriate)
86706 - HPBSAB
POWERCHART
HEPATITIS B SURFACE ANTIGEN
NAME
MERCY TEST NAME HEPATITIS B SURF Ag MERCY LAB CODE HBSA

Stability: 24 hours room temp, 14 days refrigerated, freeze if >14 days.
Included in: Prenatal Profile, Hepatitis Acute Panel, Hepatitis Chronic/Unknown Panel, or may be ordered
separately.
rejection: hemolyzed, heparinized, cadaveric samples, body fluids other than serum or plasma.
Comments: o If Hepatitis B Surface Antigen is detected, specimen will be forwarded to Mayo
Medical Laboratories for additional testing. Mayo code - HBAG, HBGNT if
appropriate.
o Performance has not been established for newborns, cord blood, body fluids.

Reference value: Non-Reactive.
CPT Code: 87340 HBSA
87340 HBsAg if indicated, Mayo code HBAG
87341 HBsAg Confirmation if indicated, Mayo code HBGNT
POWERCHART HEPATITIS B SURFACE ANTIBODY

NAME
MERCY TEST NAME HEPATITIS ANTI HBS MERCY LAB CODE HPBSAB
Comment: Test to detect immunity from vaccination and/or exposure to HBV

Included in: Hepatitis Acute Panel, Hepatitis Chronic/Unknown Panel, or may be ordered separately.
Reference value: Reactive -Indicates immunity or exposure to HBV; Non-Reactive - Indicated no immunity to
HBV

CPT Code: 86706
POWERCHART HEPATITIS B CORE IgM ANTIBODY

NAME
MERCY TEST NAME HEP B CORE IgM AB MERCY LAB CODE HBCMAB

Stability: 8-hour room temp, 48 hours refrigerated, freeze if>48 hours.
Included in: Hepatitis Acute Panel or may be ordered separately.
CPT Code: 86705
POWERCHART HEPATITIS C ANTIBODY
NAME
MERCY TEST NAME HEPATITIS C AB MERCY LAB CODE HCVAB

Stability: Refrigerate if not tested immediately. 7 days refrigerated, freeze if >7 days.
Included in: Hepatitis Acute Panel, Hepatitis Chronic/Unknown Panel, or may be ordered separately.
Comment: Confirmatory Hepatitis C Virus, Mayo test code HCVQU will be performed and charged when
screen is positive.
CPT Code: 86803
87522 (If Appropriate)
MERCY TEST HEPATITIS C AB HIGH RISK (used only for Medicare MERCY LAB CODE HCVABR
NAME screening)

Stability: Refrigerate if not tested immediately. 7 days refrigerated, freeze if>7 days.
Comment: This test should only be ordered for high-risk screening on Medicare patients.
Confirmatory Hepatitis C Virus, Mayo test code HCVQU will be performed and charged when
screen is positive.
CPT Code: G0472
87522 (If Appropriate)
POWERCHART HEPATITIS C RNA (QUANT)

NAME
MERCY TEST NAME HCV RNA DETECT/QN* MERCY LAB CODE HCVRNA

Comment: This test is intended to be used to monitor known HCV positive infections. Hepatitis C Viral
Load
This test is not intended for primary detection of HCV infections.
If Mercy's Hepatitis C antibody is positive this test is reflexed and referred to Mayo at an
additional charge.
Processing: o Spin down. **Remove serum from cells within 2 hours of collection. Freeze
aliquoted serum immediately for transport.
o Send frozen to Mayo. Mayo code - HCVQN.
Performed: 1-3 days. Monday through Saturday; 7 a.m. - 4 p.m.
Method: Real-Time Reverse Transcription-Polymerase Chain Reaction (RT-PCR)
CPT Code: 87522
POWERCHART HEPATITIS C VIRUS GENOTYPE ANALYSIS

NAME
MERCY TEST NAME HEP C VIRUS GENO* MERCY LAB HCVGS
CODE
Specimen: 5.0 mL serum from a Serum Separator Tube (SST) or no additive serum tube. Centrifuge
within 2 hours of collection and aliquot into plastic vial.
Note: 1. Specimens should contain a recommended minimum hepatitis C virus (HCV) viral load of
500 IU/mL.
2. Serum specimens previously submitted to other laboratories for non-microbiology tests

are not acceptable for add-on test requests, due to possible sample-to-sample carryover
from automation used for those tests.
Processing: Send FROZEN to Mayo. Mayo order code (HCVG).
Performed: Monday through Friday.
Method: Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR) followed by Hybridization with

Sequence-Specific, Fluorescent-Labeled Oligonucleotide Probes
CPT Code: 87902
POWERCHART HERPES SIMPLEX DNA (PCR) MC

NAME
MERCY TEST NAME HERPES BY PCR* MERCY LAB CODE HSVPCR

Ordering Guidance: HSVPCR is for non-blood and non-CSF specimens.
If Herpes Simplex Virus (HSV) is suspected in blood, order as SQ: CMIS – Mayo: LHSVB /
Herpes Simplex Virus (HSV), Molecular Detection, PCR, Blood.
If HSV is suspected in cerebrospinal fluid (CSF), order SQ: HSVC – Mayo HSVC / HSV 1 and 2
DNA Qualitative CSF.
Body fluid (Pleural, peritoneal, ascites, pericardial, amniotic, or ocular) – 0.5 mL of fluid in a
sterile container. Do not Centrifuge. Send to Mayo in sterile container.
Swab (Genital, dermal, ocular, nasal, throat, or oral) - Culturette (BBL Culture Swab)
(T092). Send swab to Mayo in multimicrobe media (M4-RT, M4 or M5).
Respiratory (Bronchial washing, bronchoalveolar lavage, nasopharyngeal aspirate or washing,
sputum, or tracheal aspirate) – 1.5 mL of specimen in a sterile container. Send to Mayo in sterile
container.
Tissue (Brain, colon, kidney, liver, lung, etc.) - Whole collection in a Multimicrobe media (M4-RT)
(T605) (Preferred) or Sterile container with 1–2 mL of sterile saline. Submit only fresh tissue.
Urine (<1-month old infant) – 0.5 mL of urine in a sterile container.
Cautions: A negative result does not eliminate the possibility of herpes simplex virus (HSV) infection.
Although the reference range is typically “negative” for this assay, this assay may detect viral
nucleic acid shedding in asymptomatic individuals. This may be especially relevant when dermal
or genital sites are tested since intermittent shedding without noticeable lesions has been
described.
This assay is only to be used for patients with a clinical history and symptoms consistent with
HSV infection and must be interpreted in the context of the clinical picture.
Processing: Send refrigerated (preferred) to Mayo. Frozen is also acceptable. Mayo order code (HSVPV).
CPT Code: 87529 x 2
POWERCHART HSV 1 and 2 DNA QUALITATIVE CSF

NAME
MERCY TEST NAME HERPES SIMPLEX PCR CSF* MERCY LAB CODE HSVC
Specimen: 0.2 mL Spinal Fluid in a sterile container (12 x 75 mm screw cap vial)
Processing: Specimen should be aliquoted and sent refrigerated. Mayo order code HSVC
Reference Range: Included in report.
Performed: Daily at Mayo Medical Laboratories
Method: Herpes Simplex Virus, PCR, CSF
CPT Code: 87529x2

POWERCHART HERPES SIMPLEX TYPE I AND TYPE II ANTIBODIES
NAME
MERCY TEST NAME HSV TYPES 1 & 2 AB* MERCY LAB CODE HSVT12
Specimen:
1.0 ml serum from a no additive serum tube or a Serum Separator Tube (SST).
Processing: Specimen should be aliquoted and sent refrigerated. Mayo order code (HSVG).
Reference Range: Included in report.
Monday - Saturday; 9 a.m.

Performed:
Results available 1-2 days from collection.
HS2G and HS1G: Multiplex Flow Immunoassay

Method
HSMR: Immunofluorescence Assay (IFA)
CPT Code: 86695 HSV IgG Type 1

86696 HSV IgG Type 2
TEST NAME HERPES SKIN SCRAPING FOR See: Cytology Section Tzanck Smear
CYTOLOGY
POWERCHART HIAA-5 HYDROXYINDOLE ACETIC ACID URINE
NAME
MERCY TEST NAME HIAA 5 24UR* MERCY LAB CODE HIAA
Patient For 48 hours before starting the 24-hour collection and during the collection do not eat any
preparation: of the following: avocados, bananas, butternut, cantaloupe, dates, eggplant, hickory nut,
grapefruit, honeydew melon, kiwi fruit, nuts, pecans, pineapples, plantain, plums, tomatoes,
tomato products and walnuts.
Specimen: o 24-hour urine collection.

o Before start of collection, add 25 ml 50% acetic acid preservative (15 ml for children
Processing: o Aliquot 5 ml into a 13 mL urine tube and indicate total 24-hour volume.
o Adjust pH to 2.0-4.0 with 50% acetic acid.
o Send refrigerated to Mayo. Frozen acceptable. Mayo order code HIAA.
Performed: 2 days. Test set up Monday through Friday;11 a.m.
Reference value: included with report
Method: Liquid Chromatography-tandem mass spectrometry (LC-MS/MS)
CPT Code: 83497
POWERCHART HISTOPLASMA ANTIBODY SCREEN

NAME
MERCY TEST NAME HISTOPLASMA ANTBDY MERCY LAB CODE HSTAB
Specimen: 0.7 ml serum from a Serum Separator Tube (SST) or a no additive serum tube
Processing: Send to Mayo refrigerated. Frozen is acceptable. Mayo order code (SHSTO).
Performed: 1 day. Monday through Friday 930 AM.
Method: Complement Fixation (CF)/ Immunodiffusion
CPT Code: 86698x3
POWERCHART HISTOPLASMA ANTIGEN URINE

NAME
MERCY TEST NAME HISTOPLASMA AG UA MERCY LAB CODE HSTOU
Specimen: 4 mL urine from random urine collection in plastic 5 mL aliquot tube. No preservative.
Processing: Send to Mayo refrigerated. Mayo order code (HSTQU).

Note: If Histoplasma Antigen test result is indeterminate, the MVista Histoplasma Ag Mayo order
code (FMVHU) will be performed at an additional cost.
Performed: 1-2 days. Monday through Sunday
Method: Enzyme Immunoassay (EIA).
CPT Code: 87385
POWERCHART HIV 1 HIV 2 ANTIBODY HIV 1 p24 ANTIGEN

NAME
MERCY TEST NAME HIV MERCY LAB CODE HIV
Specimen: 1.5 ml serum from a Serum Separator Tube (SST) for initial testing done at Mercy.
Stability: Serum: 24 hours room temp, 14 days refrigerated.
Cause for Cord blood is not an acceptable specimen for HIV testing. The mother's serum should be
rejection: tested.
Comment: If this initial HIV testing is reactive, then laboratory will place an additional order for
(Sunquest HIVDI / Mayo HIVDI) - HIV 1 HIV 2 Ab Differentiation confirmation testing, which is
performed at Mayo Medical Laboratories at an additional charge. Additional testing may be
performed and charged based on the HIVDI result.
HIV is included in the Prenatal Profile with HIV test (PNP)

CPT Code: 87389-HIV-1 and HIV-2 Antibody, HIV 1 p24 Antigen single assay.
G0475 for Medicare patients
86701-HIV-1 Differentiation (if appropriate)
87535-HIV-1 Probe & Reverse Transcrp (if appropriate)
POWERCHART HIV 1 RNA (PCR)

NAME
MERCY TEST NAME HIV 1 DETECT QUANT* (HIV Viral Load) MERCY LAB CODE HIVDQ
Specimen: Requires 2 purple top EDTA tubes. This test requires 1.5 mL of plasma from EDTA whole
blood collection. 1 EDTA tube may not provide enough plasma.
Spin down and remove plasma within 6 hours of collection. Send FROZEN plasma specimen
Processing:
to Mayo (refrigerated is acceptable) Mayo code - (HIVQN)
Performed: Monday - Thursday 1 day, Friday and Saturday, 3 days. Monday - Saturday testing performed
7 a.m. - 4 p.m.
Method: Real Time Reverse Transcription - Polymerase Chain Reaction (RT-PCR)
CPT Code: 87536
POWERCHART HIV 1 HIV 2 DIFFERENTIATION

NAME
MERCY TEST NAME HIV 1 2 Ab CONF* MERCY LAB CODE HIVDI
Specimen: 1.5 mL serum from SST.
Processing: Aliquot 1.5 mL serum to plastic vial, send FROZEN to Mayo Medical Laboratories. Mayo Code
– HIVDI.
Comment: This test is reflexed from our in-house HIV testing. If the initial HIV testing is reactive lab will
send to Mayo for this HIVDI confirmation/differentiation testing at an additional charge.
Mayo may perform additional testing beyond the HIVDI at an additional charge.
This test is also available to order if patient is previously identified as HIV positive and
additional testing is desired to follow patient's condition.
Performed: Monday - Friday

Method: Real-time polymerase chain reaction (PCR) assay
CPT Code: 86701 - HIV 1 Ab
86702 - HIV 2 Ab
POWERCHART HIV OCCUPATION EXPOSURE

NAME
(Performed on Source Patient ONLY)
MERCY TEST NAME HIVSRV MERCY LAB CODE HIVS
Specimen: • 1 ml serum for initial testing done at Mercy.
This test is designed to be done on the SOURCE patient only, following an exposure
(blood and/or body fluids). The source patient is not required to sign an informed
consent when an exposure has occurred but should be informed that testing will be
taking place. Orders need to be sent on a manual form.
Autopsy specimens are sent to UHL-order HIVAUT

Stability 24 hours room temp, 14 days refrigerated.
Cause for Cord blood is not an acceptable specimen for HIV testing. The mother's serum should be
rejection: tested.
Comments: o If employee exposure testing is needed, order a routine HIV. The routine
HIV test will be done and tests for HIV1 and HIV2 antibodies and HIV1 p24
Antigen.
o To be ordered by Mercy Employee Health, Nursing Supervisor or any outside
location requiring source patient testing.
o Reports are hand delivered to in-house Nursing Supervisors, or ED
providers. Results are faxed to Employee Health and ASC. Results do not go
to Powerchart.
o If this initial HIV testing is reactive, then laboratory will place an additional
order for HIVDI- HIV 1 HIV 2 Ab Differentiation confirmation testing, which is
performed at Mayo Medical Laboratories at an additional charge.
o If the primary instrument in Lab is down, the rapid Alere Determine HIV-1/2
Ag/Ab Combo kit will be performed on the source patient only.
CPT Code: 87389-HIV-1 and HIV-2 Antibody, HIV 1 p24 Antigen single assay.

POWERCHART HLA B27
NAME
MERCY TEST NAME HLA B27* MERCY LAB CODE HLAB27
Specimen: 6 ml whole blood collected EDTA. Minimum 1.0 ml.

Specimen must arrive at Mayo reference lab within 96 hours of collection.
Processing: o Submit in original lavender top tubes, do not transfer blood to other containers.
o Send Ambient Do NOT refrigerate and clearly label "DO NOT REFRIGERATE."
Mayo order code (LY27B).
Performed: 2-6 days. Monday through Friday 730 AM and 500 PM.
Method: Flow cytometry. All positive test results will be confirmed by complement dependent
cytotoxicity (CDC).
CPT Code: 86812
POWERCHART HOMOCYSTEINE LEVEL

NAME
MERCY TEST NAME HOMOCYSTEIN TL PL MERCY LAB CODE HCYS
Specimen: 0.5 ml EDTA plasma
Stability: Centrifuge samples and remove serum or plasma from red blood cells as soon as possible.
to ensure accurate measurement. Samples that cannot be separated soon after collection
should be stored on ice until centrifugation. Do not store samples at room temperature.
Tightly cap and refrigerate specimens at 2–8°C for up to 48 hours. Freeze samples at ≤ -20°C
if the sample is not assayed within 48 hours. Samples may be stored at ≤ -20°C for up to 13
weeks. Freeze samples only 1 time and mix thoroughly after thawing.
Performed: Within 8 hours of receipt, Available stat.
Reference Range: 3.7-13.9 µmol/L
Method The Atellica IM HCY assay is a competitive immunoassay using direct chemiluminescent.
Description: Technology.
CPT Code: 83090
POWERCHART HUMAN PAPILLOMAVIRUS DNA HIRSK

NAME
MERCY TEST NAME HPV DETECTION-HIGH RISK TYPES* MERCY LAB CODE HPVHR
Specimen: Cervical or Vaginal specimen in a ThinPrep solution vial. Indicate source of specimen on
container.
Note: This is NOT a reflex test. It requires a specific request from the provider.
Processing: Send specimens Ambient to Mercy Medical Center - Des Moines
Performed: 3-6 days. Monday through Friday

Method: Real-Time Polymerase Chain Reaction (PCR)
CPT Code: 87624
POWERCHART HYDROXYPROGESTERONE 17-D LEVEL
NAME
MERCY TEST NAME HYDROXYPROGESTRN 17* MERCY LAB CODE HYPG
Processing: Send refrigerated to Mayo. Frozen or ambient acceptable. Mayo order code (F17HY).
Performed: 10 days. Test set up is Sunday through Friday.
Reference value: Included in Report
Method: Chromatography/Mass Spectrometry
CPT Code: 83498
TEST NAME HYPERSENSITIVITY PNEUMONITIS See: Farmers Lung Serology*
POWERCHART IA-2 ANTIBODY

NAME
MERCY TEST NAME IA2 ANTIBODY* MERCY LAB CODE IAB2
Includes: Islet Antigen 2 (IA-2) Antibody

NOTE* If physician orders Islet Antigen 2 Antibody (Mayo IA2) and Glutamic Acid
Decarboxylase Autoantibodies (Mayo GD65S) see I2GAD
Specimen: 1.0 mL serum from no additive serum tube or a Serum Separator Tube (SST).
Processing: Send refrigerated to Mayo. Mayo order code (IA2).
Performed: Tuesday, Friday at 1000 PM
CPT Code: 86341
POWERCHART IGA GAMMAGLOBULIN

NAME
MERCY TEST IGA (Total) MERCY LAB IGA

NAME CODE

Stability: Specimens may be stored for up to 3 days at room temperature or for up to 7 days at 2–8°C
or stored frozen for up to 6 months at -20°C.
Reference Range: Both Male and Female (mg/dL)
0-4 months: 7-37
5 - 8 months: 16-50
9-14 months: 27-66
15 -24 months: 36-79
2-3 years: 27-246
4-6 years: 29-256
7-9 years: 34-274
10-12 years: 42-295
13-15 years: 52-319
16-17 years: 60-337
≥18 years: 66-433
Method The Atellica CH IGA_2 assay is a PEG-enhanced immunoturbidimetric method.
Description:
CPT Code: 82784
POWERCHART IGE GAMMAGLOBULIN

NAME
MERCY TEST NAME IGE (Total) MERCY LAB CODE IGE

Stability Tightly cap and refrigerate specimens at 2–8°C if the assay is not completed within 8 hours.
Freeze samples at ≤ -20°C if the sample is not assayed within 48 hours. Freeze samples only
Comment: Do not use samples stored at room temperature for longer than 8 hours.
Reference Range: 0-5 Months: 0-13 IU/ML
6-11 Months: 0-34 IU/ML
1-2 Years: 0-97 IU/ML
3 years: 0-199 IU/ML
4-6 years:0-307 IU/ML
7-8 years:0-40 IU/ML
9-12 years: 0-696 IU/ML
13-15 years: 0-537 IU/ML
16-17 years: 0-537 IU/ML
≥18 years: 0-214 IU/ML
Method The Atellica IM tIgE assay is a 2-site sandwich immunoassay using direct chemiluminescent
Description: technology, which uses constant amounts of 2 antibodies to IgE.
CPT Code: 82785
POWERCHART IGG GAMMAGLOBULIN

NAME
MERCY TEST NAME IGG (Total) MERCY LAB CODE IGG

Stability: Specimens may be stored for up to 7 days at 2–8°C or stored frozen for up to 3 months at
-20°C.
Reference Range: 0-4 months: 100-334 mg/dL
5 - 8 months: 164-588 mg/dL
9-14 months: 246-904 mg/dL
15 -24 months: 313-1170 mg/dL
2-3 years: 295-1156 mg/dL
4-6 years: 386-1470 mg/dL
7-9 years: 462-1682 mg/dL
10-12 years: 503-1719 mg/dL
13-15 years: 509-1580 mg/dL
16-17 years: 487-1327 mg/dL
≥18 years: 635-1741 mg/dL
Method The Atellica CH IgG_2 assay is a PEG-enhanced immunoturbidimetric method. Sample
Description: containing human IgG is suitably diluted and then reacted with specific antiserum to form a
precipitate
CPT Code: 82784
POWERCHART IGG INDEX CSF

NAME
MERCY TEST NAME IGG INDEX CSF* MERCY LAB CODE CIGG
Specimen: 1 ml spinal fluid plus 2 mL serum from Serum Separator Tube SST or plain red top tube. 2
individual serum samples are required. 2 mL in 2 plastic vials, each containing 1 mL.
Comment: Nursing Service must notify the Lab when the CSF is collected so that the CSF and serum
specimens can be collected within 1 week of each other.
Processing: o Include both CSF and serum specimens, label specimens appropriately.
o Send refrigerated to Mayo. Ambient and Frozen specimens are acceptable. Mayo
order code (SFIG).
Performed: Test set up Monday through Friday.
Method: SFINC, SFIGS: Nephelometry
ALBSI: Photometric
CPT Code: 82040 Albumin, serum
82042 Albumin, spinal fluid
82784 x2 IgG, serum and spinal fluid
POWERCHART IGG SUBCLASSES
NAME
MERCY TEST NAME IGG SUBCLASS* MERCY LAB CODE IGS
Comment: This test includes Total IGG with subclasses IGG1, IGG2, IGG3 and IGG4. This test
should not be ordered with IMMG. Order IGM and IGA separately if needed along with IGS.
Specimen: 1 ml serum from a Serum Separator Tube (SST) or no additive serum tube
Processing: Send aliquoted serum refrigerated to Mayo. Ambient, or frozen are acceptable. Mayo
code (IGGS).
Method: Turbidimetry
CPT Code: 82787 x4 IgG Subclasses

82784 IgG, Total
POWERCHART IGM GAMMAGLOBULIN

NAME
MERCY TEST NAME IGM (Total) MERCY LAB CODE IGM

Specimen: 1 mL serum
-20°C.
Reference Range: 0-4 months: 26-122 mg/dL

5 - 8 months: 32-132 mg/dL
9-14 months: 40-143 mg/dL
15 -24 months: 46-152 mg/dL
2-3 years: 37-184 mg/dL
4-6 years: 37-224 mg/dL
7-9 years: 38-251 mg/dL
10-12 years: 41-255 mg/dL
13-15 years: 45-244 mg/dL
16-17 years: 49-201 mg/dL
≥18 years: 45-281 mg/dL
Method The Atellica CH IgM_2 assay is a PEG-enhanced immunoturbidimetric method.
Description:
CPT Code: 82784
POWERCHART IMIPRAMINE & DESIPRAMINE LEVEL

NAME
MERCY TEST NAME IMIPRA DESIPRA* (Norpramin) MERCY LAB CODE IMDS
Specimen: o 1 ml serum in a no additive serum tube

o Collect 12 hours after the last dose.
o Spin down within 2 hours of draw.
Cause for
Serum from SST tube.
rejection:
Comment: Indicate time of last dose in comment.
Processing: o Remove plasma from cells within 2 hours of collection.
o Send refrigerated to Mayo. Ambient or frozen also acceptable. Mayo order code
(IMIPR).
Method: Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS).

CPT Code: 80335/G0480
POWERCHART IMMUNOFIXATION DELTA AND EPSILON

NAME
MERCY TEST IMMUNOFIX D AND E* MERCY LAB IFXED

NAME CODE
Specimen: 1.0 ml serum in a SST or a no additive serum tube

Processing: Send refrigerated to Mayo. Mayo order code (IFXED).
Performed: Monday through Saturday
Method: Immunofixation
CPT Code: 86334
POWERCHART IMMUNOGLOBULIN FREE LIGHT CHAIN

NAME
MERCY TEST NAME IMMUNO FR LT CHAIN* MERCY LAB CODE IFLC

Alias: Kappa and Lambda Free Light Chains
Specimen: 1.0 ml serum in a SST or a no additive serum tube

Processing: Send refrigerated to Mayo. Mayo order code (FLCS).
Method: Turbidimetry
CPT Code: 83521x2
POWERCHART IMMUNOGLOBULIN G, A, M PANEL

NAME
MERCY TEST NAME IMMUNOGLOB A, G, M MERCY LAB CODE IMMG

Stability:
Specimens may be stored for up to 7 days at 2–8°C or stored frozen for up to 3 months at -
20°C.
Comment:
Do not use hemolyzed samples. Includes IGA, IGG and IGM.
Performed: Within 8 hours of results. Available Stat

Reference Range: See individual test entry
Method
See individual test entry
Description:
CPT Code: 82784 x3
POWERCHART INSULIN LEVEL

NAME
MERCY TEST NAME INSULIN MERCY LAB CODE INS

Stability: Tightly cap and refrigerate specimens at 2–8°C if the assay is not completed within
8 hours. Freeze samples at ≤ -20°C if the assay is not completed within 24 hours. Freeze
Reference Range: 2.60-37.60 mIU/ml
Reference value: 1.9-23.0 mcIU/ml
Method The Atellica IM IRI assay is a 2‑site sandwich immunoassay using direct chemiluminescent
Description: technology which uses constant amounts of 2 antibodies.
CPT Code: 83525
POWERCHART INSULIN LIKE GROWTH FACTOR 1
NAME
MERCY TEST NAME INSULIN LIKE GF 1* (SOMATOMEDIN-C) MERCY LAB CODE INGF
o Spin down, promptly remove serum from cells.
Processing: Send frozen to Mayo order code (IGFMS).
Performed: Sunday through Friday at 1200 PM
Reference value: Reference ranges included with results.
Method: Liquid Chromatography - Mass Spectrometry (LC/MS)
CPT Code: 84305
POWERCHART INTRINSIC FACTOR ANTIBODY

NAME
MERCY TEST NAME INTRINSIC FACTOR MERCY LAB CODE IFAB
Specimen: 1.0 ml serum from a fasting patient for at least 8 hours.
Stability: Specimens may be stored for up to 14 days at 2–8°C or stored frozen at -20°C.
Comment: This test should not be performed on patients who have received a vitamin B12 injection or
radiolabeled vitamin B12 injection within the previous 2 weeks.
Performed: 1-3 days. Monday through Friday. Mayo order code (IFBA).
CPT Code: 86340
POWERCHART IRON BINDING CAPACITY PROFILE

NAME
MERCY TEST NAME IRON (FE) IBC MERCY LAB CODE IIBC

Stability: Separated specimens may be stored for up to 4 days at room temperature or for up to 7
days at 2–8°C or stored frozen for up to 2 months at -20°C.
Comment: Use the following formula to obtain serum UIBC from serum TIBC and iron: TIBC - Iron =
UIBC (μg/dL or μmol/L).
Reference Range: 250-425 mcg/dL

Method The Atellica CH Total Iron Binding Capacity (TIBC) assay uses two reagents in a sequential
Description: process that is monitored spectrophotometrically.
CPT Code: 83540

TEST NAME ISLET CELL IgG ANTIBODY
MERCY TEST IAB2 – GAD MERCY LAB CODE I2GAD

NAME
Includes: IAB2 (Mayo 89588/IA2) and GAD (Mayo order code GD65S).
Specimen:
3.0 ml serum from no additive serum tube or a Serum Separator Tube (SST).
Processing: Send 1.5 ml serum refrigerated
Performed: IA2 Tuesday, Friday; 10:00 a.m.

GAD Monday through Thursday; 10 p.m.
Method: IA2 Radioimmunoprecipitation

GAD Radioimmunoassay (RIA)
CPT Code: IA2 86341

GAD65 86341
TEST NAME ITRACONAZOLE LEVEL
MERCY TEST ITRACONAZOLE MERCY LAB CODE ITCON

NAME
Specimen:
1 mL serum from a no additive serum tube.
Stability: 14 days refrigerate, 14 days ambient, 14 days frozen
Processing: Send refrigerated to Mayo. Mayo order code ITCON
Performed: 1-3 days. Tuesday through Saturday 800 AM.
Method: Liquid Chromatography Tandem Mass Spectrometry (LC-MS/MS)
CPT Code: 80189
TEST NAME JAK2 (V617F) Mutation (PCR)
MERCY TEST JAK2 V617F MUTAT* MERCY LAB CODE JAK2B

NAME
Specimen:
4 ml EDTA whole blood from purple top EDTA tube.
Processing: o Included a completed Hematopathology Patient Information sheet
o Send ambient to Mayo. Mayo order code (JAK2B).
Performed: 2-5 days. Test set up Monday through Friday 12 p.m.
Method: Point Mutation Detection in DNA Using Quantitative Polymerase Chain Reaction
CPT Code: 81270

POWERCHART JO1 ANTIBODY
NAME
MERCY TEST NAME JO 1 AB IGG* MERCY LAB CODE JO1B
Specimen:
0.5 mL serum from a Serum Separator Tube (SST).
Processing: Send refrigerated to Mayo. Mayo order code (JO1)
CPT Code: 86235
POWERCHART KIDNEY STONE ANALYSIS (MAYO)

NAME
MERCY TEST NAME KIDNEY STONE ANAL MERCY LAB KIDST

CODE
Comment: For Mercy patients: Order on Powerchart. Indicate specimen source in comment field.
Specimen: Submit entire dried calculi specimen.
Collection Instructions:
1. Have patient collect specimen using the Patient Collection Instructions for Kidney Stones.
2. Prepare stone by cleaning any blood or foreign material from the stone with deionized water.
3. Place stone on a clean filter or paper towel and let dry at ambient temperature for a minimum
of 24 hours. A dry stone will not stick to the walls of the container.
4. Do not place stone directly in a bag. If specimen is received in a bag, either transfer stone
into a screw-capped, plastic container or place bag containing stone in a screw-capped, plastic
container.
5. Indicate source of specimen on the outside of the container (e.g., left kidney, bladder, right
ureter).
6. Repeat steps for each stone received.
-Do not send stone in formalin, surgical gel, or any other liquid as it interferes with the analytic
procedure.
-Do not tape specimen to anything. Tape interferes with the analytical procedure.
-Do not send filter.
If multiple stones are collected and individual testing is desired for each stone, place each stone
into its own container. Testing must be ordered separately on each stone. Each order will be
charged separately.
Processing: Send Ambient (Preferred) to Mayo. Refrigerated or frozen is also acceptable. Mayo order code
(KIDST).
Method: Infrared Spectrum Analysis
CPT Code: 82365
POWERCHART KOH PREP OTHER
NAME
MERCY TEST KOH PREP MERCY LAB KOH

NAME CODE
Order: This test looks for yeast and hyphal elements (fungus) in the sample submitted.
Order the specific KOH test code if the sample is scrapings, hair, skin, nails, tissue.
Order GRAM STAIN DIRECT if the specimen is from the genital tract.
Specimen: Scrapings, hair, nails, and tissue: Submit in a sterile plastic container with a tight-fitting lid.
Genital tract sample: collect the specimen on a routine red-lidded Culturette.
Comment: A concurrent fungus culture is strongly recommended as a confirmatory test.
RL Comments: o Write in KOH Prep on RL order form. Indicate source on form.

o Send at room temperature.
o Order a gram stain if a genital specimen is being sent and the provider is looking for
yeast.
Performed: Daily.
Reference value: No yeast or hyphal elements seen
Method: Direct microscopy

CPT Code: 87220
POWERCHART LACOSAMIDE LEVEL

NAME
MERCY TEST LACOSAMIDE* MERCY LAB LACO

NAME CODE
Specimen: o 1 ml serum from a no additive serum tube or from a Serum Separator Tube (SST).
o Draw specimen immediately before next scheduled dose or at least a minimum of
12 hours after last dose.
Processing: Send refrigerated to Mayo. Ambient or frozen also acceptable. Mayo order code (LACO).
CPT Code: 80235
POWERCHART LACTATE BODY FLUID

NAME
MERCY TEST LACTATE BF MERCY LAB FLCT

NAME CODE
Specimen: 0.5 ml body fluid. Place tube immediately on ice and deliver to the Lab within 15 minutes of
collection.
Stability: For body fluid, centrifuge before analysis. Separated CSF samples, may be stored for up to 24
hours at 2–8°C or stored frozen for up to 1 month at -20°C.

