PAML

PAIN MANAGEMENT PANEL 4 RFLX

Lab Tests Online: A public resource on clinical lab testing from the laboratory professionals who do the testing

Test Code
PM4				printer friendly\|search\|back

This test may reflex to additional tests depending upon results of this test. No additional fee will be added if the reflex test is necessary.
Positive results will automatically relex to confirmation testing. Confirmation by GC/MS, LC-MS/MS, or GC/FID.

This test is a lab developed test. For further information, see the Compliance Remarks section below.

Important Links

Patient Prescription Record

SPECIMEN REQUIREMENTS

Container Type

Random urine

Supply Item Number

1387 or

1678

Specimen Type

Random urine

Preferred Volume

30 mL

Emergency Minimum Volume

15 mL

Collection Procedure

Collect a random urine in a leakproof plastic urine container.

Store and Transport

Ambient (room temperature)

Required Patient Info

List last 5 days of prescription medicine taken by the patient

Stability

Room Temp 10 days Refrigerated 1 month

Unacceptable Condition

Blood, serum, or plasma samples

CPT Codes

80361, (HCPCS G0480), 80307, 80356, 80365

Interface Order Code

80101.Z210

Billing Code

PM42017

Test Schedule

Mon-Sat

Turnaround Time

1-3 days

Method

Enzyme Immunoassay, Confirmations by GC/MS, LC/MS/MS, or GC/FID

Reference Ranges

Title	Descriptor	Ranges	Units
Alcohol Screen	Negative	< 20	mg/dL
Alcohol by GC/FID	Not Detected	< 8	mg/dL
Amp/Methamphetamine Screen	Negative	< 500	ng/mL
Amphetamines by GC/MS	Not Detected	< 250	ng/mL
Methamphetamine by GC/MS	Not Detected	< 250	mg/mL
D-Methamphetamine by GC/MS	Not Detected	< 250	%
L-Methamphetamine GC/MS	Not Detected	< 250	%
Alternate Amphetamines Screen	Negative	< 500	ng/mL
MDMA by GC/MS	Not Detected	< 250	ng/mL
MDA by GC/MS	Not Detected	< 250	ng/mL
MDEA by GC/MS	Not Detected	< 250	ng/mL
Cannabinoids Screen (20)	Negative	< 20	ng/mL
Carboxy-THC by GC/MS	Not Detected	< 15	ng/mL
Cocaine Screen	Negative	< 150	ng/mL
Benzoylecgonine by GC/MS	Not Detected	< 100	ng/mL
Morphine by LC-MS/MS	Not Detected	< 50	ng/mL
Oxymorphone by LC-MS/MS	Not Detected	< 50	ng/mL
Hydromorphone by LC-MS/MS	Not Detected	< 50	ng/mL
Nor-Oxycodone by LC-MS/MS	Not Detected	< 50	ng/mL
Nor-Hydrocodone by LC-MS/MS	Not Detected	< 50	ng/mL
Oxycodone by LC-MS/MS	Not Detected	< 50	ng/mL
Codeine by LC-MS/MS	Not Detected	< 50	ng/mL
Heroin Metab (6AM) by LC-MS/MS	Not Detected	< 10	ng/mL
Hydrocodone by LC-MS/MS	Not Detected	< 50	ng/mL
Phencyclidine Screen	Negative	< 25	ng/mL
Phencyclidine by GC/MS	Not Detected	< 6	ng/mL
Propoxyphene Screen	Negative	< 300	ng/mL
Norpropoxyphene by GC/MS	Not Detected	< 80	ng/mL
Barbiturates Screen	Negative	< 200	ng/mL
Amobarbital by GC/MS	Not Detected	< 50	ng/mL
Butalbital by GC/MS	Not Detected	< 80	ng/mL
Pentobarbital by GC/MS	Not Detected	< 50	ng/mL
Phenobarbital by GC/MS	Not Detected	< 50	ng/mL
Secobarbital by GC/MS	Not Detected	< 80	ng/mL
Benzodiazepines Screen	Negative	< 200	ng/mL
Clonazepam by LC-MS/MS	Not Detected	< 10	ng/mL
7-Aminoclonazepam by LC-MS/MS	Not Detected	< 10	ng/mL
Flunitrazepam by LC-MS/MS	Not Detected	< 10	ng/mL
7-Aminoflunitrazepam by LC-MS/MS	Not Detected	< 10	ng/mL
Diazepam by LC-MS/MS	Not Detected	< 10	ng/mL
Temazepam by LC-MS/MS	Not Detected	< 25	ng/mL
Nordiazepam by LC-MS/MS	Not Detected	< 25	ng/mL
Oxazepam by LC-MS/MS	Not Detected	< 25	ng/mL
Lorazepam by LC-MS/MS	Not Detected	< 25	ng/mL
Alprazolam by LC-MS/MS	Not Detected	< 10	ng/mL
Alpha-hydroxyalprazolam by LC-MS/MS	Not Detected	< 25	ng/mL
Flurazepam by LC-MS/MS	Not Detected	< 10	ng/mL
Midazolam by LC-MS/MS	Not Detected	< 25	ng/mL
Alpha-hydroxytriazolam by LC-MS/MS	Not Detected	< 25	ng/mL
Methadone & Metabolite Screen	Negative	< 100	ng/mL
Methadone Metabolite (EDDP) by GC/MS	Not Detected	< 90	ng/mL
Meperidine Screen	Negative	< 200	ng/mL
Meperidine by GC/MS	Not Detected	< 40	ng/mL
Tramadol Screen	Negative	< 200	ng/mL
Tramadol by GC/MS	Not Detected	< 80	ng/mL
Acetaminophen Screen	Negative	< 2.5	ug/mL
Fentanyl Screen	Negative	< 2.0
Fentanyl by LC-MS/MS	Not Detected	< 2.0
Norfentanyl by LC-MS/MS	Not Detected	< 4.0
Carisoprodol Screen	Negative	< 0.1	ug/mL
Carisoprodol by GC/MS	Not Detected	< 2.5	ug/mL
Meprobamate by GC/MS	Not Detected	< 2.5	ug/mL
Buprenorphine Screen	Negative	< 25	ng/mL
Buprenorphine by GC/MS	Not Detected	< 5	ng/mL
Nor-Buprenorphine by GC/MS	Not Detected	< 5	ng/mL
ETG/ETS Screen	Negative	< 250	ng/mL
Ethyl Glucuroide by LC-MS/MS	Not Detected	< 250	ng/mL
Ethyl Sulfate by LC-MS/MS	Not Detected	< 150	ng/mL
Oxidants	Normal	< 200	ug/mL
Urine pH	Normal	4.5-9.0
Urine Creatinine	Normal	> 19	mg/dL
Specific Gravity	Normal	1.003-1.020
Glucose	Negative	< 20	mg/dL

