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22728 Executive Screen Panel

Executive Screen Panel
Test Code: EXEC
Test Components
Albumin, Alkaline Phosphatase, Alanine Amino Transferase, Aspartate Amino Transferase, Bicarbonate, Urea Nitrogen, Calcium, Chloride, Creatinine, Glucose, Potassium, Sodium, Total Bilirubin, Gamma Glutamyl Transferase, Lactate Dehydrogenase, Total Protein, Anion Gap, Uric Acid, Phosphorus, Cholesterol, Triglycerides, LDL Cholesterol, A/G ratio, BUN/Creat Ratio, TSH. (Note: LDL Cholesterol is only calculated and reported if an HDL is also ordered, and TRIG value is <= 400 mg/dL.)
Specimen Requirements
Fasting Required Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)		 Pediatric Minimum Volume
(no repeat)
​No Serum​ Red Top Tube (RTT)​ ​ 3.0 mL​ 1.0 mL​ ​
Collection Processing Instructions
Centrifuge and remove serum from cells within one hour.
Test panel includes bilirubin which is light sensitive, minimize light exposure during storage/transport.​
Specimen Stability Information
Specimen Type Temperature Time
Serum​ Refrigerate​ 2 days​
Rejection Criteria
Grossly hemolyzed samples
Specimens not separated from cells <2 hours​
Interference
Hemolyzed samples will falsely increase K and AST
Exposure to light will falsely decrease TBIL​
Performing Laboratory Information
Performing Location Day(s) Test Performed Analytical Time Methodology/Instrumentation
Marshfield​ Monday through Sunday​ 2-4 hours​ See individual tests for methodology/Beckman DXC​
Test Information
Medicare patients must sign a waiver before specimen is collected since Medicare considers this a non-covered screening panel.  Individual tests ordered for diagnostic purposes are covered.​
Reference Range Information
Performing Location Reference Range
Marshfield ​ See individual test listings for reference ranges​
Outreach CPTs
CPT Modifier
(if needed)		 Quantity Description Comments
80053 ​ ​ ​ Metabolic panel, comprehensive​ ​
84443 ​ ​ ​TSH ​
82465​ ​ ​ ​Cholesterol ​
82977 ​ ​ ​GGT ​
83615 ​ ​ ​LDH ​
84100 ​ ​ ​Phosphorus ​
84478 ​ ​ ​Triglyceride ​
84550 ​ ​ ​Uric Acid ​
Test Components
Albumin, Alkaline Phosphatase, Alanine Amino Transferase, Aspartate Amino Transferase, Bicarbonate, Urea Nitrogen, Calcium, Chloride, Creatinine, Glucose, Potassium, Sodium, Total Bilirubin, Gamma Glutamyl Transferase, Lactate Dehydrogenase, Total Protein, Anion Gap, Uric Acid, Phosphorus, Cholesterol, Triglycerides, LDL Cholesterol, A/G ratio, BUN/Creat Ratio, TSH. (Note: LDL Cholesterol is only calculated and reported if an HDL is also ordered, and TRIG value is <= 400 mg/dL.)
Ordering Applications
Ordering Application Description
If the ordering application you are looking for is not listed, contact your local laboratory for assistance.
Specimen Requirements
Fasting Required Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)		 Pediatric Minimum Volume
(no repeat)
​No Serum​ Red Top Tube (RTT)​ ​ 3.0 mL​ 1.0 mL​ ​
Collection Processing
Centrifuge and remove serum from cells within one hour.
Test panel includes bilirubin which is light sensitive, minimize light exposure during storage/transport.​
Specimen Stability Information
Specimen Type Temperature Time
Serum​ Refrigerate​ 2 days​
Rejection Criteria
Grossly hemolyzed samples
Specimens not separated from cells <2 hours​
Interference
Hemolyzed samples will falsely increase K and AST
Exposure to light will falsely decrease TBIL​
Test Components
Albumin, Alkaline Phosphatase, Alanine Amino Transferase, Aspartate Amino Transferase, Bicarbonate, Urea Nitrogen, Calcium, Chloride, Creatinine, Glucose, Potassium, Sodium, Total Bilirubin, Gamma Glutamyl Transferase, Lactate Dehydrogenase, Total Protein, Anion Gap, Uric Acid, Phosphorus, Cholesterol, Triglycerides, LDL Cholesterol, A/G ratio, BUN/Creat Ratio, TSH. (Note: LDL Cholesterol is only calculated and reported if an HDL is also ordered, and TRIG value is <= 400 mg/dL.)
Reference Range Information
Performing Location Reference Range
Marshfield ​ See individual test listings for reference ranges​
For more information visit:
Performing Laboratory Information
Performing Location Day(s) Test Performed Analytical Time Methodology/Instrumentation
Marshfield​ Monday through Sunday​ 2-4 hours​ See individual tests for methodology/Beckman DXC​
For billing questions, see Contacts
Outreach CPTs
CPT Modifier
(if needed)		 Quantity Description Comments
80053 ​ ​ ​ Metabolic panel, comprehensive​ ​
84443 ​ ​ ​TSH ​
82465​ ​ ​ ​Cholesterol ​
82977 ​ ​ ​GGT ​
83615 ​ ​ ​LDH ​
84100 ​ ​ ​Phosphorus ​
84478 ​ ​ ​Triglyceride ​
84550 ​ ​ ​Uric Acid ​
For most current information refer to the Marshfield Laboratory online reference manual.