Reference Range: 0.0 - 1.8 mmol/L
Method
The Atellica CH Lac_2 assay measures lactate in plasma by an enzymatic assay.
Description:
CPT Code: 83605
POWERCHART LACTATE CSF

NAME
MERCY TEST LACTATE CSF MERCY LAB CODE CLCT

NAME
Specimen: 5 ml body fluid. Place tube immediately on ice and deliver to the Lab within 15 minutes of
collection.
Stability; For CSF, centrifuge before analysis. Separated CSF samples, may be stored for up to 24 hours
at 2–8°C or stored frozen for up to 1 month at -20°C.

Reference Range: 0.0 - 1.8 mmol/L
Method
Description:
CPT Code: 83605
POWERCHART LACTATE LEVEL
NAME
MERCY TEST NAME LACTATE PLASMA MERCY LAB CODE LCT
Specimen: 0.5 ml Sodium Fluoride plasma from gray top tube. Place tube in ice bath immediately after
collection.
Stability: specimens may be stored for up to 1 day at 2–8°C or stored frozen for up to 30 days at -
20°C.
Comment: Serum not acceptable
Reference Range: 0.5-2.0 mmol/L
Method
Description:
CPT Code: 83605
POWER CHART LACTOFERRIN STOOL

NAME
MERCY TEST FECAL LACTOFERRIN MERCY LAB CODE LCTF
NAME
Specimen: Mercy Medical Center - North Iowa Microbiology department performs a stool
LACTOFERRIN, to determine the presence of fecal white cells in a stool sample. A fecal smear
is no longer performed.
o Fresh specimen only. Collect fecal specimens in a clean, screw-topped container

with no preservatives.
o Specimens should be submitted to Mercy lab REFRIGERATED (Frozen stool samples
are also acceptable)
o Specimens should be submitted within 2 weeks of collection
Comment: o Due to Lactoferrin being present in breast milk, fecal samples from breast fed
infants should not be used with this assay.
o Call Mercy Micro Lab (ext. 8-7494) for further directions if testing on a breast fed
infant is needed.
RL Client o Write in Fecal Lactoferrin LCTF on order form
Comment: o Send the specimen refrigerated (frozen is also acceptable, but not necessary) to
Mercy Lab.
o Send within 2 weeks of collection
Performed: Daily, test is available STAT
Reference Value: Negative, result indicates the absence of fecal leukocytes and intestinal inflammation.
Method: Immunochromatographic test

CPT Code: 83630
POWERCHART LAMOTRIGINE (LAMICTAL) LEVEL
NAME
MERCY TEST LAMOTRIGINE* MERCY LAMO

NAME LAB CODE
Specimen: 1 mL serum from no additive serum tube (Preferred). Serum from a Serum Separator Tube
(SST) is also acceptable.
Draw specimen immediately before next scheduled dose. For sustained-release formulations
only, draw blood a minimum of 12 hours after last dose. Centrifuge within 2 hours of
collection. For red-top tubes, immediately aliquot serum into a plastic vial. For serum gel
tubes, aliquot serum into a plastic vial within 24 hours of collection.
Processing: Send refrigerated (Preferred) to Mayo. Ambient or Frozen is also acceptable. Mayo order
code (LAMO).
Reference Value: Reference ranges included with report.
CPT Code: 80175
POWERCHART RHEUMATOID FACTOR

NAME
MERCY TEST NAME LATEX RA MERCY LAB CODE RA

Stability: Separated specimens may be stored for up to 7 days at 2–8°C. Specimens may be stored
Reference Range:
0 -14 IU/ML
Method The Atellica CH RF Reagent 2 is a suspension of uniform polystyrene latex particles coated
Description: with human IgG.
CPT Code: 86431
POWERCHART LDH (LACTATE DEHYDROGENASE)

NAME
MERCY TEST NAME LD MERCY LAB CODE LD

Stability: Separated specimens may be stored for up to 7 days at 20–25°C, 4 days at 4–8°C or 42 days
at -20°C.
Reference Range: 1-30 days: 135-750 U/L

31 days-11 months: 180-435 U/L
1-3 years: 160-370 U/L
4-6 years: 145-345 U/L
7-9 years: 143-290 U/L
10-12 years: 120-283 U/L
13-15 years: 110-233 U/L
16-17 years: 105-233 U/L
≥ 18 years: 122-222 U/L
Method Lactate dehydrogenase (LD) catalyzes the conversion of L-lactate to pyruvate in the presence
Description: of nicotinamide adenine dinucleotide (NAD).
CPT Code: 83615
POWERCHART LDH (LACTATE DEHYDROGENASE) BODY FLUID

NAME
MERCY TEST NAME LD BF MERCY LAB CODE FLLD
Specimen: 0.5 ml body fluid placed in a sterile container.

Stability: Separated specimens may be stored for up to 7 days at 20–25°C, 4 days at 4–8°C or 42 days
at -20°C.
Comment: Indicate specimen source in comment. Do not use hemolyzed samples.
Reference Range: No reference range has been established.
Method
Description: Lactate dehydrogenase (LD) catalyzes the conversion of L-lactate to pyruvate in the presence
CPT Code: of nicotinamide adenine dinucleotide (NAD).
83615
TEST NAME LDL CALCULATED (Low Density Lipoprotein)
Included in: Lipid Panel. Cannot be ordered individually.

Comment: Calculation invalid when triglyceride is >400 mg/dl.
Reference value: The National Cholesterol Education Program of the National Heart, Lung, and Blood Institute
has announced the following guidelines:
Optimal--------------<100mg/dl
Near Optimal--------100 – 129mg/dl
Borderline high------130 – 159mg/dl
High-------------------160 – 189mg/dl
Very High-------------≥190mg/dl
Method: Calculation
POWERCHART LEAD LEVEL

NAME
MERCY TEST NAME LEAD WHOLE BLD* MERCY LAB CODE PB1
Specimen: o 500 mcl whole blood from purple top (EDTA tube). Minimum: 200 mcl is acceptable
for capillary collection specimens.
o Alternatively, use blue top (sodium citrate) or green top (sodium heparin) tubes.
o Venous samples (3.0 ml) are required for follow-up of elevated lead levels.
Stability: EDTA specimens are stable 14 days refrigerated.
Cause for
Clotted specimens.
rejection:
Processing: Complete Blood Lead form from University Hygienic Lab (UHL).
Apply bar code label from UHL to the above form. Attach corresponding tube label from UHL
to specimen. Send by U.S. Mail to address below.
Regional Lab Clients: Please order the collection kit directly from University Hygienic Lab.
Regional lab clients are responsible for collection process, mailing kit, billing, and reporting.
University Hygienic Laboratory
Iowa Laboratories Facility
PO Box 249
Ankeny, IA 50021-9959
515-725-1600
Performed: 2 days
Reference value: < 16 years: 0 - 10 mcg/dl
16 and older: 0 - 20 mcg/dl
CPT Code: 83655
POWERCHART LEGIONELLA ANTIGEN EIA URINE

NAME
MERCY TEST NAME LEGIONELLA R UR* MERCY LAB CODE ULEG
Specimen: 0.5 ml random urine. Minimum 0.25 ml. No preservative. Refrigerate.

Processing: Send refrigerated to Mayo. Mayo test code LAGU.
Performed: 1-4 days. Test set up Monday through Friday; 12 p.m.
Method: Immunochromatographic membrane assay
CPT Code: 87899
POWERCHART CULTURE LEGIONELLA

NAME
MERCY TEST NAME LEGIONELLA CULTURE* MERCY LAB CODE LEGCLT
This test no longer includes a Legionella smear. The Legionella PCR test has replaced the
smear and will need to be ordered separately, if needed. (See Legionella PCR)
Specimen: Bronchial washings, broncho-alveolar lavage, bronchus fluid, chest fluid, chest tube
drainage, empyema, endotracheal specimens, fresh lung tissue, induced sputum, lingual
(lung), lung biopsy, pericardial fluid or tissue, heart valves, pleura, pleural fluid, protected
catheter brush, sputum, thoracentesis fluid, tracheal secretion, transbronchial biopsy, or
trans-tracheal aspirate.
Send in a screw-capped, sterile container.
Refrigerate. Maintain sterility and forward promptly.
Cause for NO frozen or ambient specimens will be accepted.

rejection: Do not transport in Culturette.
RL Client o Write LEGIONELLA CULTURE on order form. Indicate source on the form.
Comments: o Send refrigerated.
Processing: Send specimen in a screw-capped, sterile container. Maintain sterility. Send refrigerated to
Mayo.
Mayo order code (LEGI)
Performed: Monday through Sunday; Continuously

(Positive specimens will be identified/speciated by 16S rRNA gene sequencing, at an
additional charge)
Method: Conventional culture
CPT Code: 87081 Culture

87176 Tissue processing (if appropriate)
87077 Ident by MALDI-TOF Mass Spec (if appropriate)
87153 Aerobe Ident by sequencing (if appropriate)
POWERCHART LEGIONELLA PCR

NAME
MERCY TEST NAME LEGIONELLA PCR MERCY LAB CODE LEGPCR
Specimen: 1 mL Bronchial washings, bronchoalveolar lavage, lung tissue, pleural fluid, sputum,
transtracheal aspirate, or tracheal secretions.
Send in a screw-capped, sterile container.
Send Refrigerated. Maintain sterility and forward promptly.
Specimen source is required Mayo order code (LEGRP)
Performed: 3 days. Monday through Sunday

Method: Rapid Polymerase Chain Reaction (PCR)
CPT Code: 87801
POWERCHART LEUKEMIA-LYMPHOMA IMMUNOPHENOTYPING BY FLOW CYTOMETRY

NAME
MERCY TEST NAME LEUK LYMPH PHNO TYP* MERCY LAB CODE LKLYPH
Specimen: Blood, Bone marrow, tissue (lymph nodes) other than blood or bone marrow, fluids from
serous effusions.
Peripheral blood: 6 ml peripheral blood in ACD (preferred) or EDTA and sodium heparin are
acceptable. Send whole blood. Include 5-10 unstained peripheral blood smears if possible.
Bone marrow: 1-5 ml bone marrow in EDTA or sodium heparin. Bone marrow specimen is
stable 4 days. On request, we may hold specimen pending pathologists report and request
that test be sent out.
Refer to Mayo catalog for tissue or fluid specimens.
Processing: Send to Mayo LCMS at room temperature. DO NOT FREEZE.

Performed: 1-4 days. Test set up at Mayo Monday through Saturday.
Reference value: An interpretation of the immunophenotypic findings and correlation with the morphologic
features will be provided for every case.
Method: Flow cytometric immunophenotyping
CPT Code: 88184-Flow cytometry; first cell surface, cytoplasmic or nuclear marker x 1
88185-Flow cytometry; additional cell surface, cytoplasmic or nuclear marker (each)
88187-Flow Cytometry Interpretation, 2 to 8 Markers (if appropriate)
88188-Flow Cytometry Interpretation, 9 to 15 Markers (if appropriate)
88189-Flow Cytometry Interpretation, 16 or More Markers (if appropriate)
POWERCHART LEVETIRACETAM (KEPPRA) LEVEL

NAME
MERCY TEST NAME LEVETIRACETAM* MERCY LAB CODE LEVTR
Specimen: o 1.0 ml serum from a no additive serum tube or a Serum Separator Tube (SST).
o Draw blood immediately before next scheduled dose.
o For sustained-release formulations ONLY, draw blood a minimum of 12 hours after
last dose.
o Centrifuge and aliquot serum into plastic vial within 2 hours of collection.
Processing: Send refrigerated to Mayo. Ambient or frozen acceptable. Mayo order code (LEVE).
Performed: Monday through Sunday
CPT Code: 80177
POWERCHART LH (Luteinizing Hormone)

NAME
MERCY TEST NAME LH MERCY LAB CODE LH
Specimen: 0.5ml serum
8 hours. Freeze samples at ≤ -20°C if the sample is not assayed within 48 hours. Freeze
samples only 1 time and mix thoroughly after thawing. The handling and storage
information provided here is based on data.
Reference Range: 0-15 days

16 days-10 years Not Established
11 years 0.3-2.8 mIU/mL
15-16 years 0.5-7.9 mIU/mL
≥ 18 years 0.9-5.9 mIU/mL
Tanner Stage I 1.3-8.6 mIU/mL
Male Tanner Stage II 0.3-2.7 mIU/mL
Tanner Stage III 0.3-5.1 mIU/mL
Tanner Stage IV 0.3-6.9 mIU/mL
Tanner Stage V 0.5-5.3 mIU/mL
0.8-11.8 mIU/mL
0-15 days
16 days-6 years Not Established
7-8 years 0.3-1.9
12 years ≤ 3.0
13 years 0.4-9.9
14 years 0.3-5.4
15 years 0.5-20.7
16 years 0.5-20.7
17 years 0.4-29.4
≤ 18 years 1.6-12.4
Female Premenopausal
Follicular
Mid Cycle 2.1-10.9
Luteal 19.2 -103.0
Post-menopausal 1.2-12.9
Tanner Stage I 10.9-58.6
Tanner Stage II ≤ 2.0
Tanner Stage III ≤ 6.5
Tanner Stage IV 0.3-17.2
0.6-13.7
Method
The Atellica IM LH assay is a 2-site sandwich immunoassay using direct chemiluminescent
Description:
technology, which uses constant amounts of 2 antibodies that have specificity for the beta
subunit of the intact LH molecule.
CPT Code:
83002
POWERCHART LIDOCAINE LEVEL

NAME
MERCY TEST NAME LIDOCAINE MERCY LAB LIDO

CODE
Specimen: 0.5 ml serum from a no additive serum tube. A Serum Separator Tube (SST) is NOT acceptable.
Stability: 6 hours room temp, 7 days refrigerated.
Reference value: Therapeutic range: 1.5-5.0 mcg/mL
Method: Particle Enhanced Turbidimetric Inhibition Immunoassay
CPT Code: 80176
POWERCHART LIPASE
NAME
MERCY TEST NAME LIPASE MERCY LAB CODE LIPS
Specimen: 0.5ml serum

Stability: Specimens may be stored for up to 24 hours at room temperature or for up to 7 days at 2–
8°C or stored frozen for up to a year at -20°C or colder.

Reference Range: 12-53 IU/L
Method The Atellica CH Lipase (Lip) assay measures the activity of the enzyme lipase in serum and
Description: plasma by the lipase enzymatic reaction producing methylresorufin, which is determined
spectrophotometrically.
CPT Code: 83690
POWERCHART LIPID PANEL

NAME
MERCY TEST NAME LIPID PNL MERCY LAB CODE LIPD

Stability: Separated specimens in the primary collection device are stable for up to 7 days at 2–8°C.7
Separated specimens may be frozen for up to 30 days at ≤ -20°C.7 Do not store in a
frost‑free freezer. Thoroughly mix thawed specimens and centrifuge before using.
Comment: Includes: Cholesterol, Triglyceride, HDL Cholesterol, Calculated LDL, Cholesterol/HDL Ratio.
Patient must be fasting 9-12 hours with no alcohol 24 hours prior to specimen collection.
Reference Range: Cholesterol: Low risk Level <200 mg/dL, moderate risk level 200-239 mg/dL, and high-risk
level ≥ 240 mg/dL.
LDL Cholesterol: Optimal <100 mg/dL, near optimal 100-129 mg/dL, Borderline high 130-159
mg/dL, high 160-189 mg/dL, and very high ≥ 190 mg/dL.
HDL Cholesterol: Low <40 mg/dL and high ≥ 60 mg/dL.
Triglycerides: Normal <150, borderline high 150-199, high 200-499, and very high ≥ 500.
The National Cholesterol Education Program recommends that individuals be seated for at
least 5 minutes prior to phlebotomy to avoid hemo-concentration.

CPT Code: 80061
TEST NAME LIPOPROTEIN PROFILE*
MERCY TEST LIPOPROTEIN PROFILE* MERCY LAB CODE LPPROF

NAME
Patient o Draw following an overnight (12 – 14 hour) fast.

preparation: o Patient must not consume any alcohol for 24 hours before specimen is drawn.
Processing: Send refrigerated to Mayo. Frozen acceptable. Mayo order code (LMPP).
Comment: Patient’s age and gender are required on request form for processing.
Performed: 3-4 days. Test set up Monday through Saturday; 4pm.
Method: Ultracentrifugation/Electrophoresis/Automated Enzymatic Colorimetric Analysis
CPT Code: 80061 Lipid Panel
82172 Apolipoprotein B
83700 Electrophoresis Cholesterol Lp (a)
POWERCHART LITHIUM LEVEL
NAME
MERCY TEST NAME LITHIUM MERCY LAB LI

CODE
Specimen: 1 mL serum from a Serum Separator Tube (SST) or no additive serum tube.
Draw specimen 8-12 hours after last dose (trough specimen). Serum gel tubes should be
centrifuged within 2 hours of collection. Red-top tubes should be centrifuged and aliquoted
within 2 hours of collection.
Peak serum concentrations do not correlate with symptoms.
Processing: Red-top tubes should be centrifuged and aliquoted within 2 hours of collection.
Separated specimens in gel tubes are stable at room temperature 24 hours. Refrigerated up
to 7 days.
Performed: Within 8 hours. Available Stat.
Reference value: Therapeutic interval for lithium is 1.00-1.20 mmol/L
Lithium is toxic at concentrations above 1.50 mmol/L
Method: Colorimetric
CPT Code: 80178

POWERCHART LIVER KIDNEY MICROSOMAL ANTIBODIES
NAME
MERCY TEST NAME LIV/KID MICROS T1* MERCY LAB CODE LKM1
Specimen: 0.5 ml serum from a Serum Separator Tube (SST) and no additive serum tube.
Comment: Useful for evaluation of patients with chronic hepatitis (autoimmune).
Processing: Send refrigerated to Mayo. Refrigerated <= 7 days, or frozen acceptable. Mayo order code
(LKM).
Performed: 1-4 days. Test set up Monday, Wednesday, Friday at Mayo.
Method: Enzyme – Linked immunosorbent Assay (ELISA)

CPT Code: 86376
POWERCHART LUPUS ANTICOAGULANT PROFILE

NAME
MERCY TEST NAME LUPUS ANTI PROF* MERCY LAB CODE LUPUS
Specimen: 5.0 mL platelet poor plasma from light-blue top (citrate) tube.

Test should not be ordered with a Thrombophilia Profile (AATHR) because of
duplication of testing.
Processing Spin down, remove plasma, and spin plasma again. Remove plasma and place in plastic
Instructions: aliquot vials. Place 5 mL in 5 plastic vials each containing 1 mL. Freeze specimens
immediately at < or = -40 degrees C, if possible. Coagulation Patient Information
Sheet must be sent with specimen,
Shipping
1-7 days, Send specimen frozen. Mayo order code (ALUPP).
instructions:
Reference Value Included in report.
Method: PTC, PTMX, APTTB, DRVT, TT, RPTL, DRVTM, DRVTC, APTTM, STLA: Clot-Based Assay
DIRM: Automated Latex Immunoassay (LIA)
PNP: Activated Partial Thromboplastin Time (APTT) Mixing Test
F_2, FACTV, F_7, F_10, IBETH, F8IS: Prothrombin Clot-Based Assay
F8A, F_9, F_11, F_12: Activated Partial Thromboplastin Clot-Based Assay
FIBC: Clauss Methodology
SFM: Immunoturbidimetric
CPT Code: 85610

85613
85730
If indicated, additional reflex tests will be ordered by Mayo at an additional cost.
D-Dimer - 85379 Reptilase Time, P - 85635

Bethesda Units - 85335 Coag Factor II Assay, P - 85210
Coag Factor VIII Assay - 85240, Fibrinogen - 85384
Coag Factor V Assay, P - 85220 Soluble Fibrin Monomer - 85366
Coag Factor VII Assay, P - 85230 Platelet Neutralization Procedure - 85597
Thrombin Time (Bovine) - 85670 PT Mix 1:1 - 85611
Coag Factor IX Assay, P - 85250 APTT Mix 1:1 - 85732
Coag Factor X Assay, P - 85260 DRVVT Mix -85613
Coag Factor XI Assay, P - 85270 DRVVT Confirmation - 85613
Coag Factor XII Assay, P - 85280 HEX LA,P - 85598
Chromogenic FVIII-85130
Chromogenic FIX-85130, Ristocetin cofactor – 85245
von Willebrand factor antigen – 85246, von Willebrand factor multimer – 85247
Factor V inhibitor screen – 85335
PT-Fibrinogen – 85385, von Willebrand factor activity – 85397
APTT mix 1:1 - 85732, Factor VIII inhibitor screen – 85335
26-special coagulation interpretation-85390
POWERCHART LYME DISEASE EVALUATION

NAME
MERCY TEST NAME LYME DIS SERO EVAL MERCY LAB CODE LYME
Processing: Specimen is stable 14 days refrigerated. (A frozen specimen is also acceptable, but not
required)
Comment: This test detects Lyme Disease antibodies IgG and IgM. Each antibody will be reported
separately, along with which proteins the antibodies are detected against.
Note due to reagent supply issues, testing is NOT being performed in house and will be sent
to Mayo.
RL Client
Send 1.0 ml of serum refrigerated to Mercy lab. (Frozen is acceptable, but not necessary)
Comments:
Performed: Available 2-3 days from collection
Method: Immunoblot Microarray
Reference Range: Negative IgG and IgM
CPT Code: 86617 x 2
POWERCHART MAGNESIUM LEVEL

NAME
MERCY TEST NAME MAGNESIUM MERCY LAB CODE MG

Stability: Serum specimens may be stored for up to 7 days at 2–8°C. Separated serum and plasma
specimens may be stored frozen for up to 12 months at -20°C or colder.
Method
The Atellica CH Magnesium (Mg) assay is based on the modified xylidyl blue reaction.
Description:
CPT Code: 83735
POWERCHART Magnesium 24 Hour Urine

NAME
MERCY TEST NAME Misc. General Lab Designate: MAGNESIUM 24 HOUR MERCY LAB CODE CMIS
URINE in comment
Specimen: 5 mL of preserved urine from a 24-hour urine collection.

Stability:
Urine specimens may be stored for up to 7 days at 2–8°C.
Comment: Collect urine samples in a metal-free container. Urine samples should be acidified to pH 1
with concentrated HCl to prevent precipitation of magnesium ammonium phosphate.
Reference Range: No reference range has been established.
Method
Description: The Atellica CH Magnesium (Mg) assay is based on the modified xylidyl blue reaction.
CPT Code:
83735
POWERCHART Magnesium Random Urine

NAME
MERCY TEST Misc. General Lab Designate: MAGNESIUM RANDOM URINE in MERCY LAB CMIS
NAME comment CODE
Specimen: 5 ml of random urine
Stability: Urine specimens may be stored for up to 7 days at 2–8°C.

Comment: Collect urine samples in a metal-free container. Urine samples should be acidified to pH 1
with concentrated HCl to prevent precipitation of magnesium ammonium phosphate.
Reference
No reference range has been established
value:
Method
The Atellica CH Magnesium (Mg) assay is based on the modified xylidyl blue reaction
Description:
CPT Code: 83735
POWERCHART MANGANESE LEVEL

NAME
MERCY TEST NAME MANGANESE* MERCY LAB CODE MNS
Special Patients with high concentrations of Gadolinium, Iodine and Barium are known to interfere
Precautions: with most metal tests. If either Gadolinium-, Iodine, or Barium-containing contrast media
has been administered, a specimen cannot be collected for 96 hours.
Specimen: o Draw tubes for metal BEFORE any other tubes are drawn.
o 2 ml Plain, royal blue-top Vacutainer plastic trace element blood collection tube.
Processing: o Allow the specimen to clot for 30 minutes, and then centrifuge to separate serum
from the cellular fraction. Serum must be removed from cellular fraction within 4
hours of draw. Avoid Hemolysis.
o Remove the stopper. Carefully pour specimen into a Mayo metal-free,
polypropylene vial, while avoiding transfer of the cellular components of
blood. DO NOT insert a pipet into the serum to accomplish transfer, and DO
NOT ream the specimen with a wooden stick to assist with serum transfer.
o Send refrigerated to Mayo. Ambient and frozen also acceptable. Mayo order
code MNS. See Mayo’s LTI for special instructions.
Performed: 1-6 days. Test set up Tuesdays
Reference value: Included with Report.
Method: Dynamic Reaction Cell-Inductively Coupled Plasma-Mass Spectrometry (DRC-ICP-MS)
CPT Code: 83785
TEST NAME MATURATION INDEX
MERCY TEST MATURATION INDEX MERCY LAB CODE MTR

NAME
Patient Patient should not douche, use any medications or creams in the vagina, or have intercourse
preparation: for 24 - 48 hours prior to specimen collection. Specimen collection is not recommended
during a patient’s menstrual cycle.
Specimen: A vaginal smear from the mid lateral vaginal wall is the area of choice, therefore ensuring an
accurate index evaluation. Obtaining the specimen from any other area will not always
reflect an accurate or true maturation index.
Comment: Please include all appropriate information on the cytology requisition form.
Processing: After slide preparation, cytofixative spray must be applied immediately to ensure
preservation.
Slides must be labeled with patient first and last name in pencil.
Performed: Monday through Friday.

Reference value: Within normal limits. Parabasal/intermediate/superficial.
Method: Papanicolaou stain.
CPT Code: 88155
POWERCHART MERCURY LEVEL
NAME
MERCY TEST NAME MERCURY* (Hg) MERCY LAB CODE MERC
Specimen: o Full tube of whole blood from navy blue top EDTA trace metal tube. Minimum 0.3
ml.
o Always draw this tube first if multiple tubes are being drawn.
o If a syringe is needed, use only Mayo EDTA yellow labeled, metal-free syringe.
Processing: o Leave specimen in tube for shipping.
o Send refrigerated to Mayo. Ambient also acceptable. Mayo order code (HG).
Method: Inductively Coupled Plasma-Mass Spectrometry (ICP-MS)

CPT Code: 83825
POWERCHART HEAVY METALS SCREEN BLOOD
NAME
MERCY TEST NAME METAL HVY BLD* MERCY LAB CODE MTHV
Comments: o Mayo Medical Laboratories (MML) is requiring the completion of the T491,
Lead/Heavy Metal Reporting form. Due to state requirements and CDC
recommendations, MML is required to report patient demographic information to
each state on all leads and heavy metals testing. Please click on this link, Mayo
Lead/Heavy Metals Form to complete the form, print, and send with the specimen.
o To be used primarily for Hazardous Materials Teams, such as EMT's or firefighters.
Screens only for Arsenic, Cadmium, Lead and Mercury.
Special Patients with high concentrations of Gadolinium and Iodine are known to interfere with
Precautions: most metal tests. If either Gadolinium or Iodine containing contrast media has been
administered, a specimen cannot be collected for 96 hours.
Specimen: o Draw tubes for metal BEFORE any other tubes are drawn.
o At least 2.5 ml needs to be in the tube. 1 royal blue top EDTA (Monoject trace
element blood collection tube) tube.
Processing: o EDTA metal free tube: Send as is. Do not centrifuge or aliquot.
o Send refrigerated to Mayo. Ambient and frozen also acceptable. Mayo order code
(HMDB).
Performed: 3 days. Test set up Monday through Saturday
Method: Inductively Coupled Plasma-Mass Spectrometry (ICP-MS)
CPT Code: 82175 Arsenic
82300 Cadmium
83655 Lead
83825 Mercury
POWERCHART HEAVY METALS SCREEN 24 HOUR URINE

NAME
MERCY TEST NAME HEAVY METALS, URINE* MERCY LAB CODE VMET
Includes: Arsenic Cadmium Lead Mercury
Note* If arsenic concentration is greater than or equal to 35 mcg/L, then arsenic speciation
will be performed at an additional charge
Patient o Do not eat seafood for 48 hours before starting or during the collection of the 24
Instructions: Hr. urine.
o High concentrations of gadolinium and iodine are known to interfere with most
metals’ tests. If either gadolinium- or iodine-containing contrast media has been
administered, a specimen cannot be collected for 96 hours.
o 24-Hour volume is required on request form for processing.
Specimen: o 24-hour urine specimen.
o Collect in clean, plastic urine container with no metal cap or glued inserts.
o Refrigerate during collection. No preservative
Processing: o Aliquot 10 ml and indicate total 24-hour volume. Send specimen in clean, plastic
aliquot container with no metal cap or glued insert or into a 6.0 mL urine tube. Mix
well before aliquot is taken.
o Refrigerate specimen within 4 hours of completion of 24-hour collection and send
refrigerated to Mayo. Mayo order code (HMU24).
o The addition of preservative or application of temperature controls must occur
within 4 hours of completion of the collection. See Mayo Test Catalog for special
instructions on collections with preservatives
Performed: 1-4 days. Test set up Monday - Saturday
Method: Inductively Coupled Plasma-Mass Spectrometry (ICP-MS).
CPT Code: 82175 Arsenic
82300 Cadmium
83655 Lead
83825 Mercury
82175 Arsenic Speciation (if indicated)
POWERCHART METANEPHRINES FRACTIONATION FREE PLASMA

NAME
MERCY TEST NAME METANEPHEPHRINES FRAC* MERCY LAB CODE PMET
Specimen: 1 mL plasma from lavender top (EDTA) tube.
Stability: 14 days frozen, 7 days refrigerated
Lab Processing: Send frozen to Mayo. Mayo order code (PMET).
Performed: 2 - 4 days. Monday through Saturday; 1 p.m. -Not reported on Sunday.

CPT Code: 83835
POWERCHART METANEPHRINES FRACTIONATION 24 HOUR URINE
NAME
MERCY TEST NAME METANEPH, FRAC 24UR* MERCY LAB CODE MTPH
Comment: o Tricyclic antidepressants, labetalol and sotalol medications may elevate levels of
metanephrines producing results which cannot be interpreted. If clinically feasible,
it is optimal to discontinue these medications at least 1 week before collection. For
advice assessing the risk of removing patients from these medications and
alternatives, you may consider consultation with a specialist in endocrinology or
hypertension.
o A single 24- hour urine collection may be used for CATECHOLAMINE
FRACTIONATION [CTCH], METANEPHRINES and VMA [VVMA].
o The specimen must be kept refrigerated during collection.
Specimen: o At start of collection, add 25 ml 50% acetic acid preservative. Use 15 ml 50% acetic
acid for children.
o Refrigerate during collection. Click on 24-hour urine preservative chart for
other acceptable temperatures and additives.
Reference: o Adjust pH to 2.0-4.0 with 50% acetic acid.
o Aliquot 10 ml and indicate total 24-hour volume.
Lab Processing: Separate aliquots must be submitted for Catecholamine Fractionation and VMA if collected
with this specimen. Identify which specimen is for Metanephrine.
Mercy lab Send 10 ml in a 10 ml urine tube refrigerated to Mayo. Ambient and frozen also acceptable.
processing: Mayo order code (METAF).
Performed: 2 days. Test set up Monday through Saturday; 12 p.m. Not reported on Sundays.
Method: Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS) Stable Isotope Dilution
Analysis
CPT Code: 83835
POWERCHART METHEMOGLOBIN QUANTITATIVE ARTERIAL

NAME
MERCY TEST NAME METHEMOGLOBIN, ARTERIAL MERCY LAB CODE METHBG
Specimen: Arterial Whole Blood collected in a Heparinized syringe. Minimum volume of 1 ml.
station.
Comment: Respiratory or RN will call lab 87256 to come pick up Arterial specimen that Respiratory is
collecting.
Rejection Criteria: Air in sample, clotted, hemolyzed, unlabeled specimens.
Performed: Within 10 minutes of receiving sample.
Reference Value: 0-4.9%
CPT Code: 83050
POWERCHART METHOTREXATE LEVEL

NAME
MERCY TEST NAME METHOTREXATE* MERCY LAB CODE METH

Processing: Protect specimen from light. Send refrigerated to Mayo. Ambient and frozen specimens
acceptable. Mayo order code (MTHX).
Performed: 1 day. Test set up Monday through Sunday; continuously.
Method: Immunoassay
CPT Code: 80204
POWERCHART METHYLMALONIC ACID LEVEL

NAME
MERCY TEST NAME METHYLMALONIC ACID MERCY LAB CODE MMAS
Processing: Send refrigerated to Mayo. Frozen and ambient acceptable. Mayo order code (MMAS).
Performed: Monday through Friday; Continuous until noon.
CPT Code: 83921
POWERCHART MICROALBUMIN 24 HOUR URINE

NAME
MERCY TEST NAME MICROALBUMIN 24UR MERCY LAB CODE VACL
Comment: o Avoid strenuous physical activity for 24 hours prior to collection.

o A 24-hour collection is the preferred specimen. Note in comment if a 12-hour
collection is submitted. If less than a 12-hour collection, order MICROALBUMIN
RANDOM URINE.
Specimen: 5 ml aliquot from 24-hour collection. No preservative. Refrigerate.
Specimen must not be visibly contaminated with blood or menstrual fluid.
Stability: 72 hours refrigerated. Freezing specimen is not recommended.
Processing: Aliquot and indicate total volume. Centrifuge prior to analysis.

