Labs for vitamins...RNY...anyone have it?

Hi Friends!
I have searched everywhere and I'm at work...does anyone have the vitamin list for lab work? The office called and said they failed to take blood for vitamin levels...grrrrrrr. We discussed this and they assured me the lab was well aware of what lab work RNY folks needed...NOT!! I have a physical scheduled today, after work and I don't have a list with me. If anyone can post it for me, I would so appreciate it!

Thanks again everyone! I cannot believe this! They took blood for everything but vitamins....good grief! It's not like I didn't sit in there and remind them on Friday....sigh.      Connie

 Hello,

Each surgeon is different in what they feel is the "norm". Check with your surgeon. That being said this is one of the more comprehensive lists I have seen posted on the boards.  I do not remember who posted these so forgive me for not giving you credit. 

These are common lab tests ordered after WLS, along with the CPT codes (according to Labcorp) for each:

Every 12 months -

• 85025  CBC w/ diff
• 80053  Comprehensive Metabolic Profile
• 84134  Transthyretin (Prealbumin)
• 80061  Lipid profile
• 83735  Magnesium, Serum
• 7444  Thyroid panel
• 83540  Iron Profile (Includes TIBC and Sat %)
• 82728  Ferritin
• 84630  Zinc, RBC
• 84446  Vitamin A
• 82306  Vitamin D (25-hydroxy)
• 84425  Vitamin B-1 (Thiamin), whole blood
• 84207  Vitamin B-6 (Pyridoxine), plasma
• 82747  Folate, RBC
• 82607  Vitamin B12
• 83970  Parathyroid Hormone (PTH), Intact
• 83937  Osteocalcin
• 83921  Methylmalonic Acid, Serum
• 85610  PT
• 85730  PTT
• 84590  Vitamin E
• 82525  Copper
• 496  Hemoglobin A1C

Every 3-6 months -

• 85025  CBC w/ diff
• 80053  Comprehensive Metabolic Profile
• 84134  Transthyretin (Prealbumin)
• 83540  Iron Profile (Includes TIBC and Sat %)
• 82728  Ferritin
• 82306  Vitamin D (25-hydroxy)
• 84425  Vitamin B-1 (Thiamin), whole blood
• 84207  Vitamin B-6 (Pyridoxine), plasma
• 82747  Folate, RBC
• 82607  Vitamin B12
• 83970  Parathyroid Hormone (PTH), Intact
• 83921  Methylmalonic Acid, Serum
• Any additional tests as needed

Oh Kathy!!! Thank you so much! I am on my way out the door and needed this list badly....my surgeon turned me over to my pc and so they asked me what I needed. I have a complete physical in 30 minutes and you saved me!! Thank you so much, I just needed a guide!      Connie

This is probably a dollar and a day late, but shouldn't you be fasting for labs for an accurate glucose & lipid panel?  Not taking vitamins for past 12 hrs?

Your surgeon should have requested specific vitamin levels to be checked. This is one of the primary reasons for labes?  I'd have a good talk with your surgeon to make sure it doens't happen to other patients. DAVE

Yes, I did fast for labs last week...today was a "make-up" session for vitamins only and they said nothing about not taking vitamins for 12 hours. It had only been 7 hours since I had vitamins. My primary care doctor did my labs, not my surgeon. The surgeon was only checking iron, vit. D and a couple of others so I combined my physical and labs to save time.  

Also, the surgeon will not check A1c's, liver function, cholesterol etc. I think if they check it, they must be able to address problems so, they don't do those other tests. I was actually trying to only have one lab draw...lol...so much for that!

This time, the lab took 10 tubes of blood so I'm fairly certain they got them all, we will see. All my other labs were awesome!! I have a healthy liver (had fatty liver with signs of cirrhosis), A1c's were 5.7...yay! My trigylceride level was 62, HDL 85 and LDL 94. My doctor was thrilled...so was I!  Connie

Not to be construed as medical advice, this list includes labs we have had performed as gastric bypass patients. The first group, every 3 to 6 months for life, as we are able. The second group, annually, as long as the results were comfortably within normal limits for more than 2 years in a row.



