Test Summary Sheet for:

Purpose
Screening for a Class of Drugs and Quantitation of Positive Findings
Method(s)
Gas Chromatography (GC)
Suggested CPT Code(s)
80332
80337
80338
New York State Approval Status

Approved

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

5 days

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

Test Also Known As
Adapin®; Rhotrimine®; Triptil®
Specimen Type
Fluid
Requested Volume
3 mL
Minimum Volume
1.2 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 Amitriptyline Elavil®; Endep® Gas Chromatography (GC) ng/mL 10 Antidepressant
2 Nortriptyline Amitriptyline Metabolite; Aventyl®; Pamelor® Gas Chromatography (GC) ng/mL 10 Antidepressant
3 Clomipramine Anafranil® Gas Chromatography (GC) ng/mL 10 Antidepressant
4 Desmethylclomipramine Clomipramine Metabolite Gas Chromatography (GC) ng/mL 10 Antidepressant
5 Imipramine Tofranil® Gas Chromatography (GC) ng/mL 10 Antidepressant
6 Desipramine Imipramine Metabolite; Norpramin®; Pertofrane® Gas Chromatography (GC) ng/mL 10 Antidepressant
7 Doxepin Sinequan® Gas Chromatography (GC) ng/mL 10 Antidepressant
8 Desmethyldoxepin Doxepin Metabolite Gas Chromatography (GC) ng/mL 10 Antidepressant
9 Trimipramine Surmontil® Gas Chromatography (GC) ng/mL 10 Antidepressant
10 Desmethyltrimipramine Trimipramine Metabolite Gas Chromatography (GC) ng/mL 10 Antidepressant
11 Fluoxetine Prozac® Gas Chromatography (GC) ng/mL 10 Antidepressant
12 Norfluoxetine Fluoxetine Metabolite Gas Chromatography (GC) ng/mL 10 Antidepressant
13 Protriptyline Vivactil® Gas Chromatography (GC) ng/mL 10 Antidepressant Desmethylsertraline (Sertraline metabolite); Norcyclobenzaprine (Cyclobenzaprine metabolite)
14 Maprotiline Ludiomil® Gas Chromatography (GC) ng/mL 10 Antidepressant
15 Trazodone Desyrel® Gas Chromatography (GC) mcg/mL 0.1 Antidepressant
16 Amoxapine Asendin® Gas Chromatography (GC) ng/mL 10 Antidepressant
17 Mirtazapine Remeron® Gas Chromatography (GC) ng/mL 5 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.