POLG DNA Sequencing Test

Test Code
901335


CPT Codes
81406<br /> Restricted Client Code

Physician Attestation of Informed Consent
This germline genetic test requires physician attestation that patient consent has been received if ordering medical facility is located in AK, DE, FL, GA, IA, MA, MN, NV, NJ, NY, OR, SD or VT or test is performed in MA.


Includes
Related to all allelic disorders


Preferred Specimen
8 mL whole blood collected in two EDTA (lavender-top) tubes, or
Pediatric 0-3 years: 2 mL whole blood


Minimum Volume
6 mL • 1 mL pediatric


Instructions
Please label each specimen with two forms of patient identification. These forms of identification must also appear on the requisition form.

Avoid freezing.

Note: Higher blood volumes ensure adequate DNA quantity, which varies with WBC, specimen condition, and need for confirmatory testing. Patients, 0-3 years have higher WBC, yielding more DNA per mL of blood.


Transport Temperature
Room temperature


Specimen Stability
Room temperature: 10 days
Refrigerated: 10 days
Frozen: Unacceptable


Methodology
Sanger Sequencing

Setup Schedule
Set up: Varies; Report available: 21-28 days


Reference Range
No mutations detected


Clinical Significance
Identifies mutations in the POLG gene related to mitochondrial disease and all allelic disorders




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.