Base Data
Date of Order
Client / Patient Information
Ordering Physician Information
Insurance Carrier
Laboratory Tests Needed
Cardiac Markers
Other Tests

“Please use for ordering.”


BL = Light Blue Top BC = Blood Culture Bottles (Aerobic/Anaerobic) GD = Gold Top GT = Gray top BD Vacutainer w/Urine Culture Preservative GN = Light Green Top
LAV = Lavender Top SW = Swab SC = Sterile Container ST = Sputum Trap R = Red Top U = Urine Cup UT =Red/Yellow BD UA Preservative Tube
*Send-out tests: Please note these tests may have longer TAT (Turn-Around-Times).

Panel Description
BASIC METABOLIC PANEL (BMP): BUN, Bicarbonate (CO2), Calcium, Chloride (Cl), Creatinine, Glucose, Potassium (K), Sodium (Na) COMPREHENSIVE METABOLIC PANEL (CMP): Albumin, Alkaline Phosphatase, ALT(SGPT), AST (SGOT), Bilirubin (Total), BUN, Bicarbonate (CO2), Calcium, Chloride (Cl), Creatinine, Glucose, Potassium (K), Protein (Total), Sodium (Na)
ELECTROLYTE: Sodium (Na), Potassium (K), Chloride (Cl), Bicarbonate (CO2) HEPATIC FUNCTION PANEL (HFP): Albumin, Bilirubin (Total & Direct), Alkaline Phosphatase, Protein (Total), AST (SGOT), ALT (SGPT)
HEPATITIS PANEL, ACUTE: Hepatitis A Antibody (A-Ab), Hepatitis B Core Antibody (Bc-Ab), Hepatitis B Surface Antigen (Bs-Ag), Hepatitis B Surface Antibody (Bs-Ab), Hepatitis C Antibody (C-Ab) IRON PANEL: Iron (Fe), UIBC, % Saturation
IRON PANEL PLUS: Iron (Fe), UIBC, % Saturation, Ferritin LIPID PANEL: Cholesterol, LDL (Calc.), HDL, Triglyceride
RENAL FUNCTION PANEL: Albumin, BUN, Calcium, Chloride (Cl), Bicarbonate (CO2), Creatinine, Glucose, Phosphorus (Phosphate), Potassium (K), Sodium (Na) THYROID PANEL: Free Thyroxine (FT4), TSH, Thyroxine (T4), T3 Uptake
Most Common ICD-10 Codes
Most Common ICD-10 Codes
Abdominal Pain, Unspecified R10.9 Hypertension, Essential (Primary) I10
Abnormal Feces R19.5 Hypocalcemia (Low Calcium) E83.51
Abnormal Weight Gain R63.5 Hypoglycemia, Unspecified E16.2
Abnormal Weight Loss R63.4 Hypokalemia E87.6
Acute Kidney Failure, Unspecified N17.9 Hyponatremia (Low Sodium) E87.1
Adverse Effect of Unspecified Drug, Initial encounter T50.905A Hypothyroidism, Unspecified E03.9
Alzheimer’s Disease G30.9 Liver Disease, Unspecified K76.9
Anemia, Unspecified D64.9 Long Term (Current) Use of Antibiotics Z79.2
Arthropathy Unspecified M12.9 Long Term (Current) Use of Anticoagulants Z79.01
Atrial Fibrillation(A-Fib) I48.91 Long Term (Current) Use of Insulin Z79.4
Benign Hypertrophy of Prostate (BPH) N40.0 Long Term (Current) Use of Other Drug Therapy Z79.899
Blood in Stool(Melena) K92.1 Malaise, Other R53.81
Breast Cancer(FEMALE), Unspecified C50.919 Malignant Cancer – Colon C18.9
Breast Cancer(MALE), Unspecified C50.929 Malignant Cancer – Liver C22.9
Carcinoma in situ of Prostate D07.5 Malignant Cancer – Ovarian C56.9
Cardiac Arrhythmia, Unspecified I49.9 Malignant Cancer – Prostate C61
Chronic Kidney Disease (CKD), Unspecified N18.9 Malignant Cancer – Uterine C55
Chronic Obstructive Pulmonary Disease (COPD), Unspecified J44.9 Malnutrition, Unspecified Protein-Calorie E46
Cirrhosis of the Liver, Unspecified K74.60 Muscle Weakness (General) M62.81
Chronic Pulmonary Edema J81.1 Nausea Alone R11.0
Constipation, Unspecified K59.00 Nausea with Vomiting, Unspecified R11.2
Convulsions/Seizures, Unspecified R56.9 Osteoarthritis, Unspecified, Unspecified Site M19.90
Coronary Artery Disease (CAD) I25.10 Osteomyelitis, Unspecified M86.9
Cough R05 Osteoporosis, Age-Relat. w/o Current Pathological Fracture M81.0
Deep Vein Thrombosis, Lower Extremity (DVT) I82.409 Other Specified Abnormal Findings of Blood Chemistry R79.89
Dehydration E86.0 Parkinson’s Disease G20
Dementia w/ Behavioral Disturbance F03.91 Peptic Ulcer Disease (PUD), Unspecified K27.9
Dementia w/out Behavioral Disturbance F03.90 Peripheral Vascular Disease (PVD), Unspecified I73.9
Diabetes Mellitus, Type 1 E10.9 Personal History of Breast Cancer Z85.3
Diabetes Mellitus, Type 2 E11.9 Personal History of Prostate Cancer Z85.46
Diarrhea, Unspecified R19.7 Pneumonia, Unspecified Organism J18.9
Disorders of Magnesium Metabolism, Unspecified E83.40 Prostatitis, Unspecified N41.9
Dysuria (Pain or Urination) R30.0 Psychosis, Unspecified F29
End Stage Renal Disease (ESRD) N18.6 Pulmonary Embolism, Other, w/o Acute Cor Pulmonale I26.99
Epilepsy, Unspecified, Not Intractable, w/Status Epilepticus G40.901 Renal Failure N19
Epilepsy, Unspecified, Not Intractable, w/o Status Epilepticus G40.909 Respiratory Failure (Acute) J96.00
Failure to Thrive – Adult (Age 15+) R62.7 Rheumatoid Arthritis, Unspecified M06.9
Failure to Thrive – Child R62.51 Schizophrenia, Unspecified F20.9
Fatigue, Other R53.83 Senile Dementia, Unspecified w/o Behavioral Disturbance F03.90
Fever, Unspecified R50.9 Upper Respiratory Infection (Acute), Unspecified J06.9
Gastrointestinal Hemorrhage, Unspecified K92.2 Urination Frequency R35.0
Heart Failure, Unspecified I50.9 Urination Incontinence, Unspecified R32
Hematuria (Blood in Urine), Unspecified R31.9 Urinary Retention, Unspecified R33.9
Hypercalcemia (Excess Calcium) E83.52 Urinary Tract Infection (UTI) N39.0
Hypercholesterolemia E78.0 Vitamin B12 Deficiency Anemia D51.1
Hyperkalemia (Excess Potassium) E87.5 Vitamin B Group Deficiency, Other Specified E53.8
Hyperlipidemia, Unspecified E78.5 Vomiting, Unspecified R11.10
Hypernatremia (Excess Sodium) E87.0
Time Drawn/PU: