Lipoprotein Fractionation, Ultracentrifugation

Test Code

36435

CPT Codes
82465, 83701, 84478

Includes

Total Cholesterol
Triglycerides
HDL Cholesterol
LDL Cholesterol
VLDL, Calculated

Preferred Specimen

4 mL serum

Patient Preparation
Fasting for at least 12 hours is required.
The assay manufacturer Beckman Coulter advises: N-Acetyl Cysteine (NAC), when administered in therapeutic concentrations (for the treatment of acetaminophen overdose), has been determined to interfere with assays for cholesterol, uric acid where NAC interference may lead to falsely low results. According to Beckman Coulter, the NAC interference should be insignificant by 12 hours after completion of the initial loading dose of an IV infusion treatment regimen consisting of an initial loading dose of 150 mg/kg administered over 1 hr, a second dose of 50 mg/kg administered over 4 hrs and a third dose of 100 mg/kg administered over 16 hrs.

Minimum Volume

2 mL

Instructions

The assay manufacturer, Roche, notes that N-acetylcysteine, when administered in high concentrations (such as for treatment of acetaminophen overdose), can interfere with their assay for HDL cholesterol, leading to falsely low results.

Transport Temperature

Refrigerated (cold packs)

Specimen Stability

Room temperature: 24 hours
Refrigerated: 7 days
Frozen -20° C: 14 days
Frozen -70° C: 1 year

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

Received room temperature

Methodology
Ultracentrifugation • Colorimetric • Enzymatic

Setup Schedule

A.M. Sets up 2 days a week.

Report Available

Reports in 2 to 4 days.

Clinical Significance

This panel measures serum concentrations of total cholesterol, triglycerides, high-density lipoprotein (HDL) cholesterol, and low-density lipoprotein (LDL) cholesterol and provides a calculated concentration of very low-density lipoprotein (VLDL) cholesterol. Comprehensive lipid assessment aids in evaluating cardiovascular disease (CVD) risk and the likelihood of an ischemic event. It is also useful for the prevention and management of atherosclerotic disease and diagnosis of metabolic syndrome [1].

CVD is the leading cause of death in the United States. Individuals with high LDL cholesterol and triglyceride levels are at elevated risk for developing CVD and having an ischemic event [2,3]. The American Heart Association recommends that Americans aged 20 and above have their lipid levels tested every 4 to 6 years. Children should have their cholesterol tested for the first time between ages 9 and 11 and again between ages 17 and 21. Testing should start earlier if there is a family history of high cholesterol [4].

Treatment with N-acetyl cysteine for acetaminophen overdose may generate a falsely low result for cholesterol [5]. Venipuncture immediately after or during administration of the painkiller metamizole (dipyrone) may also lead to falsely low results for cholesterol [6].

Note: Any or all individual tests from a panel can be ordered separately.

The results of this test should be interpreted in the context of pertinent clinical and family history as well as physical examination findings.

References
1. Stone NJ, et al. Circulation. 2014;129(25 Suppl 2):S1-S45.
2. CDC. Heart disease facts. Accessed January 3, 2022. https://www.cdc.gov/heartdisease/facts.htm
3. Arbel Y, et al. Card Diabetol. 2016;15:11.
4. Grundy SM, et al. Circulation. 2019;139(25):e1082-e1143.
5. Beckman Coulter AU analyzers. Instructions for use. Beckman Coulter Inc; 2015. Accessed January 19, 2023. https://www.beckmancoulter.com/wsrportal/techdocs?docname=/cis/BAOSR6X16/%25%25/EN_CHOL%20OSR%20General%20Chemistry.pdf
6. Gascon N, et al. Clin Chem. 1993;39(6):1033-1036.

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.