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Multiple Sclerosis (MS) Differential Evaluation with Reflexes
Test Code18216
CPT Codes
82607, 86038, 86052, 86235 (x2), 86362, 86431, 86618, 86790
Includes
ANA Screen,IFA, with Reflex to Titer and Pattern
Aquaporin-4 (AQP4) (NMO-IgG) Antibody with Reflex to Titer, Serum
HTLV-I/II Antibody, with Reflex to Confirmatory Assay
Lyme Disease Ab with Reflex to Blot (IgG, IgM)
Myelin Oligodendrocyte Glycoprotein(MOG)Antibody with Reflex to Titer,Serum
Rheumatoid Factor
Sjogren's Antibodies (SS-A, SS-B)
Vitamin B12 (Cobalamin)
If ANA Screen, IFA is Positive, then ANA Titer and Pattern will be performed at an additional charge (CPT code(s): 86039).
If the Aquaporin 4 Antibody, Serum is Positive, then Aquaporin 4 Antibody, Titer, Serum will be performed at an additional charge (CPT code: 86052).
If the HTLV-I/II Antibody is Reactive, then HTLV-I/II Confirmatory Assay will be performed at an additional charge (CPT code: 86689).
If Lyme Disease Antibody Screen is ≥0.90, then Lyme Disease Antibodies (IgG, IgM), Immunoblot will be performed at an additional charge (CPT code(s): 86617(x2)).
If the MOG Antibody screen is Positive, then a semi-quantitative titer will be performed at an additional charge (CPT code(s): 86362).
Aquaporin-4 (AQP4) (NMO-IgG) Antibody with Reflex to Titer, Serum
HTLV-I/II Antibody, with Reflex to Confirmatory Assay
Lyme Disease Ab with Reflex to Blot (IgG, IgM)
Myelin Oligodendrocyte Glycoprotein(MOG)Antibody with Reflex to Titer,Serum
Rheumatoid Factor
Sjogren's Antibodies (SS-A, SS-B)
Vitamin B12 (Cobalamin)
If ANA Screen, IFA is Positive, then ANA Titer and Pattern will be performed at an additional charge (CPT code(s): 86039).
If the Aquaporin 4 Antibody, Serum is Positive, then Aquaporin 4 Antibody, Titer, Serum will be performed at an additional charge (CPT code: 86052).
If the HTLV-I/II Antibody is Reactive, then HTLV-I/II Confirmatory Assay will be performed at an additional charge (CPT code: 86689).
If Lyme Disease Antibody Screen is ≥0.90, then Lyme Disease Antibodies (IgG, IgM), Immunoblot will be performed at an additional charge (CPT code(s): 86617(x2)).
If the MOG Antibody screen is Positive, then a semi-quantitative titer will be performed at an additional charge (CPT code(s): 86362).
Preferred Specimen
11 mL serum collected in a red-top tube (no gel)
Minimum Volume
4.7 mL
Instructions
Label the tubes according to your standard operating procedure, making sure that each tube has at least two unique patient identifiers. Draw 9 tubes, 11 mL serum in a red-top tube (no gel). Allow the blood to clot for at least 30 minutes, but not longer than 1 hour before centrifugation. Centrifuge each tube for 15 minutes at 1250 to 1600 RCF. Transfer serum to plastic, screw-cap vial(s). The plastic, screw-cap vial containing serum must be labeled with the specimen type. Place sample(s) on cold packs or in refrigerator. Sample is stable for 7 days at 2-8° C (refrigerated). Do not transport or store samples at room temperature.
Transport Temperature
Refrigerated (cold packs)
Specimen Stability
Room temperature: Unacceptable
Refrigerated: 7 days
Frozen: 21 days
Refrigerated: 7 days
Frozen: 21 days
Reject Criteria (Eg, hemolysis? Lipemia? Thaw/Other?)
Hemolysis • Grossly lipemic • Grossly icteric • Visible particulate matter • Serum separator tube (SST) • Microbial contamination • Plasma
Methodology
Cell-based Immunofluorescence Assay • Immunoassay (IA) • Immunoturbidimetric Assay • Immunofluorescence Assay (IFA) • Immunoblot (IB)
Setup Schedule
Set up: Mon-Sun; Report available: 8 days
Reference Range
See Laboratory Report
Clinical Significance
Clinical presentation of Multiple Sclerosis (MS) can vary significantly, with neurological signs and symptoms in clinically isolated syndrome (CIS) overlapping with other inflammatory disorders (e.g. Sjogren's, Lyme disease, SLE, NMO, MOGAD, transverse myelitis, etc.). These disorders can be considered mimics of MS and can make initial diagnosis and treatment decisions difficult. This test will aid in the differential diagnosis of MS by evaluating for other pathological causes of neurological symptoms mimicking MS.