1st Group



*80053 Comprehensive Metabolic profile: (sodium, potassium, chloride, glucose,BUN, creatinine, calcium, total protein, albumin, total bilirubin, alkaline phosphatase, aspartate aminotransferase) (10231)

* 84134 Pre-albumin:

* 7600 Lipid profile: (cholesterol, HDL, LDL, triglycerides, chol/HDL ratio)

* 10256 Hep panel: includes ALT (SPGT) & GGT)

* 84100 Phosphorous - Inorganic: (718)

* 83735 Magnesium:

* 84550 Uric Acid: (905)

* 7444 Thyroid panel: (T3U, T4, FTI, TSH) (84437; 84443; 84479; 84480)

* 85025 Hemogram with platelets: (1759)

* 7573 Iron: TIBC, % sat

* 83550 Ferritin: (457)

* 84630 Zinc: (945)

* 84446 Vitamin A: (921)

* 82306 Vitamin D: (25-hydroxy) (680)

* 84052 Vitamin B-1: (Thiamin) (4052)

* 84207 Vitamin B-6: (Pyridoxine)

* 7065 Vitamin B-12 & Folate: (82607; 82746)

* 83970 Serum intact: PTH

* 83937 Osteocalcin:

* 84597 Vitamin K:

* 85610 PT:

* 85730 PTT:



2ND GROUP



* 593 LDH:

* 31789 Homocysteine, Cardio:

* 83921 MMA:

* 367 Cortisol:

* 84255 Selenium:

* 84590 Vitamin E:

* 82525 Copper:





For diabetics: *496 - HEMOGLOBIN A1C













POSSIBLE DIAGNOSIS CODES





269.2 Hypovitaminosis



268 Vitamin D deficiency



275.40 Calcium deficiency



266.2 Cyanocobalamin deficiency (B12)



281.1 other B12 deficiency anemia



281.0 Pernicious anemia



280.9 Iron-deficiency anemia



281.2 Folate deficiency anemia



285.9 Anemia, unspecified



269.3 Zinc deficiency



244.9 Hypothryoidism



250.0 Diabetes



401.9 Hypertension



276.9 Electrolyte and fluid disorders



272.0 Hypercholesterolemia

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - -



*579.3 Surgical malabsorption*



*579.8 Intestinal malabsorption *





* Bands or sleeves should not use these codes as they are not accurate.



*Some insurance companies will not pay for any procedure that uses these codes.





LAB TARGETS





This is NOT medical advice, just my own targets for the main blood levels I watch.



Protein: 7's

Albumin: 4's

Pre-Albumin: 20-30's



Iron: 80-100

Ferritin: 200-300

HGB: 12+

HCT: 36+



Vit A: 60- 80

Vit D: 80-120



Calcium: 9.0-9.4

PTH: 20-40



Vit B1: Mid to top of range

Vit B6: Mid to top of range

Magnesium: Mid range (but also go by if we have leg/foot cramping)

Zinc: Mid range



Vit B12: 1000 +

Folate: Top of range



AST (sgot): Below 40

ALT (sgpt): Below 40



We usually want to "meet or beat" pre-op levels. In some cases, higher is better, and in other cases (Cholesterol, PTH for example), lower is better.



The only things *I* don't mind being on the high end of out of range are Ferritin and B12. But that applies to ME.



My doctors don't show interest in any of these until I am out of range. *I* am interested when I begin heading that direction.

Hey Michele! Great to hear from you again...I'm so sorry we didn't get to see you when you were here. How is Don? My vitamin levels won't be back for a few days but I have the following...
sodium          141
potassium     4.4
chloride          103
co2                  30
calcium Ca     9.9
BUN                 13
creatine (new) 0.70
protein total     6.3
albumin            4.2
albumin/globulin ratio   2.0
bilirubin, total    0.8
alkaline phosphate  74
AST                      34
ALT                      30
cholesterol         191
triglycerides        62
HDL                     85
LDL calculated   94
chol/HDL ratio    2.2
LDL/HDL ratio     1.1
WBC                      4.3
RBC                       4.74
Hgb                       14.6
Hct                         44.1
MCV                       93
MCH                      31
MCHC                   33
RDW                     13.2
platelet count       200
TSH                       1.90
HA1C                     5.7

My doctor was thrilled! They don't mean that much to me, just the common ones. I do know my liver was biopsied at one time and I was told I had cirrhosis....liver seems to look better. I will print this list you gave me and put it in my files. My primary care physician needs a little guidance...he is wonderful. Do you know if Flexeril is ok for us. He said yes but I am nervous about it. I have had trouble with my sciatic nerve lately...OUCH! I lift a lot with my special needs students. Thank you so much!             Connie          

Holy moly, how'd you miss us? We were there for ever and ever!

I don't like the calcium, but got no vit D or PTH to help out. Otherwise, these are mostly medical and not my thing. I want vites, minerals. Let Charles and Liz run interference for ya on this one!