HEMOSIDERIN, URINE OR BRONCHOALVEOLAR LAVAGE (BAL)

Additional Codes

Software	Test Code
Label Text	HMSID
EPIC	LAB399

Performing Laboratory

NorDx Laboratories

Useful For

Determining whether an intravascular hemolytic episode has occurred

Method Name

Light Microscopy

Reference Values

Negative (reported as positive or negative)

Days and Times Test Performed

Monday through Friday

Report Available

1 Day

Profile Information

Individual Test Description
HEMOSIDERIN
SPECIMEN, HEMOSIDERIN

Specimen Type

Submit one of the following:

~ Bronchoalveolar Lavage

~ Sputum

~ Urine, clean-catch

Preferred Container

Dark Green Top Tube (Lithium Heparin)

Urine Cup – See Specimen Collection and Handling

Preferred Volume

Bronchoalveolar Lavage: 2 mL (Dark Green Top Tube (Lithium Heparin))

Urine, clean-catch: 15 (Urine Cup) – See Specimen Collection and Handling

Specimen Collection and Handling

Submit only one of the following specimens:

URINE:

1. 15 mL from a clean-catch random urine collection.

2. No preservative.

3. Send specimen refrigerated in a clean, non-sterile, plastic urine container supplied.

BAL:

2.0 mL of fluid in a green-top (heparin) tube or other suitable container. Indicate source.

SPUTUM:

2.0 of fluid in a plastic container. Indicate source.

Specimen Stability Information

Specimen Type: Bronchoalveolar Lavage

Refrigerated: 1 Day

Specimen Type: Sputum

Refrigerated: 1 Day

Specimen Type: Urine, clean-catch

Note: Urine specimens are only stable for 12 hours

Add On Capable

Yes

Advance Beneficiary Notice Requirements

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
83070	Hemosiderin, qualitative

Performing Laboratory Location