Special Instructions

Test request form requires:

  • Date and time of specimen collection
  • Specimen type
  • Patient information: date of birth, sex, and medical record number
  • Ordering physician and contact number
  • Reason for referral
  • Clinical status
  • Information regarding medications or transfusions
  • Previous or pending genetic testing result


 

A signed informed consent in the patient's medical record is required. The consent should not be sent to the laboratory. A link to the Genetic Testing Consent Form is provided as a convenience for the providers and genetic counselors. See Associated Links.

MRL Ordering Instructions

MN Statute:  Obtain and retain genetic testing informed consent in your patient's chart.

Turnaround Time

Results are reported within 7-14 days.

Use

Useful for the differential diagnosis between idiopathic aplastic anemia and Fanconi anemia. After treatment with similar doses of bifunctional alkylating agents such as Diepoxybutane (DEB) or Mitomycin C (MMC), Fanconi anemia patients will typically show a greater than 50-fold increase in rates of chromosome breakage compared to concurrent controls or other aplastic anemia patients.

Specimen Type

Whole blood.

Collection Containers

Green (sodium heparin, no gel)

Collection Volume

5 mL

Minimum Collection Volume

3 mL

1-3 mL will be accepted for patients with blood draw limitations. No heel sticks or finger sticks accepted.
 

Specimen Preparation

Store at room temperature. Do NOT refrigerate or freeze.


Specimens must be received in the Cytogenetics laboratory Mon-Fri by 5:30 pm. Weekends and holidays by 4:30 pm. Specimens received after the above cut off times will be processed the following day.

Unacceptable Conditions

Clotted or frozen specimen. Incorrect specimen collection tube (anticoagulant).

Shipping Instructions

Ship at room temperature.

Stability (from collection to initiation)

For optimal testing results the specimen must arrive within 24 hours.

Remarks

Contact the Cytogenetics Laboratory (lab/voice mail) at 612-273-3171.

  • Monday - Friday, weekends/holidays between 8:00 am - 5:00 pm
  • After hours leave a voice mail to indicate specimen has arrived. Specimens will be picked up the next day.

Containers

Green (Sodium Heparin, No Gel)

CPT Disclaimer

The Current Procedural Terminology (CPT) Codes published in the M Health Fairview Test Directory are based on American Medical Association (AMA) guidelines and are provided for informational purposes only. CPT codes are provided only as guidance to assist clients with billing. CPT coding is the responsibility of the billing party. M Health Fairview Laboratories does not assume responsibility for billing errors due to reliance on the CPT codes listed in this Test Directory. Charges may vary due to reflexing, susceptibilities, specimen source, patient age, methodology requirements, etc..

Patient Price Inquiries

Requester Contact Information
Patient and UMP/FV Care Team Fairview Consumer Line at 612-672-1048
MRL Outreach Client DEPT-MRL-CLIENT-MANAGEMENT@Fairview.org
Research research@fairview.org

CPT Codes

CPTQtyHC HospitalPR ClinicNote
88230131088230058823005CHROM CULT FAN ANEMIA
88249131088249018824901CHROM ANALYSIS FAN ANEMIA
8829119718829101HC CYTOGENETICS INTERP PF
8829118829101PR CYTOGENETICS&MOLEC CYTOGENETICS INTERP&REP

Additional CPT codes may be charged if additional work is needed to interpret patient results. The culture fee (88230) may still apply if a specimen does not yield sufficient growth for complete analysis.

Methodology

Chromosome breakage analysis.

MRL Test Build

Test Name Component Required Description Type LOINC
LAB4755     Chromosome Fanconi Mutagen Sensitivity Orderable  
  127025 Y Clinical indications for testing: Prompt  
  158442 Y Interpretation request: Prompt  
  158445 Y Family history: Prompt  
  158446 Y Previous cytogenetic studies: Prompt  
  158924   Previous history: Prompt  
  QUE_NRBC   Nucleated RBC count (if patient <1w old) Prompt  
  SRC_1001 Y Blood specimen source: Prompt  
  1230000027   Methods Cytogenetics Result  
  1230000029   Results Cytogenetics Result  
  1230000030   Interpretation Cytogenetics Result  
  1230000031   Additional Comments Result  
  1230005210   Signout Location if Remote Result 90119-9

Data Type / Multiple Choice Response

127025 Free Text
158442
With Professional Interpretation|Without Professional Interpretation
Default: With Professional Interpretation 158445 Free Text
158446
Yes|No
158924 Free Text
QUE_NRBC Free Text
SRC_1001
Blood specimen source:
Arm, Left|Arm, Right|Hand, Left|Hand, Right|Blood, Capillary|Other|Peripheral Blood
Default: Peripheral Blood

Contact

For questions regarding the test code Interface Map, please contact DEPT-LAB-CLIENT-INTERFACE@fairview.org
Ordering

Special Instructions

Test request form requires:

  • Date and time of specimen collection
  • Specimen type
  • Patient information: date of birth, sex, and medical record number
  • Ordering physician and contact number
  • Reason for referral
  • Clinical status
  • Information regarding medications or transfusions
  • Previous or pending genetic testing result


 

A signed informed consent in the patient's medical record is required. The consent should not be sent to the laboratory. A link to the Genetic Testing Consent Form is provided as a convenience for the providers and genetic counselors. See Associated Links.