Performed: Within 8 hours of receipt
Reference values: Normal: Calculated Microalbumin: Microalbumin Clearance:
Micro: 0-30 mg/24 Hours 0-20 mcg/MIN
Macro: 30-300 mg/24 Hours 20-200 mcg/MIN
>300 mg/24 Hours >200 mcg/MIN
Method: Turbidimetric
CPT Code: 82043
POWERCHART MICROALBUMIN + CREATININE URINE

NAME
MERCY TEST NAME MICROALB CRT R UR MERCY LAB CODE UMAL
Specimen: 5 ml random urine

-20°C.
Comment: Includes Microalbumin, Creatinine, Microalbumin/creatinine ratio.

Method The Atellica CH μALB_2 assay is a PEG-enhanced immunoturbidimetric assay.
Description:
CPT Code: 82043 Microalbumin Urine
82570 Creat R UR
POWERCHART MISCELLANEOUS GENERAL LAB

NAME
MERCY TEST NAME MISC GENERAL LAB MERCY LAB CODE CMIS
Specimen: Specimen dependent on test ordered.

Comment: Indicate test in comment field.
POWERCHART General Lab Miscellaneous (MC) Non-Blood or Miscellaneous Lab Procedure (MC) Non-
NAME Blood
MERCY TEST MISC GNERAL NONBLD* MERCY LAB CODE CMISN

NAME
Specimen: Specimen dependent on test ordered. This should be for non-Blood specimens
only. Please refer to reference lab test catalog for specimen requirements.
Comment: Indicate reference lab test code with name of test desired.
If ordering in Cerner Powerchart a task will be created for nursing to collect specimen.
POWERCHART MISCELLANEOUS IMMUNOHEMATOLOGY

NAME
MERCY TEST NAME MISC IMMUNOHEM MERCY LAB CODE MISI
Specimen: Specimen dependent on test ordered.

Comment: Indicate test in comment field.
POWERCHART MITOCHONDRIAL ANTIBODY (M2)

NAME
MERCY TEST NAME MITOCHOND AB, M2* MERCY LAB CODE MTAB
Comment: Duplicate testing if ordered with ALDP
Processing: Send refrigerated to Mayo. Mayo test code (AMA).
Performed: 1 day. Test set up Monday through Saturday; 11 a.m.
CPT Code: 86381
POWERCHART General Lab Miscellaneous Non-Blood
NAME
(MONKEY POX) ORTHOPOX, conclusion, Qualitative Real- Time PCR*
MERCY TEST NAME MISC GENERAL NONBLOD* MERCY LAB CODE CMISN
(MONKEY POX) ORTHOPOX, conclusion, Qualitative

Real- Time PCR*
Requirements: Clinicians must report suspected monkeypox cases to the IDPH Center for Acute
Disease Epidemiology (CADE) as soon as monkeypox is suspected and PRIOR TO
COLLECTING SPECIMENS.
Specimens approved by IDPH for testing at SHL should be submitted using a current IDPH
Epidemiological Investigation Test Request Form (TRF) obtained by contacting IDPH
CADE.
IDPH will consult with CDC and SHL to determine the need and plan for laboratory testing.
Contact Information:
IDPH CADE........................... (business hours) 515-242-5935 | (non-business hours) 515-323-

4360
SHL....................................... 319-335-4500 or 1-800-421-4692
Clinics should not send specimen to MercyOne North Iowa Medical Center. Do not
order enter an order for MercyOne North Iowa. Refer to SHL and CDS website for
ordering and transporting. Contact CDS courier to schedule pick-up of specimens:
http://cdsofiowa.com / or 515-289-9990
Monkeypox Dry Swab Kit or Monkeypox VTM Kit, order

at www.shl.uiowa.edu/kitsquotesforms/clinicalkit.xml
The provider must contact the IDPH to be provided access to the IDPH Epidemiological
Specimen: Investigation Test Request Form (TRF).
MercyOne North Iowa Laboratory will have a limited number of kits.
Each lesion will require an order. The recommendation is to select two lesions to
swab.
Use one kit per lesion.
The kit will have 2 swabs. Swab one selected lesion vigorously with both swabs from a
kit. Each swab must be placed into its own container and labeled. The swab may be placed
in viral transport media (VTM) or a dry swab tube. Lesion crust is also acceptable. Place
both swabs for the single lesion back into the kit’s bag. Each kit (two swabs of the same
lesion) must be accompanied by the completed IDPH Epidemiological Investigation Test
Request Form (TRF).
2 lesions require 2 orders and 2 kits. Per kit: two swabs and one TRF.
Transport Inpatient or ED should walk to lab properly packaged specimen. Lab will order on SHL
website and schedule for transport.
Other sites: Contact CDS courier to schedule pick-up of specimens: http://cdsofiowa.com /

or 515-289-9990
Refrigerated specimens- ship on ice packs; acceptable 7 days. Frozen specimens- ship on
dry ice; acceptable 30 days
Reject if cotton or rayon swabs; wooden swabs; M4 media, UTM; FlexTrans or Room Temp
Days Performed: Specimen referred to State Hygienic Laboratory at University of Iowa; Set up daily; Report
available: 2-3 days
Method: Real-Time PCR
Reference value: Orthopoxvirus DNA OPX3 Not Detected

Monkeypox Virus DNA, VAC1 Not Detected
POWERCHART MONOCLONAL PROTEIN STUDY 24 HOUR URINE

NAME
MERCY TEST NAME MONOCLONAL PRT STY, 24UR* MERCY LAB CODE MCPSU
Cautions: Monoclonal gammopathies are rarely seen in patients younger than 30 years of age.
Hemolysis may cause a discrete band on protein electrophoresis, which will be negative on
M-protein isotyping.
Penicillin may split the albumin band.
Radiographic agents may produce an uninterpretable pattern.
Specimen: 50 mL urine from a 24-hour collection (no preservative).
Refrigerate specimen during collection and send refrigerated.
Processing: Aliquot between 30 mL and 50 mL urine into plastic, 60-mL urine bottle.
Send refrigerated to Mayo. Mayo order code (MPU).
Methods: PTU: Turbidimetry, PEU: Agarose Gel Electrophoresis, MPTU: Matrix-Assisted Laser
Desorption/Ionization Time-of-Flight Mass Spectrometry (MALDI-TOF MS)
CPT Code: 84156
84166
0077U
POWERCHART MONOCLONAL PROTEIN STUDY QUANTITATIVE

NAME
MERCY TEST MONCL PRT STY QNT* MERCY LAB QMPSS
NAME CODE
Specimen: 2 mL serum from Serum Separator Tube (SST
NOTE: Clients should order both Mayo QMPSS and Mayo FLCS for diagnostice cases. QMPSS
should be ordered on its own for monitoring cases.
Processing: 2 mL total serume in 2 separate plastic vials, each containing 1 mL of serum. Send refrigerated.
Mayo order code (QMPSS)
Stability: 28 days refrigerated (preferred), 28 days frozen or 7 days ambient.

Reference
Included with test results.
Values:
Methods: QMPTS: Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry
(MALDI-TOF MS)
IGG,IGA,IGM: Nephelometry
TMAB: Patient Information
CPT Code: 82784x3
0077U
POWERCHART MONOCLONAL PROTEIN STUDY RANDOM URINE

NAME
MERCY TEST NAME MONO PRT STY R UR* MERCY LAB CODE MPSUR
Specimen: 50 mL urine from a random collection. No preservative.
Processing: o Aliquot specimen among one plastic, 60mL urine bottle.

o Send refrigerated to Mayo. Frozen acceptable. Ambient within 24 hours. Mayo
order code (RMPU).
Cautions: o Monoclonal gammopathies are rarely seen in patients < 30 years of ages.
o Penicillin may split the albumin band.
o Radiographic agents may produce an uninterpretable pattern.
Comment: see MCPSU for 24o collection
Performed: Result available 4-6 days from collection. Monday – Friday.
Reference Values: Included with test results.
Method: Matrix-Assisted Laser Desorption/Ionization-Time of Flight Mass Spectrometry (MALDI-TOF

MS)
Agarose Gel Electrophoresis
Turbidimetry/Enzymatic Colorimetric Assay
CPT Code: 84156

82570
84166
0077U
POWERCHART MONOCLONAL PROTEIN QUANT 24 HR URINE
NAME
MERCY TEST NAME MONCL PRT QNT 24UR* MERCY LAB CODE VELC
Comment: 05/16/2023 Mayo Update: Electrophoresis, Protein, 24 Hour, Urine (Mayo: EPU) was made
obsolete and replaced with Monoclonal Protein Quantitation, 24 Hour, Urine (Mayo:
MPQU). This is due to an improved methodology to detect monoclonal proteins.
Cautions: Patients suspected of having a monoclonal gammopathy may have a normal urine protein
electrophoretic pattern, and these patients should have M-protein isotyping performed.
Monoclonal gammopathies are rarely seen in patients younger than 30 years of age.
Hemolysis may cause a discrete band on protein electrophoresis, which will be negative on
M-protein isotyping.
Penicillin may split the albumin band.
Radiographic agents may produce an uninterpretable pattern.
Specimen: 50 mL urine from a 24-hour collection (no preservative).
Refrigerate specimen during collection and send refrigerated.
Processing: Aliquot between 30 mL and 50 mL urine into plastic, 60-mL urine bottle.
Send refrigerated to Mayo. Mayo order code (MPQU).

Methods: PTU: Turbidimetry, PEU: Agarose Gel Electrophoresis, MPTU: Matrix-Assisted Laser
Desorption/Ionization Time-of-Flight Mass Spectrometry (MALDI-TOF MS)
CPT Code: 84156
84166
0077U (if appropriate)
POWERCHART MONOCLONAL PROTEIN QUANTITATION RANDOM URINE

NAME
MERCY TEST NAME MONO PRT QNT R UR* MERCY LAB REPU
CODE
Specimen: 50 mL from a random collection. No preservative.
Stability: Refrigerated 14 days, Frozen 5 days, Ambient 24 hours.
Processing: Mercy Lab Processing only: Aliquot into 60-mL urine bottle. Send refrigerated. Mayo order
code (RMPQU).
Performed: 4-6 days. Electrophoresis Monday through Friday.

Reference values: Included with report.
Method: Turbidimetry/Enzymatic Colorimetric Assay

Agarose Gel Electrophoresis
Matrix-Assisted Laser Desorption/Ionization-Time of Flight Mass Spectrometry (MALDI-TOF
MS)
CPT Code: 84156

82570
84166
007U (if appropriate)
POWERCHART MONO SCREEN

NAME
MERCY TEST NAME MONOSCREEN (Heterophile Titer) MERCY LAB CODE MOSC
o Heparin or EDTA plasma.
o Remove serum in no additive serum tube or plasma from cells.
Stability: 48 hours refrigerated. Freeze if >48 hours.
Processing: Freeze if not done within 48 hours.

Method: Immunochromatographic dipstick technology.
CPT Code: 86308 Monoscreen
POWERCHART MRSA NASAL
NAME
MERCY TEST NAME MRSA NASAL MERCY LAB MRSANX

CODE
Specimen: Nasal, collect using routine Culturette.
Comments: Make sure collection site (Nasal) is indicated on Culturette label also.
If the provider is checking for a nasal infection and wants to treat the patient, contact the
Microbiology lab department for correct ordering of this type of request.
Intended Use: Testing is used to monitor Vancomycin de-escalation in the treatment of pneumonia.
Enter “Vancomycin de-escalation” as the Reason for Laboratory Order.
If the need is screen or to determine colonization/decolonization status, use order MRSA

Nasal Surveillance. Mercy Lab Code MRSANS.
Regional Laboratory clients: Use order MRSANX for any of your submissions.
Stability: Send Culturette at room temperature within 24 hours. Stable for 5 days refrigerated.

Method: PCR
CPT Code: 87641
POWERCHART MRSA NASAL SURVEILLANCE

NAME
MERCY TEST MRSA NASAL SCREEN MERCY LAB MRSANS

NAME CODE
Specimen: Nasal, collect using routine Culturette.
Comments: Make sure collection site (Nasal) is indicated on Culturette label also.
If the provider is checking for a nasal infection and wants to treat the patient, contact the
Microbiology lab department for correct ordering of this type of request.
Intended Use: The intended use of this surveillance assay is to screen patients for MRSA
colonization/decolonization. There is NO susceptibility testing performed with this assay.
Pharmacy/Providers: If the test is being used for Vancomycin de-escalation in the

treatment of pneumonia: Refer to MRSA NASAL. Mercy Lab Code of MRSANX.
For non-Mercy Locations: Order code will be MRSANX. This testing will be billed back to
the ordering facility.
Stability: Send Culturette at room temperature within 24 hours. Stable for 5 days refrigerated.
Method: PCR
CPT Code: 87641
POWERCHART MRSA PCR (MRSA Wound Surveillance)

NAME
MERCY TEST NAME MRSA by PCR MERCY LAB CODE MRSAWD
Specimen: Superficial wound, skin swab, Collect using a routine Culturette.
Comments: This order is to screen for colonization ONLY.
Enter site of collection in specimen source area. Make sure collection site is indicated on
Culturette.
If the provider is checking for infection and wants to treat the patient, see Culture wound
other (WND/ABS CLT/GS).
Intended Use: The intended use of this assay is to screen Mercy Hospital patients for MRSA colonization.
CLINICS: The wound surveillance assay is not intended for clinic use. Nasal surveillance assay
is the only appropriate assay, in this instance. Wounds should continue to be ordered as a
culture, to look for MRSA.
HOSPITAL REFERENCE LABS: The wound surveillance assay is not intended for hospital
reference lab use, unless a wound surveillance protocol has been established by the
reference lab's infection prevention department for this type of specimen.
NON-Mercy locations: The non-Mercy orders should be placed as MRSAWX (wound).
Stability: Send Culturette at room temperature within 24 hrs., 5 days refrigerated.

Method: PCR
CPT Code: 87641
POWERCHART MS (MULTIPLE SCLEROSIS) PANEL

NAME
MERCY TEST NAME MS PROFILE* MERCY LAB CODE MSPROF
Comment: This test requires both CSF and serum. Please notify Lab when this test is ordered so that
a blood specimen can be collected at the same time.
Includes: Kappa Free Light Chain, CSF, possible additional test result if appropriate for serum bands,
CSF bands, CSF Olig Bands Interpretation
Specimen: 1.0 ml CSF and 1.0 ml serum from no additive serum tube or Serum Separator Tube
(SST). Minimum 0.5 ml CSF and 0.5 ml serum. Nursing Service must notify the Lab when CSF
is collected so that the CSF and serum specimens can be collected. Spinal Fluid must be
obtained within 1 week of serum draw.
Processing: o DO NOT perform any CSF testing at Mercy Laboratory until AFTER CSF
specimen has been processed for Mayo testing.
o 1 ml CSF, send in original tube when possible. Label tube as CSF.
o 1 ml serum in vial labeled as such.
Mayo Code order code (MSP3)
Record on Mayo batch list: # of ml of CSF sent.
SEND ALL SPECIMENS FROZEN TO MAYO. LABEL 1 ALIQUOT CSF (1.0 ML) AND 1
ALIQOUT SERUM (1.0 ML)
Performed: Monday through Saturday; 7 a.m. – 12 p. m.

Method: Refer to individual tests.
CPT Code: 83521-MSP3
83916 x 2 (if appropriate)
TEST NAME MUMPS ANTIBODY IgG
MERCY TEST MUMPS IgG Screen MERCY LAB CODE MUMPGG

NAME
Comment: This test is for immune status only.

Cause for
Grossly hemolyzed, lipemic or icteric serum.
Rejection:
Processing: Samples can be sent Refrigerated. Frozen is acceptable. Mayo order code (MPPG)
Performed: Monday through Saturday; 9 a.m.
CPT Code: 86735
TEST NAME MUMPS ANTIBODY IgG IgM
MERCY TEST MUMPS IGG, IGM* MERCY LAB CODE MUMP

NAME
Specimen: 1 ml Serum from a Serum Separator Tube (SST) or no additive serum tube
Processing: Send refrigerated to Mayo (Frozen is acceptable). Mayo order code (MMPGM).

Method: Mumps IgG - Multiplex Flow Immunoassay (MFI) Mumps IgM - Enzyme Immunoassay (EIA)
CPT Code: 86735 - IgG

86735 - IgM
TEST NAME MUMPS Virus PCR

MERCY TEST MUMPS Virus PCR MERCY LAB CODE MISM
NAME
Comment: This surveillance testing is for symptomatic patients only. The State Hygienic Lab Mumps
surveillance is a buccal (mouth) PCR. A SHL Viral and Bacterial PCR Test Request Form will be
required for testing.
Specimen: 1 buccal swab (mouth).
Collection: Collect sample using a SHL Virus Isolation and Detection Kit (contains M4-RT viral transport
medium and swab) or equivalent virus transport media. Kits may be request through
MercyOne North Iowa Lab.
Buccal (Oral) Swab: The buccal cavity is the space between the cheek and teeth. The
parotid duct drains in the space near the upper molars. Massage the parotid gland area just
in front of the ear and near the angle of the jaw for 30 seconds prior to collecting secretions
on the swab. Swab the buccal cavity by sweeping the swab near the upper molar to the
lower molar. Place swab in M4-RT viral transport medium and do not remove swab.
Send sample refrigerated (2-8°C)
Reason for rejection include Frozen samples, sample obtained on cotton-tipped, wooden-
shafted, or calcium alginate swabs.
Performed: Monday through Friday, at State Hygienic Lab, Iowa City, Ia.
Method: PCR
CPT Code: 87798
TEST NAME MUSCLE BIOPSY

MERCY TEST NAME MUSCLE BIOPSY* MERCY LAB MSCX
CODE
Comment: o Notify Pathology Department 24 hours in advance. Test done Monday through
Wednesday only.
o Complete a manual Pathology Specimen form and a Muscle Histochemistry
Information sheet.
These forms are available from the Histology Laboratory.
Specimen: Excise 2 samples using sterilized muscle clamps. Sterilized biopsy forceps are available from
the Histology Department. Send immediately to the Histology Laboratory for processing.
Processing: Send specimen frozen on dry ice to Mayo. Mayo test code (MPCT).
Preformed: 7 days. Test set up 1-2 times a week at Mayo.
Reference value: Interpretive report provided.
CPT Code: 88314 X 7 acetic non-specific esterase, acid phosphatase, alpha-naphthyl, cytochrome
oxidase, NADH dehydrogenase, phosphorytase, and succinic dehydrogenase stains.
88314 X 3 ATPase acid-alkaline stain
88313 X 4 Hematoxylin-and-eosin, oil red O, periodic-acid Schiff, and trichrome stains.
88305 surgical pathology exam.
POWERCHART MYASTHENIA GRAVIS PANEL

NAME
MERCY TEST NAME MYASTHN GRAV* MERCY LAB CODE MYASA

Specimen: 3 ml serum from a Serum Separator Tube (SST) or no additive serum tube. Hemolyzed
specimen is unacceptable.
NOTE: Patient should have no general anesthesia or muscle-relaxant drugs in the previous
24 hours. Avoid Hemolysis.
Processing: Send refrigerated to Mayo. Mayo code: (MGMR)
Method: ARBI, MUSK: Radioimmunoassay (RIA)

ACMFS: Flow Cytometry
CPT Code: 86041

POWERCHART MYCOPHENOLIC ACID LEVEL

NAME
MERCY TEST NAME MYCOPHENOLIC ACID* MERCY LAB CODE MYPA
Specimen: 1.0 ml of serum from a red top tube. Serum gel/SST is NOT acceptable.
Processing: Send refrigerated. Frozen and ambient acceptable. Mayo order code (MPA).
Performed: 1-3 days. Monday through Sunday; Varies
Method: Tandem Mass Spectrometry (MS/MS)
CPT Code: 80180
POWERCHART MYCOPLASMA PNEUMONIAE DNA PCR

NAME
MERCY TEST NAME MYCPLSMA PNEUN PCR* MERCY LAB CODE MYCPCR
Specimen: Specimen Type: Respiratory

Sources: Bronchial washing, bronchoalveolar lavage, tracheal secretions, sputum
Container: Sterile container
Specimen Volume: 1 mL
Specimen Type: Fluid

Sources: Pleural, pericardial, cerebrospinal
Container: Sterile container
Specimen Volume: 0.5 mL
**Update: 10/10/23: Respiratory fluid and body fluid specimens submitted for this test will
no longer be accepted if sent in viral transport media (VTM). These fluids should be
transported in a sterile container not containing media.
Clearly indicate specimen source, this information is required for testing.
RL Client Write Mycoplasma Pneumoniae by PCR, Mayo code - MPRP on the requisition, Specimen
Comments: Source information is required.
Send specimen refrigerated to Mercy Lab
Processing: Send specimen refrigerated to Mayo. Mayo order code (MPRP).
Performed: 3-4 days, Monday through Sunday
Method: Rapid Polymerase Chain Reaction (PCR) using Light Cycler and Fluorescent Resonance
Energy Transfer (FRET)
CPT Code: 87581

87798-Mycoplasma pneumoniae Macrolide Resist PCR (if appropriate)
POWERCHART MYCOPLASMA PNEUMONIAE IgG IgM

NAME
MERCY TEST NAME MYCO.PNEUM IGG, IGM* MERCY LAB CODE MYCOGM
Specimen: 0.5 ml of serum from a Serum Separator Tube (SST) or no additive serum tube.
Processing: Send specimen refrigerate. Frozen acceptable. Mayo order code (MYCO).
Performed: 1 day, Monday through Friday; 9 A.M.
Comment: Cautions: The use of hemolyzed, lipemic, bacterially contaminated, or heat-inactivated
specimens should be avoided. The continued presence or absence of antibodies cannot be
used to determine the success or failure of therapy.
CPT Code: 86738 x 2
86738-Mycoplasm pneumoniae by indirect IFA (if appropriate)
POWERCHART MYELODYSPLASTIC SYNDROME (MDS) BY FLOW CYTOMETRY BONE MARROW

NAME
MERCY TEST NAME MDS BONE MARROW* MERCY LAB CODE MYEFL
Specimen: 2-5 ml bone marrow specimen in ACD (preferred), EDTA and Sodium heparin bone marrow
samples are also acceptable.
Processing: Label specimen as Bone Marrow. Include 5 to 10 unstained bone marrow aspirate smears.
Send AMBIENT to Mayo Medical Laboratories for testing.
Mayo Code - (MYEFL).
**Specimen must be received within 72 hours of collection.
Performed: Specimens are processed and reported Monday-Saturday. Maximum Laboratory time 4 days
Method: Flow Cytometry Immunophenotyping

CPT Code: 88184 - Flow Cytometry; First Cell Surface, cytoplasmic or nuclear marker x1
88185 - Flow Cytometry; Additional Cell Surface, cytoplasmic or nuclear marker (each) x18
POWERCHART MYELOPEROXIDASE (MPO) ANTIBODIES
NAME
MERCY TEST MYELOPEROXIDASE AB* MERCY LAB CODE MYPOX

NAME
Comment: Useful for evaluation of patients with vasculitis and renal disease. If Cytoplasmic Neutrophil
ABS is ordered, and p-ANCA is positive, Myeloperoxidase Antibodies, serum will be done and
charged per Mercy Medical Center – North Iowa Lab policy. Test is also included in
Cytoplasmic Neutrophil Antibodies Vasculitis Panel (VAPNL).
Processing: Send refrigerated to Mayo. Frozen acceptable. Mayo order code (MPO).
Performed: 4 days. Test set up Monday through Saturday; 4 p.m..
Method: Multiplex flow immunoassay.
CPT Code: 83516
POWERCHART MPN JAK2 V617F WITH REFLEX TO CALR AND MPL

NAME
MERCY TEST NAME MYELO NEOPLSM JAK2* MERCY LAB MPNR

CODE
Specimen: Peripheral Blood: 3 mL whole blood in EDTA or yellow top ACD. Send specimen in original
tube. Do NOT aliquot. Label specimen as blood.
Bone marrow: 2 mL bone marrow in EDTA or yellow top ACD. Send specimen in original
tube. Do NOT aliquot. Label specimen as bone marrow.
Processing: Send at room temperature. Refrigerated is acceptable. Mayo order code (MPNR).
Method: Quantitative Polymerase Chain Reaction (qPCR)
CPT Code: 81270

81219 (CALR if appropriate)
81339 (MPL if appropriate)
POWERCHART MYOGLOBIN
NAME
MERCY TEST NAME MYOGLOBIN MERCY LAB CODE MYO

8 hours. Freeze samples at ≤ -20°C if the sample is not assayed within 48 hours. Freeze
Reference value: Female: 14 - 66 ng/ml
Male: 17 - 106 ng/ml
Method: The Atellica IM MYO assay is a 2-site sandwich immunoassay using direct chemiluminescent
technology, which uses constant amounts of 2 antibodies.
CPT Code: 83874
POWERCHART MYOGLOBIN URINE

NAME
MERCY TEST NAME MYOGLOBIN R UR* MERCY LAB CODE MYOU
Specimen: 5 ml preservative free random urine in10 mL plastic myoglobin transport tube.
Processing: o If sample is ambient, aliquot the urine to a urine myoglobin transport tube within
one hour of collection (Supply T691). Refrigerate specimen.
o If sample is refrigerated, aliquot the urine to a urine myoglobin transport tube
within two hours of collection.
NOTE: Urinary myoglobin is highly unstable unless alkalinized with Na2CO3

preservative. Even with alkalinization, myoglobin deterioration is variable and
sample dependent (approximately averages of 10% at 1 day, 20 % at 3 days, and
30% at 7 days. MAYO order code (MYGLU).
o Send refrigerated.
Caution: An elevated level of myoglobin in urine does not identify the clinical disorder. Urine collected
with acid as preservative will NOT be valid because acid interferes with analyte integrity.
Performed: 1-2 days. Test set up Monday through Sunday, continuously.
Method: Latex Particle-Enhanced Immunoturbidimetric Assay.
CPT Code: 83874
POWERCHART NEONATAL METABOLIC SCREEN

NAME
MERCY TEST NAME NEONT MET SCR* MERCY LAB CODE NNT
Includes: Hypothyroidism Phenylketonuria Expanded Screening Disorders

Hemoglobinopathies Biotinidase Deficiency Congenital Adrenal Hyperplasia
Galactosemia Cystic Fibrosis Severe Combined Immunodeficiency
Specimen: o Capillary blood specimen collected by Laboratory on INMSP form.

o Instructions for collection technique on the INMSP form must be carefully followed
to avoid rejection of the specimen.
o The specimen should be collected when the infant is more than 24 hours old and
less than 5 days but must be collected prior to discharge.
o A repeat specimen must be collected within 14 days of age when the first specimen
was collected prior to 24 hours after birth.
Processing: Send to University Hygienic Laboratory, Des Moines.
Performed: 7 days
Reference value: See State Laboratory report for reference values.
Method: Phenylketonuria: No longer reported separately 9/3/05 included in Expanded Screening
Disorders.
Galactosemia (Classic): Quantitative Fluorometric Assay
Hemoglobinopathy: High Precision liquid Chromatography Hemoglobin Electrophoresis
Congenital Adrenal Hyperplasia: Fluoroimmunoassay for 17 alpha-OH Progesterone (17
OHP)
Hypothyroidism: Fluoroimmunoassay for Thyrotropin (TSH)
Biotinidase Deficiency: Qualitative Assay for Biotmidase
Expanded Screening Disorders: Tandem Mass Spectrometry (MS/MS)
Cystic Fibrosis: Immuno Reactive Trypsinogen (IRT)
Severe Combined Immunodeficiency
CPT Code: Newborn Metabolic Screen S3620
Comment: If the State lab requests the patient to be retested due to the results from the initial testing,
Laboratory staff can order the NEONT MET SCR RPT*, Sunquest order code
NNTR. Neonate Met Scr Rprt* is not orderable from Powerchart. Lab must order. Connected
to the Sunquest order code NNTR is a processing fee only. The NNTR is not to be used when
a second collection is required due to an error in the collection process.
Recollection due to a lab error should be the Sunquest order code NNT with the first test
being credited. Nursery is to notify ER as to which baby will be returning. A repeat INMSP
form will be provided to the Lab by the State Lab. A repeat specimen must be collected
within 14 days of age if the first specimen was collected prior to 24 hours after birth.
POWERCHART NEWBORN METABOLIC SCREEN REPEAT

NAME
MERCY TEST NAME NEONT MET SCR RPT* MERCY LAB CODE NNTR
Includes: Hypothyroidism Galactosemia Expanded Screening Disorders

Hemoglobinopathies Congenital Adrenal Hyperplasia Biotinidase Deficiency
Phenylketonuria Cystic Fibrosis Severe Combined Immunodeficiency
Comment: o To be used when the neonatal metabolic screen is to be repeated by the State Lab.
o The patient will be charged a processing fee only.
o Nursery is to notify ER as to which baby will be returning.
o A repeat INMSP form will be provided to the Lab by the State Lab.
o A repeat specimen must be collected within 14 days of age if first specimen was
collected prior to 24 hours after birth.
Specimen: Capillary blood specimen collected by Laboratory on INMSP form. Instructions for collection
technique on the INMSP form must be carefully followed to avoid rejection of the specimen.
Processing: Send to University Hygienic Laboratory, Des Moines.

Performed: 7 days
Reference value: Send to University Hygienic Laboratory, Des Moines
Method: Phenylketonuria: No longer reported separately 9/3/05 included in Expanded Screening
Disorders
Galactosemia (Classic): Quantitative Fluorometric Assay
Hemoglobinopathy: High Precision liquid Chromatography Hemoglobin Electrophoresis
Congenital Adrenal Hyperplasia: Fluoroimmunoassay for 17 alpha-OH Progesterone (17
OHP)
Hypothyroidism: Fluoroimmunoassay for Thyrotropin (TSH)
Biotinidase Deficiency: Qualitative Assay for Biotmidase
Expanded Screening Disorders: Tandem Mass Spectrometry (MS/MS)
Cystic Fibrosis: Immuno Reactive Trypsinogen (IRT)
Severe Combined Immunodeficiency
CPT Code: 99001
POWERCHART NICOTINE AND METABOLITE SCREEN

NAME
MERCY TEST NAME NICOTINE METABOLITE* MERCY LAB CODE NICOT

Processing: Send refrigerated to Mayo. Ambient and frozen also acceptable. Mayo order code (NICOS).
Performed: 2-4 days. Monday through Saturday; 11 a.m., Sunday; 4 p.m.
CPT Code: G0480 / 80323
POWERCHART NICOTINE AND METABOLITES URINE

NAME
MERCY TEST NAME NICOT METABOLIT UR* MERCY LAB CODE NICOU
Specimen: 3.0 mL urine from random urine specimen in 5 mL urine tube.
Processing: Send refrigerated to Mayo. Ambient and frozen also acceptable. Mayo order code (NICOU).
Performed: 2-5 days, Monday through Sunday.
CPT Code: G0480 / 80323
POWERCHART NUTRITION PANEL

NAME
MERCY TEST NAME NUTRITION PNL MERCY LAB CODE NPNL
Specimen: 0.5 ml serum and 1 unspun Lithium Heparin tube on ice.

