or - Natera · Blighted ovum and nonhydatidiform mole O02.0 Other abnormal products of conception O02.89 Abnormal product of conception O02.9

10 mL 10 mL

10 mL 10 mL

= 10mL Tiger-top Streck blood tube = 10mL/6mL Lavender-top K2 EDTA blood tube Tube = 2 mL Oragene saliva collection tube

6 mL

10 mL

or

2mL

10 mL

Encounter for screening for other metabolic disorders Z13.228

Family history of carrier of genetic disease Z84.81 Family history of other specified conditions Z84.89 Family history of intellectual disabilities Z81.0 Family history of other diseases of

the musculoskeletal system and connective tissue Z82.69

Encounter for genetic counseling Z31.5Other ICD-10 Code____________________________Refer to reverse side for additional ICD-10 Codes

Recurrent pregnancy loss N96 Maternal care for intrauterine death, not

applicable or unspecified O36.4XX0 Encounter for elective termination of pregnancy Z33.2 Missed abortion O02.1 Blighted ovum and nonhydatidiform mole O02.0 Other abnormal products of conception O02.89 Abnormal product of conception O02.9

Other ICD-10 Code___________________________________Refer to reverse side for additional ICD-10 Codes

Supervision of elderly primigravida, 1st trimester O09.511 Supervision of elderly primigravida, 2nd trimester O09.512 Supervision of elderly multigravida, 1st trimester O09.521 Supervision of elderly multigravida, 2nd trimester O09.522 Encounter for other screening for genetic and

chromosomal anomalies Z13.79 Unspecified abnormal findings on antenatal screening

of mother O28.9 Encounter for other genetic testing of female for

procreative management Z31.438Other ICD-10 Code________________________________________Refer to reverse side for additional ICD-10 Codes

Horizon 4 (SMA, CF, Fragile X, DMD panel) Sample Requirements 1 10mL Lavender-top K2 EDTA blood tube OR 1 Oragene saliva tube

Horizon 27 (27 disease Pan-ethnic Standard panel)

Sample Requirements 1 10mL Lavender-top K2 EDTA blood tube PLUS 1 additional 10mL Lavender-top K2 EDTA blood tube for Tay-Sachs Enzyme OR 1 Oragene saliva tube (Tay-Sachs Enzyme is not available if using saliva)

Horizon 106 (106 disease Comprehensive Jewish panel)


Horizon 137 (137 disease Pan-ethnic Large panel)


Horizon 274 (274 disease Pan-ethnic Extended panel)


Go to horizonscreen.com for complete list of diseases tested

Standard Panorama Prenatal Panel Sample Requirements 2 10mL Tiger-top Streck blood tubes

Chromosomes 13, 18, 21, and X and Y; Triploidy; 22q.11.2 deletion syndrome

Panorama Extended Panel Sample Requirements 2 10mL Tiger-top Streck blood tubes

Chromosomes 13, 18, 21, and X and Y; Triploidy; 22q.11.2 deletion syndrome, 1p36 deletion syndrome, Cri-du-chat syndrome, Angelman syndrome, and Prader-Willi syndrome

Go to panoramatest.com for more details

Anora Miscarriage Test (Fresh)Sample Requirements For fetal tissue: chorionic villi, gestational sac, fetal skin/tissue, umbilical cord tissue, cord blood, and cytogenetic tissue cell pellets Parental sample: 1 6 mL Lavendar-top K2 EDTA blood tube or parental buccal swab (blood preferred)

Whole chromosome aneuploidy, Triploidy, Tetraploidy (3:1 only), Uniparental disomy (UPD) of a single chromosome pair, full/complete UPD, deletions and duplications greater than 5 Mb, clinically significant deletions greater than 1 Mb and duplications greater than 2 Mb

Anora Miscarriage Test (Paraffin) Sample Requirements For fetal tissue: 10 serial slides: 1 H&E stained slide and 9 unstained slides OR formalin-fixed sample in a paraffin blockParental sample: 1 6 mL Lavender-top K2 EDTA blood tube or buccal swab from BOTH biological parents (blood preferred)

Whole chromosome aneuploidy, Triploidy (paternal only), Tetraploidy (3:1), UPD of a single chromosome pair, full/complete UPD

Go to prenatal.natera.com for more details

ICD-10 CODES

The Referring Practitioner should select the ICD-10 code(s) that best describes the patient’s clinical condition, even if such ICD-10 code is not listed below.Enter ICD-10 Diagnosis code per respective test on front page of the requisition form.

