Laboratory Fee Schedule
Procedure #: BZZ0008A
CPT: 83020, 83021
| Synonym(s): |
Hemoglobinopathy, Hemoglobin Type, or Sickle Cell Screening |
| Requisition Form |
G-1B or G-THSTEPS |
| Test Description |
Testing for clinically significant hemoglobinopathies and thalassemias, including sickle cell anemia. |
| Pre-Approval Needed |
N/A |
| Supplemental Information Required |
N/A |
| Supplemental Form(s) |
N/A |
| Performed on Specimens from (sources) |
Human |
| Sample/Specimen Type for Testing |
Dried whole blood on DSHS approved filter paper card. |
| Minimum Volume/Size Required |
One - two completely filled ½ inch dried blood spots |
| Storage/Preservation Prior to Shipping |
- Allow card to dry thoroughly at room temperature in a horizontal position for at least 3 hours. Do NOT allow specimen to touch any surface.
- Cover dried specimen with attached flap.
- Keep specimen away from heat and direct sunlight.
|
| Transport Medium |
N/A |
| Specimen Labeling |
- Two patient-specific identifiers required (e.g., patient full name, date of birth, medical record number)
- Identifiers on specimen must match submission form exactly
|
| Shipping and Specimen Handling Requirements |
Ship all specimens according to Dangerous Good Regulations, IATA, and/or CFR 49.
Must include one completed requisition form (G-1B or G-THSTEPS as appropriate) per specimen.
DRIED FILTER PAPER BLOOD SPECIMENS
- U.S. Postal regulations require Double containment of dried blood filter paper specimens. Ensure specimens are thoroughly dried prior to placing in envelope.
- 1st containment: Use the attached wrap-around cover with printed universal biohazard symbol. Do not put biohazard labels on outside of envelope.
- 2nd containment: Place dried filter paper blood specimen in an envelope that is not hermetically sealed. Do not put specimens in plastic bags
- Ship as soon as possible; within 24hrs of collection.
- Avoid temperatures greater than 100°F.
|
| Method |
Isoelectric focusing |
| Turn-around Time |
7-10 working days after receipt of specimen |
| Interferences/Limitations |
N/A |
| Common Causes for Rejection |
- Use of expired specimen collection device
- No date of collection provided
- Missing/invalid patient demographic information
- Specimen is too old upon receipt (received 14 or more days following collection)
- No blood samples received with request form
- Insufficient blood has been submitted
- Specimen is contaminated or discolored
- Improper specimen submitted (i.e., EDTA whole blood)
- Serum separation due to improper drying or collection
Visit website for complete list.
|
| Additional Information |
Additional information for specimen collection:
• View a specimen collection training video for collecting on filter paper
|