20°C.
Comment: Includes: A/G Ratio, Albumin, Anion Gap, BUN, BUN/Create Ratio, Calcium, Ionized Calcium,
Chloride, Cholesterol, Creatinine, CO2, Glucose, Magnesium, Phosphorus, Potassium,
Prealbumin, Sodium, Total Protein, Triglycerides, GFR.

Method
Description:
CPT Code: 82330 Calcium Ionized+
84134 Prealbumin
82465 Cholesterol
84155 Prot TTL
80069 Renal Function Panel
84478 Triglyceride
83735 Magnesium
TEST NAME OCCULT BLOOD
MERCY TEST NAME OCCULT BLOOD FECAL ICT MERCY LAB CODE OBFS
SCREEN
Comment: o Must use Beckman Counter Hemoccult® ICT blue card

o This is for stool specimens only.
o If using the Beckman Coulter Hemoccult® green/yellow card, SEE Hemoccult®
Specimen: o Fresh, unpreserved stool specimen
o No dietary restrictions are required.
o NOTE: Fecal samples should not be collected if hematuria or obvious rectal
bleeding, such as from hemorrhoids, is present. Pre-menopausal women should
not collect fecal samples during or in the 3 days following a menstrual period.
o Collect a small fecal sample on one end of the applicator stick (may use tongue
depressor) Apply a small thin smear inside box A. Use the other end of the
applicator to obtain a second sample from a different area of the stool. Apply a
thin smear inside box B and close the cover.
o The test slide MUST be labeled with patient first and last name along with date and
time of collection.
CPT Code: G0328

82274
POWERCHART OLIGOCLONAL BANDING CSF Also included in: MS Panel/Myelin

NAME Basic Protein*
MERCY TEST OLIGOCLONL BANDING* MERCY LAB CODE OLGBND
NAME
Comment: o This test requires both CSF and serum.

o Please notify Lab when this test is ordered so that a blood specimen can be
collected at the same time.
Includes: Oligoclonal Bands: CSF bands, serum bands
Specimen: o 0.5 ml CSF and 0.5 ml serum from plain red top tube or serum gel tube.
o Minimum 0.4 ml CSF and 0.4 ml serum.
o Nursing Service must notify the Lab when CSF is collected so that the serum
specimen can be collected.
o Spinal Fluid must be obtained within 1 week of serum draw.
Processing: o DO NOT perform any CSF testing at Mercy Laboratory until AFTER CSF
specimen has been processed for Mayo testing.
o 0.5 ml CSF, send in original tube when possible. Label tube as CSF.
o 0.5 ml serum in vial labeled as such.
o Record on Mayo batch list: # of ml of CSF sent.
o SEND ALL TESTS REFRIGERATED TO MAYO. LABEL 1 ALIQUOT CSF (0.5 ml) AND 1
ALIQUOT SERUM (0.5 ml). Mayo - (OLIG). AMBIENT AND FROZEN ACCEPTABLE.
Method: Isoelectric Focusing (IEF) with IgG Immunoblot Detection
CPT Code: 83916 Oligoclonal Banding x2 (CSF and Serum)

TEST NAME OPIATES See: Drug Abuse Random Urine
Drug Screen Body Fluid*
Drug Screen Serum*
MERCY TEST NAME OPIATES UR* CONFIRMATION MERCY LAB CODE UOPIAT
Processing: Send refrigerated to Mayo. Mayo code (OPATU)
Performed: Monday-Friday
Reference
Included in report.
Value:
Method: Liquid Chromatography - Tandem Mass Spectrometry (LC - MS/MS)
CPT Code: G0480/ 80361 / 80365
POWERCHART ORTHOPEDIC PANEL

NAME
MERCY TEST NAME ORTHOPEDIC PANEL MERCY LAB CODE OPNL

20°C.
Comment: Includes: Sodium, Potassium, Glucose, BUN, Creatinine, BUN/Creatinine Ratio, eGFR,
Calcium, Alkaline Phosphatase, Gamma GT, Albumin.
Performed: Within 8 hours of collection. Available stat.
Method
Description:
CPT: See Individual test entry
POWERCHART OSMOLALITY SERUM

NAME
MERCY TEST NAME OSMOLALITY BLOOD MERCY LAB CODE OSM
Reference value: 280-300 mOsm/kg
Method: Freezing point depression.
CPT Code: 83930
POWERCHART OSMOLALITY URINE

NAME
MERCY TEST NAME OSMOLALITY R UR MERCY LAB CODE UOSM

Specimen: 5 mL from a random urine specimen
Reference value: 300-1000 mOsm/kg
Method: Freezing point depression.
CPT Code: 83935
POWERCHART OXALATE 24 HOUR URINE

NAME
MERCY TEST NAME OXALATE 24UR* MERCY LAB CODE VOXL
Patient
Avoid taking large doses (greater than 2.0 g orally/ 24 hours) of Vitamin C during collection.
preparation:
Specimen: o 24-hour urine collection.
o Add 5 mL of diazolidinyl urea (Germall) as a preservative at start of collection OR
refrigerate specimen during and after collection.
o Collect in metal free container with no metal cap or glued insert.
o Specimen pH should be between 4.5 and 8 and will stay in this range if kept
refrigerated during and after collection. Specimens with pH > 8 indicate bacterial
contamination, and testing will be cancelled.
o DO NOT attempt to adjust pH as it will adversely affect results.
Cause for
Samples collected in or sent in containers with metal caps will not be tested.
rejection:
Processing: o Transfer 4 ml urine to 5 mL metal-free container. Mix well before the aliquot is
taken.
o Indicate total 24-hour volume.
o Send refrigerated to Mayo. Mayo order code (OXU). Frozen and Ambient are
acceptable.
o Click on 24-hour urine preservative chart for other acceptable temperatures and
additives.
o Diazolidinyl Urea (Germall) is listed as preferred, but Mercy Lab does not
have this in our inventory.
Performed: Results 3-5 days. Monday through Saturday.
Method: Enzymatic using Oxalate Oxidase.
CPT Code: 83945
POWERCHART OXCARBAZEPINE (TRILEPTAL) LEVEL

NAME
MERCY TEST NAME OXCARBAZEPINE MET* MERCY LAB CODE OXCARB
Specimen: 1 mL serum from a no additive serum tube. a Serum Separator Tube (SST) are NOT
acceptable.
o Collect specimen immediately before next scheduled dose.

o Centrifuge and aliquot serum into plastic vial within 2 hours of collection.
Processing: Send refrigerated to Mayo. Mayo order code (OMHC).
Performed: 1-3 days. Tuesday through Saturday.

Reference
Included in report.
Value:
Method: High-Turbulence Liquid Chromatography Mass Spectrometry (HTLC-MS/MS)
CPT Code: 80183
POWERCHART OXYGEN SATURATION

NAME
MERCY TEST NAME OXYGEN SATURATION MERCY LAB O2SAT

CODE
Specimen: Arterial, mixed venous, venous collected in a Heparinized syringe. Minimum volume of 1 ml.
non-Heparinized syringes are also acceptable.
station.
Comment: RN will page lab on pager #420 to pick up specimen after collect.
Rejection Criteria: Air in sample, clotted, hemolyzed, unlabeled specimens, or received greater than 10 minutes
after collection.

CPT Code: 82810
POWERCHART PANCREATIC ELASTASE 1 FECAL

NAME
MERCY TEST NAME PANCREATIC ELASTASE STOOL* MERCY LAB CODE PANCS
Specimen: Collect 5 gm random stool submitted in a container with a tight-fitting lid. No preservative
Processing: Specimen may be stored refrigerated up to 72 hours following collection. Send frozen to
Mayo. Mayo order code (ELASF).
Separate specimens must be submitted when multiple tests are ordered. If only a
single specimen is collected, it must be split prior to transport.
Performed: 3-5 days; Monday through Friday

Reference Values: Included in report
CPT Code: 82653
POWERCHART PARANEOPLASTIC AUTOANTIBODIES

NAME
MERCY TEST NAME PARANEOPLASTIC AB* MERCY LAB CODE PAVAL

Specimen: 4 mL serum from no additive serum tube (Preferred). Serum from a Serum Separator Tube
(SST) is also acceptable.
Patient o For optimal antibody detection, specimen collection is recommended prior to

Preparation: initiation of immunosuppressant medication or intravenous immunoglobulin
treatment.
o This test should not be requested for patients who have recently received
radioisotopes, therapeutically or diagnostically, because of potential assay
interference. The specific waiting period before specimen collection will depend
on the isotope administered, the dose given, and the clearance rate in the
individual patient. Specimens will be screened for radioactivity prior to
analysis. Radioactive specimens received in the laboratory will be held 1 week and
assayed if sufficiently decayed or canceled if radioactivity remains.
Processing: Send refrigerated (Preferred) to Mayo. Ambient or frozen is also acceptable. Mayo order
code (PAVAL).
Performed: 10-17 days. Profile Tests: Monday through Sunday; Reflex tests: Varies.
Method: *Methodology abbreviations: Immunofluorescence assay (IFA), Cell-binding assay (CBA),

Western blot (WB), Radioimmunoassay (RIA), and Immunoblot (IB)
CPT Code: 86255 x 9, 83519, 86596 If Indicated: 84182-AGNBS, 84182-AMIBS, 84182-AN1BS, 84182-
AN2BS, 86255-CS2CS, 84182-CRMWS, 86255-LG1CS, 84182-PC1BS, 84182-PCTBS, 86256-
AGNTS, 86256-APHTS, 86256-AN1TS, 86256-AN3TS, 86256-CRMTS, 86256-PC1TS, 86256-
PC2TS, and 86256-PCTTS.
POWERCHART PARASITE EXAM
NAME
MERCY TEST NAME PARASITE EXAM* (Ova & Parasites or O & P) MERCY LAB CODE PARSIT
Note: This test should be ordered when suspicion of parasitic infection is based on travel history in
endemic areas or when a patient is immunocompromised.
Comments: It is strongly recommended that multiple stool specimens be submitted for ova and parasite
analysis. At least 3 specimens should be collected, 1 each day or on alternate days (over a
maximum 10-day period).
Parasites are shed irregularly in stool and examination of a single specimen does not
guarantee detection.
Test will NOT detect Cryptosporidium. See “Cryptosporidium” if this test is desired.
This test is useful for patients who have traveled to foreign countries, or an area of the USA
where helminth (worm) infections have been reported with some frequency.
For patients who have not traveled, order Giardia and Cryptosporidium Antigen testing
(GLCP) instead of Parasitic Exam, performed at MercyOne Lab.
Patient Specimen collection should be delayed for 7 to 10 days after administration of barium,
Preparation: bismuth, kaolin, magnesia, castor oil or mineral oil, and 2 to 3 weeks after antibiotics have
been given since these may interfere with identification of protozoa.
Specimen: Stool delivered within 30 minutes of collection: 5-10 gm of feces submitted in a clean
container with tight fitting lid. Mercy lab will transfer the stool into the Ecofix transporter
(within 30 minutes of collection).
If stool will not be delivered within 30 minutes of collection: The patient will need to transfer
the stool into an Ecofix transporter before the delivery of specimen to the lab. Transfer
enough stool to bring the liquid level up to the fill line, indicated on the Ecofix preservative
vial. Mix the contents of the tube with the spoon, twist the cap tightly closed and shake
vigorously until the contents are well mixed.
Do NOT fill above the line indicated on the container.
Deliver Ecofix transporter to lab within 5 days of collection.
Mercy Inpatient Specimens collected from inpatients after the fourth hospital day will NOT be tested
Comments: without prior approval from the Microbiology Department.
Processing: Send ambient (preferred) to Mayo. Refrigerated is also acceptable. Mayo order code (OPE).
Method: Microscopic
CPT Code: 87177

87209
POWERCHART PARATHYRIOD HORMONE (PTH) INTRAOPERATIVE
NAME
MERCY TEST NAME PTH INTRAOPERATIVE MERCY LAB CODE PTHIO
Specimen: 0.5 ml serum from a Serum Separator Tube (SST)

Comment: Creatinine, Calcium, Phosphorus is not included and must be ordered separately or as part
of another panel if desired
Stability: Plasma: 8 hours room temperature, 48 hours refrigerated, freeze if >48 hours.
Serum: 4 hours room temperature, 8 hours refrigerated, freeze if >8 hours.
Performed: Stat will take approximately 25 minutes from receipt to result.
For Intraoperative Mode of testing in patients undergoing parathyroidectomy for primary

hyperparathyroidism, the following practices are recommended:
Baseline samples should be drawn at pre-operation/exploration and pre-excision.
Samples should be drawn at 5- and 10-minutes post-resection of the hyperfunctioning
parathyroid tissue.
At least a 50% reduction in PTH value should be observed when the highest baseline sample
is compared to the post-resection samples.
The Intraoperative Mode testing is NOT recommended for use in routine PTH testing
Reference value: 12-88 pg/ml
Method: Immunoenzymatic("sandwich") assay.
CPT Code: 83970 Parathyroid Hormone
POWERCHART PARATHYROID HORMONE INTACT
NAME
MERCY TEST NAME PTH INTACT MERCY LAB CODE PTHINT

Stability: Specimens may be stored for up to 8 hours at 25°C, 2-8°C for up to 8 hours, or stored frozen
for up to 1 month at ≤ 20°C.
Comment: For serum specimens, complete clot formation should take place before centrifugation.
Serum should be physically separated from cells as soon as possible with a maximum limit of
2 hours from the time of collection.
Performed: Within 8 hours of receipt. Available stat. May be used for Intraoperative testing as well.
Reference Range: 12-88 pg/ml
Method The Atellica IM PTH assay is a 2-site sandwich immunoassay using direct chemiluminescent
Description: technology, which uses constant amounts of 2 anti-human PTH antibodies.
CPT Code: 83970 Parathyroid Hormone
POWERCHART PARVOVIRUS B19 IgG IgM ANTIBODIES

NAME
MERCY TEST NAME PARVOVIRUS B19* MERCY LAB CODE HPB
o Maintain sterility of specimen.
o Send to Mayo refrigerated. Frozen and ambient also acceptable.
o Mayo order code (PARVs).
Cause for
Hemolyzed specimens not acceptable.
rejection:
Performed: 1 day. Test set up Monday through Friday; 11 a.m.
Reference Values: Included in report
Method: Enzyme Immunoassay.

CPT Code: 86747 x2 (IgG, IgM)
POWERCHART
PERTUSSIS PCR
NAME
MERCY TEST NAME PERTUSSIS PCR* MERCY LAB CODE BPC
Specimen: Nurse to collect. Use the kit provided by Mercy Microbiology Lab.
o Collect one nasopharyngeal swab (provided in kit) by passing the swab through the
nares of the patient until resistance signifies the swab has reached the posterior
wall of the pharynx. Rotate axially and hold for 30-60 seconds or until coughing
occurs or the patient resists. Perform this same technique for both nares, using the
one swab provided.
o Place the swab in the empty tube provided and cut the swab off, ensuring it is cut
short enough to allow the lid to be screwed on the tube. Screw the lid on the tube
securely. Write the patient's name, date, and time of collection on the tube that
contains the swab.
o Complete the patient information form and return with the specimens to Mercy
Lab. Submit specimen at room temperature.
Alias:
o BORDETELLA PERTUSSIS PCR
RL Client Collection kits can be requested directly from the State Hygienic Lab if RL clients
o
Comments: would like to send the kits directly from their site, otherwise kits can be requested
from Mercy Microbiology.
Processing: Specimens are sent to State Hygienic Lab, Iowa City (SHL)
Performed: TAT within 1-3 days, from time of receipt at SHL
Method: PCR
CPT Code: 87798
POWERCHART pH BLOOD VENOUS

NAME
MERCY TEST NAME pH VENOUS MERCY LAB CODE PHV
Specimen: o 0.5 ml whole blood from green top tube.

o Keep the tube capped until analysis.
o For single pH Venous orders, completely fill a separate tube.
o Place on ice and deliver to the Lab immediately.
Processing: Perform test within 1 hour.
Performed: Immediately upon receipt. Available stat.
Normal values: 7.31 - 7.41
Method: Direct Potentiometry
CPT code: 82800
POWERCHART pH NASOGASTRIC
NAME
MERCY TEST NAME PH NASOGASTRIC MERCY LAB CODE NGPH
Specimen: o 0.5 ml nasogastric specimen.

o Collect in clean dry container.
o Deliver to Lab within 1 hour of collection.
Normal values: 1.5 - 3.5
Method: pH indicator strips.
CPT Code: 83986
POWERCHART pH Pleural Fluid

NAME
MERCY TEST NAME pH Pleural Fluid MERCY LAB CODE PHPLEU
Specimen: o 0.5 ml Pleural Fluid collected in a syringe.

o Keep the syringe capped until analysis.
o Place on ice and deliver to the Lab immediately.
Processing: Perform test within 1 hour.
Performed: Immediately upon receipt. Available stat.
Normal values: Normal Range has not been established. The test must be integrated into the clinical context
for interpretation.
Method: Direct Potentiometry
CPT code: 82800
MERCY TEST NAME PHENCYCLIDINE UR* PCP CONFIRMATION MERCY LAB CODE UPCP

Processing: Send refrigerated to Mayo laboratories, Mayo code - (PCPU).
Performed: Mondays
Method: Gas Chromatography - Mass Spectrometry (GC - MS) Confirmation and Quantitation
CPT Code: G0480 / 83992
POWERCHART PHENOBARBITAL LEVEL

NAME
MERCY TEST NAME PHENOBRB MERCY LAB CODE PHNB
Specimen: 0.5 mL
Comment: Indicate time of last does in comment field.
Therapeutic 15-40 mcg/mL

Range:
Method The Atellica® CH Phenobarbital (Phnb) assay is a homogeneous particle-enhanced
Description: turbidimetric inhibition immunoassay (PETINIA) technique which uses a synthetic particle-
phenobarbital reagent (PR) and phenobarbital-specific monoclonal antibody (Ab).
CPT Code: 80184
POWERCHART PHENYTOIN (DILANTIN) TOTAL AND FREE

NAME
MERCY TEST NAME PHENYTOIN TTL&FREE MERCY LAB CODE PHYF
Alias: DILANTIN/ DIPHENYLHYDANTOIN (Free)
Specimen: 2 mL serum from plain red-top tube.
Stability: 7 days refrigerated
Comment: Includes Free and Total Phenytoin.
Grossly hemolyzed specimens will be rejected.
Performed: Completed at Mayo laboratories with 1 day’s turnaround time: Mayo code - (PNTFT)
Reference Range: Included in the report.

Method Free phenytoin is isolated from serum by ultrafiltration. The phenytoin assay is based on the
Description: kinetic interaction of microparticles in a solution (KIMS). Phenytoin antibody is covalently
coupled to microparticles, and the drug derivative is linked to a macromolecule.
CPT Code: 80186 Phenytoin Free*

80185 Phenytoin Total*
POWERCHART PHLEBOTOMY THERAPEUTIC

NAME
MERCY TEST NAME PHLEBOTOMY MERCY LAB CODE PHLB
Comment: Test available ONLY Monday-Friday 0800-1530 by appointment only. Appointments can be
set up by calling the cancer center scheduling desk at 641 428 6321. Not available stat
except with special arrangements between laboratory and staff physician. A written order by
the physician is necessary. Lab will order a hemoglobin on any patient, not followed with
ferritin values, who has not had a hemoglobin performed at MMC-NI within the past 30 days
if the patient present without any pre-phlebotomy orders. If the following criteria are not
met, pathologist authorization must be given to proceed with the phlebotomy.
ALL NEW PHLEBOTOMY PATIENTS:

Hemoglobin: Female >12.5 gm/dl Male >13.5 gm/dl
OR above the target set by physician;
OR if ferritin levels are monitored, the previous ferritin obtained within 2 months must be
>30 ng/ml or above the target set by physician.
No more than 450 ml whole blood every 24 hours may be collected from the patient.
Method: Venipuncture
CPT Code: 99195 Phlebotomy+
POWERCHART PHOSPHORUS LEVEL

NAME
MERCY TEST NAME PHOSPHORUS MERCY LAB CODE PHOS

Stability: 2–8°C or stored frozen for up to several months at -70°C for serum.
Method The Atellica CH Inorganic Phosphorus (IP) assay is based on the Daly and Ettingshausen
Description:
procedure, which relies on the formation of a UV absorbing complex between phosphorus
and molybdate.
CPT Code: 84100
POWERCHART PHOSPHORUS 24 HOUR URINE

NAME
MERCY TEST PHOSPHORUS 24UR MERCY LAB CODE VPHS

NAME
Specimen: Aliquot of 5 ml from a 24-hour urine specimen refrigerated during collection.

Stability: Refrigerated acidified specimens are stable for up to 6 months at 2–8°C.
Comment: Acidify with HCl after collection to achieve a pH of < 3.
Reference
0.4-1.3 g/24 hours
Range:
Method The Atellica CH Inorganic Phosphorus (IP) assay is based on the Daly and Ettingshausen
Description: procedure, which relies on the formation of a UV absorbing complex between phosphorus
and molybdate.
CPT Code: 84105
POWERCHART PINWORM EXAM

NAME
MERCY TEST NAME PINWORM PREP MERCY LAB CODE PIN
Specimen: Collect the specimen on a pinworm paddle. Paddles are available from the Microbiology
Department.
o Collect in the morning, before the patient has bathed.

o Touch the sticky side of the paddle to several areas directly around the anal
opening.
o Place the paddle back in the transport tube.
Cause for Stool specimens will not be accepted for pinworm examination. Pinworm ova are RARELY
rejection: seen in stool specimens.
RL Client
Comments: o Write PINWORM PREP on the order form.
Processing: Send at room temperature.
Performed: Monday - Friday 1400 cutoff
Reference value: No Enterobius vermicularis ova seen
Method: Direct microscopy
CPT Code: 87172
POWERCHART PLASMA CELL DNA CONTENT PROLIFERATION

NAME
MERCY TEST NAME PLASMA CELL DNA MERCY LAB CODE PCPRO
Specimen: o4.0 ml processed bone marrow.

o Collected in ACD (preferred), EDTA or sodium heparin tubes acceptable.
Processing: Samples MUST arrive within 72 hours of collection. Include patient history. Send ambient
to Mayo. Mayo test code (PCPRO).
Performed: 2 days. Specimens are processed Monday-Sunday. They are reported Monday-Friday.
Method: Flow Cytometry, DNS Content, Cell Cycle analysis
CPT Code: 88182 Flow Cytometry Cell cycle or DNA Analysis
88184 Flow Cytometry First Marker
88185 (x5) Flow Cytometry, Each Additional Marker
88187 Flow interpretation: 2 to 8 markers
POWERCHART PLASMA HEMOGLOBIN

NAME
MERCY TEST NAME PLASMA HEMOGLOBIN MERCY LAB CODE PHGB
Specimen: 2 ml EDTA plasma from purple top tube.

Cause for
Serum unacceptable and will not be tested.
rejection:
Processing: o Centrifuge and separate immediately, plasma must be separated within 2 hours of collection.
o IMPORTANT-Results could be falsely elevated due to artifactual post draw RBC lysis, if not
spun down within 2 hours.
o Send refrigerated to Mayo. Mayo test code (PLHBB). Frozen and ambient also acceptable.
Performed: Test set up Monday through Sunday.
Method: Spectrophotometry
CPT Code: 83051
POWERCHART PLATELET COUNT

NAME
MERCY TEST NAME PLATELET COUNT MERCY LAB CODE PLTX

Processing: Specimen stable 24 hours at room temperature or 48 hours refrigerated.
CPT Code: 85049
POWERCHART IMMATURE PLATELET FRACTION

NAME
MERCY TEST NAME IMMATURE PLATELET MERCY LAB CODE IPFP
Includes: Platelet Immature Platelet Fraction (IPF)
Specimen: 1 purple top (EDTA) tube

Stability: 24 hours room temperature, or 48 hours refrigerated
Reference value: Immature Platelet Fraction / IPF 1.0 - 7.0%
Method: Sysmex XN automated hematology analyzer

CPT Code: 85055
POWERCHART PLATELET INHIBITION ASPIRIN

NAME
MERCY TEST NAME PLT INHIB ASPIRIN MERCY LAB CODE PLTASR
Specimen: Draw one waste tube (blue top tube or plain red top tube.) followed by 2 blue top Greiner
tubes. Blue top Greiner tubes fill only half full. Use 21 gauge or larger needle to draw. If
drawing with a syringe, use first syringe to draw waste or other tests, change syringe and
use 2nd syringe for this test. GENTLY invert tube 5 times to mix. DO NOT shake or send in
pneumatic tube system. DO NOT refrigerate or centrifuge. Always draw blue top tubes
before purple top tubes. Flag top of tubes for indication not to spin.
Cause for
Specimen older than 4 hours, refrigerated, or centrifuged.
rejection:
Reference range: Results are reported in ARU (Aspirin Reaction Units).
>550 ARU - Platelet dysfunction consistent with aspirin has not been detected.
Method: Verify Now System

CPT Code: 85576
Limitations: This assay is not for use in patients with underlying congenital platelet abnormalities,
patients with non-aspirin induced acquired platelet abnormalities or in patients receiving
non-aspirin anti-platelet agents.
(May be used in patients treated with selective COX-2 inhibitors, e.g., celecoxib (Celebrex).
Verify Now Aspirin Assay is a qualitative assay to aid in the detection of platelet dysfunction
due to aspirin ingestion. Other uses of the ARU value are not endorsed by Accumetrics and
is not FDA cleared.
Interference Studies:
The following medications may cause a change in platelet function.
Patients who have been treated with eptifibatide (Integrillin) and tirofiban (Aggrastat) should
not be tested for 48 hours, or abciximab (ReoPro) for 14 days.
Anti-Platelet agents can inhibit platelet function and may result in a decreased ARU value
independent of the effects of aspirin. Average duration times are Plavix and Ticlid - 5 days,
Aggrenox - 10 days, Persantine and Platell/Cilostazol - 12 hours.
NSAID's inhibit platelet function, but not irreversibly like aspirin. Average times for inhibitory
effects for each drug are Ibuprofen - 8 hours: Naproxen, Diclofenac, Indocin - 24 hours,
Feldene 50 hours.
POWERCHART PLATELET INHIBITION P2Y12

NAME
MERCY TEST NAME PLT INHIB P2Y12 MERCY LAB CODE PLTIHB
Includes: PLT Inhibition P2Y12

Comment: This test may be used to follow patients taking any approved thienopyridines drugs,
including Plavix (Clopidogrel), Ticlid (Ticlopidine) and Effient (Prasugrel).
Specimen: Draw 1 waste tube (plain red top or blue top tube) followed by 2 blue top Vacuette Greiner
tubes. Blue top Greiner tubes fill only half full. Use 21 gauge or larger needle to draw. If
drawing with a syringe, use first syringe to draw waste or other tests, change syringe and
use 2nd syringe for this test. GENTLY invert tube 5 times to mix. DO NOT shake or send in
pneumatic tube system. DO NOT refrigerate or centrifuge. Always draw blue top tubes
before purple top tubes. Flag top of tubes for indication not to spin.
Cause for
Specimen older than 4 hours, refrigerated, or centrifuged.
rejection:
Therapeutic range: Therapeutic range is
Normal range: PLT Inhibition P2Y12: 194-418 PRU (P2Y12 Reaction Units) for person not
taking thienopyridines drugs.
Method: Verify Now System

CPT Code: 85576
Limitations: Patients with inherited platelet disorders such as von Willebrand Factor Deficiency,
Glanzmann Thrombasthenia and Bernard-Soulier syndrome have not been studied with this
assay. Therefore, this assay is not intended for use with these types of platelet disorders.
Interfering Substances:
o Glycoprotein IIb/IIIa inhibitor (abciximab, eptifibatide, and tirofiban) and

antiplatelet agents (cilastazol) inhibit platelet function. Some degree of platelet
inhibition by these drugs was detected.
o Drugs that affect platelet function may be detected up to 14 days after ingestion.
o Other classes of commonly used drugs were tested with no significant effect on
assay performance: antioxidants, ACE inhibitor, antiarrhythmics, anticoagulants,
aspirin, antidepressants, insulin, allopurinol, alcohol, beta blockers,
bronchodilators, calcium channel blockers, gastrointestinal medications,
betamethasone, lovastatin, NSAIDs (including COX-1 and COX-2 enzyme inhibitors),
and the thyroid hormone L-thyroxine.
The thrombolytic agent streptokinase showed no significant inhibition of platelet
function.
o Results may not be available for patients with a platelet count <50,000.
POWERCHART PLATELET MAPPING TEG

NAME
MERCY TEST NAME PLATELET MAPPING MERCY LAB CODE PLTMAP
Specimen: o Non-gel heparin dark green top tube

Reference Values:

CPT Code: 85576 x3
POWERCHART TRANSFUSION ORDER SET PLATELET PRODUCT FOR INFUSION
NAME
MERCY TEST NAME PLATLTS FOR INFUS MERCY LAB CODE TPLT
Comment: A Platelet Count must also be ordered if one has not been performed at Mercy Medical
Center-North Iowa within one week prior to platelet infusion. Pheresis platelets and
Acrodose platelets are stocked depending upon our blood supplier's availability. Both are
prestorage leukoreduced and equivalent in dosage to 6-8 random platelets.
An order for pheresis platelets may be filled with either product. If irradiation is need,
indicate so in the comment field for EACH order placed. It is not sufficient to send a message
to cover all orders. Call the Lab when irradiated platelets are ordered. Orders for irradiated
platelets must be entered into the computer and called to the Lab no later than 1515,
Monday through Friday. Special arrangements must be made if irradiated products are
requested after 1515 or on weekends or holidays.
PHERESIS PLATELETS:
Order PLATELETS FOR INFUSION (TPLT)
Units ordered: The default is 1 unit. Any additional instructions, such as IRRAD (irradiation
needed), can be entered also at this time. All pheresis platelets are leuko depleted and
therefore a leukocyte (WBC) removal filter is not needed.
Specimen: No specimen is needed provided the patient's blood type is on file in the lab.
Processing: If RH negative units are required, they may have to be specially ordered from TBCCI.
CPT Code: P9019
POWERCHART PNEUMONIA PANEL PCR
NAME
MERCY TEST NAME PNEUMONIA PANEL PCR MERCY LAB CODE BFPNEU
Note: This does NOT test for SARS COVID-19.
Specimen: o Bronchoalveolar lavage (BAL)

o Sputum
Stability Refrigerated for up to 1 day (2-8 °C)
Comments o Only order with evidence of lower respiratory tract pneumonia.

o Do not order with Respiratory Panel PCR
Targets:

Referenced Value: Not Detected
Complete report will be scanned into EMR
Method: Polymerase chain reaction (PCR)
CPT Code: 87633 or 87631 (Medicare/Medicaid)
POWERCHART PORPHYRIN QUANTITATIVE FRACTION 24 HOUR URINE

NAME
MERCY TEST NAME PORPHY QNT 24UR* MERCY LAB CODE PRPQ
Patient Patient should abstain from alcohol for 24 hours prior to, as well as during, collection.
preparation: Include a list of medications the patient is currently taking.
Includes: Uroporphyrins, heptacarboxylporphyrins, hexacarboxylporphyrins, tricarboxyl,

pentacarboxylporphyrins, coproporphyrins and porphobilinogen.
Specimen: o 24-hour urine specimen.

o Add 5-gram sodium carbonate as a preservative BEFORE starting the
collection. * DO NOT substitute sodium bicarbonate for sodium carbonate.
o PROTECT FROM LIGHT specimen must be collected in amber colored 24-hour
container and aliquoted in amber colored bottle or covered in foil.
o pH of specimen must be >7.0.
Processing: o Aliquot 20-50 ml and indicate total 24-hour volume.
o Send frozen to Mayo. Mayo order code (PQNU).
Performed: 2-3 days. Test set up Monday through Friday; 7 a.m.
Method: High-Performance Liquid Chromatography (HPLC) with Fluorometric Detection.
CPT Code: 84120 Porphyrins, Quantitative and Fractionation
84110 Porphobilinogen, Quantitative
POWERCHART PORPHYRIN QUANTITATIVE FRACTION RANDOM URINE

NAME
MERCY TEST NAME PORPHY QNT RNDM UR* MERCY LAB CODE PORPHR
Specimen: o 20 - 50 mL random urine.

o PROTECTED FROM LIGHT.
o Note: Patient should abstain from alcohol 24 hours prior to collection. Please
include list of medications the patient is currently taking and forward with the
specimen.
Processing: o Specimen should be sent frozen within 72 hours to Mayo in a amber vial
to PROTECT FROM LIGHT.
o Mayo order code (PQNRU).
Method: High Performance Liquid Chromatography with Fluorometric Detection (HPLC)
CPT Code: 84120 Porphyrins
84110 Porphobilinogen
POWERCHART POTASSIUM LEVEL

NAME
MERCY TEST NAME POTASSIUM MERCY LAB CODE K

Stability: Serum may be stored for up to 7 days at 2–8°C or stored frozen for up to 30 days at
-20°C.
Comment: Thawed or frozen specimens which are turbid must be clarified by centrifugation prior to
testing.
Reference Range: 0 - 2 days: 3.7 - 5.9 mmol/L
3 days - 11 months: 4.1 - 5.3 mmol/L
1 - 12 years: 3.4 - 4.7 mmol/L
> 12 years: 3.5 - 5.1 mmol/L
Method: The methods for measurement of electrolytes include flame photometry, spectrophotometry
and direct or indirect ion selective electrode potentiometry.
The A‑LYTE Na, K, and Cl assays use indirect Integrated Multisensor Technology (IMT). There
multisensor.
CPT Code: 84132
POWERCHART POTASSIUM RANDOM URINE

NAME
MERCY TEST NAME POTASSIUM R UR MERCY LAB CODE UK

Stability: Urine may be stored for up to 7 days at 2–8°C or stored frozen for up to 30 days at -20°C.
Reference Range: No established reference range available. Random urine potassium values average 40
mmol/L. These values are diet dependent. Longer 12- or 24-hour urine collections are
preferred.
Description: and direct or indirect ion selective electrode potentiometry.
multisensor.
CPT Code: 84133 Potassium Urine
POWERCHART POTASSIUM 24 HOUR URINE

NAME
MERCY TEST NAME POTASSIUM 24 UR MERCY LAB CODE VK
Specimen: 5 ml of urine from an unpreserved, refrigerated, 24-hour urine specimen.