Screening for other metabolic disorders.................... Z13.228

Nonprocreative screening for genetic disease carrier status.............................................................Z13.71

Other screening for genetic and chromosomal anomalies................................................................. Z13.79

Screening for other disorder......................................Z13.89

Female for testing for genetic disease carrier status for procreative management............................Z31.430

Male for testing for genetic disease carrier status for procreative management............................Z31.440

Pregnant state, incidental..........................................Z33.1

Supervision of normal 1st pregnancy, 1st trimester..............................................................Z34.01

Supervision of normal 1st pregnancy, 2nd trimester.............................................................Z34.02

Supervision of other normal pregnancy, 1st trimester..............................................................Z34.81

Supervision of normal pregnancy, unspecified, 1st trimester...........................................Z34.91

Family history of intellectual disabilities.....................Z81.0

Family history of other diseases of the musculoskeletal system and connective tissue..........Z82.69

Family history of carrier of genetic disease................Z84.81

Family history of other specified conditions............... Z84.89

Encounter for genetic counseling.............................. Z31.5

Recurrent pregnancy loss......................................... N96

Maternal care for intrauterine death, not applicable or unspecified............................................................O36.4XX0

Encounter for elective termination of pregnancy........ Z33.2

Missed abortion........................................................ O02.1

Blighted ovum and nonhydatidiform mole................. O02.0

Other abnormal products of conception.................... O02.89

Abnormal product of conception................................O02.9

Supervision of pregnancy with history of infertility, 1st trimester..............................................................O09.01Supervision of pregnancy with history of infertility, 2nd trimester.............................................................O09.02Supervision of pregnancy with other poor reproductive or obstetric history, 1st trimester........... O09.291Supervision of pregnancy with other poor reproductive or obstetric history, 2nd trimester.......... O09.292Supervision of elderly primigravida, 1st trimester.......O09.511Supervision of elderly primigravida, 2nd trimester..... O09.512Supervision of elderly multigravida, 1st trimester.......O09.521Supervision of elderly multigravida, 2nd trimester......O09.522Supervision of pregnancy resulting from assisted reproductive technology, 1st trimester....................... O09.811Supervision of pregnancy resulting from assisted reproductive technology, 2nd trimester......................O09.812Supervision of other high risk pregnancies, 1st trimester................................................................... O09.891Supervision of other high risk pregnancies, 2nd trimester................................................................... O09.892Abnormal hematological finding on antenatal screening of mother...................................................O28.0Abnormal biochemical finding on antenatal screening of mother...................................................O28.1Abnormal cytological finding on antenatal screening of mother...................................................O28.2Abnormal ultrasonic finding on antenatal screening of mother...................................................O28.3Abnormal radiological finding on antenatal screening of mother...................................................O28.4Abnormal chromosomal and genetic finding on antenatal screening of mother...................................O28.5Other abnormal findings on antenatal screening of mother...................................................................O28.8Unspecified abnormal findings on antenatal screening of mother...................................................O28.9Maternal care for (suspected) chromosomal abnormality in fetus, fetus 1...................................... 35.1XX1Maternal care for (suspected) hereditary disease in fetus, fetus 1.............................................................35.2XX1Family history of other disabilities and chronic diseases leading to disablement, not elsewhere classified.................................................................. Z82.8Encounter for other screening for genetic and chromosomal anomalies .......................................... Z13.79Maternal care for other (suspected) fetal abnormality and damage, fetus 1................................................. O35.8XX1Encounter for antenatal screening of mother............. Z36Encounter for other genetic testing of female for procreative management...........................................Z31.438

Documents

or - Natera · Blighted ovum and nonhydatidiform mole O02.0 Other abnormal products of conception O02.89 Abnormal product of conception O02.9