Venous Thrombosis Hypercoagulability Panel with Reflex and Consultation

Test Code

19656

CPT Codes
85307, 81240, 85303, 85306, 85305, 85300, 83090, 86147 (x2), 85240, 86146 (x2), 85730, 85613 <br>Dependent on the complexity of the consultation, 80503 or 80504 or 80505 may be assigned. 80506 may also be billed if high complexity with more than 60 minutes of time spent for the consultation.

Includes

Activated Protein C Resistance with Reflex to Factor V (Leiden) Mutation
Prothrombin (Factor II) 20210G→A Mutation Analysis
Protein C Activity
Protein S Antigen, Free and Protein S Antigen, Total
Antithrombin III Activity
Homocysteine
Cardiolipin Antibodies (IgG, IgM)
Factor VIII Activity, Clotting
Beta-2-Glycoprotein I Antibodies (IgG, IgM)
Lupus Anticoagulant Evaluation with Reflex (PTT-LA and dRVVT with Reflex Confirmations)
Coagulation Consultation

If Activated Protein C-Resistance is <2.1 ratio, then Factor V (Leiden) Mutation Analysis will be performed at an additional charge (CPT code(s): 81241).

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).

Preferred Specimen

5 mL whole blood collected in an EDTA (lavender-top) tube, and
1 mL frozen platelet-poor plasma (x6) collected in separate 3.2% sodium citrate (light-blue top) tubes, and
1 mL serum collected in a red-top tube (no gel)

Minimum Volume

3 mL whole blood • 0.5 mL (x6) plasma • 0.5 mL serum

Instructions

•Whole blood sample is for the Factor V Mutation Analysis and Prothrombin (Factor II) Mutation Analysis.
•Serum sample is for the Homocysteine.

Red top tubes: Place the specimen in a refrigerator or ice bath for 30 minutes after collection. Centrifuge the specimen as soon as possible after complete clot formation has taken place. Transfer the serum to a plastic screw-capped vial.

Barrier gel separator tubes: Place the specimen in a refrigerator for 30 minutes after collection. Centrifuge the specimen as soon as possible after complete clot formation has taken place. Do not place barrier tubes in an ice bath as freezing may prevent the barrier gel from adequately separating serum from cells. Platelet-poor plasma is for remaining tests.

Platelet-poor plasma: Centrifuge light blue-top tube 15 minutes at approximately 1500 x g within 60 minutes of collection. Using a plastic pipette, remove plasma, taking care to avoid the WBC/platelet buffy layer and place into a plastic vial. Centrifuge a second time and transfer platelet-poor-plasma into four plastic vials. Plasma must be free of platelets (<10,000/mcL). Freeze immediately and transport on dry ice.

Note: Storage of whole blood at refrigerated temperatures prior to processing may lead to cryoprecipitate formation and falsely low Factor VIII and von Willebrand Factor studies.

Transport Temperature

Whole blood: Room temperature
Plasma and serum: Frozen

Specimen Stability

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

Serum
Room temperature: 4 days
Refrigerated: 14 days
Frozen: 6 months

Plasma
Room temperature: Unacceptable
Refrigerated: Unacceptable
Frozen: 14 days

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

See individual assays

Methodology
See individual tests

Setup Schedule

Set up and Report available: See individual assays

Reference Range

See Laboratory Report

Clinical Significance

This panel evaluates for the most common hereditary and acquired venous thrombophilia risk factors.

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.