Stability: Twenty-four-hour urine collection should be made without addition of preservatives. Store
refrigerated at 2–8°C or frozen for delayed analysis.
Reference Range: Potassium:25-125 mmol/24 HR
multisensor.
CPT Code: 84133
POWERCHART PREALBUMIN
NAME
MERCY TEST NAME PREALBUMIN MERCY LAB CODE PAB

Stability: Separated specimens may be stored for up to 8 hours at room temperature or for up to 2
days at 2–8°C or stored frozen at -20°C or colder.

Method The Atellica® CH Prealbumin (PreAlb) assay measures prealbumin in serum by an
Description immunoturbidimetric assay.
CPT Code: 84134
POWERCHART PRE-ECLAMPTIC PANEL

NAME
MERCY TEST NAME PRE-ECLAMPTIC PNL MERCY LAB CODE PEPN
Specimen: Whole blood from EDTA tube and 0.5 ml serum

Stability: EDTA tube: 36 hours room temp or refrigerated, and serum may be stored for up to 8 hours
at room temperature or for up to 2 days at 2–8°C or stored frozen at -20°C or colder.
Comment: Includes CBC with automated diff, ALT, AST, LD, Uric Acid, and Creatinine
Method
Description:
CPT Code: 85025 CBC
84460 ALT
84550 Uric Acid
84450 AST
82565 Creat
83615 LD
POWERCHART PREGNANCY TEST QUALITATIVE SERUM

NAME
MERCY TEST NAME PREG TEST SERUM MERCY LAB CODE HCGS
Specimen: o Preferred: 1 ml serum from a Serum Separator Tube (SST).

o Hemolysis and icterus do not interfere with testing.
Cause for
Plasma is not acceptable.
rejection:
Stability: 8 hours room temp, 48 hours refrigerated, freeze if >48 hours. May be frozen only once.
Reference value: Negative: Non-pregnant females and healthy males
Positive: HCG present is equal to or greater than 10 MIU/ML
Method: Immunoassay with monoclonal antibody.

CPT Code: 84703
POWERCHART PREGNANCY TEST URINE
NAME
MERCY TEST NAME PREG TEST UR QAL MERCY LAB CODE HCGU
Specimen: 5 ml fresh urine specimen (first AM specimen preferred)

Stability: 48 hours refrigerated.
Reference value: Negative: Non-pregnant females and healthy males
Positive: HCG present is equal to or greater than 10 MIU/mL
Method: Immunoassay with monoclonal antibody.

CPT Code: 81025
POWERCHART PRENATAL PANEL WITH HIV

NAME
MERCY TEST NAME PRENATAL PROFILE (WITH HIV) MERCY LAB CODE PTYS & PNP
Includes: Rubella Ab IgG

CBC with Diff
Hep B Surface Ag (HBsAg)
HIV 1 & 2 Ab
Syphilis Total Ab
ABO Group/RH Type
Antibody screen, Antibody ID (when antibody screen is positive)
Comment: Blood Bank Antibody titer is not included. If desired, it must be ordered separately by the
physician.
All reflex testing will be completed at an additional charge. This includes the following:
-Antibody screen is positive; the antibody ID will be done.
-HIV test is positive; a HIV evaluation will be done.
-Hep B Surface Ag is positive, neutralization testing will be done.
-Syphilis test is positive, RPR testing will be done.
Specimen: Two 8.5 mL Serum Separator Tubes (SST), One 6 mL pink top (EDTA) tube, and one 3 mL
purple top (EDTA) tube.
Specimen Minimums:
Pink tube: 2 mL for ABO/RH & Antibody Screen.
Purple tube: 1 mL for CBC. May also use a capillary tube minimum of 300 mcl.
SST tube: 3-4 mL serum.
Processing: CBC is stable 36 hours at either room temperature or refrigerated.

HBsAg, HIV, Syphilis, and Rubella: Centrifuge within 6 hours of draw and leave in original tube.
-Label 1st tube: HBsAg & HIV. Label 2nd tube: Rubella & Syphilis.
Type & Screen: One Pink top tube, centrifuged, Do NOT Aliquot.
Performed: Type & Screen: Daily.

Syphilis: Monday-Friday 0800 cutoff.
Rubella, HIV, and HBsAg: Within 8 hours of receipt.
CBC: Within 8 hours of receipt.
Reference value: See individual test entries.
Method: See individual test entries.
CPT Code: 85025 CBC with Diff

87340 Hepatitis B Surface Ag
87389 HIV 1 & 2 Ab
86762 Rubella Ab IgG
86780 Treponema Pallidum (Syphilis)
86850 Antibody Screen RBC
86900 Blood Typing ABO
86901 Blood Typing RH (D)
POWERCHART PRENATAL PANEL (NO HIV)
NAME
MERCY TEST NAME PRENATAL PROF (NO HIV) MERCY LAB CODE PNPO & PTYS
Includes: Rubella Ab IgG

CBC with Diff
Hep B Surface Ag (HBsAg)
Syphilis Total Ab
ABO Group/RH Type
Antibody screen, Antibody ID (when antibody screen is positive)
Comment: Blood Bank Antibody titer is not included. If desired, it must be ordered separately by the
physician.
All reflex testing will be completed at an additional charge. This includes the following:
-Antibody screen is positive; the antibody ID will be done.
-Hep B Surface Ag is positive, neutralization testing will be done.
-Syphilis test is positive, RPR testing will be done.
Reference Lab Clients: Please specify on order form PNP/NO HIV. If nothing is specified, a
Prenatal Profile with HIV will be done.
Specimen: Two 8.5 mL Serum Separator Tubes (SST), One 6 mL pink top (EDTA) tube, and one 3 mL
purple top (EDTA) tube.
Specimen Minimums:
Pink tube: 2 mL for ABO/RH & Antibody Screen.
Purple tube: 1 mL for CBC. May also use a capillary tube minimum of 300 mcl.
SST tube: 3-4 mL serum.
Processing: CBC is stable 36 hours at either room temperature or refrigerated.

HBsAg, Syphilis, and Rubella: Centrifuge within 6 hours of draw and leave in original tube.
-Label 1st tube: HBsAg. Label 2nd tube: Rubella & Syphilis.
Type & Screen: One Pink top tube, centrifuged, Do NOT Aliquot.
Performed: Type & Screen: Daily.

Syphilis: Monday-Friday 0800 cutoff.
Rubella and HBsAg: Within 8 hours of receipt.
CBC: Within 8 hours of receipt.
Reference value: See individual test entries.
Method: See individual test entries.

CPT Code: 85025 CBC with Diff
87340 Hepatitis B Surface Ag
86762 Rubella Ab IgG
86780 Treponema Pallidum (Syphilis)
86850 Antibody Screen RBC
86900 Blood Typing ABO
86901 Blood Typing RH (D)
POWERCHART PRIMIDONE (MYSOLINE) WITH PHENOBARBITAL LEVEL

NAME
MERCY TEST NAME PRIMIDON PHENOBRB* MERCY LAB CODE PRIM
Comments: DO NOT order an additional Phenobarbital. Indicate time last dose in the comment field.
Specimen: 0.5 ml serum from a Serum Separator Tube (SST). Send specimen Refrigerated. Mayo order
code (PRMB).
Performed: 1 day. Monday through Sunday.
Method: Immunoassay
CPT Code: 80188 Primidone
80184 Phenobarbital
POWERCHART PROCALCITONIN LEVEL

NAME
MERCY TEST NAME PROCALCITONIN MERCY LAB CODE PCTB

Freeze samples at ≤ -20°C if the sample is not assayed within 48 hours. Freeze samples up to
5 times and mix thoroughly after thawing.

Reference Range: 0-0.10 ng/mL
Method The Atellica IM BRAHMS PCT assay is a 2-site sandwich immunoassay using direct
Description: chemiluminescent technology that uses 3 mouse monoclonal antibodies specific for PCT.
CPT Code: 84145
POWERCHART PROCESSING COLLECTION KIT

NAME
MERCY TEST NAME PROCESSING CHG MERCY LAB CODE PRCS

Comment: To be ordered on any specimen collected for shipping and testing at an outside facility when
the order and results are not handled through Mercy.
POWERCHART PROGESTERONE LEVEL

NAME
MERCY TEST NAME PROGESTERONE MERCY LAB CODE PROG

Comment: Storing progesterone samples in gel barrier tubes can affect progesterone results.
Progesterone samples collected in gel barrier tubes should be tested within 24 hours.

Reference Range: Male: 0 - 1 years: 0.87 - 3.37 ng/ml
Male: 2 - 9 years: 0.12 - 0.14 ng/ml
Male: 10 - 18 years: Adult levels are attained by puberty
Male, adult: 0.1 - 2.1 ng/ml
Female: 0 - 1 years: 0.87 - 3.37 ng/ml

Female: 2 - 9 years: 0.20 - 0.24 ng/ml
Female: 10 - 18 years: Values increase through puberty and adolescence.
Non-pregnant female: mid-follicular phase: 0.3 - 1.5 ng/ml.
mid-Luteal phase: 5.2 - 18.6 ng/ml
Post menopausal, (not on hormone replacement therapy):
Pregnant female: first trimester: 4.7 - 50.7 ng/ml.
second trimester: 19.4 - 45.3 ng/ml.
Method The Atellica IM PRGE assay is a competitive immunoassay using direct chemiluminescent
CPT Code: 84144
POWERCHART PROLACTIN LEVEL

NAME
MERCY TEST NAME PROLACTIN MERCY LAB CODE PRL

Comment: Pregnancy, lactation, and the administration of oral contraceptives can increase prolactin
concentrations.
Reference Range: Male: 2.6 - 13.1 ng/ml

Female: >50 years: 2.7 - 19.6 ng/ml
<50 years: 3.3 - 26.7 ng/ml
Method The Atellica IM Prolactin assay is a 2-site sandwich immunoassay using direct
Description: chemiluminescent technology, which uses constant amounts of 2 antibodies.
CPT Code: 84146
POWERCHART PROSTATIC ACID PHOSPHATASE

NAME
MERCY TEST NAME PROSTATIC ACID PHOS* MERCY LAB CODE ACPH

Processing: Send refrigerated to Mayo. Mayo test code (PACP).
Performed: 1-3 days. Test set up Monday through Friday; 5 a.m.- 12 a.m., Saturday; 6 a.m.- 6 p.m..
Method: Automated Chemiluminescent Immunometric Assay.
CPT Code: 84066
POWERCHART PROTEINASE 3 AUTOANTIBODY

NAME
MERCY TEST NAME PROTEINASE 3 AB* MERCY LAB CODE PRT3AB
Comment: If Cytoplasmic Neutrophil ABS is ordered and p-ANCA is positive, Proteinase 3

Autoantibodies will be done and charged per Mercy Medical Center - North Iowa Lab policy.
Test is also included in Cytoplasmic Neutrophil Antibodies Vasculitis Panel. (VAPNL)
Processing: Send refrigerated to Mayo. Mayo order code (PR3).
Performed: 1 day. Monday through Saturday.
Reference Value: Reference ranges included with results.

CPT Code: 83516
POWERCHART PROTEIN C ACTIVITY

NAME
MERCY TEST NAME PROTEIN C ACTIVITY* MERCY LAB CODE PRTCA
Specimen: 1 mL platelet-poor plasma from blue top (citrate) tube.

Processing: Double spin specimen to ensure that all platelets are removed:
o Centrifuge specimen.
o Aliquot plasma (leaving some above the cells) to a plastic centrifuge tube.
o Centrifuge the aliquot tube.
o Pipette plasma (leaving some above the bottom of the tube) to another plastic
aliquot tube.
o Send frozen to Mayo. Mayo order code (CFX).
Performed: 1 - 3 days. Monday through Friday.
Method: Amylolysis of Chromogenic Substrate
CPT Code: 85303
POWERCHART PROTEIN C ANTIGEN

NAME
MERCY TEST NAME PROTEIN C AG* MERCY LAB CODE PCAG
Note: Due to manufacturer supply backorder at Mayo, PCAG is temporarily unavailable. Recommended
alternative test is Mayo: FPCTA. Order CMIS: FPCTA (Protein C, Total Antigen). See Mayo Lab Test Index for
specimen requirements.
POWERCHART PROTEIN CREATININE RATIO RANDOM URINE

NAME
MERCY TEST PROTEIN/CREATININE RATIO URINE MERCY LAB CODE UPCRTO

NAME
Specimen: 5 ml random urine
Stability: Urine specimens may be stored for up to 4 days at 2–8°C or stored frozen at or below -20°C.

Reference Range: Protein Random Urine: 0 - 13.5 mg/dl
Creatinine Random Urine: no reference value available
Protein/Creatinine Ratio Urine:>3.5 is in the nephrotic range.
Method See individual test entry.

Description:
CPT Code: 82570 Creatinine Urine
84156 Protein Total Urine
POWERCHART PROTEIN S ACTIVITY
NAME
MERCY TEST NAME PROTEIN S ACTIVITY* MERCY LAB CODE PRSA
Specimen: 1 mL platelet-poor plasma from blue top (citrate) tube.

Processing: Double spin specimen to ensure that all platelets are removed:
o Centrifuge specimen.
aliquot tube.
o Send frozen to Mayo. Mayo test code (SFX).
Performed: 1 - 4 days. Monday through Friday.
Method: Optical Clot-Base
CPT Code: 85306
POWERCHART PROTEIN S ANTIGEN

NAME
MERCY TEST NAME PROTEIN S ANTIGEN* MERCY LAB CODE PSAG
Specimen: 1.0 mL platelet-poor plasma from blue top (citrate) tube. Must send 0.5 mL in 2 separate
aliquot tubes.
Processing Double spin specimen to ensure that all platelets are removed:
o Centrifuge specimen
aliquot tube.
o Send frozen to Mayo. Mayo order code - (PSTF)
Comment If this initial Protein S Antigen free testing is abnormal, the Protein S Antigen Total will be
Performed: 1 - 3 days. Monday through Friday
CPT Code: 85306 Free Protein S Antigen
85305 Protein S Antigen Total (If Appropriate)
POWERCHART PROTEIN
NAME
MERCY TEST NAME PROT TTL MERCY LAB CODE TP

Stability: Separated specimens may be stored for up to 8 hours at room temperature6 or for up to 3
days at 2–8°C or stored frozen for up to 180 days at -20°C.
Reference Range: <1 month: 4.4 - 7.6 g/dl
1 -3 months: 4.2 - 7.4 g/dl
4 - 11 months: 5.6 - 7.2 g/dl
≥ 1 year: 5.7 - 7.8 g/dl
Method The Atellica CH Total Protein II (TP) assay is based on the method of Weichselbaum using
Description: biuret reagent.
CPT Code: 84155
POWERCHART PROTEIN BODY FLUID

NAME
MERCY TEST NAME PROT TTL BF MERCY LAB CODE FPRT
Specimen: 1 ml body fluid placed in a sterile container

Analyze fresh specimens or store at 4°C7 for less than 72 hours. Frozen specimens are
Stability:
stable at -20°C for 6 months.
Comment: Indicate specimen source in comment field. Centrifuge before analysis.
Reference Range:
No established reference range available.
Method
The Atellica CH UCFP assay is an adaptation of pyrogallol red-molybdate method.
Description:
CPT Code: 84157
POWERCHART PROTEIN CSF

NAME
MERCY TEST NAME PROT TTL CSF MERCY LAB CODE CPRT
Specimen: 0.5 ml spinal fluid.

Stability: Analyze fresh specimens or store at 4°C7 for less than 72 hours. Frozen specimens are
stable at -20°C for 6 months.
Comment: Centrifuge every CSF specimen and analyze the supernatant. Specimens should not contain
blood and should avoid hemolysis.
Reference Range: 0-3 months: 20-100 mg/dl
>3 months: 15-45 mg/dl
Method
Description:
CPT Code: 84157
POWERCHART PROTEIN 24 HOUR URINE

NAME
MERCY TEST NAME PROT TTL 24UR MERCY LAB CODE VPRT
5 mL of urine from an unpreserved 24-hour urine specimen that was refrigerate during
Specimen:
collection.
After 24 hours, store urine aliquots at 2–4°C for < 72 hours or frozen at -20°C for up to
Stability:
1 year.
Reference Range: 0 - 150 mg/24 hours
Method
Description:
CPT Code: 84156
POWERCHART PROTEIN RANDOM URINE
NAME
MERCY TEST NAME PROT TTL R UR MERCY LAB CODE UPRT

After 24 hours, store urine aliquots at 2–4°C for < 72 hours or frozen at -20°C for up to
Stability:
1 year.
Reference Range: 0 - 13.5 mg/dl
Method
Description:
CPT Code: 84156
POWERCHART PROTHROMBIN G20210A MUTATION

NAME
MERCY TEST NAME PROTHROMBIN G20210* MERCY LAB CODE PTG202
Patient A previous bone marrow transplant from an allogenic donor will interfere with testing. Call
Preparation: 800-533-1710 for instructions for testing patients who have received a bone marrow
transplant.
Specimen: 3 ml whole blood in an EDTA tube.
Processing: Send ambient in original tube. DO NOT ALIQUOT. Mayo order code (PTNT).
Coagulation Consultation Patient Information Sheet must be sent with specimen.
Performed: 3-5 days, weekly.
Reference Value: Included with test results
Method: Direct Mutation Analysis
CPT Code: 81240
POWERCHART PROTIME
NAME
MERCY TEST NAME PROTIME INR MERCY LAB CODE PTR
Specimen: Draw a blue top tube (3.2% Citrate) filled appropriately with amount of blood listed on label.
Cause for
Improperly filled tubes will NOT be tested. Gross hemolysis unacceptable.
rejection:
Processing: Store refrigerated. Unopened, unspun tubes are stable 24 hours from time of collection. If
the order is for only a Protime, freeze if testing will not be done within 24 hours. Freeze
plasma if testing not done within 4 hours of collection if a PTT is also ordered. Label
frozen vial "CITRATED PLASMA". NOTE: Specimens for PTT MUST be removed from cells and
tested within 4 hours of collection or frozen.
Reference value: Protime INR Normal range (for patient not receiving anticoagulant): 0.8 - 1.2
Therapeutic range: Protime INR range: Indications:
2.0 - 3.0 Prophylaxis and treatment of venous
thrombosis
Treatment of pulmonary embolism
Prevention of systemic embolism
Tissue heart valves
Acute myocardial infarction
Valvular heart disease
Atrial fibrillation (valvular and nonvalvular)
INR range: 3.0 - 4.5 Indications:
Recurrent systemic embolism
Mechanical prosthetic valves
(recommendation currently under review)
PT in seconds: 9.5 – 13.3

Method: Photo-optical Clot Detection
CPT Code: 85610
POWERCHART PROTIME
NAME
MERCY TEST NAME PROTIME- POINT OF CARE MERCY LAB CODE PTR
Specimen: Fingerstick specimen obtained off first drop of blood or venous specimen collected in a non-
heparinized syringe.
Cause for Results greater than or equal to 6.0 will require a lab draw to be ran on the analyzer.
rejection: Clinic performed INR testing: Refer to the specific clinic procedure for the INR threshold that
will require a venipuncture specimen for analysis.
Reference value: Protime INR Normal range (for patient not receiving anticoagulant): 0.8 - 1.2
Method: Point of Care
CPT Code: 85610
POWERCHART PSA DIAGNOSTIC
NAME
MERCY TEST NAME PSA MERCY LAB CODE PSA

Freeze samples at ≤ -20°C if the assay is not completed within 48 hours. Do not store in a
frost-free freezer. Freeze samples only 1 time and mix thoroughly after thawing.
Comment: Do not use specimens that have been stored at room temperature for longer than 8 hours.
Obtain Specimen before prostate manipulation procedures.

Reference value: MALE
0 - 49: 0 - 2.5 ng/ml
50 - 59: 0 - 3.5 ng/ml
60 - 69: 0 - 4.5 ng/ml
> 69: 0-6.5 ng/ml
Method The Atellica IM PSA assay is a 2‑site sandwich immunoassay using direct chemiluminescent
CPT Code: 84153
POWERCHART PSA SCREENING

NAME
MERCY TEST NAME PSAS MERCY LAB CODE PSAS

Freeze samples at ≤ -20°C if the assay is not completed within 48 hours. Do not store in a
frost-free freezer. Freeze samples only 1 time and mix thoroughly after thawing.
Comment: **Only for Medicare Screening** The screening prostate specific antigen PSAS test should be
ordered only if all the following conditions are true:
o Patient is 50 years of age or older.

b. Test is being ordered for screening (no medically necessary signs, symptoms, or diagnosis on
the Local Medical Review Policy).
At least 12 months have passed following the month in which the last PSAS was performed.
Do not use specimens that have been stored at room temperature for longer than 8 hours.
Obtain Specimen before prostate manipulation procedures.

Reference value: MALE
0 - 49: 0 - 2.5 ng/ml
50 - 59: 0 - 3.5 ng/ml
60 - 69: 0 - 4.5 ng/ml
> 69: 0 - 6.5 ng/ml
Method The Atellica IM PSA assay is a 2‑site sandwich immunoassay using direct chemiluminescent
CPT Code: 84153
G0103
POWERCHART PSA FREE AND TOTAL

NAME
MERCY TEST NAME PSA, TOTAL/FREE* MERCY LAB CODE FPSA
Processing: Send frozen to Mayo, (PSAFT).
Performed: 3 days. Monday through Saturday
Method: Electrochemiluminescent Immunoassay (ECLIA)
CPT Code: 84153 PSA, Total

84154 PSA, Free
POWERCHART PSEUDOCHOLINESTERASE
NAME
MERCY TEST NAME PSUDOCOLNSTRAS TTL* MERCY LAB CODE CLNS
Processing: Sent refrigerated to Mayo. Mayo order code (PCHE1).
Performed: 1-2 days, Monday through Sunday; continuously.
Reference value:
Method: Colorimetric Assay

CPT Code: 82480
POWERCHART PTT Partial Thromboplastin Time (aPTT)

NAME
MERCY TEST NAME PTT (Partial Thromboplastin Time) MERCY LAB CODE PTT
Specimen: Draw a blue top tube (3.2% citrate) filled appropriately with amount of blood listed on label.
Cause for
Improperly filled tubes will NOT be tested. Avoid gross hemolysis.
rejection:
Processing: In-house patients: Centrifuge immediately. Refrigerate. Test within 4 hours of collection.
if testing will be delayed longer than 4 hours. Double spin coagulation specimens to ensure
that all platelets are removed:
o Centrifuge specimen. Aliquot plasma (leaving some above the cells) to a plastic
centrifuge tube.
o Store plasma in freezer. Label aliquot vial "CITRATED PLASMA."
Regional Lab Clients:
o Centrifuge immediately.
o Aliquot specimen (leaving some above the cells) to a plastic centrifuge tube.
o Send refrigerated if testing can be performed within 4 hours of collection.
o If testing will not be performed within 4 hours freeze specimen and send frozen.
o Label aliquot vial "CITRATED PLASMA."

Reference value: 23.2-34.2 seconds. Applies only to PTT performed at MMC-NI using IL reagent SynthASil lot #
N0670635.
Therapeutic 60-102 seconds. Applies only to PTT performed at MMC-NI using IL reagent SynthASil lot #
range: N0670635.
Method: Photo-optical clot detection.
CPT Code: 85730
POWERCHART RENAL FUNCTION PANEL

NAME
MERCY TEST NAME RENAL (Kidney) FUNCTION PANEL MERCY LAB CODE RPNL
-20°C.
Comment: Includes: Albumin, Anion Gap, BUN, Bun/Creatinine Ratio, Calcium, CO2, Chloride, Creatinine,
eGFR, Glucose, Phosphorus, Potassium, Sodium
Thawed or frozen specimens which are turbid must be clarified by centrifugation prior to
testing.
Method See individual test entry.
Description:
CPT Code: 80069
POWERCHART RENIN LEVEL

NAME
MERCY TEST NAME RENIN ACTIVITY* MERCY LAB CODE RNN
Comment: There can be 2 types of specimens drawn. Please check orders carefully as there are
different requirements for each specimen type.
non-venous specimens: Schedule with Radiology and indicate in the comment field if
specimen is to be other than venous collection. Consult Lab for patient preparation.
Venous specimens: Enter in comment field: venous specimen. Consult lab for patient
preparation.
Specimen: Non-venous: Lab is to draw in conjunction with radiology procedure. Need 2 ml plasma
from pre-chilled purple top tubes. Draw blood with chilled syringe, from a patient in a
seated position, place in chilled tube, mix immediately and place in an ice water bath until
thoroughly chilled.
Venous: Need 2 ml plasma from pre-chilled purple top tubes. Draw with a vacutainer from
patient in seated position.
Mix immediately and place in an ice water bath until thoroughly chilled.
Processing: Centrifuge in refrigerated centrifuge. Separate immediately and freeze. Indicate specimen
source on specimen tube and on order form. Send frozen to Mayo. Mayo order code PRA.
Mercy Lab Processing Note: Due to volumes showing that we are now only using a single
peripheral collection, the source has been hidden on the report and no longer needs to be
resulted. However, if a patient should require collections during a procedure that are non-
venous, the result of HIDE will need to be changed to the specific source of collection.
Performed: 2-5 days. Test set up Monday through Friday ;1 p.m.

Method: Liquid Chromatography - Tandem Mass Spectrometry (LC-MS/MS)
CPT Code: 84244
POWERCHART RESPIRATORY CULTURE + SMEAR DIRECT OTHER

NAME
MERCY TEST NAME RESP UP CLT/GS MERCY LAB CODE RESP
Specimen: Nasopharyngeal, Nose or Sputum
o Nasopharyngeal: Use a Mini-Tip Culturette to collect. Insert swab gently through

the nose to the posterior nasopharynx. Gently rotate the swab. After several
seconds, gently withdraw the swab. Insert the swab back into the Culturette
tube. Specimen stability: <24 hours room temperature
o Nose: Submit specimen on a swab(s) in a double Culturette. Specimen
stability: <24 hours room temperature.
o Sputum: 2 ml minimum. Submit in a sterile plastic container with a tight-fitting lid.
The specimen of choice is an expectorant obtained after a deep cough, preferably
early in the morning. The patient should avoid contaminating the specimen with
saliva. Specimen stability: Expectorated sputum: <24 hours 40 C Induced
sputum: <24 hours room temperature
o Sinus & Sinus meatus: Collected by ENT physician, using the ESWAB specimen
collection device. Specimen stability: deliver to lab same day as collection.
THROAT specimens are not an acceptable specimen for a Respiratory culture. If a
throat specimen is collected, please contact the microbiology lab for other order options.
Comments: o Gram stain is done to assess sputum quality using the following criteria:
o >25 epithelial cells/low power field: The specimen is UNACCEPTABLE for
culture due to the large number of squamous epithelial cells present.
This is indicative of saliva. The specimen must be recollected for culture.
Nursing personnel will be notified by the laboratory.
o 11-25 epithelial cells/low power field: The specimen is probably a mixture
of lower respiratory secretions and saliva. The culture will be done, but
results may be unreliable.
o 0-10 epithelial cells/low power field: This is indicative of a good specimen.
Culture will be processed.
o Sinus Cultures are held for 7 days, and all bacterial growth is identified.
Susceptibility testing is done when possible.
o The gram stain report will also indicate the amount of epithelial cells seen, the
amount of WBCs, and any bacteria that may be present.
o Susceptibility testing will be routinely performed on significant isolates.
RL Client o Mark RESPIRATORY UPPER CULTURE/GRAM STAIN on order form.
Comments: Write collection site on SOURCE line.
If ordering in the computer, order test code RESP
Reference value: Normal flora of the upper respiratory tract
Performed: Gram stain: Within 1 day

Preliminary report: 1 day

87070 Resp Up Clt
POWERCHART RESPIRATORY PANEL PCR with COVID-19

NAME
MERCY TEST NAME RESP PNL COVID19 MERCY LAB BFRESC

CODE
Note: This DOES INCLUDE test for SARS COVID-19.
Specimen: Nasopharyngeal swab in transport media (VTM or ESwab)

Obtain kit from Lab
Stability o Room temperature for up to 4 hours (15-25 °C)

o Refrigerated for up to 3 days (2-8 °C)
o Frozen (≤-15 °C or ≤-70°C) (for up to 30 days)
Comment:
Do not order with Pneumonia Panel PCR
Targets: o Adenovirus
o Coronavirus 229E
o Coronavirus HKU1
o Coronavirus NL63
o Coronavirus OC43
o Human Metapneumovirus
o Human Rhinovirus/Enterovirus
o Influenza A, including subtypes H1, H1-2009, and H3
o Influenza B
o Parainfluenza Virus 1
o Respiratory Syncytial Virus
o Bordetella parapertussis (IS1001)
o Bordetella pertussis (ptxP)
o Chlamydia pneumoniae
o Mycoplasma pneumoniae
Performed:
Within 8 hours of receipt. Available stat
Complete report will be scanned into EMR
SARS COVID-19 will be resulted discretely and found within the Cerner Powerchart Results
Viewer
Method:
Polymerase chain reaction (PCR)
CPT Code: 0202U
MERCY TEST NAME RESP PROFILE REG 8 MERCY LAB RPRS
CODE
Comment: This profile includes Immunoglobulin E, house dust mites DP, house dust mites DF, cat
epithelium, dog epithelium, Bermuda grass, timothy grass, cockroach, penicillium,
Cladosporium, Aspergillus fumigatus, Alternaria alternata, maple box elder, mountain cedar,
white oak, elm, walnut tree, eastern sycamore, cottonwood, white ash, pecan hickory,
mulberry, short ragweed, Russian thistle, rough pigweed, rough marsh elder
Processing Send refrigerated to Mayo.
Mayo test order code (RPR8)
CPT Code:
86003 x26
POWERCHART RETICULOCYTE COUNT (% AND #)

NAME
MERCY TEST NAME RETICULOCYTE CNT MERCY LAB CODE RETIC

Specimen: 1 ml whole blood from purple top tube or capillary specimen. Specimen stable 24 hours
room temp and 48 hours when refrigerated.

