Cholesterol and HDL Cholesterol with Ratio

Test Code

7432

CPT Codes
82465, 83718

Includes

Cholesterol, Total; HDL Cholesterol; Cholesterol/HDL Ratio (calculated)

If an HDL Cholesterol measurement is to be performed along with Triglycerides, the patient should be fasting 9-12 hours prior to collection.

Preferred Specimen

1 mL serum

Patient Preparation
If a cholesterol measurement is to be performed along with triglycerides, the patient should be fasting 9-12 hours prior to collection. 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 hour, 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

0.5 mL

Other Acceptable Specimens

Plasma collected in: Sodium heparin (green-top) tube or lithium heparin (green-top) tube

Instructions

Centrifuge within 30-60 minutes following collection

Transport Container

Transport tube

Transport Temperature

Room temperature

Specimen Stability

Serum
Room temperature: 48 hours
Refrigerated: 7 days
Frozen: 28 days

Plasma
Room temperature: 48 hours
Refrigerated: 48 hours
Frozen: 28 days

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

Gross hemolysis • Moderate to gross icterus • Anticoagulants other than heparin

Methodology
Spectrophotometry (SP)

Clinical Significance

This panel measures serum concentrations of total cholesterol and high-density lipoprotein (HDL) cholesterol and provides a calculated total cholesterol/HDL cholesterol ratio. Measurements of cholesterol in conjunction with lipoproteins are used primarily in the risk assessment of atherosclerotic cardiovascular disease (ASCVD) [1].

Elevated total cholesterol is an established risk factor for atherosclerotic coronary disease [1]. HDL cholesterol level has been inversely related to the ASCVD risk, whereas very high HDL levels may increase all-cause mortality [2]. The cholesterol/HDL cholesterol ratio, also known as atherogenic or Castelli index, has been proposed as a stronger predictor of ASCVD risk than total cholesterol or HDL cholesterol alone [3].

Treatment with N-acetyl cysteine for acetaminophen overdose may generate a falsely low result for cholesterol [4]. Venipuncture immediately after or during administration of the painkiller metamizole (dipyrone) may also lead to falsely low results for cholesterol [5].

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. Meeusen J, et al. Lipids and lipoproteins. In: Rifai R, et al. eds. Tietz Textbook of Laboratory Medicine. 7th ed. Elsevier Inc; 2022.
2. Madsen CM, et al. Eur Heart J. 2017;38(32):2478-2486.
3. Millan J, et al. Vasc Health Risk Manag. 2009;5:757-765.
4. 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
5. Gascon N, et al. Clin Chem. 1993;39(6):1033-1036.

Performing Laboratory

Quest Diagnostics-Seattle

1737 Airport Way S Suite 200

Seattle, WA 98134-1636

Last Updated: November 6, 2024

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.