Bile Acids, Fractionated
| PATIENT INFO |
| Patient Name: |
| Medical Record #: |
| BD: / / Sex: F M |
| PHYSICIAN INFO |
| Physician Name : |
| Address: |
| Ph: ( ) - Fax: ( ) - |
| Additional Report to: |
| Ph: ( ) - Fax: ( ) - |
| TESTS REQUESTED | |
| Test Name: | ICD9 Code: (required) |
| 1. Bile Acids, Fractionated | |
| 2. | |
| 3. | |
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| 6. | |
| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
BLACF
Test Workstation :
MAYO
Specimen Type:
Blood
Tube Type:
Red top (no anticoagulant) tube
Alternate Tube Type:
SST
Collection Volume:
1.5 mL
Minimum Volume:
1.0 mL
Storage:
Refrigerated
Availability:
Sent to reference lab
Methodology:
Liquid Chromatography Tandem Mass Spectrometry
Special Instructions:
Overnight fasting preferred.
Lab/Phone:
330-543-8418
TAT:
2-7 days
Additional Info:
Reference range:
Total Cholic Acid: < or = 5.00 nmol/mL
Total Deoxycholic Acid: < or = 6.00 nmol/mL
Total Chenodeoxycholic Acid: < or = 6.00 nmol/mL
Total Ursodeoxycholic Acid: < or = 2.00 nmol/mL
Total Bile Acids: < or = 19.00 nmol/mL
CPT Code:
82542
Panel Includes:
Cholic Acid, Chenodeoxycholic Acid, Deoxycholic Acid, Urodeoxycholic Acid, Total Fractionated Bile Acids
