Test Summary Sheet for:

Purpose
Therapeutic Drug Monitoring
Method(s)
Gas Chromatography (GC)
Suggested CPT Code(s)
80176
New York State Approval Status

Approved

Known Interference(s)
Lidocaine [GC]: Diphenhydramine
Turnaround Time

8 days

Test Includes
1 Lidocaine Xylocaine® Gas Chromatography (GC) mcg/mL 0.5 Anesthetic (Local) Diphenhydramine
2 Monoethylglycinexylidide (MEGX) Lidocaine Metabolite Gas Chromatography (GC) mcg/mL 0.5 Anesthetic (Local)

Specimen Type
Fluid
Requested Volume
2 mL
Minimum Volume
0.9 mL
Special Handling
None
Specimen Container
Plastic container (preservative-free)

Additional Collection Instructions

Transport Temperature
Refrigerated
Light Protection
Not Required
Rejection Criteria
None

Rejection criteria pertain to clinical specimen submissions only.

Stability
Room Temperature: Undetermined
Refrigerated: Undetermined
Frozen (-20 °C): Undetermined
1 Lidocaine Xylocaine® Gas Chromatography (GC) mcg/mL 0.5 Anesthetic (Local) Diphenhydramine
2 Monoethylglycinexylidide (MEGX) Lidocaine Metabolite Gas Chromatography (GC) mcg/mL 0.5 Anesthetic (Local)

Interface Map

LOINC® Information

The CPT Codes provided in this document are based on AMA Guidelines and are for informational purposes only. NMS Labs Does not assume responsibility for billing errors due to Reliance on the CPT Codes listed in this document.

*The information contained in this document represents database configurations, as they will appear on the effective date listed above.