Reference value: Retic %: 0.54 – 2.59
Retic Absolute: 0.019 – 0.110 m/mcl
Reticulocyte Hemoglobin (RET-He): 29.0-37.8 pg
Immature Retic Fraction: Male 2.3-13.4% Female 3.0-15.9%
Method: Sysmex XN automated hematology analyzer

CPT Code: 85045
POWERCHART RHIG ELIGIBILITY STUDIES

NAME
MERCY TEST RHIG ADM TESTS MERCY LAB RHEL

NAME CODE
Comment: Ordered by Blood Bank personnel only. Will be ordered by Blood Bank personnel when RH
IMMUNE GLOBULIN WORKUP indicates eligibility for RH Immune Globulin.
Includes: ABO/RH, Antibody Screen, and Fetal/Maternal Screen on the mother.

Specimen: One 6 ml Pink top tube.
Cause for
Specimens collected prior to delivery are not satisfactory for the Fetal/Maternal Screen.
rejection:
Method: Serological
86901 RH+
86850 Antibody Sc
85461 Fetal/Mat Screen+
POWERCHART RHIG LOT NUMBER

NAME
MERCY TEST NAME RHIG LOT # (RH IMMUNE GLOBULIN LOT#) MERCY LAB RHG
CODE
Comment: Please call the Lab when order is placed.
NOTE: If the mother's type is unknown, an ABO Group/Rh Type should be ordered prior to
ordering RHIG. Order in the following conditions on Rh negative mothers: Per physician's
order when the RHIG injection only is ordered prenatally or following miscarriage,
amniocentesis, or after any event which may allow fetal cells to enter the mother's
circulation. If the physician also orders an antibody screen, order Antibody Screen.
Specimen: No specimen needed.
CPT Code: NA
POWERCHART RHIG STUDIES

NAME
MERCY TEST RHIG WORKUP (RH IMMUNE GLOBULIN WORKUP or MERCY LAB RHGW
NAME RHOGAM) CODE
Comment: Order on the mother after delivery. A Cord Blood Routine must be ordered on the neonate.
Includes: ABO/RH and Direct Coomb's (DAT) results for Cord Blood Routine on the neonate.
If mother is eligible for Rh immune globulin injection, Lab will order RHIG Eligibility Studies.
Specimen: None.
Method: Decisional to establish eligibility of mother to receive RHIG.
CPT Code: NA
POWERCHART RIBOSOMAL P PROTEIN IGG ANTIBODY

NAME
MERCY TEST NAME RIBOSOME P AB IGG* MERCY LAB RIBB

CODE
Specimen: 0.5 mL serum from a Serum Separator Tube (SST)

Processing: Send refrigerated to Mayo. Mayo order code (RIB)
CPT Code: 83516
POWERCHART RNA POLYMERASE III AB IGG

NAME
MERCY TEST NAME RNA POLYMERASE AB* MERCY LAB RNAP
CODE
Specimen: 0.5 mL serum from a Serum Separator Tube (SST).

Processing: Send refrigerated to Mayo. Mayo order code (RNAP)
Performed: 1-7 days. Wednesday
CPT Code: 83516
POWERCHART RNP ANTIBODIES, IGG

NAME
MERCY TEST NAME RNP AB IGG* MERCY LAB RNPB

CODE
Processing: Send refrigerated to Mayo. Mayo test order code (RNP)
Performed: 1-2 days. Performed Monday through Saturday; 4 p.m.
CPT Code: 86235
POWERCHART ROTAVIRUS ANTIGEN FECES

NAME
MERCY TEST NAME ROTAVIRUS FECES MERCY LAB RTAV
CODE
Specimen: Minimum of 1 gm of a random stool specimen submitted in a clean container with a tight-
fitting lid. Deliver to the laboratory immediately after collection. Send to Mercy Lab
refrigerated. Specimen is stable 72 hours refrigerated.
Freeze specimen if testing will not occur within 72 hours.
RL Client o Mark ROTAVIRUS on the order form.

Comments: o Refrigerate specimen if unable to deliver to the lab immediately.
o Freeze specimen if specimen will not be delivered and tested within 72 hours of
collection. Specimen MUST remain frozen until testing. NOTE: There may be a
loss of sensitivity of the test procedure when frozen specimens are used. Do
not freeze and thaw specimens repeatedly.
Performed: Daily. Available STAT.
Method: EIA
CPT Code: 87425
POWERCHART RSV ANTIGEN

NAME
MERCY TEST NAME RSV DIR ATGN MERCY LAB RSVS
CODE
Note: Do not order this test on patients greater than 18 years old.
Specimen: Nasal wash/aspirate or Nasopharyngeal swab stored at 2° C - 30° C for up to 8 hours

prior to testing.
Comment: o Test is very specimen dependent. False negatives may be reported if the
specimen is inadequate or poorly collected.
o If Pertussis by PCR is also ordered, collect the Pertussis PCR swabs first.
o Although testing is always available whenever a diagnosis of RSV is suspected,
testing for RSV is not recommended outside of the respiratory virus season or in
the absence of an outbreak due to low specificity of the test.
RL Client o Order test code RSVS or mark RSV ANTIGEN on order form.
Comments:
Processing: Deliver to lab immediately.
Performed: Daily. Available stat.
Reference value: Negative for Respiratory Syncytial Virus
Method: EIA
CPT Code: 87807

POWERCHART RUBELLA ANTIBODY IgG
NAME
MERCY TEST NAME RUBELLA IMM MERCY LAB RBLA

CODE

Stability: Store specimens at 2–8°C for up to 7 days. Specimens may be stored on the clot. Freeze
samples, devoid of red blood cells, at ≤ -20°C for longer storage. Do not store in a
frost-free freezer.
Comment: The performance of the assay has not been established with cord blood, neonatal
specimens, cadaver specimens, or body fluids other than serum or plasma, such as saliva,
urine, amniotic fluid, or pleural fluid.
The performance of the assay has not been established for populations of
immunocompromised or immunosuppressed patients.
Reference Range: Immune
Within 8 hours of receipt
Method The Atellica IM Rub G assay is a sandwich immunoassay using direct chemiluminescent
CPT Code: 86762
POWERCHART RUBEOLA ANTIBODY IGG

NAME
MERCY TEST RUBEOLA AB IGG* (Measles) MERCY LAB ROPG
NAME CODE
Comment: This testing is for the determination of immune status only. Contact the microbiology
department for ordering and collection information should testing for measles as an active
disease state be required.
Cause for rejection: Grossly hemolyzed, lipemic or icteric specimens
CPT Code: 86765
POWERCHART RUPTURE OF MEMBRANES

NAME
MERCY TEST RUPTURE OF MEMBRANES MERCY LAB ROM

NAME CODE
Specimen: Specimen Collection Precautions and Warnings:
o AmniSure should not be used earlier than 6 hours after the removal of any
disinfectant solution or medicines from the vagina.
Cellular debris may potentially interfere with sample preparation.
o Specimens should not be obtained from patients with suspected or known placenta
previa.
o Intended for use in patients with gross bleeding.
Specimen Collection Instructions are included in the collection kit.
Regional Lab: Refrigerate if not tested within 30 minutes. Must be tested within 6 hours.
Method: Rapid Non-instrumented qualitative immunochromatography
CPT Code: 84112
POWERCHART SALICYLATE LEVEL

NAME
MERCY TEST NAME SALICYLATES (ASPIRIN) MERCY LAB CODE SLY

Stability: Specimens are stable for 7 days at 20–25°C or for 14 days at 2–8°C or stored frozen for
6 months at -20°C or colder.
Therapeutic range: <30.0 mg/dL
Method The Atellica CH Sal assay is based on the reaction of salicylate hydroxylase with salicylate
Description: and reduced nicotinamide adenine dinucleotide (NADH).
CPT Code: G0480 / 80179
POWERCHART
ANTI SCLERODERMA (SCL-70)
NAME
MERCY TEST NAME SCK 70 AB IGG* MERCY LAB CODE SCL70B
Processing: Send refrigerated to Mayo. Mayo order code (SCL70)
CPT Code: 86235
POWERCHART
SED RATE - ERYTHROCYTE
NAME
MERCY TEST NAME SED RATE MERCY LAB CODE ESR
Specimen: On Campus; preferred specimen: 1.5 ml whole blood collected in purple top EDTA tube or
500 mcl collected in MAP capillary tube. Draw 2 tubes if CBC and ESR are ordered. Do not
draw in pink top EDTA tubes.
Processing: Refrigerated specimen best if run within 24 hours but will be accepted up to 36 hours.
Reference value: AGE MALE FEMALE
1-30 days 0-2 0-2 MM/HR
30 days - 11 yr. 3-13 3-13 MM/HR
12 - 49 years 0 - 15 0 - 20 MM/HR
> 49 years 0 - 20 0 - 30 MM/HR
Method: Automated, ISED analyzer NOTE: Results from the ISED are not affected by low patient HCT.
Therefore, it may be necessary to establish a new patient baseline.
CPT Code: 85652
POWERCHART SELENIUM LEVEL

NAME
MERCY TEST NAME SELENIUM* MERCY LAB CODE SES
Specimen: o Draw before any other tubes are drawn. 0.8 ml serum from Navy blue monoject-
no additive, trace element blood collection tube.
specimen to separate serum from the cellular fraction. Serum must be removed
from the cells within 4 hours of specimen collection. Pour serum into a
Mayo Metal FREE vial. Do NOT use a transfer pipet or wooden sticks.
o Send to Mayo refrigerated. Ambient acceptable. Mayo order code (SES)
Method: Dynamic Reaction Cell-Inductively Coupled Plasma-Mass Spectrometry (DRC-ICP-MS)
CPT Code: 84255
POWERCHART SELENIUM LEVEL RBC

NAME
MERCY TEST NAME SELENIUM BLOOD* MERCY LAB CODE SEWB
Specimen: o Draw before any other tubes are drawn. 0.8 ml whole blood from metal free Royal
blue top EDTA additive, blood collection tube.
Processing: o Send specimen in original tube.
o Send to Mayo refrigerated. Ambient and frozen are acceptable. Mayo order code
(SEWB)
Performed: 1-7 days. Monday
Method: Inductively Coupled Plasma Mass Spectrometry
CPT Code: 84255
TEST NAME SEMEN ANALYSIS FERTILITY See: Fertility Test Semen (RL Clients ONLY)
POWERCHART SEMEN ANALYSIS

NAME
MERCY TEST NAME SEMEN ANALYSIS MERCY LAB CODE SMEN
Note: For Semen Analysis from Reference Lab Clients please refer to Fertility Test Semen.
Comment: Specimen accepted Monday-Thursday only, not the day before a holiday, until 8 PM
nightly.
Mayo courier picks up specimens at Mercy after 8PM. Specimen should be collected as close
to shipping time as possible. If ONLY a sperm count is ordered, see SPERM COUNT.
Includes: Semen analysis includes description of Appearance, Ph, Volume, Sperm Count, Motility
Evaluation and Sperm Morphology.
Specimen: Semen specimen collected in Semen Collection Kit provided by Mayo. Patient is to deliver
the specimen, packed in the collection kit, to Mercy Lab within 1 hour of collection. For
accurate results, the patient should have 2-7 days of sexual abstinence prior to specimen
collection. It is critical to keep specimen at room temperature.
Processing: Processing must be completed as soon as possible after collection.

Send Semen Fertility to Mayo, Mayo order code (SEMB).
Performed: 2 Days. Monday-Thursday
Reference value: Ph: 7.2 - 8.0
Volume: > 2.0ml
Motility, Count, Morphology: See Mayo report
Method: Includes color, volume, viscosity, pH, % motility, concentration, grade of motility, viability,
morphology, and presence of cellular elements.
CPT Code: 89322 Semen Analysis with Strict Morphology

99001 Processing (For specimens processed at Mercy only)
TEST NAME SEX CHROMATIN See: Cytology Section Barr Body Smear
POWERCHART
NAME SEX HORMONE BINDING GLOBULIN
MERCY TEST NAME SEX HORM BIND GLOB* MERCY LAB CODE SHBG
Specimen: 1 mL serum from a Serum Separator Tube (SST) or no additive serum tube.
Processing: Send refrigerated to Mayo. Mayo order code (SHBG1)
Performed: 1-3 days. Monday through Friday; 5 a.m. - 3 p.m., Saturday; 6 a.m. - 3 p.m.
CPT Code: 84270
POWERCHART SIROLIMUS (RAPAMYCIN) LEVEL
NAME
MERCY TEST NAME SIROLIMUS* MERCY LAB CODE SIRO
Specimen: 3 mL EDTA (Purple Top) whole blood
When a Sirolimus and Tacrolimus are ordered on the same patient 2 tubes must be
collected, one for each test.
Processing: Send specimen in original collection tube. Send Refrigerated to Mayo. Mayo order
code SIIRO
Performed: Daily

Method: Liquid Chromatography / Tandem mass spectrometry
CPT Code: 80195
POWERCHART ANTI SCLERODERMA (SCL-70)

NAME
MERCY TEST NAME SCK 70 AB IGG* MERCY LAB CODE SCL70B
Processing: Send refrigerated to Mayo. Mayo order code (SM)
CPT Code: 86235
POWERCHART SODIUM LEVEL

NAME
MERCY TEST NAME SODIUM MERCY LAB CODE NA

-20°C.
testing.
Reference Range: 0-2 days: 133-146 mmol/L
3 days-11 months: 139 - 146 mmol/L
1-12 years: 138 - 145 mmol/L
≥13 years: 133 - 146 mmol/L
multisensor.
CPT Code: 84295
POWERCHART SODIUM 24 HOUR URINE
NAME
MERCY TEST NAME SODIUM 24 HOUR URINE MERCY LAB CODE VNA
Specimen: 5 ml of urine from a unpreserved, refrigerated, 24-hour urine specimen.

Performed: Within 8 hours of receipt. Stat available.
Reference Range: 40-220 mmol/24 hours
multisensor.
CPT Code: 84300
POWERCHART SODIUM AND POTASSIUM LEVELS

NAME
MERCY TEST NAME RAPID SOD POT MERCY LAB NAK
CODE
OR
0.5 ml whole blood from green top (lithium heparin) tube without gel for ICU patients
-20°C.
Performed: testing.
Reference Range: Sodium
0 - 2 days: 133 -146 mmol/L
3 days-11 months: 139 - 146 mmol/L
1 - 12 years: 138 - 145 mmol/L
>12 years: 133 - 146 mmol/L
Potassium
0 - 2 days: 3.7 -5.9 mmol/L
3 days-11 months: 4.1 - 5.3 mmol/L
1 -12 years: 3.4 - 4.7 mmol/L
>12 years: 3.5 - 5.1 mmol/L
Method The methods for measurement of electrolytes include flame photometry,
Description: spectrophotometry and direct or indirect ion selective electrode potentiometry.
multisensor.
CPT Code: 84295 Sodium
84132 Potassium
POWERCHART SODIUM AND POTASSIUM 24 HOUR URINE
NAME
MERCY TEST NAME SOD POT 24UR MERCY LAB CODE VLYT
Specimen: 5 ml of urine from an unpreserved, refrigerated, 24-hour urine specimen.

Performed: Within 8 hours of receipt. Stat available.
Reference Range: Sodium: 40 - 220 mmol/24 HR
Potassium: 25 - 125 mmol/24 HR
multisensor.
CPT Code: 84300 Sod Urine +
84133 Pot Urine +
POWERCHART SODIUM AND POTASSIUM BODY FLUID

NAME
MERCY TEST NAME SOD POT BF MERCY LAB CODE FLYT
Specimen: 0.5 ml body fluid

Stability: 7 days at 2–8°C or stored frozen for up to 30 days at -20°C.
Comment: Indicate specimen source in comment
.
Performed Within 8 hours of receipt. Available stat.
:
Reference Range: No established reference range available.
multisensor.
CPT Code: 84295 Sodium
84132 Potassium
POWERCHART SODIUM AND POTASSIUM RANDOM URINE

NAME
MERCY TEST NAME SOD POT R UR MERCY LAB CODE ULYT
Specimen: 5 ml random urine. .

Performed Within 8 hours of receipt. Available stat.
:
multisensor.
CPT Code: 84300 Sod Urine+
84133 Pot Urine+
POWERCHART SODIUM RANDOM URINE

NAME
MERCY TEST NAME SODIUM R UR MERCY LAB CODE UNA

Method
Description: The methods for measurement of electrolytes include flame photometry, spectrophotometry
and direct or indirect ion selective electrode potentiometry.
multisensor.
CPT Code: 84300 Sod Urine+
TEST NAME SOMATOMEDIN-C PLASMA* See: Insulin-Like Growth Factor I*
POWERCHART SPERM COUNT

NAME
MERCY TEST NAME SPERM COUNT MERCY LAB CODE SPC
Comment: This is also the test to be ordered when checking for sperm after a vasovasostomy
procedure- slides will come from surgery. Under comment: enter Vasovasostomy and
source. Obtain specimen on a slide and place in the surgery pass through. Notify the Lab
that a specimen is there.
Specimen: Semen specimen collected in a clean plastic container. Deliver to the Lab within 12 hours of
collection. The specimen should not be collected or delivered in a condom. For accurate
results, the male should not ejaculate semen for a minimum of two days prior to specimen
collection.
Processing: Test within 12 hours of collection

Performed: Monday - Friday 0600 - 2000. Saturday and Sunday 0600 – 1500.
Reference value: None seen.
Method: Microscopy
CPT Code: 89321
TEST NAME SPUTUM CYTOLOGY See: Cytology Section Sputum

POWERCHART
SJOGREN'S ANTIBODIES (SSA)
NAME
MERCY TEST NAME SSA ARO AB IGG* MERCY LAB CODE SSAB
Processing: Send refrigerated to Mayo. Mayo order code (SSA)
CPT Code: 86235
POWERCHART
SJOGREN'S ANTIBODIES (SSA/SSB)
NAME
MERCY TEST NAME SSA AND SSB AB IGG MERCY LAB CODE SSABB
Mayo order code (SSAB).

CPT Code: 86225x2
POWERCHART
SJOGREN'S ANTIBODIES (SSB)
NAME
MERCY TEST NAME SS BLA AB IGG* MERCY LAB CODE SSBB
Processing: Send refrigerated to Mayo. Mayo order code (SSB)
CPT Code: 86235
POWERCHART STOOL PATHOGENS PCR

NAME
MERCY TEST NAME STOOL PATHOGENS PCR MERCY LAB CODE STLPCR
Specimen: Preferred Sample: Cary-Blair preserved liquid or soft stool specimens.
Also acceptable: Unpreserved liquid or soft stool specimen in a dry, clean container.
MercyOne lab staff will transfer unpreserved stool sample immediately into a Cary-Blair preservative
container for possible serotyping of any positive result on receipt.
Cause for o Formed specimen.

rejection: o Specimens contaminated with toilet water or urine.
o Avoid using during collection: Nystatin cream, Spermicidal lubricant,
hydrocortisone cream, and Vagisil. These substances have proven to interfere with
testing.
Inpatient orders whose length of stay is more than three days, and whose
o
admitting diagnosis was not gastroenteritis. Clostridium difficile testing should be
considered.
o Exposure to excessive heat
Collection o Inpatient samples should be delivered to lab within 1 hour of collection.
Comments: o RL Clients: Deliver to MercyOne Lab as soon as possible but no later than 4 days after
collection if kept at 2–8 °C in Cary- Blair Transport Container.
o Specimens should be kept between 2 °C and 25 °C during transport.
Result Comments: o Inpatient samples should be delivered to lab within 1 hour of collection.
o RL Clients: Deliver to MercyOne Lab as soon as possible but no later than 4 days after
collection if kept at 2–8 °C in Cary- Blair Transport Container.
o Specimens should be kept between 2 °C and 25 °C during transport.
Reference value: Negative for Salmonella, Shigella, Campylobacter, Yersinia, and Enterotoxic E. Coli (ETEC), Shiga toxin
producing bacteria, Vibrio, or Plesiomonas shigelloides
Performed: Daily, 0900 cut off time for morning run and 1900 cut off time for evening run
Method: Amplified DNA
CPT Code: 87506
POWERCHART STREP PNEUMONIAE ANTIGEN URINE

NAME
MERCY TEST NAME STREP PNEUM AG, UR* MERCY LAB CODE SPNAU
Specimen: Collect random urine specimen.

2 ml random urine in a 10 mL plastic urine tube, no preservative, Refrigerate
Caution: Streptococcus pneumoniae vaccine may cause false-positive results, especially in patients
who have received the vaccine within 5 days of having test performed.
The performance of this assay in patients who have received antibiotics for > 24 hours has
not been established.
The accuracy of this assay has not been proven in small children
Processing: Send Refrigerated to Mayo. Mayo order code (SPNEU).
Performed: Results available 1-2 days, test set up Monday - Friday, 12 p.m.
Method: Immunochromatographic Membrane Assay
CPT Code: 87899
POWERCHART STREP PNEUMONIAE IGG ANTIBODIES 23 SEROTYPES

NAME
MERCY TEST NAME STREP PNEUMO AB* MERCY LAB CODE PN23
Specimen: 0.5 ml serum from a Serum Separator Tube (SST) or a plain red top tube.
Processing: Send refrigerated to Mayo. Mayo code (PN23M)
Method: Microsphere Photometry
CPT Code: 86317 x23

POWERCHART STREP SCREEN THROAT RAPID
NAME
MERCY TEST NAME STREP SCRN THRT MERCY LAB CODE GAS
Specimen: Collect the specimen from the tonsils and pharynx using 2 swabs. Submit in a double
Culturette.
Comments: o A throat culture will be ordered and charged by lab personnel on all negative Rapid
Strep Screens in order to detect very low numbers of beta strep Group A and other
significant beta streptococci.
o This test is very specimen dependent. False negative results may be reported if the
specimen is inadequate or poorly collected.
RL Client
o Write GROUP A STREP SCREEN on the order form.
Comments:
o Send Culturette at room temperature.
Reference value: Negative for Group A streptococcus
Method: EIA
CPT Code: 87880
POWERCHART CULTURE SURVEILLANCE MERCY VRE (VANCOMYCIN RESISTANT ENTEROCOCCUS)

NAME
MERCY TEST NAME VRE SRV CLT / MERCY MERCY LAB CODE VRES
Specimen: Rectal swab. Submit on routine Culturette.
Comment: oThis order screens for colonization of Vancomycin Resistant Enterococcus only.
o Contact the microbiology lab if other sites are being submitted to look for VRE.
Performed: Preliminary report: 2 days.
Final report: 3 days.
Reference value: No Vancomycin Resistant Enterococcus isolated.
CPT Code: 87081
POWERCHART CULTURE SURVEILLANCE EXTERNAL VRE (VANCOMYCIN RESISTANT ENTEROCOCCUS)

NAME
MERCY TEST NAME VRE SRV CLT / NON-MERCY MERCY LAB CODE VREX
Specimen: Rectal swab. Submit on routine Culturette.
Comment: o This order screens for colonization of Vancomycin Resistant Enterococcus only.
o Contact the microbiology lab if other sites are being submitted to look for VRE.
o Send specimen at room temperature.
o Write VRE Screen or VRE Surveillance on the order form.
o This testing will be billed back to the ordering facility.
Performed: Preliminary report: 2 days.
Final report: 3 days.
Reference value: No Vancomycin Resistant Enterococcus isolated.
CPT Code: 87081
POWERCHART SYPHILIS TOTAL ANTIBODY

NAME
MERCY TEST NAME SYPHILIS TOTAL ANTIBODY MERCY LAB CODE SYPHT
WITH REFLEX

Processing: Specimen can be refrigerated up to 7 days, before testing. After 7 days specimens should be
frozen
Comment: Included in prenatal profiles.
Propose algorithms for syphilis testing:
o For suspected, undiagnosed syphilis, a serum specimen should be submitted for a
treponemal-specific antibody test: Syphilis Total Antibody-SYPHLS performed by
Mercy Lab. Further confirmatory testing will be ordered and performed at Mayo
Medical Labs. The confirmatory testing is Mayo test: RPRT3. (RPR, either RPR Titer or
RTPPA as indicated).
o For determining the current disease status/evaluating response to therapy for syphilis,
Mayo Med Lab Rapid Plasma Reagin (RPR), Response to Therapy, Mayo order
code RPRT1, testing should be used.
Performed: Within 8 hours of receipt. If additional reflex testing is indicated, results available 1-4 days from
receipt.
Any Reactive or Equivocal result will be referred to Mayo, If Mayo's syphilis RPR is positive, the
RPR titer will be performed, at an additional charge. If the RPR is negative, the TP-PA will be
Method: Chemiluminescent Immunoassay (CLIA)
CPT Code: 86780 Syphilis Total Ab
86592 Syphilis Rapid Plasma Reagin Screen
86593 Rapid Plasma Reagin Titer (If appropriate)
86780 Syphilis Antibody by TP-PA (If appropriate)
POWERCHART T3 (TRIIODOTHYRONINE) FREE

NAME
MERCY TEST NAME T3 FREE MERCY LAB CODE T3F

Performance of this assay has not been established with neonatal specimens.
Reference Range: 2.5 - 3.9 pg/ml
Method The Atellica IM FT3 assay is a competitive immunoassay using direct chemiluminescent
CPT Code: 84481
POWERCHART T3 TOTAL
NAME
MERCY TEST NAME T3 TOTAL MERCY LAB CODE T3
Specimen: 0.5 ml serum.

Reference Range: 1-23 months: 117-239 ng/dL
2-12 years: 105-207 ng/dL
13-20 years: 86-192 ng/dL
>20 years: 20-181 ng/dL
Method The Atellica IM T3 assay is a competitive immunoassay using direct chemiluminescent

CPT Code: 84480
POWERCHART T4 (THYROXINE) FREE
NAME
MERCY TEST NAME T4 FREE MERCY LAB CODE T4F

Reference Range: 0.89-1.76 ng/mL
Method The Atellica IM FT4 assay is a competitive immunoassay using direct chemiluminescent
CPT Code: 84439
POWERCHART T4 TOTAL
NAME
MERCY TEST NAME T4 TOTAL MERCY LAB CODE T4TL

Preparation: containing biotin (vitamin B7), which is commonly found in hair, skin and nail supplements
and multivitamins.
Processing: Sent refrigerated to Mayo. Mayo order code (T4).
Performed: Monday through Friday 5 a.m. - 12 a.m., Saturday 6 a.m. - 6 p.m.

CPT Code: 84436
POWERCHART T AND B CELL QUANTITATION BY FLOW CYTOMETRY

NAME
MERCY TEST NAME T&B CELL QN* MERCY LAB CODE TBCL
Preparation: containing biotin (vitamin B7), which is commonly found in hair, skin and nail supplements
and multivitamins.
Specimen: 3 mL EDTA (purple top) whole blood. Minimum 1.0 mL.
Processing: Send specimen in original collection tube, DO NOT ALIQUOT.

Specimen must be received by Mayo within 24 hr. of collection. Specimen stable for 52
hours only. Send Ambient to Mayo. Mayo order code (TBBS).
Performed: Daily, Monday thru Sunday continuously

Method: Flow cytometry
CPT Code: 86359 – T Cells, Total Count
86360 – Absolute CD4/CD8 Count with Ratio
86355 – B Cells, Total Count
86357 – Natural Killer (NK) Cells, Total count
POWERCHART TACROLIMUS LEVEL

NAME
MERCY TEST NAME TACROLIMUS* (Prograf) MERCY LAB CODE TACRO
Specimen: 3 mL whole blood from a (purple top) EDTA. Minimum 1.0 mL.
When a Tacrolimus and Sirolimus are ordered on the same patient 2 tubes must be
collected, one for each test.
Processing: Send specimen in original collection tube. Sent refrigerated to Mayo. Mayo order code
(TAKRO).
Performed: Daily
Method: High-Pressure Liquid Chromatography/Tandem Mass Spectrometry (HPLC-MS/MS)
CPT Code: 80197 - Tacrolimus
POWERCHART QUANTIFERON TB GOLD IN-TUBE
NAME
MERCY TEST NAME TB QUANTIFERON* MERCY LAB CODE QFT3
Specimen: Special collection kit, QuantiFERON - TB Gold In-Tube collection kit. Kit Includes: Collection
directions, 4 tubes, QTB Transport bag. Kit is stored in MercyOne Laboratory. Lab Aide's rack
shelf A5.
o Collect 1 mL of blood in each of the 4 tubes. When the tube is upright, blood must
meet the small black mark on label.
o Tubes fill slowly.
o If butterfly needle is used, first collect other required tubes or use a "purge" tube
to remove the air and then proceed with collecting the QTB tubes.
o Shake tubes firmly for 10 times (entire inner surface of tube must be coated with
blood)
o Overly energetic shaking may cause gel disruption and could lead to aberrant
results.
o Label tubes appropriately
o Maintain tubes at room temperature until incubation portion of test preparation is
started.
INCUBATION OF TUBES NEEDS TO BE PERFORMED WITHIN 16 HOURS OF INITIAL
COLLECTION OF TUBES
Cause for Improper collection, incubation, centrifugation, or storage of specimens is cause for
rejection: rejection
Processing: Collect kit specifically as directed, incubate tubes 16-24 Hr., centrifuge and store as directed
in instructions. Send Refrigerated to Mayo Medical Laboratories Mayo code (QFT4).
Performed: 2 days, Monday - Friday; 9 A.M.
Method: Enzyme Linked Immunosorbent Assay (ELISA).
CPT Code: 86480
POWERCHART TESTOSTERONE TOTAL

NAME
MERCY TEST NAME TESTOST TTL* MERCY LAB CODE TSTT
Specimen: Spin no additive serum tube and remove from red cells 1.0 mls of serum. No other tube
type acceptable.
Processing: Send refrigerated to Mayo. Mayo order code (TTST).
Patients’ age and sex are required on requisition for processing.

Method: Liquid Chromatography – Tandem Mass spectrometry (LC-MS/MS)
CPT Code: 84403
POWERCHART TESTOSTERONE LEVEL TOTAL + FREE
NAME
MERCY TEST NAME TESTOST TTL FRE* MERCY LAB CODE TSTF
Specimen: Spin no additive serum tube and remove from red cells 2.5 mls of serum. No other tube
type acceptable.
Processing: Send refrigerated to Mayo. Mayo order code (TGRP).
Performed: Monday through Sunday. Free Testosterone determination may take 10 days.
Method: Liquid Chromatography – Tandem Mass spectrometry (LC-MS/MS)
Equilibrium Dialysis
CPT Code: 84403 Testosterone, Total
84402 Testosterone, Free
MERCY TEST DELTA 8 N 9 THC UR* MERCY LAB CODE THCU

NAME
Specimen: 3 ml random urine specimen in 5 mL Sarstedt aliquot tube, no preservative.

Processing: Send refrigerated to Mayo. Mayo order code (THCU).
Performed: Monday through Friday
Method: Liquid Chromatography Tandem Mass Spectrometry (LC-MS/MS)
CPT Code: G0480 / 80349
POWERCHART THEOPHYLLINE LEVEL
NAME
MERCY TEST NAME THEOPHYLLINE MERCY LAB CODE THEO

Comment: Indicate date and time of last dose in comment.
Therapeutic range: Intermediate: 2.0-7.0 mcg/mL
Peak: 4.0-8.0 mcg/mL
Trough: <1.0 mcg/mL
Toxic Peak: >12.0 mcg/mL
Method The Atellica CH Theo assay is a homogeneous particle-enhanced turbidimetric inhibition
Description: immunoassay (PETINIA) technique which uses a synthetic particle-theophylline conjugate
(PR) and theophylline-specific monoclonal antibody (Ab).
CPT Code: 80198
POWERCHART THROAT CULTURE

NAME
MERCY TEST NAME THRT CLT STREP MERCY LAB CODE THSC
Specimen: Collect the specimen with a double swab Culturette. Rub the sterile swabs firmly over the
back of the throat (posterior pharynx), both tonsils, and any areas of inflammation. Submit
the specimen as soon after collection as possible. If there is a delay in transport, the
specimen should be forwarded within 48 hours of collection. The specimen should be stored
and sent at room temperature.
Comments: o Screens only for significant Beta Hemolytic Streptococci.

o If specifically looking for yeast, see Yeast Culture/Direct Prep.
o Susceptibility testing will NOT routinely be performed, unless requested by the
provider at the time of ordering.
RL Client
o Mark THROAT CULTURE FOR BETA STREP on order form.
Comments:
o Store and send at room temperature within 48 hours of collection.
Performed: Final report: 1-2 days
Reference value: No Group A beta-hemolytic Streptococci isolated.

