Test Summary Sheet for:

Purpose
Identification and Quantitation
Method(s)
Gas Chromatography (GC) and Gas Chromatography/Mass Spectrometry (GC/MS)
Suggested CPT Code(s)
80332
80337
80338
New York State Approval Status

Approved

Known Interference(s)
Protriptyline [GC & GC/MS]: Desmethylsertraline (Sertraline metabolite); Norcyclobenzaprine (Cyclobenzaprine metabolite)
Turnaround Time

4 days

Test Includes
1 Amitriptyline Elavil®; Endep® Gas Chromatography (GC) and Gas Chromatography/Mass Spectrometry (GC/MS) ng/mL 10 Antidepressant
2 Nortriptyline Amitriptyline Metabolite; Aventyl®; Pamelor® Gas Chromatography (GC) and Gas Chromatography/Mass Spectrometry (GC/MS) ng/mL 10 Antidepressant
3 Clomipramine Anafranil® Gas Chromatography (GC) and Gas Chromatography/Mass Spectrometry (GC/MS) ng/mL 10 Antidepressant
4 Desmethylclomipramine Clomipramine Metabolite Gas Chromatography (GC) and Gas Chromatography/Mass Spectrometry (GC/MS) ng/mL 10 Antidepressant
5 Imipramine Tofranil® Gas Chromatography (GC) and Gas Chromatography/Mass Spectrometry (GC/MS) ng/mL 10 Antidepressant
6 Desipramine Imipramine Metabolite; Norpramin®; Pertofrane® Gas Chromatography (GC) and Gas Chromatography/Mass Spectrometry (GC/MS) ng/mL 10 Antidepressant
7 Doxepin Sinequan® Gas Chromatography (GC) and Gas Chromatography/Mass Spectrometry (GC/MS) ng/mL 10 Antidepressant
8 Desmethyldoxepin Doxepin Metabolite Gas Chromatography (GC) and Gas Chromatography/Mass Spectrometry (GC/MS) ng/mL 10 Antidepressant
9 Trimipramine Surmontil® Gas Chromatography (GC) and Gas Chromatography/Mass Spectrometry (GC/MS) ng/mL 10 Antidepressant
10 Desmethyltrimipramine Trimipramine Metabolite Gas Chromatography (GC) and Gas Chromatography/Mass Spectrometry (GC/MS) ng/mL 10 Antidepressant
11 Fluoxetine Prozac® Gas Chromatography (GC) and Gas Chromatography/Mass Spectrometry (GC/MS) ng/mL 10 Antidepressant
12 Norfluoxetine Fluoxetine Metabolite Gas Chromatography (GC) and Gas Chromatography/Mass Spectrometry (GC/MS) ng/mL 10 Antidepressant
13 Protriptyline Vivactil® Gas Chromatography (GC) and Gas Chromatography/Mass Spectrometry (GC/MS) ng/mL 10 Antidepressant Desmethylsertraline (Sertraline metabolite); Norcyclobenzaprine (Cyclobenzaprine metabolite)
14 Maprotiline Ludiomil® Gas Chromatography (GC) and Gas Chromatography/Mass Spectrometry (GC/MS) ng/mL 10 Antidepressant
15 Trazodone Desyrel® Gas Chromatography (GC) and Gas Chromatography/Mass Spectrometry (GC/MS) mcg/mL 0.1 Antidepressant
16 Amoxapine Asendin® Gas Chromatography (GC) and Gas Chromatography/Mass Spectrometry (GC/MS) ng/mL 10 Antidepressant
17 Mirtazapine Remeron® Gas Chromatography (GC) and Gas Chromatography/Mass Spectrometry (GC/MS) ng/mL 10 Antidepressant

Test Also Known As
Adapin®; Rhotrimine®; Tricyclics; Triptil®
Specimen Type
Blood
Requested Volume
3 mL
Minimum Volume
1.2 mL
Special Handling
None
Specimen Container
Gray top tube (Sodium Fluoride / Potassium Oxalate), Lavender top tube (EDTA)

Additional Collection Instructions

Transport Temperature
Refrigerated
Light Protection
Not Required
Rejection Criteria
None

Rejection criteria pertain to clinical specimen submissions only.

Stability
Room Temperature: 7 day(s)
Refrigerated: 14 day(s)
Frozen (-20 °C): 14 day(s)
1 Amitriptyline Elavil®; Endep® Gas Chromatography (GC) and Gas Chromatography/Mass Spectrometry (GC/MS) ng/mL 10 Antidepressant
2 Nortriptyline Amitriptyline Metabolite; Aventyl®; Pamelor® Gas Chromatography (GC) and Gas Chromatography/Mass Spectrometry (GC/MS) ng/mL 10 Antidepressant
3 Clomipramine Anafranil® Gas Chromatography (GC) and Gas Chromatography/Mass Spectrometry (GC/MS) ng/mL 10 Antidepressant
4 Desmethylclomipramine Clomipramine Metabolite Gas Chromatography (GC) and Gas Chromatography/Mass Spectrometry (GC/MS) ng/mL 10 Antidepressant
5 Imipramine Tofranil® Gas Chromatography (GC) and Gas Chromatography/Mass Spectrometry (GC/MS) ng/mL 10 Antidepressant
6 Desipramine Imipramine Metabolite; Norpramin®; Pertofrane® Gas Chromatography (GC) and Gas Chromatography/Mass Spectrometry (GC/MS) ng/mL 10 Antidepressant
7 Doxepin Sinequan® Gas Chromatography (GC) and Gas Chromatography/Mass Spectrometry (GC/MS) ng/mL 10 Antidepressant
8 Desmethyldoxepin Doxepin Metabolite Gas Chromatography (GC) and Gas Chromatography/Mass Spectrometry (GC/MS) ng/mL 10 Antidepressant
9 Trimipramine Surmontil® Gas Chromatography (GC) and Gas Chromatography/Mass Spectrometry (GC/MS) ng/mL 10 Antidepressant
10 Desmethyltrimipramine Trimipramine Metabolite Gas Chromatography (GC) and Gas Chromatography/Mass Spectrometry (GC/MS) ng/mL 10 Antidepressant
11 Fluoxetine Prozac® Gas Chromatography (GC) and Gas Chromatography/Mass Spectrometry (GC/MS) ng/mL 10 Antidepressant
12 Norfluoxetine Fluoxetine Metabolite Gas Chromatography (GC) and Gas Chromatography/Mass Spectrometry (GC/MS) ng/mL 10 Antidepressant
13 Protriptyline Vivactil® Gas Chromatography (GC) and Gas Chromatography/Mass Spectrometry (GC/MS) ng/mL 10 Antidepressant Desmethylsertraline (Sertraline metabolite); Norcyclobenzaprine (Cyclobenzaprine metabolite)
14 Maprotiline Ludiomil® Gas Chromatography (GC) and Gas Chromatography/Mass Spectrometry (GC/MS) ng/mL 10 Antidepressant
15 Trazodone Desyrel® Gas Chromatography (GC) and Gas Chromatography/Mass Spectrometry (GC/MS) mcg/mL 0.1 Antidepressant
16 Amoxapine Asendin® Gas Chromatography (GC) and Gas Chromatography/Mass Spectrometry (GC/MS) ng/mL 10 Antidepressant
17 Mirtazapine Remeron® Gas Chromatography (GC) and Gas Chromatography/Mass Spectrometry (GC/MS) ng/mL 10 Antidepressant

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.