Centralized Core Laboratory - Mayo Clinic Laboratories :
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PATIENT INFO
Patient Name:
Medical Record #:
BD: //Sex: F M
PHYSICIAN INFO
Physician Name :
Address:
Ph: ()-Fax: ()-
Additional Report to:
Ph: ()-Fax: ()-
TESTS REQUESTED
Test Name:
ICD9 Code: (required)
1. Mycoplasma pneumoniae Abs IgG and IgM
2.
3.
4.
5.
6.
SPECIMEN INFO
Collection Date & Time:
Collected By:
Hospital:
Test ID :
MYCPN
Test Workstation :
MAYO
Specimen Type:
Blood
Tube Type:
Red top (no anticoagulant) tube
Collection Volume:
2.5 mL (minimum 1.5 mL)
Cause for Rejection:
Gross Hemolysis, Gross lipemia
Storage:
Refrigerated
Availability:
Sent to Reference Laboratory
Methodology:
Enzyme Immunoassay (EIA) and Indirect Immunofluorescence Assay (IFA) if reflexed
Lab/Phone:
330-543-8418
TAT:
1-3 days
CPT Code:
86738 x 2 (additional 86738 if IFA performed)
Panel Includes:
Mycoplasma pneumoniae IgG
Mycoplasma pneumoniae IgM
Mycoplasma pneumonia Interpretation
If Mycoplasma pneumoniae IgM is positive or equivocal, test will reflex to Mycoplasma IgM by IFA.
Mycoplasma pneumoniae Abs IgG and IgM
Test ID/Workstation :
MYCPN
Specimen Type:
Blood
Tube Type:
Red top (no anticoagulant) tube
Collection Volume:
2.5 mL (minimum 1.5 mL)
Cause for Rejection:
Gross Hemolysis, Gross lipemia
Storage:
Refrigerated
Availability:
Sent to Reference Laboratory
Methodology:
Enzyme Immunoassay (EIA) and Indirect Immunofluorescence Assay (IFA) if reflexed
Lab/Phone:
330-543-8418
TAT:
1-3 days
CPT Code:
86738 x 2 (additional 86738 if IFA performed)
Panel Includes:
Mycoplasma pneumoniae IgG
Mycoplasma pneumoniae IgM
Mycoplasma pneumonia Interpretation
If Mycoplasma pneumoniae IgM is positive or equivocal, test will reflex to Mycoplasma IgM by IFA.
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