Compliance Remarks

This test was developed and its performance characteristics determined by PAML. The U.S. Food and Drug Administration (FDA) has not approved or cleared this test. However, FDA approval or clearance is currently not required for clinical use of this test. The results are not intended to be used as the sole means for clinical diagnosis or patient management decisions. PAML is authorized under Clinical Laboratory Improvement Amendments (CLIA) to perform high-complexity testing.

Reflex Testing

Reflex Condition	Reflex Test Name	Reflex CPT codes	Reflex Billing codes
If any Analyte in panel positive	Reflex testing built into panel, no additional test codes required	Reflex testing built into panel, no additional CPT codes required	N/A
If screen for Alcohol is positive
If screen for Amphetamines is positive
If screen for Alternate Amphetamines is positive
If screen for Cannabinoids (THC) is positive
If screen for Cocaine is positive
If screen for Propoxyphene is positive
If screen for Phencyclidine is positive
If screen for Barbiturates is positive
If screen for Benzodiazepines is positive
If screen for Methadone is positive
If screen for Meperidine is positive
If screen for Tramadol is positive
If screen for Acetaminophen is positive
If screen for Fentanyl is positive
If screen for Carisoprodol/Meprobamate is positive
If screen for Buprenorphine is positive
If screen for ETG/ETS is positive