MRL Ordering Instructions

MN Statute:  Obtain and retain genetic testing informed consent in your patient's chart.

Turnaround Time

Results are reported within 7-14 days.

Use

Useful for the differential diagnosis between idiopathic aplastic anemia and Fanconi anemia. After treatment with similar doses of bifunctional alkylating agents such as Diepoxybutane (DEB) or Mitomycin C (MMC), Fanconi anemia patients will typically show a greater than 50-fold increase in rates of chromosome breakage compared to concurrent controls or other aplastic anemia patients.
Collection & Processing

Specimen Type

Whole blood.

Collection Containers

Green (sodium heparin, no gel)

Collection Volume

5 mL

Minimum Collection Volume

3 mL

1-3 mL will be accepted for patients with blood draw limitations. No heel sticks or finger sticks accepted.
 

Specimen Preparation

Store at room temperature. Do NOT refrigerate or freeze.


Specimens must be received in the Cytogenetics laboratory Mon-Fri by 5:30 pm. Weekends and holidays by 4:30 pm. Specimens received after the above cut off times will be processed the following day.

Unacceptable Conditions

Clotted or frozen specimen. Incorrect specimen collection tube (anticoagulant).

Shipping Instructions

Ship at room temperature.

Stability (from collection to initiation)

For optimal testing results the specimen must arrive within 24 hours.

Remarks

Contact the Cytogenetics Laboratory (lab/voice mail) at 612-273-3171.

  • Monday - Friday, weekends/holidays between 8:00 am - 5:00 pm
  • After hours leave a voice mail to indicate specimen has arrived. Specimens will be picked up the next day.
Containers

Containers

Green (Sodium Heparin, No Gel)

Result Interpretation
Administrative

CPT Disclaimer

The Current Procedural Terminology (CPT) Codes published in the M Health Fairview Test Directory are based on American Medical Association (AMA) guidelines and are provided for informational purposes only. CPT codes are provided only as guidance to assist clients with billing. CPT coding is the responsibility of the billing party. M Health Fairview Laboratories does not assume responsibility for billing errors due to reliance on the CPT codes listed in this Test Directory. Charges may vary due to reflexing, susceptibilities, specimen source, patient age, methodology requirements, etc..

Patient Price Inquiries

Requester Contact Information
Patient and UMP/FV Care Team Fairview Consumer Line at 612-672-1048
MRL Outreach Client DEPT-MRL-CLIENT-MANAGEMENT@Fairview.org
Research research@fairview.org

CPT Codes

CPTQtyHC HospitalPR ClinicNote
88230131088230058823005CHROM CULT FAN ANEMIA
88249131088249018824901CHROM ANALYSIS FAN ANEMIA
8829119718829101HC CYTOGENETICS INTERP PF
8829118829101PR CYTOGENETICS&MOLEC CYTOGENETICS INTERP&REP

Additional CPT codes may be charged if additional work is needed to interpret patient results. The culture fee (88230) may still apply if a specimen does not yield sufficient growth for complete analysis.

Methodology

Chromosome breakage analysis.

Interface Mapping

MRL Test Build

Test Name Component Required Description Type LOINC
LAB4755     Chromosome Fanconi Mutagen Sensitivity Orderable  
  127025 Y Clinical indications for testing: Prompt  
  158442 Y Interpretation request: Prompt  
  158445 Y Family history: Prompt  
  158446 Y Previous cytogenetic studies: Prompt  
  158924   Previous history: Prompt  
  QUE_NRBC   Nucleated RBC count (if patient <1w old) Prompt  
  SRC_1001 Y Blood specimen source: Prompt  
  1230000027   Methods Cytogenetics Result  
  1230000029   Results Cytogenetics Result  
  1230000030   Interpretation Cytogenetics Result  
  1230000031   Additional Comments Result  
  1230005210   Signout Location if Remote Result 90119-9

Data Type / Multiple Choice Response

127025 Free Text
158442
With Professional Interpretation|Without Professional Interpretation
Default: With Professional Interpretation 158445 Free Text
158446
Yes|No
158924 Free Text
QUE_NRBC Free Text
SRC_1001
Blood specimen source:
Arm, Left|Arm, Right|Hand, Left|Hand, Right|Blood, Capillary|Other|Peripheral Blood
Default: Peripheral Blood

Contact

For questions regarding the test code Interface Map, please contact DEPT-LAB-CLIENT-INTERFACE@fairview.org
Private Details

Test Detail

Processing Key


See Processing Key "Special" Definitions document for *SPECIAL* definition.
Abbreviation
FANCCG
Performing Lab
UMMC East Bank
Department
Cytogenetics
Test Search Categories
  • Cytogenetics

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