Thrombophilia panel

Test Code

385221

CPT Codes
81240, 81241, 85613, 85730, 86146 (x3), 86147 (x3)<br>Restricted Client Code

Includes

Lupus Anticoagulant Evaluation with Reflex
Cardiolipin Ab (IgA, IgG, IgM)
Beta-2-Glycoprotein I Antibodies (IgG, IgA, IgM)
Factor V (Leiden) Mutation Analysis (performed at Quest San Juan Capistrano)
Prothrombin (Factor II) 20210G>A Mutation Analysis (performed at Quest San Juan Capistrano)

If PTT-LA Screen is prolonged (>40 seconds), then Hexagonal Phase Confirmation will be performed at an additional charge (CPT code(s): 85598).

If Hexagonal Phase Confirmation is positive or weakly positive, then Thrombin Clotting Time will be performed at an additional charge (CPT code(s): 85670).

If dRVVT Screen is prolonged (>45 seconds), then dRVVT Confirm will be performed at an additional charge (CPT code(s): 85597).

If dRVVT Confirm is positive, then dRVVT 1:1 Mixing Study will be performed at an additional charge (CPT code(s): 85613).

If the dRVVT Confirmation is positive, a dRVVT 1:1 dilution will be performed at an additional charge (CPT: 85613).

Preferred Specimen

12 mL whole blood collected in an EDTA (lavender-top) tube, and
13 mL plasma collected in a sodium citrate 3.2% (light blue-top) tube

Minimum Volume

6 mL whole blood and 6.5 mL plasma

Other Acceptable Specimens

Whole blood collected in: EDTA (royal blue-top) tube, or sodium heparin (green-top) tube, or lithium heparin (green-top) tube, or ACD (yellow-top) tube, and 3.2% sodium citrated plasma

Transport Temperature

Whole blood: Room temperature
Plasma: Frozen

Specimen Stability

Whole blood
Room temperature: 8 days
Refrigerated: 8 days
Frozen: 30 days

Plasma
Room temperature: Unacceptable
Refrigerated: Unacceptable
Frozen: 30 days

Reject Criteria (Eg, hemolysis? Lipemia? Thaw/Other?)

Gross hemolysis • Grossly lipemic • Received thawed

Methodology
Immunoassay • Photometric Clot Detection

FDA Status
This test was developed and its analytical performance characteristics have been determined by Quest Diagnostics. It has not been cleared or approved by the U.S. Food and Drug Administration. This assay has been validated pursuant to the CLIA regulations and is used for clinical purposes.

Setup Schedule

Set up and Report available: See individual assays

Reference Range

See Laboratory Report

The CPT Codes provided in this document are based on AMA guidelines and are for informational purposes only. CPT coding is the sole responsibility of the billing party. Please direct any questions regarding coding to the payor being billed. Any Profile/panel component may be ordered separately. Reflex tests are performed at an additional charge.