Geisinger Medical Laboratories/Geisinger Proven Diagnostics Test Catalog

Order Display Name: Geisinger Epic Procedure Code Or ID CPT Code:  

D-XYLOSE ABSORPTION TEST, URINE

ORDERING INFORMATION:
Geisinger Epic Procedure Code: LAB2172         Geisinger Epic ID: 19450

SPECIMEN COLLECTION
Specimen type:
5-hour urine
Preferred collection container:
Specimen required:
5 mL (minimum 1 mL) of a 5-hour urine collection, post oral ingestion of d-Xylose, collected without preservative, submitted in a plastic, leakproof container and placed into a gray-top fluoride/oxalate tube, room temperature.
Special notes:
  1. Some physicians recommend checking a fasting urine and/or a blood sample for non-specific interferences. If requested, retain an aliquot of the urine and collect a blood specimen at this time.
  2. Give 25 grams of D(+)-xylose (or 5 grams if so specified by the physician) dissolved in 250 mL water followed immediately by an additional 250 mL water to ensure a urine flow of at least 60 mL/hour. For children, give 0.5 g xylose/kg of body weight up to 25 g, reducing the amount of water accordingly. Note and record starting time of the test and the amount of xylose given.
  3. Collect all urine specimens voided during the next 5-hour period, including the final 5-hour void in the same container. Keep container refrigerated during collection.
  4. Mix total urine collection thoroughly, measure total volume and aliquot. Aliquot urine into an empty gray-top blood collection tube (the oxalate/fluoride will serve as a preservative for the urine). If gray-top tube is glass, please transfer urine to a plastic tube before shipping.
  5. Record the dose of xylose given and the total 5-hour volume of the urine collection. If additional tests are ordered, please submit a separate specimen. Ok to thaw.
Patient preparation:
At the start of the test, have the patient empty the bladder completely and discard the urine. Adult patients and children should be kept fasting overnight and during test period (infants are fasted for 4 hours).

SPECIMEN PROCESSING
Transport temperature:
Room temperature.
Specimen stability:
Room temperature: 7 days. Refrigerated: 7 days. Frozen: 30 days.
Rejection criteria:
Stability limits exceeded.

TEST DETAILS
Reference interval:
25 g dose: 4.1-8.2 g in 5-hr urine
5 g dose: 1.2-2.4 g in 5-hr urine
CPT code(s):
84620
Note: The billing party has sole responsibility for CPT coding.  Any questions regarding coding should be directed to the payer being billed.  The CPT codes provided by GML are based on AMA guidelines and are for informational purposes only.
Test includes:
d-Xylose, 5-hour urine.
Methodology:
Spectrophotometric (Colorimetric)
Synonyms:
UDXYL5, Quest test code 11613

Performing Locations

Quest Diagnostics

Technical Lead: Michael Weaver    
Frequency: Monday, Thursday morning    
Performed stat? No
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