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Test Code DICP DISSEMINATED INTRAVASCULAR COAGULATION (DIC) SCREEN, BLOOD AND PLASMA

Additional Codes

Software Test Code
SoftID DICP
EPIC LAB20053

Performing Laboratory

NorDx Laboratories

Useful For

The diagnosis of disseminated intravascular coagulation (DIC).

Reptilase Time will be performed if indicated at an additional charge.

Method Name

Clot-Based Assay

Latex Agglutination Quantitative

Reference Values

D-Dimer (XDPV), Plasma: <230 ng/mL DDU

Fibrinogen (FIBR), Plasma: 160 – 450 mg/Dl

Partial Thromboplastin Time (PTT), Plasma: 26-34 seconds

Platelet Count, Blood: 140 – 400 x10^3/µL

INR, Plasma: 0.9 – 1.2

Reptilase Time (REPTI), Plasma: <14 – 21 seconds

Thrombin Clotting Time (TCT), Plasma: 11.0 – 15.0 seconds

(TCT performed only if reflexed)

Days and Times Test Performed

Monday through Sunday

Report Available

1 Day

Available Stat

Profile Information

Individual Test Description

D-DIMER
FIBRINOGEN, PLASMA
INR, PLASMA
PARTIAL THROMBOPLASTIN TIME (PTT), PLASMA
PLATELET COUNT
THROMBIN CLOTTING TIME, PLASMA

Specimen Type

Submit all of the following:

~ Plasma

~ Whole Blood

Preferred Container

Lavendar top tube 13×75 mm 4.0 mL (EDTA)

Lavendar top tube 13×75 mm pediatric (EDTA)

Light Blue Top Tube (Sodium Citrate) – Tube must be full at time of collection. See Specimen Collection and Handling for additional processing instructions.

Preferred Volume

Plasma: 1 mL (Light Blue Top Tube (Sodium Citrate)) – Frozen Aliquots

Whole Blood: 0.5 mL (EDTA Microtainer®) – Use of minimum volumes may not support repeat testing if required

Whole Blood: 4 mL (Lavendar top tube 13×75 mm 4.0 mL (EDTA))

Whole Blood: 2 mL (Lavendar top tube 13×75 mm pediatric (EDTA))

Minimum Volume

Plasma: 0.5 mL (Light Blue Top Tube (Sodium Citrate))

Whole Blood: 0.25 mL (EDTA Microtainer®)

Whole Blood: 1 mL (Lavendar top tube 13×75 mm 4.0 mL (EDTA))

Whole Blood: 1 mL (Lavendar top tube 13×75 mm pediatric (EDTA))

Specimen Collection and Handling

Collect Both: 1 Lavender Top (EDTA) and 2 Light Blue Tops (3.2% sodium citrate)

To Process:

WHOLE BLOOD:

Send sample at ambient temperature.

PLASMA:

1. Draw blood in two light blue-top (3.2% sodium citrate) tubes. Separate plasma from cells within 4 hours of collection in a centrifuge at 2,500 rpm for 15 minutes or 3,000 rpm for 10 minutes.

2. Using a plastic transfer pipette (do not use a glass pipette) decant the plasma to a screw-capped, plastic (polypropylene) vial. Glass vials will not be accepted.

3. Spin the specimen again at the speeds mentioned above.

4. Divide the specimen into as many 0.5-1.0 mL aliquots as possible and cap the vial(s) tightly.

5. Freeze specimen(s) immediately at ≤ – 40º C.

6. Send specimen(s) FROZEN on dry ice.

Click here to view the Procedure for Collecting a Specimen from an A-line

Rejection Information

Underfilled (< 90%), clotted, high hematocrit (> 55%), or grossly hemolyzed

Specimen Stability Information

Specimen Type: Plasma

Room Temp: 4 Hours

Must be spun/separated within: 4 Hours

Specimen Type: Whole Blood

Refrigerated: 24 Hours

Add On Capable

Yes

Advance Beneficiary Notice Requirements

Yes, for Partial Thromboplastin Time (PTT) and Prothrombin Time (PT) only

This test, when ordered on Medicare patients, is subject to the National Coverage Determination (NCD) policies. Please verify that the diagnosis code (ICD code) you have chosen demonstrates medical necessity for the test as documented in the physician’s patient record. The CMS web site is 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 code chosen.

CPT Code Information

CPT Code

CPT Description

CPT Disclaimer

85008 Blood Count, Blood Smear, Microscopic Examination without Manual Differential Leukocyte (WBC) Count  
85049 Blood Count, Platelet, Automated  
85379 Fibrin Degradation Products, D-Dimer, Quantitative  
85384 Fibrinogen, Activity  
85610 Prothrombin Time  
85635 Reptilase Test if Indicated
85670 Thrombin Time, Plasma  
85730 Thromboplastin Time, Partial (PTT), Plasma or Whole Blood  

Acceptable Alternative Container(s)

EDTA Microtainer®

Performing Laboratory Location

NorDx Laboratories