Interface Codes

type	order code	test description	result code	result description	units	decimal places	loinc code
o	80101.Z210	Pain Management Panel 4
r	80101.Z210	Pain Management Panel 4	80101.Z193	Clonazepam	ng/mL		16229-7
r	80101.Z210	Pain Management Panel 4	80101.Z198	Alcohol Screen	mg/dL		42242-8
r	80101.Z210	Pain Management Panel 4	80101.Z199	Amp / Methamphetamine Screen	ng/mL		33280-9
r	80101.Z210	Pain Management Panel 4	80101.Z200	Alternate Amphetamines Screen	ng/mL		19146-0
r	80101.Z210	Pain Management Panel 4	80101.Z201	Cannabinoids Screen	ng/mL		42860-7
r	80101.Z210	Pain Management Panel 4	80101.Z202	Cocaine Screen	ng/mL		3398-5
r	80101.Z210	Pain Management Panel 4	80101.Z203	Phencyclidine Screen	ng/mL		3937-0
r	80101.Z210	Pain Management Panel 4	80101.Z204	Propoxyphene Screen	ng/mL		19429-0
r	80101.Z210	Pain Management Panel 4	80101.Z205	Barbiturates Screen	ng/mL		20664-9
r	80101.Z210	Pain Management Panel 4	80101.Z206	Benzodiazepines	ng/mL		9428-4
r	80101.Z210	Pain Management Panel 4	80101.Z207	Methadone Screen	ng/mL		3774-7
r	80101.Z210	Pain Management Panel 4	80101.Z208	Meperidine Screen	ng/mL		58385-6
r	80101.Z210	Pain Management Panel 4	80101.Z209	Tramadol Screen	ng/mL		17719-6
r	80101.Z210	Pain Management Panel 4	80101.Z230	Acetaminophen Screen	ug/mL	1	59384-8
r	80101.Z210	Pain Management Panel 4	80101.Z278	7-Aminoclonazepam	ng/mL		51776-3
r	80101.Z210	Pain Management Panel 4	80101.Z279	Flunitrazepam	ng/mL		20528-6
r	80101.Z210	Pain Management Panel 4	80101.Z280	7-Aminoflunitrazepam	ng/mL		51777-1
r	80101.Z210	Pain Management Panel 4	80101.Z281	Diazepam	ng/mL		16227-1
r	80101.Z210	Pain Management Panel 4	80101.Z282	Nordiazepam	ng/mL		16228-9
r	80101.Z210	Pain Management Panel 4	80101.Z283	Alprazolam	ng/mL		59615-5
r	80101.Z210	Pain Management Panel 4	80101.Z284	Flurazepam	ng/mL		16231-3
r	80101.Z210	Pain Management Panel 4	80101.Z285	Midazolam	ng/mL		16233-9
r	80101.Z210	Pain Management Panel 4	80101.Z286	Alpha-hydroxytriazolam	ng/mL		49876-6
r	80101.Z210	Pain Management Panel 4	80102.Z124	Alcohol by GC/FID	mg/dL		46983-3
r	80101.Z210	Pain Management Panel 4	80102.Z125	Amphetamine by GC/MS	ng/mL		20410-7
r	80101.Z210	Pain Management Panel 4	80102.Z126	Methamphetamine by GC/MS	ng/mL		16235-4
r	80101.Z210	Pain Management Panel 4	80102.Z127	MDMA by GC/MS	ng/mL		18358-2
r	80101.Z210	Pain Management Panel 4	80102.Z128	MDA by GC/MS	ng/mL		20545-0
r	80101.Z210	Pain Management Panel 4	80102.Z129	MDEA by GC/MS	ng/mL		45143-5
r	80101.Z210	Pain Management Panel 4	80102.Z130	Carboxy-THC by GC/MS	ng/mL		20521-1
r	80101.Z210	Pain Management Panel 4	80102.Z131	Benzoylecgonine by GC/MS	ng/mL		16226-3
r	80101.Z210	Pain Management Panel 4	80102.Z132	Morphine by LC-MS/MS	ng/mL		16251-1
r	80101.Z210	Pain Management Panel 4	80102.Z133	Oxymorphone by LC-MS/MS	ng/mL		17395-5
r	80101.Z210	Pain Management Panel 4	80102.Z134	Hydromorphone by LC-MS/MS	ng/mL		16998-7
r	80101.Z210	Pain Management Panel 4	80102.Z135	Nor-Oxycodone by LC-MS/MS	ng/mL		61425-5
r	80101.Z210	Pain Management Panel 4	80102.Z136	Nor-Hydrocodone by LC-MS/MS	ng/mL		61422-2
r	80101.Z210	Pain Management Panel 4	80102.Z137	Oxycodone by LC-MS/MS	ng/mL		16249-5
r	80101.Z210	Pain Management Panel 4	80102.Z138	Codeine by LC-MS/MS	ng/mL		16250-3
r	80101.Z210	Pain Management Panel 4	80102.Z139	Heroin Metab (6AM) by LC-MS/MS	ng/mL		19593-3
r	80101.Z210	Pain Management Panel 4	80102.Z140	Hydrocodone by LC-MS/MS	ng/mL		16252-9
r	80101.Z210	Pain Management Panel 4	80102.Z141	Phencyclidine by GC/MS	ng/mL		16254-5
