|Test||THROMBOTIC RISK PANEL|
|Description||Useful for the diagnosis of thrombotic disorders.
Antithrombin III Activity
If an abnormal lupus screen is detected the following tests will be performed at an additional cost:
If the thrombin time is greater than 30, a Reptilase Time will be performed.
NOTE: Tests may be ordered individually.
NOTE: This test, when ordered on Medicare patients, is subject to the National Coverage Determination (NCD) policies "Partial Thromboplastin Time (PTT)" and "Prothrombin Time (PT)". Please verify that the diagnosis code (ICD-9) you have chosen demonstrates medical necessity for the test as documented in the physician's patient record. The CMS web site or the NorDx Limited Coverage Documentation Guide are available to assist you with this verification. A properly executed Advance Beneficiary Notice (ABN) must be submitted with the specimen if medical necessity is not demonstrated by the ICD-9 code chosen.
2. PLASMA FOR HOMOCYSTEINE, TOTAL:
3. BLOOD FOR HEMATOCRIT:
4. PLASMA FOR ANTITHROMBIN III, FIBRINOGEN, LUPUS ANTICOAGULANT, PROTEIN C and S, REPTILASE TIME, THROMBIN TIME, INR, and PTT:
5. SERUM FOR CARDIOLIPIN ANTIBODIES and BETA-2-GLYCOPROTEIN ANTIBODIES:
|Reference Values||An interpretive report will be issued.|
|Analytic Time||14 - 21 Days|
|Day(s) Test Set Up||Varies|
84285 Silica Screen
84285 Silica Mix Study, if indicated
84285-90 Silica Confirmation
85300 Antithrombin III activity
85303 Protein C activity
85306 Protein S activity
85613 DRVVT Confirmation
85613 DRVVT Mix Study, if indicated
85613 DRVVT Screen
85635 Reptilase Time, if indicated
85670 Thrombin time
85730 PTT with sensitive reagent, (Dade Actin FS),if indicated
85732 PTT mixing studies, if indicated
86146 x 2 Beta-2-glycoprotein antibody, each
86147 x 3 Cardiolipin antibodies, each