Autoimmune Hepatitis Differential Panel for Hep-C Patient

Test Code

91705

CPT Codes
86038, 86381, 86015, 86376, 83520

Includes

ANA Screen, IFA, with Reflex to Titer and Pattern
Mitochondrial Antibody with Reflex to Titer
Actin (Smooth Muscle) Antibody (IgG)
Liver Kidney Microsomal (LKM-1) Antibody (IgG)
Soluble Liver Antigen (SLA) Autoantibody

If ANA Screen, IFA is positive, then ANA Titer and Pattern will be performed at an additional charge (CPT code(s): 86039).
If Mitochondrial Antibody Screen is positive, then Mitochondrial Antibody Titer will be performed at an additional charge (CPT code(s): 86381).

Preferred Specimen

Serum - Please see the individual assays for specific specimen requirements and stabilities.

Instructions

Submit refrigerated serum

Specimen Stability

See individual tests

Reject Criteria (Eg, hemolysis? Lipemia? Thaw/Other?)

Hemolysis • Lipemia

Methodology
See individual tests

Setup Schedule

Set up and Report available: See individual tests

Reference Range

See individual tests

Clinical Significance

This panel may help diagnose or exclude autoimmune hepatitis (AIH) in patients with hepatitis C for the purpose of informing treatment options. This panel includes an antinuclear antibody (ANA) immunofluorescence assay (IFA) screen, performed on human epithelial type 2 (HEp-2) cells, with reflex to titer and pattern; smooth muscle antibody (SMA); liver kidney microsome type 1 (LKM-1) antibody; soluble liver antigen (SLA) antibody; and anti-mitochondrial antibody (AMA) with reflex to titer.

Certain hepatitis C therapies, such as peginterferon and ribavirin, are contraindicated for patients with AIH or other autoimmune conditions. The detection of certain antibodies associated with AIH may help establish or exclude the diagnosis. ANA and SMA are characteristic of type 1 AIH, while LKM-1 antibody is characteristic of type 2 AIH [1]. ANAs are detected in 75% of patients with type 1 AIH but are also common in many other autoimmune diseases [2]. SMAs are present in approximately 85% of patients with type 1 AIH but can be detected in a range of other conditions, such as viral hepatitis, malignancies, rheumatic diseases, and nonalcoholic fatty liver disease [2]. LKM-1 antibody is specific for type 2 AIH and usually is not concurrent with ANA and SMA.

Up to 20% of patients with AIH are negative for ANA, SMA, and LKM-1 antibody. In these patients, testing other antibodies associated with AIH, such as AMA and SLA, may help assess the diagnosis [1]. AMA is the serologic hallmark of primary biliary cholangitis (PBC) but can also be detected in PBC-AIH overlap syndrome or type 1 AIH [2]. SLA antibody is highly specific (99%) for AIH and can be detected as a sole marker in 14% to 20% of patients [1]. The presence of SLA antibody is associated with the likelihood of severe disease and relapse after drug withdrawal [1]. Unlike ANA, SMA, and LKM-1, SLA is very rarely present in patients with hepatitis C [2].

The results of this test should be interpreted in the context of pertinent clinical and family history and physical examination findings.

References
1. Mack CL, et al. Hepatology. 2020;72(2):671-722.
2. Neuberger J, et al, eds. Autoimmune Liver Disease: Management and Clinical Practice. 1st ed. John Wiley & Sons Ltd, 2020.

The CPT Codes provided in this document are based on AMA guidelines and are for informational purposes only. CPT coding is the sole responsibility of the billing party. Please direct any questions regarding coding to the payor being billed. Any Profile/panel component may be ordered separately. Reflex tests are performed at an additional charge.