r	80101.Z210	Pain Management Panel 4	80102.Z142	Norpropoxyphene by GC/MS	ng/mL		17377-3
r	80101.Z210	Pain Management Panel 4	80102.Z143	Amobarbital by GC/MS	ng/mL		16239-6
r	80101.Z210	Pain Management Panel 4	80102.Z144	Butalbital by GC/MS	ng/mL		16237-0
r	80101.Z210	Pain Management Panel 4	80102.Z145	Pentobarbital by GC/MS	ng/mL		16240-4
r	80101.Z210	Pain Management Panel 4	80102.Z146	Phenobarbital by GC/MS	ng/mL		16241-2
r	80101.Z210	Pain Management Panel 4	80102.Z147	Secobarbital by GC/MS	ng/mL		16238-8
r	80101.Z210	Pain Management Panel 4	80102.Z148	Oxazepam by GC/MS	ng/mL		16201-6
r	80101.Z210	Pain Management Panel 4	80102.Z149	Temazepam by GC/MS	ng/mL		20559-1
r	80101.Z210	Pain Management Panel 4	80102.Z150	Lorazepam by GC/MS	ng/mL		17088-6
r	80101.Z210	Pain Management Panel 4	80102.Z151	Alpha-OH Alprazolam by GC/MS	ng/mL		16348-5
r	80101.Z210	Pain Management Panel 4	80102.Z152	Methadone Metab (EDDP) by GC/MS	ng/mL		58429-2
r	80101.Z210	Pain Management Panel 4	80102.Z153	Meperidine by GC/MS	ng/mL		16253-7
r	80101.Z210	Pain Management Panel 4	80102.Z154	Nor-Meperidine by GC/MS	ng/mL		58389-8
r	80101.Z210	Pain Management Panel 4	80299.Z60	D-Methamphetamine	%	0	31026-8
r	80101.Z210	Pain Management Panel 4	80299.Z61	L-Methamphetamine	%	0	15404-7
r	80101.Z210	Pain Management Panel 4	81000.Z18	SpGravity		3	2965-2
r	80101.Z210	Pain Management Panel 4	81099.Z11	Oxidants	ug/mL		19146-0
r	80101.Z210	Pain Management Panel 4	82003.Z2	Acetaminophen by GC/MS	ug/mL	1	13622-6
r	80101.Z210	Pain Management Panel 4	82491.Z153	Carisoprodol by GC/MS	ug/mL		58427-6
r	80101.Z210	Pain Management Panel 4	82491.Z154	Carisoprodol Screen	ug/mL		10979-3
r	80101.Z210	Pain Management Panel 4	82541.Z12	Tramadol by GC-MS	ng/mL		20561-7
r	80101.Z210	Pain Management Panel 4	82570.Z22	Creatinine	mg/dL	0	2161-8
r	80101.Z210	Pain Management Panel 4	83789.Z26	Ethyl Glucu/Ethyl Sulfate Screen	ng/mL		19146-0
r	80101.Z210	Pain Management Panel 4	83789.Z27	Ethyl Glucuronide by LC-MS/MS	ng/mL		58378-1
r	80101.Z210	Pain Management Panel 4	83789.Z28	Ethyl Sulfate by LC-MS/MS	ng/mL		58425-0
r	80101.Z210	Pain Management Panel 4	83805.Z4	Meprobamate by GC/MS	ug/mL		58374-0
r	80101.Z210	Pain Management Panel 4	83925.Z33	Fentanyl Screen	ng/mL		58379-9
r	80101.Z210	Pain Management Panel 4	83925.Z34	Fentanyl by LC-MS/MS	ng/mL		58381-5
r	80101.Z210	Pain Management Panel 4	83925.Z35	Norfentanyl by LC-MS/MS	ng/mL		58383-1
r	80101.Z210	Pain Management Panel 4	83925.Z36	Buprenorphine Screen	ng/mL		3415-7
r	80101.Z210	Pain Management Panel 4	83925.Z37	Buprenorphine by GC/MS	ng/mL		49752-9
r	80101.Z210	Pain Management Panel 4	83925.Z38	Norbuprenorphine by GC/MS	ng/mL		49751-1
r	80101.Z210	Pain Management Panel 4	83986.Z5	pH			2756-5
r	80101.Z210	Pain Management Panel 4	99199.Z101	Prescribed Drug 1
r	80101.Z210	Pain Management Panel 4	99199.Z102	Prescribed Drug 2
r	80101.Z210	Pain Management Panel 4	99199.Z103	Prescribed Drug 3
r	80101.Z210	Pain Management Panel 4	99199.Z104	Prescribed Drug 4
r	80101.Z210	Pain Management Panel 4	99199.Z105	Prescribed Drug 5
r	80101.Z210	Pain Management Panel 4	99199.Z106	Prescribed Drug 6
r	80101.Z210	Pain Management Panel 4	99199.Z107	Prescribed Drug 7
r	80101.Z210	Pain Management Panel 4	99199.Z108	Prescribed Drug 8
r	80101.Z210	Pain Management Panel 4	99199.Z109	Prescribed Drug 9
r	80101.Z210	Pain Management Panel 4	99199.Z110	Prescribed Drug 10

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