which labs to get......

May 24, 2009

many people when getting labs drawn after their one year follow up with surgeon, have to get labs done by their PCP or regular doc...here's a list of what is usually ordered for the post op RNY patient..

 common question is "which labs?" And "how can I get my insurance company to pay for the lab draws?"

• COMPREHENSIVE METABOLIC PROFILE (sodium, potassium, chloride, glucose, BUN, creatinine, calcium, total protein, albumin, total bilirubin,alkaline phosphatase, aspartate aminotransferase) (Nc,K,C1,CO2,Glu,BUN,Cr,Ca,TP,Alb,Tbili,AP,AST,ALT)
• LIPID PROFILE (cholesterol, HDL, LDL, triglycerides, chol/HDL ratio) (Fasting specimen) , Tchol,Trig,HDL,Calc,,LDL)
• ALT (SPGT)
• GGT (important if liver, renal or pancreatic issues are suspected)
• LDH PHOSPHORUS – INORGANIC
• URIC ACID (usually used to determine if a patient has gout)
• CBC (HEMOGRAM/PLT/DIFF)
• B-12 & FOLATE - and HOMOCYSTEINE
• IRON, TIBC, % SAT AND FERRITIN (very important)
• VITAMIN A & D (25-hydroxy)
• THYROID PANEL (T3U, T4, FTI, TSH)
• SERUM INTACT PTH PARATHYROID
• THIAMINE (B1)
• COPPER
• ZINC
• MAGNESIUM
• RBC
• A1C
• YEARLY - DEXA SCAN for bone density (same time of year).

Possible diagnosis codes:

• 244.9 hypothyroidism
• 250.0 diabetes
• 265.0 Beriberi
• 265.1 Other and Unspecificed Manifestations of Thiamine Deficiency (B1)
• 266.2 cyanocobalamin deficiency (B12)
• 268 vitamin D deficiency
• 268.2 metabolic bone disease
• 269.2 hypovitaminosis
• 269.3 zinc deficiency
• 272.0 hypercholesterolemia
• 275.40 calcium deficiency
• 276.9 electrolyte and fluid disorders
• 280.9 iron-deficiency anemia
• 281.0 pernicious anemia
• 281.1 other B12 deficiency anemia
• 281.2 folate deficiency anemia
• 285.9 anemia, unspecified
• 401.9 hypertension
• 579.3 post-surgical malabsorption
• 579.8 intestinal malabsorption

and these are the ranges that your labs should be within....

Protein:           7's
Albumin:         4's
Pre-Albumin: 20-30's  

Iron:                80-100
Ferritin:        200-300
HGB:              12+
HCT:               36+  

Vit A:               60- 80

Vit D:              80-12 0   

Calcium:        9.0-9.4
PTH:               20-40  

Vit B1:         Mid to top of range
Vit B6:             Mid to top of range
Magnesium: Mid range (but also go by if we have leg/foot cramping)
Zinc:                Mid range  
Vit B12:          1000 +
Folate:           Top of range  
AST (sgot):    Below 40 A
LT (sgpt):     Below 40

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