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16334: Triple Screen (ny) Print View
Interpretation      
Risk for ONTD      
AGE RISK DOWN SYNDROME      
MSS Down Syndrome Risk      
MSS Trisomy 18 Risk      
Calc'd Gestational Age      
AFP, Serum ICMA    ng/mL 
AFP MoM CALC    MoM 
hCG, Serum ICMA    IU/mL 
HCG, MoM CALC    MoM 
Estriol, Free ICMA    ng/mL 
Estriol, MoM CALC    MoM 
Date of Birth      
Collection Date      
Maternal Weight      
Est'd Date of Delivery      
EDD Determined by      
Mother's Ethnic Origin      
Number of Fetuses      
Insulin Depend Diabetic      
Repeat Specimen      
Hx of Neural Tube Defects      
Brief History      
Prev Pregnancy Down Synd      
Donor Egg      
Donor Age: Egg Retrieval      
Cigarette Smoker      

PRIMARY
1 Serum 3 (0.6) mL   Room Temperature - 14 Day(s)/Refrigerated - 14 Day(s)/Frozen - 45 Day(s)  
ALTERNATE

The Maternal Serum Screen in pregnant women should be performed between 14.0 and 22.9 weeks gestational age, although the optimal period is 15.0-16.9 weeks. This time frame allows sufficient opportunity for further diagnostic studies if the initial Maternal Serum Screen test results are abnormal. Specimens submitted before 14.0 weeks or after 22.9 weeks gestation cannot be properly evaluated for open neural tube defects, down syndrome or trisomy 18. The "Maternal Serum Screen Requisition" designed to obtain patient data and the patient's informed consent must be utilized when ordering the Maternal Serum Screen test. Because the Maternal Serum Screen test results are influenced by certain patient characteristics, the following data must be provided with the specimen in order to permit accurate interpretation of results: Date of collection, patient's (maternal) date of birth, patient's estimated date of delivery, patient's weight, patient's race, patient's diabetic status (is patient insulin dependent prior to pregnancy), number of fetuses, and whether this is a repeat sample.

Maternal date of birth (mm/dd/yy), Estimated Date of Delivery
by US/LMP/PE, weight, race, insulin-dependent diabetes status,
repeat sample (Y/N), number of fetuses, and neural tube defect
history must be provided for interpretation of results.
Setup Schedule
Monday-Saturday

Reported (Analytical Time)
3 days

CPT Codes
82105,84702,82677

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
**This test is not available for non-New York patient testing. For non-New York patient testing please use test code 7292-Triple Screen**

82105, 82677, 84702 or 81510* *The 2018 AMA CPT codebook contains the component CPT codes and the new MAAA codeset. Please direct any questions regarding coding to the payor being billed.

Specimen Requirements: 3 mL (0.6 mL minimum) serum

Transport Temperature: Room temperature

Reject Criteria: Grossly lipemic

Methodology: Immunochemiluminometric Assay






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