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15128: Tricyclic Antidepressant Panel (3) Print View
Doxepin LC/MS/MS    mcg/L 
Nordoxepin LC/MS/MS    mcg/L 
Total LC/MS/MS  110 - 250  mcg/L 
Imipramine LC-MS-MS    mcg/L 
Desipramine LC-MS-MS    mcg/L 
Total   150 - 250  mcg/L 
Amitriptyline LC-MS-MS    mcg/L 
Nortriptyline LC-MS-MS    mcg/L 
Total CALC  100 - 250  mcg/L 

PRIMARY
1 Serum 3 (1.5) mL   Refrigerated - 7 Day(s)/Room Temperature - 5 Day(s)  
ALTERNATE
  Plasma Heparinized 3 (1.5) mL   Refrigerated - 7 Day(s)/Room Temperature - 5 Day(s)  
  Plasma EDTA 3 (1.5) mL   Refrigerated - 7 Day(s)/Room Temperature - 5 Day(s)  
  Plasma Lithium 3 (1.5) mL   Refrigerated - 7 Day(s)/Room Temperature - 5 Day(s)  

Collect at steady-state trough concentration. Specimen should be
> 12 hrs after dose. Do not use gel barrier/Serum Separator tubes.
ACD tubes are unacceptable.
Setup Schedule
Tuesday-Saturday

Reported (Analytical Time)
Same day

CPT Code
80335x3

The CPT codes provided are based on AMA guidelines and are for informational purposes only. CPT coding is the sole responsibility of the billing party. Please direct any questions regarding coding to the payer being billed.

Notes
Reject Criteria: Gross hemolysis: Gel barrier/Serum Separator tubes






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