Normal throat flora.
Method: Routine culture techniques.
CPT Code: 87081
POWERCHART THROMBIN TIME

NAME
MERCY TEST NAME THROMBIN TIME MERCY LAB CODE TT
Specimen: Draw blue top tube filled with amount of blood listed on label.
Cause for
Gross hemolysis. Improperly filled tubes will not be tested.
Rejection:
Processing: Centrifuge immediately. Stable 4 hours at room temperature. Test heparin containing
specimens within 2 hours. DO NOT FREEZE SPECIMEN.
Performed: Within 8 hours of receipt, available stat.
Reference value: 13.0-17.0 seconds
Method: Photo-optical clot detection.
CPT Code: 85670
POWERCHART THROMBOPHILIA PROFILE

NAME
MERCY TEST NAME THROMBOPHILIA PROF* MERCY LAB CODE THRMP
Specimen: 3.0 mL whole blood EDTA tube. Yellow top ACD tube and sodium citrate are also acceptable.
AND
6.0 mL platelet poor plasma from light-blue top (citrate) tube. (Requires at least 6 blue-
top tubes)
Both whole blood and plasma are required.

Test should not be ordered with a Lupus Anticoagulation Profile (ALUPP) because of
duplication of testing.
Mixing test is not orderable from Mayo, but may be performed based on results as
part of the Thrombophilia Profile
We can call Mayo and request they perform the mixing test, regardless of the
patient's results.
Processing Draw 3.0 mL of whole blood and do not transfer blood to other containers. Label specimen
Instructions: as whole blood. Send ambient.
Draw enough citrated whole blood to spin down and aliquot 6.0 mL platelet poor
plasma in 6 plastic vials, each containing 1 mL
Draw enough citrated whole blood to spin down and aliquot 6.0 mL platelet poor plasma in
6 plastic vials, each containing 1 mL.
Spin down, remove plasma, and spin plasma again. Remove plasma and place in plastic
aliquot vials. Freeze specimens immediately at
< or = -40 degrees C, if possible. Label specimens as plasma.
Double-centrifuged specimen is critical for accurate results. Coagulation Consultation

Patient Information Sheet must be sent with specimen.
Shipping
Send plasma frozen and whole blood ambient. Mayo order code (AATHR).
Instructions:
Performed: Results 1-7 days.
Method: Clot-Base Assay, Clauss Methodology, Automated Latex Immunoassay,

Immunoturbidimetric, Chromogenic Assay, Direct Mutation Analysis, Activated Partial
Thromboplastin Mixing Test
CPT Code: 81240 85730 85613 85303

85300 85610 85384 85307
85670 85379 85306
If indicated the following reflex tests will be ordered by Mayo at an additional cost:
Bethesda Units- 85335 Reptilase Time- 85635

Coag Factor VIII Assay Inhib Scrn - 85335 Coag Factor II Assay -85210
Antithrombin Antigen - 85301 Protein C Ag - 85302
Coag Factor V Assay - 85220 Factor V Leiden (R506Q) Mutation- 81241
Coag Factor VII Assay - 85230 Platelet Neutralization Procedure - 85597
Coag Factor IX Assay 85250 PT Mix 1:1 - 85611
Coag Factor X Assay - 85260 APTT Mix 1:1 - 85732
Coag Factor XI Assay - 85270 Protein S Ag, Total, P - 85305
Coag Factor XII Assay 85280 HEX LA,P - 85598
Coag Factor VIII Activity Assay - 85240 DRWT Mix - 85613
DRWT Confirmation - 85613 Protein S Activity, P - 85306
Soluble Fibrin Monomer-85366 PT-Fibrinogen-85385
POWERCHART THYROGLOBULIN ANTIBODY

NAME
MERCY TEST NAME THYROGLOBULIN AB SCN * MERCY LAB CODE THYBS
Specimen: 1 ml serum from a no additive serum tube. A Serum Separator Tube (SST) is NOT acceptable.
Processing: Send refrigerated. Mayo order code TGAB. If Thyroglobulin Tumor Marker testing is desired
and ordered, DO NOT order this test. Order a Thyroglobulin Tumor Marker which includes
both Thyroglobulin and Thyroglobulin antibody.
Performed: Test set up Monday through Friday 6 AM - 12 AM, Saturday 6 AM - 6 PM.
CPT Code: 86800
POWERCHART THYROGLOBULIN TUMOR MARKER

NAME
MERCY TEST NAME THYROGLOBLN TUMOR* MERCY LAB CODE THYTMR
Specimen: 1 ml serum from a no additive serum tube. A Serum Separator Tube (SST)
is NOT acceptable.
Processing: Send refrigerated to Mayo. Mayo order code (HTG2). DO NOT order a Thyroid Antibody
Screen with Thyroglobulin Tumor Marker. The screen is included in Tumor Marker testing
and a separate order would be considered duplicate testing.
Method: Thyroglobulin Mass Spectrometry
CPT Code: 86800 Thyroglobulin Antibody Screen
84432 Thyroglobulin Tumor Marker
POWERCHART THYROPIN BINDING INHIBITORY IMMUNOGLOBULINS

NAME
MERCY TEST NAME TBG IMMUNOLOGIC* MERCY LAB CODE TBGI

Cause for
Hemolysis is not acceptable.
rejection:
Processing: Send refrigerated to Mayo. Mayo order code (TBGI).
Performed: 1-3 days. Test set up Monday through Friday; 5 AM - 12 AM, Saturday; 6 AM - 6 PM.
Method: Solid-Phase Chemiluminescent Assay
CPT Code: 84442
POWERCHART THYROID HYPER PANEL

NAME
MERCY TEST NAME THYRD HYPER PNL MERCY LAB CODE THPE

Comment: Includes T4 Free and T3 Free
Do not use samples that have been stored at room temperature for longer than 8 hours.
Performed:
Method
Description:
CPT Code: 84439 T4 Free
84481 T3 Free
POWERCHART THYROID HYPO PANEL (TSH SENSITIVE AND FREE T4)
NAME
MERCY TEST NAME THYRD HYPO PNL MERCY LAB CODE THPO

Comment: Includes T4 Free and TSH

Method
Description: See individual test entry.
CPT Code: 84439 T4 Free
84443 TSH
TEST NAME THYROID-STIMULATING IMMUNOGLOBULIN SERUM*
MERCY TEST NAME THYROID STIM IMGLB* MERCY LAB CODE THYIMG
Specimen: 0.5 ml serum from a no additive serum tube or Serum Separator Tube (SST).
Processing: Send frozen to Mayo. Mayo order code (TSI).
Performed: 2-6 days. Monday - Friday 10 AM
Reference Value: Included with results
Method: Recombinant Bioassay
CPT Code: 84445
POWERCHART THYROPEROXIDASE ANTIBODY (TPO)

NAME
MERCY TEST THYROPEROXIDASE AB (Antithyroid antibody) MERCY LAB CODE TPXD

NAME

Stability: Separate serum or plasma from the red blood cells before storage at 2–8°C or -20°C.
Comment: Performance of this assay has not been established with neonatal specimens.
Reference Range: 0-59.9 U/ml
Method The Atellica IM aTPO assay is a competitive immunoassay using chemiluminescent
CPT Code: 86376
POWERCHART THYROTROPIN RECEPTOR AUTOANTIBODY
NAME
MERCY TEST NAME THYROTROPIN RECEPT* MERCY LAB CODE THYRO
Specimen: 1 mL serum from a Serum Separator Tube (SST) (Preferred). Serum from a no additive
serum tube is also acceptable.
Preparation: containing biotin (vitamin B7), which is commonly found in hair, skin, nail supplements and
multivitamins.
Patient should not be receiving heparin treatment.
Processing: Send refrigerated (Preferred) to Mayo. Frozen is also acceptable. Mayo order code (THYRO).
CPT Code: 83520
POWERCHART TISSUE CULTURE OTHER

NAME
MERCY TEST NAME TISSUE CLT MERCY LAB CODE TISC
Specimen: Aseptically place the specimen in a sterile plastic container with a tight-fitting lid. The
specimen should be surgically obtained. If unable to transport to the laboratory promptly,
add 1 - 2 ml of sterile saline to the specimen container.
Comment: Susceptibility testing will routinely be performed on significant isolates.
RL Client
o Write TISSUE CULTURE on the order form. Indicate the specimen source.
Comments:
Performed: Preliminary reports: Days 1-4
Reference value: No growth.
CPT Code: 87070
TEST NAME TISSUE EXAMINATION GROSS & MICROSCOPIC
Includes: Gross examination and microscopic if indicated.

Comment: Complete manual Pathology Specimen requisition form. Requisition must include pre-op
diagnosis and operative findings. Specific specimen source and relevant patient history must
be indicated.
Specimen: Tissue specimen covered with 10% Formalin. Transport containers and 10% formalin are
available from the Laboratory.
Performed: 2 days.
Reference value: Interpretation will be provided.
Method: Pathologist evaluation.
CPT Code: Varies.
POWERCHART TISSUE TRANSGLUTAMINASE ANTIBODIES, IgA*

NAME
MERCY TEST NAME TISSUE TRANSGLUT AB IGA MERCY LAB CODE TTA
Specimen: 1.0 ml of serum from a no additive serum tube or Serum Separator Tube (SST). Refrigerated
Cause for
Hemolysis.
rejection:
Comment: This new assay performs the Tissue Transglutaminase and deamidated Gliadin
simultaneously for IgA. There is no need for a separate order for the tTG and deamidated
gliadin. Ordering the TTA will cover for both assays, simultaneously, but will be reported as
one result for IgA.
Processing: Specimen can be refrigerated for up to 21 days. Send refrigerated to Mayo. Frozen is
acceptable. Mayo order code TTGG.
Performed: Monday thru Saturday at Mayo
Method: EIA
CPT Code: 86364
POWERCHART TISSUE TRANSGLUTAMINASE ANTIBODIES, IgA and IgG

NAME
MERCY TEST NAME TISSUE TRANSGLUT AB* MERCY LAB CODE TISTA
Specimen: 1.0 ml of serum from a no additive serum tube or Serum Separator Tube (SST). Refrigerated
Cause for
Hemolysis.
rejection:
Comment: This new assay performs the Tissue Transglutaminase and deamidated Gliadin
simultaneously for IgA and simultaneously for IgG. There is no need for a separate order for
the tTG and deamidated gliadin. Ordering the TISTA will cover for both assays,
simultaneously, but will be reported as one result for IgA and one result for IgG
Processing: Specimen can be refrigerated for up to 21 days. Send refrigerated to Mayo. Frozen is
acceptable. Mayo order code TSTGP.
Performed: Monday thru Saturday at Mayo
Method: EIA
CPT Code: 86364 x 2.
POWERCHART TOBRAMYCIN LEVEL

NAME
MERCY TEST NAME TOBRAMYCIN INT MERCY LAB TBI
CODE

Stability: Specimens may be stored for up to 8 hours at 25°C, stored for up to 72 hours at 2–8°C, or
stored frozen for up to 30 days at -20°C.5 For patients on penicillin or its derivatives, freeze
sample if not analyzed within 4–6 hours.
Reference Range: 2.0-7.0 mcg/ml
Method The Atellica CH Tob assay involves a homogeneous particle-enhanced turbidimetric
Description: inhibition immunoassay (PETINIA) technique which uses a synthetic particle-tobramycin
conjugate (PR) and tobramycin-specific monoclonal antibody (Ab).
CPT Code: 80200
POWERCHART TOBRAMYCIN PEAK LEVEL

NAME
MERCY TEST NAME TOBRAMYCIN PEAK MERCY LAB CODE TBPK

Comment: Do not use hemolyzed specimens.
Therapeutic range: 4.0-8.0 mcg/ml
CPT Code: 80200
POWERCHART TOBRAMYCIN TROUGH LEVEL

NAME
MERCY TEST NAME TOBRAMYCIN TRGH MERCY LAB CODE TBTR

Comment: Do not use hemolyzed samples
Therapeutic range: <1.0 mcg/mL
CPT Code: 80200
POWERCHART TOPIRAMATE (TOPAMAX) LEVEL

NAME
MERCY TEST TOPIRAMATE* MERCY LAB CODE TOPIR
NAME
Specimen: 1 ml serum from a plain, no additive serum tube. Serum gel/SST are not acceptable.
Processing: Send refrigerated (Preferred) to Mayo. Ambient or Frozen also acceptable. Mayo order code
(TOPI).
Performed: 1-2 Day. Monday through Saturday
CPT Code: 80201
MERCY TEST TORCH TEST MERCY LAB CODE CMIS

NAME
Includes: This testing includes Mayo Medical Lab's Torch Profile IgG, Toxoplasma gondii Antibody, IgM
and Cytomegalovirus (CMV) Antibodies, IgM (Mayo TRCHG, TXM and CMVM).
TRCHG: HSV Type 1 and Type 2 Ab IgG, Toxoplasma Ab IgG, Rubella Ab IgG, Cytomegalovirus
Ab IgG
TXM: Toxoplasma gondii Antibody, IgM
CMVM: Cytomegalovirus (CMV) Antibodies, IgM
This testing should be ordered as a Miscellaneous General Chemistry. Indicate that testing is
for TORCH.
This test is to be ordered only on neonates, pregnant women or women who have had
miscarriages.
If the patient does not meet any of these qualifications, then each test must be ordered
separately.
Specimen: 3.5 mL serum from a Serum Separator Tube (SST). Refrigerate.

Cause for
Grossly hemolyzed or grossly lipemic specimens.
rejection:
Processing: Performed at Mayo Medical Labs, Rochester, MN.
MERCY LAB: Order TRCHG, TXM and CMVM on the Mayo PC. Order all tests under the
same order number so all results print on the same report.
Report: 1 week
Method: Multiplex Flow Immunoassay, (MFI)
CPT Code: Toxoplasmosis Ab IgG 86777
Toxoplasmosis Ab IgM 86778
Rubella IgG Ab 86762
Cytomegalovirus Ab IgM 86645
Cytomegalovirus Ab IgG 86644
HSV Ab, IgM 86694
HSV Type 1 Ab IgG 86695
HSV Type 2 Ab IgG 86696
POWERCHART TOXIC VOLATILE SCREEN
NAME
MERCY TEST NAME TOXIC VOLATILE SCRN MERCY LAB CODE TVS
Includes: Beta-hydroxybutyrate (Ketone) Alcohol, Ethyl Calculated Osmolality

Interpretation Metabolic Panel Osmolality
Osmolality Gap pH Venous
Comment: Complete and send to Lab a Toxic Volatile Screen Patient Information Sheet.
Specimen: 1 Spun Serum Separator Tube (SST). Send refrigerated.
1 no additive serum tube, spun, aliquoted and labeled as no additive serum tube. Send
refrigerated
1 gray top Sodium Fluoride. Send refrigerated
1 small dark green top lithium heparin tube completely filled and on ice.
Use aqueous betadine for cleaning venipuncture site, not alcohol swab.
Processing: 1.0 ml serum from orange or gold tube for metabolic panel and osmolality. Perform alcohol
testing upon first opening. Keep small green top tube closed and on ice for venous pH. Plain
red top tube and gray top tube are used only if confirmatory tests are indicated.
Reference value: Refer to individual test entry and Toxic Volatile Screen Laboratory Results for Frequent
Situations table which follows on next page. Mercy technical staff, refer to Osmolality
procedure for analysis, calculations, & interpretation.
Performed: On receipt. Available stat.

Method: Refer to individual test entry.
CPT codes: 83930 Osmolality
82800 Ph
80048 Basic Metabolic Panel
82010 Beta Hydroxybutyrate Level
G0480 / 82077 Alcohol (Ethanol)
POWERCHART TOXOPLASMOSIS ANTIBODY IgG IgM

NAME
MERCY TEST NAME TOXOPLASMA IGG, IGM* MERCY LAB CODE TOXOGM
Includes: Toxoplasma IgG and Toxoplasma IgM

Processing: Send refrigerated to Mayo. Mayo order code (TXMGP).
Performed: 1-3 day(s). Test set up Monday through Friday
Method: IgM: Enzyme Immunoassay (EIA)
IgG: Multiplex Flow Immunoassay (MFI)
CPT Code: 86777/IgG
86778/IgM
POWERCHART TRANSFERRIN
NAME
MERCY TEST NAME TRANSFERRIN MERCY LAB CODE TRNS

Stability: Separated specimens may be stored for up to 8 hours at room temperature or for up to 7
days at 2–8°C or stored frozen for up to 1 month at -20°C or 1 year at -70°C.
Reference Range: 200 - 360 mg/dl
Method The Atellica CH Trf assay is a polyethylene glycol (PEG) enhanced immunoturbidimetric
Description: assay.
CPT Code: 84466
TEST NAME TRANSFUSION REACTION WORK-UP
Comment: MMC-NI Nursing Services should notify the physician and Lab immediately and follow
Nursing Policy #602 Blood Transfusion Reaction Investigation which can be found on the
Mercy Intranet Home page, Policies, Procedures and By-Laws, Nursing. In this policy under
the procedure portion, A.5. follow the helpful link to Documentation Guidelines: Blood
Transfusion Reaction. Nursing will fill out "Post Transfusion" documentation form in
Powerchart selecting "YES" in the Transfusion Reaction box and any other required fields.
Once "YES" is selected the "Transfusion Reaction Workup" will be automatically ordered and
generated to the Laboratory.
Nursing should continue with the Transfusion Reaction by delivering the Lab copy of the
Blood/Blood Component Transfusion Form and the blood/component bag with all attached
tubing and IV solutions to the Lab immediately. Continue to monitor patient. There is no
charge to the patient.
Specimen: 6 ml pink top tube.

Performed: Immediately on receipt.
Reference value: A Transfusion Reaction Investigation report which includes a written interpretation by a
pathologist will be completed.
Method: Serological
CPT Code: NA
POWERCHART TRAUMA PANEL

NAME
MERCY TEST NAME TRAUMA PANEL MERCY LAB CODE TPNL
Comment: For use by Emergency Center ONLY and only in a trauma situation.
Includes: Alcohol, blood Amylase CBC with Diff
Metabolic Panel Protime PTT
Specimen: Draw a Serum Separator Tube (SST), a blue top sodium citrate tube filled appropriately with
amount of blood listed on label, 1 purple top (EDTA) tube, 1 pink top tube, and 1 gray top
Sodium Fluoride tube on ice for a possible lactic acid.
Reference value: See individual test entry.
CPT Code: 85025 CBC
85610 Protime
85730 PTT
80048 Basic Metabolic Pnl
82150 Amylase
G0480 / 82077 Alcohol Ethyl Bld
TEST NAME TRAVEL CHARGE

MERCY TEST TRAVEL CHG MERCY LAB CODE TRVL
NAME
Comment: To be ordered by Lab on any specimen collected by Lab personnel outside the Laboratory
facility.
CPT Code: P9604
POWERCHART TRICHOMONAS VAGINALIS PCR

NAME
MERCY TEST NAME TRICHOMONAS PCR MERCY LAB TRCHM

CODE
Specimen: Urine: First void urine specimens must be transferred from the collection cup to the Xpert
Urine Transport Reagent Tube (Yellow Cap) immediately (preferred) or within 4 hours of
collection when kept at Room Temperature or within 4 days of collection when stored at 2–
8°C.
Urine specimens in Xpert Urine Transport Reagent Tubes should be kept between 2°C and
30°C during transport and can be stored for up to 14 days at this temperature.
Urine Specimen Collection:
o Collect the specimen in a sterile, preservative-free specimen collection cup.
o The patient should collect the first 20–60 mL of voided urine (the first part of the
stream - not midstream) into a urine collection cup.
o Cap and label the urine collection cup with patient identification and date/time
collected.
Vaginal/Endocervical/: Collect using only the Xpert Swab Specimen Collection Kit (Pink
Cap). Swab samples in Xpert Swab Transport Reagent are stable up to 60 days at 2–30°C.
Performed: Performed daily. Available STAT.
Reference value: Trichomonas Not Detected
Method: DNA Extraction
CPT Code: 87661
POWERCHART TRIGLYCERIDES
NAME
MERCY TEST NAME TRIGLYCERIDE MERCY LAB CODE TRIG

Separated specimens may be frozen for up to 30 days at ≤ -20°C.7 Do not store in a frost‑free
freezer. Thoroughly mix thawed specimens and centrifuge before using.
Comment: Do not use hemolyzed samples, as they may cause significant interference with this assay.
Reference Range: 35-150 mg/dL

Method The Atellica CH Trig_2 assay is based on an enzymatic procedure in which a combination of
Description: enzymes is employed for the measurement of serum or plasma triglycerides.
CPT Code: 84478
POWERCHART TRIGLYCERIDE BODY FLUID

NAME
MERCY TEST NAME TRIGLYCERIDE BF MERCY LAB CODE FTRG
Specimen: 0.5 ml of body fluid placed in a sterile container

Separated specimens may be frozen for up to 30 days at ≤ -20°C.7 Do not store in a frost‑free
freezer. Thoroughly mix thawed specimens and centrifuge before using.
Comment: Indicate body fluid source in comment.
Reference Range:
No established reference range available.
Method The Atellica CH Trig_2 assay is based on an enzymatic procedure in which a combination of
Description: enzymes is employed for the measurement of serum or plasma triglycerides.
CPT Code: 84478
POWERCHART T3 REVERSE
NAME
MERCY TEST NAME T3 REVERSE* MERCY LAB CODE RT3B
Specimen: 0.8 ml serum from a no additive serum tube or a Serum Separator Tube (SST).
Performed: 2-6 days. Test set up Monday, Wednesday, Friday: 8:30 a.m.
Processing: Send refrigerated to Mayo. Mayo order code (RT3).
CPT Code: 84482
POWERCHART TROPONIN I
NAME
MERCY TEST NAME TROPONIN I MERCY LAB CODE TRPI

Stability: Samples are stable up to 8 hours when tightly capped and stored at room temperature.
Samples are stable up to 24 hours when tightly capped and stored at 2–8°C. Samples can be
frozen at ≤ -20°C for up to 40 days. Do not store in a frost-free freezer. Samples can be
frozen at ≤ -70°C for up to 1 year. Freeze samples only once and mix thoroughly after
thawing.
Comment: The use of a single sample type (either lithium-heparin plasma or serum) is recommended
for troponin analysis when collecting serial samples from the same patient.
For serum specimens, complete clot formation should take place before centrifugation.
Serum should be physically separated from cells as soon as possible from the time of
collection.

Reference Range: Male <53 pg/mL
Female <38 pg/dL
Method The Atellica IM TnIH is a 3-site sandwich immunoassay using direct chemiluminescent
CPT Code: 84484
POWERCHART TRYPTASE
NAME
MERCY TEST NAME TRYPTASE* MERCY LAB CODE TRYPT
Specimen: 0.5 mL serum from a Serum Separator Tube (SST-preferred), or a no additive serum tube-
acceptable
Processing: Aliquot specimen, send FROZEN to Mayo. Mayo order code (TRYPT).
Performed: 1-5 days. Monday - Friday 9 am to 1 pm

CPT Code: 83520
POWERCHART TSH (THYROID STIMULATING HORMONE)

NAME
MERCY TEST NAME TSH SENSITIVE MERCY LAB CODE TSH

Stability: Separated specimens are stable for 24 hours at room temperature or 2 days at 2–8°C. For
longer storage, serum and EDTA plasma samples may be frozen for up to 30 days at ≤ -20°C.
Lithium heparin samples can be stored at ≤ -20°C for up to 14 days. Freeze samples only 1
time and mix thoroughly after thawing. Thawed specimens that are turbid must be clarified
by centrifugation prior to testing.
Comment: This assay has not been validated for testing samples from newborns.

Reference Range: < 1 year: 0.800-6.300 mIU/L
1-5 years: 0.300-6.000 mIU/L
6 years to adult: 0.300-5.00 mIU/L
Method The Atellica IM TSH3‑UL assay is a third-generation assay that employs anti-FITC monoclonal
Description: antibody covalently bound to paramagnetic particles, an FITC-labeled anti-TSH capture
mouse monoclonal antibody, and a tracer consisting of a proprietary acridinium ester and
an anti‑TSH mouse monoclonal antibody conjugated to bovine serum albumin (BSA) for
chemiluminescent detection.
CPT Code: 84443
POWERCHART TYPE AND SCREEN

NAME
MERCY TEST NAME TYPE AND SCRN MERCY LAB CODE TYSC
Includes: ABO Group/RH Type and Antibody Screen.

Please note: NO units will be crossmatched.
Type and Screen is included in: Crossmatch.
Specimen: One 6 ml pink top tube.
All patients drawn for possible blood product transfusion MUST be correctly identified
and MUST BE WEARING an armband with their FULL NAME and MEDICAL RECORD
NUMBER before the patient is drawn.
A (check mark) must be put by the Medical Record number on the tubes drawn for
a Type and Screen by the person drawing the specimen indicating the phlebotomist
has matched the medical record number on the Specimen with the medical record
number on the Patient Armband and it is identical along with the name and other
pertinent information.
Date, time, and initials of the individual collecting the specimen must be on the tube.
FOR OUTPATIENT AND PRE-SURGICAL PATIENTS:

All the above guidelines must be followed. The PATIENT is also to be informed to leave
the armband on and if the armband is removed, they will need to be redrawn and
testing repeated. **Qualified staff may remove the armband and replace it with
another armband after careful matching.
If a type and screen specimen is subsequently used for a crossmatch order, the crossmatch
expiration is 3 days following the day the type and screen specimen was collected.

Method: Serological
86901 RH+
86850 Antibody Sc
POWERCHART
UREA BREATH TEST
NAME
MERCY TEST NAME UREA BREATH TEST MERCY LAB CODE HPUBT
Patient Patient cannot eat or drink (including chewing gum) 1 hour prior to testing. Must be able to
Preparation: swallow a solution and blow-up balloon. For Further directions please see the Patient
Preparation and Specimen Collection Procedure Located in the Special Helps Section.
Processing: Bag of breath must be full. Send specimen ambient. Mayo order code UBT.
It is not available to inpatients due to the extensive preparation of discontinuing medication.
Comment:
Testing for Helicobacter Pylori
Performed: Monday through Friday; 6:30 a.m. - 4:30 p.m.
Method: Infrared Spectrophotometry (SP)
CPT Code: 83013
POWERCHART
UREA NITROGEN 24 HOUR URINE
NAME
MERCY TEST NAME UREA NITROGEN 24UR MERCY LAB CODE VUN
Specimen: 5 mL of urine from an unpreserved 24-hour urine specimen kept refrigerate during
collection.
Urine urea nitrogen may be stored for up to 4 days at 4–8°C when preserved with thymol to
Stability:
avoid bacterial action.
Reference Range: 12 - 20 g/24 hours
Method The Atellica CH Urea Nitrogen (UN_c) assay is based on the Roch-Ramel enzymatic reaction
Description: using urease and glutamate dehydrogenase.
CPT Code: 84540
POWERCHART
Urea Nitrogen Random Urine
NAME
MERCY TEST NAME Urea Random Urine MERCY LAB CODE RUREA
Specimen: 5 ml of random urine

Stability: Urine urea nitrogen may be stored for up to 4 days at 4–8°C when preserved with thymol to
avoid bacterial action.

CPT Code: 84540
POWERCHART
UREA CLEARANCE 24 HOUR URINE
NAME
MERCY TEST NAME UREA CL 24 UR MERCY LAB CODE VUCL
0.5 mL serum and 5 mL urine from an unpreserved 24-hour urine specimen kept
Specimen:
refrigerate during collection.
Separated blood urea nitrogen is stable in separated serum or plasma and may be stored
Stability: for up to 3–5 days at room temperature or for up to 7 days at 4°C or stored frozen
Urine urea nitrogen may be stored for up to 4 days at 4–8°C when preserved with thymol
to avoid bacterial action.
Includes: Volume (ml/24 hours) Raw Urea Nitrogen (mg/dl)
Calc. Urea Nitrogen (g/24 hours) Urea Nitrogen Clearance (ml/min)
Comment: Outpatients and Inpatients: MercyOne Laboratory will order and draw the appropriate
no charge serum BUN (BUNNC) if a serum BUN has not been completed within 48 hours.
Regional Lab Clients: MercyOne Laboratory will order the serum BUN at no charge. Do
not order a single BUN on the requisition.

Reference Range: No established reference range available
CPT Code: 84545
POWERCHART
URIC ACID
NAME
MERCY TEST NAME URIC ACID MERCY LAB CODE URIC

Stability: Specimens may be stored for 3–4 days at ambient temperature, up to 3–5 days at 4°C or
stored frozen for up to 6 months at -20°C.
Male: 4.4-7.6 mg/dl

Reference Range: Female: 2.3-6.6 mg/dl
Method The Atellica CH Uric Acid (UA) assay is based on the Fossati enzymatic reaction using uricase
Description: with a Trinder-like endpoint.
CPT Code: 84550
POWERCHART
URIC ACID 24 HOUR URINE
NAME
MERCY TEST NAME URIC ACID 24UR MERCY LAB CODE VURI
Specimen: 5 mL urine from an unpreserved 24-hour urine specimen kept refrigerate during collection.
Stability: Specimens may be stored for 3–4 days at ambient temperature for alkaline urine.
Reference Range: 250 - 750 mg/24 hours
CPT Code: 84560
POWERCHART
URIC ACID BODY FLUID
NAME
MERCY TEST NAME URIC ACID BF MERCY LAB CODE FURI
Specimen: 0.5 mL of refrigerated joint fluid in a sterile container.

