Spreadsheet: 6140ce1b-5b15-4107-bf63-2b9105edbbdf
Sheet: Sheet1

Test Referenced | Entry Type | Mayo ID | Description | Reporting Description | Method | Collection Container | Temperature | Stability | [NAME] | Unit of Measure | [NAME] | Minimum Volume | Reject Due To | Reference Values | Days/Times Performed | Analytic Time | Maximum Lab Time | CPT Units | CPT Code | LOINC® Code | LOINC® Attributes | Always Performed | Orderable Separately | Performing Location
TRICY | Test | TRICY | Tricyclic Antidepressant Screen, Serum | [NAME], S | High-Performance Liquid Chromatography (HPLC) | Plain, Red-Top Tube: Red |  |  | 3 | mL | Container/Tube: Red top [NAME]: 2 mL Additional Information: Serum must be separated from cells within 2 hours of draw. | 1 mL | Hemolysis	Mild OK; Gross reject Thawing	Warm OK; Cold OK Lipemia	Mild OK; Gross reject Icterus	Mild OK; Gross reject Other	Serum gel tube | AMITRIPTYLINE AND NORTRIPTYLINE Therapeutic concentration: 80-200 ng/mL Toxic concentration: > or =300 ng/mL   NORTRIPTYLINE Therapeutic concentration: 70-170 ng/mL Toxic concentration: > or =300 ng/mL   IMIPRAMINE AND DESIPRAMINE Therapeutic concentration: 175-300 ng/mL Toxic concentration: > or =300 ng/mL   DESIPRAMINE Therapeutic concentration: 100-300 ng/mL Toxic concentration: > or =300 ng/mL   DOXEPIN AND NORDOXEPIN Therapeutic concentration: 50-150 ng/mL Toxic concentration: > or =300 ng/mL | Monday through Friday, Sunday; Varies | Same day/1 day | 3 days |  | Profile |  |  |  |  | New England
TRICY | [NAME] | SRED | Serum Red |  |  |  | Refrigerated | 14 days
TRICY | Result | 7925 | Amitriptyline | Amitriptyline | Numeric |  |  |  |  | ng/mL |  |  |  |  |  |  |  |  |  | 3333-2 | Amitriptyline:MCnc:Pt:Ser/Plas:Qn:
TRICY | Result | 7926 | Nortriptyline | Nortriptyline | Numeric |  |  |  |  | ng/mL |  |  |  |  |  |  |  |  |  | 3872-9 | Nortriptyline:MCnc:Pt:Ser/Plas:Qn:
TRICY | Result | 7927 | Amitriptyline and Nortriptyline | Amitriptyline and Nortriptyline | Numeric |  |  |  |  | ng/mL |  |  |  |  |  |  |  |  |  | 3335-7 | Amitriptyline+Nortriptyline:MCnc:Pt:Ser/Plas:Qn:
TRICY | Result | 7928 | Imipramine | Imipramine | Numeric |  |  |  |  | ng/mL |  |  |  |  |  |  |  |  |  | 3690-5 | Imipramine:MCnc:Pt:Ser/Plas:Qn:
TRICY | Result | 7929 | Desipramine | Desipramine | Numeric |  |  |  |  | ng/mL |  |  |  |  |  |  |  |  |  | 3531-1 | Desipramine:MCnc:Pt:Ser/Plas:Qn:
TRICY | Result | 7930 | Imipramine and [NAME] | Imipramine and [NAME] | Numeric |  |  |  |  | ng/mL |  |  |  |  |  |  |  |  |  | 9627-1 | Imipramine+Desipramine:MCnc:Pt:Ser/Plas:Qn:
TRICY | Result | 7931 | [NAME] | [NAME] | Numeric |  |  |  |  | ng/mL |  |  |  |  |  |  |  |  |  | 3579-0 | Doxepin:MCnc:Pt:Ser/Plas:Qn:
TRICY | Result | 7932 | Nordoxepin | Nordoxepin | Numeric |  |  |  |  | ng/mL |  |  |  |  |  |  |  |  |  | 3862-0 | Nordoxepin:MCnc:Pt:Ser/Plas:Qn:
TRICY | Result | 7933 | [NAME] and Nordoxepin | [NAME] and Nordoxepin | Numeric |  |  |  |  | ng/mL |  |  |  |  |  |  |  |  |  | 3582-4 | Doxepin+Nordoxepin:MCnc:Pt:Ser/Plas:Qn:
TRICY | Billing Component | TRICY |  | Nortriptyline |  |  |  |  |  |  |  |  |  |  |  |  |  | 1 | 80182
TRICY | Billing Component | TRICY |  | Imipramine |  |  |  |  |  |  |  |  |  |  |  |  |  | 1 | 80174
TRICY | Billing Component | TRICY |  | [NAME] |  |  |  |  |  |  |  |  |  |  |  |  |  | 1 | 80166
TRICY | Billing Component | TRICY |  | Desepramine |  |  |  |  |  |  |  |  |  |  |  |  |  | 1 | 80160
TRICY | Billing Component | TRICY |  | Amitriptyline |  |  |  |  |  |  |  |  |  |  |  |  |  | 1 | 80152