Stability: Specimens may be stored for 3–4 days at ambient temperature, up to 3–5 days at 4°C or
stored frozen for up to 6 months at -20°C.
CPT Code: 84560
POWERCHART
UA URINALYSIS COMPLETE
NAME
MERCY TEST NAME UA with MICROSCOPIC MERCY LAB CODE UAMC
Includes: Appearance, Glucose, Occult Blood, Urobilinogen, Bilirubin, Ketones, Ph, Leukocytes,
Protein, Nitrites, Specific Gravity.
A microscopic description of the specimen will be included.
**This order is for lab generated order only. The order is NOT available in Cerner
Powerchart.
Specimen: Recommend testing volume: 15 mL of freshly voided urine.
4 mL minimum (adults)
2 mL minimum (infant/pediatric)
Deliver specimen to lab as soon as possible after collection.
First morning specimen is preferred for testing, but random collections are
acceptable.
Midstream:
Instruct patient of the proper collection technique. Collect in a sterile plastic container with
a tight-fitting lid. Provide the patient with 3 antiseptic towelettes.
Use the following collection procedure:
-The patient should thoroughly wash their hands.
-Remove the lid from the container. Do not touch the inside surfaces.
-Remove all clothing from waist down.
-Assume the appropriate position.
-Female: Sit on the toilet seat with legs spread apart.
-Male: Stand facing the toilet or sit on the toilet with legs spread apart.
-Open the towelettes and cleanse perineal area.
-Female: Separate the labia with the thumb and forefinger. Using downward strokes,
cleanse one labia with a towelette and discard. Cleanse the other labium and meatus in the
same fashion, using a separate towelette for each stroke, and discard. Keep the labia
separated.
-Male: If uncircumcised, retract the foreskin before proceeding. Cleanse the head of the
penis with a towelette, using a circular motion from the urethral opening to the outer
diameter of the penis. Discard towelette. Repeat using all the towelettes.
-Hold container by the outside surface. Begin urinating into the toilet.
-Place container under the stream of urine after a good flow has started.
-Fill container half full and void remainder of the urine into the toilet.
-Screw on the sterile cover. Do not touch the inner surface.
Cause for Unpreserved specimens >2 hours at room temperature or >8 hours refrigerated.
rejection:
Comment: Indicate time of collection in comment. Indicate method of collection using the following
codes:
MURN Midstream
CURN Cath
SURN Suprapubic
Reference Value: Spec. Gravity: 1.001-1.035 Urine Microscopic:

Ph: 4.6-8.0 WBC: 0-5/HPF
Protein: Negative RBC: 0-2/HPF
Glucose: Negative SQ Epithelial: 0-5/HPF
Ketones: Negative CAST: Rare Hyaline/LPF
Bilirubin: Negative Crystals: None Seen/HPF
Occult Blood: Negative Bacteria: None Seen/HPF
Urobilinogen: Negative Yeast: None Seen/HPF
Leukocytes: Negative
Nitrites: Negative
Method: Reagent strip, microscopic examination.
CPT Code: 81001 Urine Routine and Micro

POWERCHART
UA URINALYSIS ROUTINE
NAME
MERCY TEST NAME URINALYSIS ROUTINE MERCY LAB CODE UA
A microscopic description of the specimen will be included on hazy and cloudy specimens
and those specimens having one or more positive results on the dipstick except Glucose and
Ketone. Clear urines with negative dipsticks will not have the microscopic analysis
performed.

acceptable.
Midstream:
separated.
Nursing Home and Reference Lab Specimens:
-Deliver to the lab within 2 hours of collection if urine has been stored at room temperature,
or within 8 hours if the urine has been stored in the refrigerator. Send
urines refrigerated*.
Clinic Laboratories and Nursing Homes:
-If delivery will exceed 2 hours (for samples kept at room temperature) or 8 hours (for
samples kept refrigerated) from collection to receipt at MercyOne lab, the urine needs to be
transferred into the BD Vacutainer Urinalysis Preservative Plus conical urine tube (yellow
and red marbled lid, with a pointed end).
Send the preserved urine at room temperature to MercyOne Lab.
The stability of the BD Vacutainer Urinalysis Plus preserved specimen is 72 hours.
Samples should be stored protected from light.
The BD Vacutainer Preservative tubes should be filled to the minimum fill line and not to
exceed the maximum fill line.
ONLY ROUTINE URINALYSIS TESTING CAN BE PERFORMED from the BD Vacutainer
Urinalysis Preservative Plus conical urine tubes. This preservative is NOT acceptable
for urine cultures.
Cause for Unpreserved specimens >2 hours at room temperature or >8 hours refrigerated.
rejection:
codes:
MURN Midstream
CURN Cath
SURN Suprapubic
A microscopic exam is performed and charged if any of the following exist:
Clarity is hazy, cloudy, or turbid.
All positive Chemstrip results except for positive Glucose or positive Ketones.
Providers may specifically request a microscopic be performed by writing “Urinalysis with
Micro” on the requisition.
Reference Value: Spec. Gravity: 1.001-1.035 Urine Microscopic:

Ph: 4.6-8.0 WBC: 0-5/HPF
Protein: Negative RBC: 0-2/HPF
Glucose: Negative SQ Epithelial: 0-5/HPF
Ketones: Negative CAST: Rare Hyaline/LPF
Bilirubin: Negative Crystals: None Seen/HPF
Occult Blood: Negative Bacteria: None Seen/HPF
Urobilinogen: Negative Yeast: None Seen/HPF
Nitrites: Negative
Method: Reagent strip, microscopic examination.
CPT Code: 81003 Urinalysis Routine (if microscopic not done)

81001 Urine Routine and Micro (when microscopic is done)
POWERCHART
URINE CULTURE
NAME
MERCY TEST NAME URINE CLT MERCY LAB CODE URNC
Midstream, catheterized, suprapubic, or nephrostomy.

0.5 ML urine minimum.
Send immediately to the lab for culture.
* If immediate delivery will be delayed, the specimen should be refrigerated and delivered
refrigerated, within 2 hours of collection.
* If delivery will exceed 2 hours, best practice is to place the specimen in a urine culture
transport tube (gray lid) and deliver within 48 hours, at room temperature.
Although not recommended, an unpreserved urine can be used for culture, up to 24 hours
Specimen: old, if the specimen has remained refrigerated.
Midstream:
Instruct patient of the proper collection technique. Collect in a sterile plastic container with a
tight-fitting lid. Provide the patient with 3 antiseptic towelettes. Use the following collection
procedure:
o The patient should thoroughly wash their hands.

o Remove the lid from the container. Do not touch the inside surfaces.
o Remove all clothing from the waist down.
o Assume the appropriate position:
Female-Sit on the toilet with legs spread apart.
Male-Stand facing the toilet or sit on the toilet with legs spread apart.
o Open the towelettes and cleanse perineal area.
Female: Separate the labia with the thumb and forefinger. Using downward
strokes, cleanse one labium with a towelette and discard. Cleanse the other labium
and meatus sin the same fashion, using a separate towelette for each stroke, and
discard. Keep the labia separated.
Male: If uncircumcised, retract the foreskin before proceeding. Cleanse the head of
the penis with a towelette, using a circular motion from the urethral opening to the
outer diameter of the penis. Discard towelette. Repeat using all the towelettes.
o Hold container by the outside surface. Begin urinating into the toilet.
o Place container under the stream of urine after a good flow has started.
o Fill container half full and void remainder of the urine into the toilet.
o Screw on the sterile cover. Do not touch the inner surface.
In-dwelling catheter:
Obtain the specimen with a needle and syringe. Select a puncture site 1-2 inches distal to the
meatus. Clean the area to be punctured with 70% alcohol. Aspirate 10 ml of urine with a
sterile needle and syringe.
NOTE: Specimens obtained from the collection bag are NOT clinically useful. FOLEY
TIPS WILL NOT BE ACCEPTED.
ALL OUTSIDE CLIENTS (INCLUDING NURSING HOMES)
o If specimen is a Suprapubic or Nephrostomy specimen, write this on the SOURCE

line.
o Refrigerate urine immediately after collection and during transport. Deliver to
Mercy Lab within 2 hours of collection (DO NOT LEAVE URINE AT ROOM
TEMPERATURE AFTER COLLECTION).
o If delivery will exceed 2 hours from collection, specimens must be transferred to a
urine transport tube. (Available from Mercy Lab.):
1. Fill the urine transport tube with the urine specimen (about 4 ml).
2. If there is <4 ml of urine, remove the rubber stopper from the tube and
fill it to the minimum mark with urine. Replace the rubber stopper and
mix well.
3. If the specimen was collected from an in-dwelling catheter using a
syringe, inject the needle through the rubber stopper and allow the
vacuum inside of the tube to draw the correct volume into the tube.
4. Transport at room temperature. Specimen must be received by
Microbiology Lab within 48 hours of collection.
o Results will be quantitated in colony forming units/ml.
o Specimens containing more than 3 organisms will NOT routinely have organism
identifications or susceptibility testing reported. This is generally indicative of an
Comments:
improperly collected specimen.
o Foley catheter tips will NOT be cultured.
o Susceptibility testing will be routinely performed on all significant isolates.
o Urine culture transport tubes are not acceptable for urinalysis.
Performed: Final report: 1 - 2 days
Reference value: No growth (<10,000 CFU/ml)

CPT Code: 87086
POWERCHART
URINE DIPSTICK
NAME
MERCY TEST NAME URINE DIPSTICK MERCY LAB CODE UCS

acceptable.
Midstream:

separated.
Cause for Specimens >2 hours at room temperature or >8 hours refrigerated.
rejection:
codes:
MURN Midstream
CURN Cath
SURN Suprapubic
Reference Value: Spec. Gravity: 1.001-1.035
Ph: 4.6-8.0
Protein: Negative
Glucose: Negative
Ketones: Negative
Bilirubin: Negative
Occult Blood: Negative
Urobilinogen: Negative
Nitrites: Negative
Method: Reagent strip.
CPT Code: 81003
POWERCHART
URINE MEASUREMENT
NAME
MERCY TEST NAME URINE MEASUREMENT MERCY LAB CODE VMSM
Comment: To be ordered by the Lab on any urine specimen measured by Mercy Lab personnel.
Method: Manually using a graduated cylinder or container.
CPT Code: 81050
POWERCHART
URINE MICROSCOPIC ONLY
NAME
MERCY TEST NAME URINE MICRO ONLY MERCY LAB CODE UCM
Includes: Description of the sediment.

Deliver specimen to lab within 1 hour of collection.
acceptable.
Midstream:

separated.
codes:
MURN Midstream
CURN Cath
SURN Suprapubic
Reference Value: Urine Microscopic:

WBC: 0-5/HPF
RBC: 0-2/HPF
SQ Epithelial: 0-5/HPF
CAST: Rare Hyaline/LPF
Crystals: None seen/HPF
Bacteria: None seen/HPF
Yeast: None seen/HPF
Method: Microscopic examination.
CPT Code: 81015

TEST NAME See: Porphyrin Quantitative 24Hour Urine*
UROPORPHYRINS Porphyrins Quantitative Random Urine
POWERCHART
VALPROIC ACID (DEPAKENE) LEVEL
NAME
MERCY TEST NAME VALPRO ACID MERCY LAB CODE VAL

Comment: Indicate time last dose in comment.
Therapeutic 50-100 mcg/ml
Range:
Method The Atellica CH VPA assay is based on a particle-enhanced turbidimetric inhibition
Description: immunoassay (PETINIA) technique which measures the level of valproic acid, an
anticonvulsant drug.
CPT Code: 80164
POWERCHART VANCOMYCIN LEVEL INTERMEDIATE

NAME
MERCY TEST NAME VANCOMYCIN INT MERCY LAB VNI

CODE
Specimens may be stored for up to 8 hours at room temperature (25°C), up to 2 days at
Stability:
2–8°C, or stored frozen for up to 30 days at -20°C.
Comment: Consult Pharmacy to establish collection time. Indicate time last dose in comment.
Therapeutic
The Atellica CH Vanc assay is based on a homogeneous particle enhanced turbidimetric
Range:
inhibition immunoassay (PETINIA) technique which uses a synthetic particle-vancomycin
Method
conjugate (PR) and monoclonal vancomycin specific antibody (Ab).
Description:
CPT Code: 80202
POWERCHART VANCOMYCIN TROUGH LEVEL

NAME
MERCY TEST NAME VANCOMYCIN TRGH MERCY LAB CODE VNTR

Specimens may be stored for up to 8 hours at room temperature (25°C), up to 2 days at
Stability:
2–8°C, or stored frozen for up to 30 days at -20°C.
Comment: Consult Pharmacy to establish collection time. Indicate time last dose in comment.
Therapeutic
10-20 mcg/mL
Range:
The Atellica CH Vanc assay is based on a homogeneous particle enhanced turbidimetric
Method
inhibition immunoassay (PETINIA) technique which uses a synthetic particle-vancomycin
Description:
conjugate (PR) and monoclonal vancomycin specific antibody (Ab).
CPT Code: 80202
POWERCHART VARICELLA ZOSTER ANTIBODY IgG
NAME
MERCY TEST VARI ZOSTER AB IGG* MERCY LAB VZVGG

NAME CODE
This test is for immune status.
For diagnosis of recent infection, testing of IgM and IgG antibodies are recommended
Comment:
(VZGM)
Alias: Chicken Pox
Processing: Specimen stability is 14 days when refrigerated. Send refrigerated to Mayo. Mayo order
code VZPG.

CPT Code: 86787
POWERCHART VARICELLA ZOSTER ANTIBODY IgG IgM

NAME
MERCY TEST NAME VARIC ZOST IgG IgM* MERCY LAB VZGM
CODE
Comment: Includes IgG and IgM results
Processing: Send in screw-capped, round bottom, plastic vial, refrigerated to Mayo. Mayo order code
(VZGM).
Alias: Chicken Pox
Reference value: Included with Results
Method: IgG: Multiplex Flow Immunoassay (MFI)
IgM: Immunofluorescence Assay (IFA)
CPT Code: 86787 x2
TEST NAME VARICELLA ZOSTER PCR (MC)
MERCY TEST NAME VARIC ZST, NOT BLD* MERCY LAB LVZV
CODE
Body fluid (Spinal, pleural, peritoneal, ascites, pericardial, amniotic, or ocular) – 0.5 mL of
fluid in a sterile container. Do not centrifuge. Send to Mayo in Sarstedt Aliquot Tube, 5
mL (T914).
Swab (Miscellaneous; dermal, eye, nasal, or throat) – Culturette (BBL Culture Swab)
(T092). Send swab to Mayo in multimicrobe media (M4-RT, M4 or M5).
Genital Swab (Cervix, vagina, urethra, anal/rectal, or other genital sources) – Culturette
(BBL Culture Swab) (T092). Send swab to Mayo in multimicrobe media (M4-RT, M4 or M5).
Respiratory (Bronchial washing, bronchoalveolar lavage, nasopharyngeal aspirate or
washing, sputum, or tracheal aspirate) – 1.5 mL of specimen in sterile container.
Tissue (Brain, colon, kidney, liver, lung, etc.) – Entire collection in a Multimicrobe media
(M4-RT) (T605) (Preferred) or Sterile container with 1–2 mL of sterile saline.
Cautions: A negative result does not exclude the possibility of varicella-zoster virus (VZV)
infection. The reference range is typically “negative” for this assay. This assay is only to be
used for patients with a clinical history and symptoms consistent with VZV infection and
must be interpreted in the context of the clinical picture. This test should not be used to
screen asymptomatic patients.
Processing: Send refrigerated to Mayo. Frozen is also acceptable. Mayo order code (VZVPV).
CPT Code: 87798
TEST NAME VASCULAR ENDOTHELIAL GROWTH FACTOR
MERCY TEST NAME VASC ENDO GRW FCTR* MERCY LAB VEGF
CODE
o Immediately after specimen collection, place the tube on wet ice.
Collection
o Centrifuge at 1500 x g for 10 minutes and aliquot plasma into plastic vial.
Instructions:
o Freeze specimen within 30 minutes.
0.5 mL plasma from a Lavender-top (EDTA) tube.
Specimen:
Aliquoted plasma MUST be frozen within 30 minutes of collection
Processing: Send frozen to Mayo. Mayo order code (VEGF).
Performed: 1-8 days, Tuesday & Friday

Method: Electrochemiluminescence Immunoassay (ECLIA)
CPT Code 83520
POWERCHART NEUTROPHIL CYTOPLASM ANTIBODY VASCULITIS PANEL

NAME
MERCY TEST NAME VASCULITIS ANCA PANEL* MERCY LAB VAPNL

CODE
Processing: Send refrigerated to Mayo. Mayo order code (VASC).
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.
POWERCHART VDRL CSF QUALITATIVE

NAME
MERCY TEST NAME VDRL CSF* MERCY LAB CODE VDRC
Specimen: 0.5 ml spinal fluid in a CSF tube. Minimum 0.2 mL.

Processing: Send frozen to Mayo. Mayo order code (VDSF).
Performed: 1-3 days. Test set up Monday through Friday 12 p.m..
Method: Flocculation/Agglutination
CPT Code: 86592
POWERCHART VISCOSITY
NAME
MERCY TEST NAME VISCOSITY SERUM* MERCY LAB CODE VSCT
3.0 ml serum from a no additive serum tube, serum gel/SST are NOT acceptable. Keep
Specimen:
specimen at 37°C until after centrifugation and separation of cells.
Processing: Send to Mayo. Mayo order code (SVISC).
Performed: 1-3 days. Test set up Monday through Friday; continuously until 2 p.m.
Method: Benson BV200 capillary method
CPT Code: 85810
POWERCHART VITAMIN A (Retinol) LEVEL
NAME
MERCY TEST NAME VITAMIN A* MERCY LAB CODE VITA
Collection: o Specimen must be collected following an overnight (12-14 hr.) fast.
o Infants - draw prior to next feeding.
Processing: Send serum refrigerated to Mayo Medical Laboratories. Mayo order code (VITA).
Performed: Monday through Friday; first shift

Method: Liquid Chromatography-Tandem mass Spectrometry (LC-MS/MS)
CPT Code: 84590
POWERCHART VITAMIN B1 (THIAMIN) WHOLE BLOOD

NAME
MERCY TEST NAME THIAMIN VIT B1* MERCY LAB CODE VB1
Specimen: 3 mL Whole Blood from a EDTA tube. **Protect from light**

Processing: Process by transferring whole blood into amber plastic vial to protect from light. Specimen
must be Frozen within 24 hours of collection. Send to Mayo Medical Laboratories Mayo
Code - TDP
Cause for
Specimens other than whole blood.
Rejection:
Performed: Within 6-11 days from receipt at Mayo Labs.
Reference ranges included with result
Reference value:
Method: High Performance Liquid Chromatography
CPT Code: 84425 Vitamin B1
POWERCHART VITAMIN B6 Profile

NAME
MERCY TEST NAME VITAMIN B6 PROF* MERCY LAB CODE B6PRO
1 mL plasma heparin from a sodium or lithium heparin or plasma gel separator tube (PST).
Specimen:
**Protect from light**
Patient Prep: Patient must be fasting overnight (12-14 hours) (infants-collect prior to next feeding)
Patient must not ingest vitamin supplements for 24 hours before specimen collection
Centrifuge at 4 degrees C within 2 hours of collection, then aliquot all plasma
Processing:
into amber vial. Send to Mayo Frozen. Mayo Code - (B6PRO)
Performed: 1 - 7 days. Monday through Thursday, Sunday
Reference value: Reference ranges included with result
82542
CPT Code:
84207
POWERCHART VITAMIN B12 LEVEL

NAME
MERCY TEST NAME VITAMIN B12 MERCY LAB CODE B12

Comment:
Intrinsic Factor (Mayo test IFBA) will be reflex ordered and charged on all specimens with a
B12 less than 180 pg/mL.
Preservatives, such as fluoride and ascorbic acid, interfere with the Atellica IM VB12 assay.
Excessive exposure of samples to light may alter vitamin B12 values.

180-914 pg/mL
Reference Range: Indeterminate Range: 146 - 179 pg/mL
Deficient Range: 0 - 145 pg/mL
The Atellica IM VB12 assay is a competitive immunoassay using direct chemiluminescent
Method
Technology.
Description:
CPT Code: 82607 Vit B12
POWERCHART VITAMIN B12 AND FOLATE LEVEL

NAME
MERCY TEST NAME VIT B12 FOLATE MERCY LAB CODE B12F
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.
Stability: 8 hours room temp, 72 hours refrigerated, or >72 hours frozen.

Cause for
Hemolyzed specimen not acceptable.
rejection:
Method
Description:
CPT Code: 82607 Vit B12+
82746 Folate+
POWERCHART VITAMIN D 25 HYDROXY LEVEL

NAME
MERCY TEST NAME VIT D, 25-HYDROXY MERCY LAB CODE VD25H

Stability: Tightly cap and refrigerate specimens at 2–8°C for up to 7 days if the assay is not completed
within 24 hours. Specimens may be stored on the clot for up to 6 days.18
Freeze samples at ≤ -20°C if the sample is not assayed within 7 days. Freeze samples up to 4
times and mix thoroughly after thawing.
Comment: Includes: Total 25-Hydroxyvitamin D (Sum of D2 + D3)
Reference Range: 10-24 ng/mL (mild to moderate deficiency)
25-80 ng/mL (optimum levels)
>80 ng/mL (toxicity possible)
Method The Atellica IM VitD assay is a competitive immunoassay that uses an anti-fluorescein mouse
Description: monoclonal antibody covalently bound to paramagnetic particles
CPT Code: 82306
POWERCHART 25 HYDROXYVITAMIN D2 D3 LEVL

NAME
MERCY TEST NAME 25 HYDROXY VD2 D3* MERCY LAB CODE 25HDN
Comment: The test will report out three results, 25-Hydroxy D2, 25-Hydroxy D3, and 25-Hydroxy Total
Serum stable 14 days refrigerated.
Processing: Specimen is to be sent refrigerated. Mayo order code (25HDN).
Performed: 2-5 days.

CPT Code: 82306
POWERCHART VITAMIN D 1,25 DIHYDROXY LEVEL

NAME
MERCY TEST NAME 1,25 DIHYDR VTMN D* MERCY LAB CODE DHVD
Collection
Fasting (4-hour preferred but not required)
Instructions:
Processing: Send serum refrigerated to Mayo. Mayo order code (DHVD)
Performed: 2-4 days. Monday through Friday; 3 p.m.
Reference
Value:
Method: Extraction/Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS).
CPT Code: 82652
POWERCHART VMA URINE

NAME
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 urine) 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 Administration of L-dopa may falsely-increase vanillylmandelic acid results; it should be

preparation: discontinued 24 hours prior to collection of specimens.
Specimen: Add 25 mL 50% acetic acid preservative at the start of the collection. If specimen is
refrigerated during collection, preservative may be added up to 4 hours after collection. This
preservative is intended to achieve a pH of between approximately 1 and 5. If necessary,
adjust urine pH to 1 to 5 with 50% acetic or HCl acid. Patient's age and 24-hour volume
required.
Reference Lab Adjust pH to 1.0-5.0 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: 2-4 days. Test set up Monday through Friday; 8 a.m..

Mercy lab
Send 5 ml in a 5 ml urine tube to Mayo refrigerated.
Processing:
Reference value: Included on report.
Method: Liquid Chromatography-tandem mass spectrometry (LC-MS/MS)
CPT Code: 84585 VMA UR+
POWERCHART FACTOR VIII VON WILLEBRAND ANTIGEN
NAME
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 Von Willebrand Antigen Mayo test code (VWAG).

CPT Code: 85246
POWERCHART VON WILLEBRAND PROFILE

NAME
MERCY TEST NAME PROFILE VON WILL* MERCY LAB CODE VWPR
Specimen: 3 mL plasma from blue top tube filled appropriately with the amount of blood listed on the
label.
Aliquot 3 mL of platelet poor plasma in 3 plastic vials each containing 1 mL.
Processing: Centrifuge, remove plasma, spin plasma again, aliquot to a new plastic tube. Freeze plasma
in plastic vial. Send frozen to Mayo. Order Mayo (AVWPR).
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. Performed Monday through Friday: Varies

Method: F8A, F8IS, IBETH: Activated Partial Thromboplastin Time-Based Clotting Assay
VWAG: Automated Latex Immunoassay (LIA)
VWFX: Latex particle Enhanced Immunoassay
RIST: Ristocetin induced Aggregation of Washed Normal Platelets
VWFM: Agarose Gel Electrophoresis/Infrared Dye-Labeled Antibody Detection
CPT Code: 85240-Coagulation factor VIII assay
85246-von Willebrand factor antigen
85397-von Willebrand factor activity
85245-von Willebrand factor ristocetin cofactor activity (if appropriate)
85247-von Willebrand factor multimer (if appropriate)
85335-Bethesda titer (if appropriate)
85335-Coagulation factor VIII inhibitor screen (if appropriate)
85390-26-Special coagulation interpretation (if appropriate)
POWERCHART WEST NILE VIRUS IgG AND IgM ANTIBODY (Serum)
NAME
MERCY TEST NAME WEST NILE, IgG & IgM* MERCY LAB
WNILE
CODE
Processing: Send refrigerated to Mayo. Mayo order code (WNS).
Performed: 1-4 days. Monday - Friday: 9 a.m. (June-October)
Monday, Wednesday, Friday; 9 a.m. (November-May)

CPT code: 86788 WNV, IgM
86789 WNV, IgG
POWERCHART WEST NILE VIRUS CSF

NAME
MERCY TEST WEST NILE CSF* MERCY LAB

WNLCSF
NAME CODE
Specimen: 2.0 ml of CSF

Processing: Send refrigerated to Mayo. Mayo order code WNC.
Performed: 1 - 4 days. Monday - Friday (June to Oct), Monday, Wednesday, Friday (Nov to May)
CPT code: 86788 - IgM
86789 - IgG
TEST NAME WET MOUNT Order Gram Stain

Smear Wet Mount Trichomonas
POWERCHART WBC AND AUTOMATED DIFFERENTIAL (WBC)

NAME
MERCY TEST NAME WBC AND AUTOMATED DIFF MERCY LAB WBCADI
CODE
WBC and automated differential (include absolute neutrophil counts). Manual differential is
Includes:
done if indicated by test results.
Processing: Specimen stable 36 hours at either room temperature or refrigerated.
CPT Code: 85048 WBC
85004 AUTOMATED DIFFERENTIAL
POWERCHART WBC COUNT
NAME
MERCY TEST NAME WBC MERCY LAB WBCX

CODE

Processing: Specimen stable 36 hours at either room temperature or refrigerated.
CPT Code: 85048
POWERCHART CULTURE WOUND OTHER

NAME
MERCY TEST NAME WND/ABS CLT/GS MERCY LAB WNDC

CODE
Order: Specify collection site when ordering.
Specimen: Disinfect the skin. If possible, aspirate purulent material with a sterile needle and syringe.
Transfer this material to a sterile plastic container with a tight-fitting lid. If an aspirate is not
possible, collect purulent material from a deep area of the wound/abscess on a culture swab
device (that contains 2 swabs).
Specimen stability: Aspirate: 24 hours room temperature. Culture Swab: 48 hours room
temperature.
Comment: o If anaerobic organisms are suspected, collect a second specimen. See Anaerobic
Culture/Gram Stain for collection and ordering instructions.
o Susceptibility testing will routinely be performed on significant isolates.
RL Client o Mark WOUND CULTURE on order form. Write collection site on SOURCE line.
Comments: If ordering in the computer, use order code WNDC.
Performed: Gram stain: Within 8 hours of receipt.
Preliminary report: Days 1 and 2
Reference value: No growth.
CPT Code: 87205 Gram Stain+

87070 Wnd/Abs Clt+
POWERCHART YEAST CULTURE + DIRECT PREP OTHER

NAME
MERCY TEST NAME YEAST CLT/DIR PR MERCY LAB YEST

CODE

Specimen: o Genital: Submit specimen on a routine Culturette. Collect urethral exudate or areas of
inflammation using a routine Culturette. Cultures from females should be obtained via
speculum under direct observation.
o Oral: Submit the specimen on a routine Culturette.
o Esophageal: Submit a minimum of 1 ml of esophageal washings in a sterile plastic
container with a tight-fitting lid.
o Urine: Submit 0.5 ml urine in a sterile plastic container with a tight-fitting lid.
Refrigerate urine if not delivered to the Lab promptly.
Comment: o Screens for yeast only.
o If a fungus is suspected, see Fungus Culture/Direct Preparation for ordering and
collection information.
RL Client o Write YEAST CULTURE/DIRECT PREP on the order form. Indicate the specimen source.
Comments: o Send Culturette at room temperature.
o Send urine refrigerated.
Performed: Final report: 1 week
Reference value: No yeast isolated.
CPT codes: 87205 Gram Stain+

87106 Yeast Clt+
MERCY TEST NAME ZIKA VIRUS MERCY LAB CODE MISM
Specimen: o Serum: minimum 1.0 mL

o Urine: minimum 10 mL but SHL will accept lessor amounts if that is all that is available
NOTE: Healthcare providers suspecting a potential case of Zika virus should first contact the
Iowa Department of Public Health at: 800-362-2736.
If testing criteria is met, IDPH will fax a test request form for the provider to fill out. This form
includes patient history. THIS FORM MUST ACCOMPANY ANY SAMPLE(s) SENT TO MERCY
LAB.
Send all samples to Mercy Lab refrigerated.
This testing is performed at no charge
Processing: Mercy Lab: send to State Hygienic Lab, refrigerated. Place the urine in a biohazard bag, place
the serum in a biohazard bag and then place both
of those in another biohazard bag (double bagged). Place the form in the outside pocket of the
biohazard bag. Place that biohazard bag into the clear Ziploc CDS bag. Follow the CDS send out
procedure for scheduling a pickup.
Performed: M-F at State Hygienic Lab, Coralville, Iowa
POWERCHART ZINC LEVEL

NAME
MERCY TEST NAME ZINC, SERUM MERCY LAB ZINCS

CODE
Specimen: o Draw before any other tubes are drawn. 0.8 ml serum from Navy blue monoject-no
additive, trace element blood collection tube.
Cause for rejection: The use of other tubes is unacceptable.
specimen to separate serum from the cellular fraction. Serum must be removed from
the cells within 4 hours of specimen collection. Pour serum into a Mayo Metal Free
vial. Do NOT use a transfer pipet or wooden sticks. Avoid hemolysis.
o Send to Mayo refrigerated. Ambient and frozen are acceptable. Mayo order code
(ZN_S).
Performed: 1-3 Days. Monday through Saturday.
Reference Values: included with report
Method: Dynamic Reaction Cell Inductively Coupled Plasma Mass Spectrometry (DRC-ICP-MS)
CPT Code: 84630

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TEST NAME ABDOMINAL FLUID CYTOLOGY See: Cytology Section Peritoneal Fluid

COLLECTION CHARGE CAPILLARY BLOOD GASES.

MERCY TEST NAME ACETAMINOPHEN MERCY LAB CODE ACMN

Specimen: 0.5 ml serum

Performed: Within 8 hours of receipt. Available stat.

Therapeutic 10-20 mcg/mL

CPT Code: 80143

MERCY TEST ACET RECP BNDG* MERCY LAB CODE ACHRBA

POWERCHART ACTH Adrenocorticotropic

MERCY TEST ACTH* MERCY LAB ACTH

Comment: Morning (0600 – 1030) specimens are desirable.

Specimen: o Draw 5 ml blood into pre-chilled purple top (EDTA) tubes.

POWERCHART AFB CULTURE OTHER

MERCY TEST ACID FAST CLT/SMR* MERCY LAB AFBCLT

Comment: Specify collection site when ordering.

Specimen: Submit each specimen in a sterile container with a tight-fitting lid.

o Body fluids: Minimum of 5 ml specimen. 60 ml preferred.

Processing: o Send to the laboratory immediately after collection.

o If tissue is submitted for testing, an additional charge will be assessed for

AFB culture: No acid-fast organisms isolated.

CPT Code: 87206- Smear

POWERCHART AG RATIO (Albumin Globulin Ratio)

MERCY TEST NAME AG RATIO MERCY LAB CODE AG

Specimen: 0.5 ml serum

Performed: Within 8 hours of receipt. Available stat.

CPT Code: N/A

POWERCHART ALBUMIN LEVEL

MERCY TEST NAME ALBUMIN MERCY LAB ALB

Specimen: 0.5 ml serum

Comment: Do not use hemolyzed samples

Performed: Within 8 hours of receipt. Available Stat.

Reference Range: 0 - 30 days 2.9 - 5.5 g/dl

CPT Code: 82040

POWERCHART ALCOHOL (ETHANOL) LEVEL

Specimen: 0.5 ml serum

Performed: Within 8 hours of receipt. Available stat.

Reference Range: <10 mg/dL

CPT Code: 82077

MERCY TEST NAME ALDOLASE* MERCY LAB CODE ALDL

Specimen: 1 ml serum from a no additive serum tube. (0.5 ml minimum)

POWERCHART ALDOSTERONE LEVEL

Method: Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS)

POWERCHART ALDOSTERONE 24 HOUR URINE

MERCY TEST NAME ALDOSTERONE, 24UR* MERCY LAB CODE ALDOU

Includes: Aldosterone, Urine Collection Duration, Urine Volume

POWERCHART ALKALINE PHOSPHATASE

MERCY TEST NAME ALK PHOS MERCY LAB CODE ALKP

Specimen: 0.5 ml serum

Comment: Avoid repeated freezing and thawing.

Performed: Within 8 hours of receipt. Available stat.

Reference Range: Female: Male:

CPT Code: 84075

POWERCHART ALKALINE PHOSPHATASE BONE SPECIFIC

POWERCHART ALKALINE PHOSPHATASE ISOENZYMES

Includes: Total Alkaline Phosphatase; Bone, Intestine and Liver Isoenzymes.

Performed: 2-4 days. Test performed Monday through Friday.

CPT Code: 84080 Alk Phos Isoenzymes

TEST NAME ALLERGEN MULTIPLE SCREEN*

MERCY TEST MISC GENERAL LAB MERCY LAB CODE CMIS

Mayo offers the following multiple allergen screens: