Multifocal Neuropathy Evaluation

Test Code

92823

CPT Codes
81324, 83520 (x4)<br>Limited Access Code

Physician Attestation of Informed Consent

This germline genetic test requires physician attestation that patient consent has been received if ordering medical facility is located in AK, DE, FL, GA, IA, MA, MN, NV, NJ, NY, OR, SD or VT or test is performed in MA.

Includes

Co-GM1 Quattro™, PMP22 Duplication/Deletion Test

Preferred Specimen

2 mL serum, and
8 mL whole blood in two EDTA (lavender-top) tubes

Minimum Volume

0.5 mL serum • 6 mL whole blood

Instructions

Please label each specimen tube with two forms of patient identification. These forms of identification must also appear on the requisition form.

Serum must be separated from cells within 48 hours of collection.

Transport Temperature

Refrigerated (cold packs)

Specimen Stability

Room temperature: 10 days
Refrigerated: 10 days
Frozen: Unacceptable

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

Hemolysis; Icteric; Lipemia

Methodology
Enzyme-Linked Immunosorbent Assay (ELISA) • Multiplex Ligation-dependent Probe Amplification

FDA Status
This test was developed and its analytical performance characteristics have been determined by Athena Diagnostics. It has not been cleared or approved by the U.S. Food and Drug Administration. This assay has been validated pursuant to the CLIA regulations and is used for clinical purposes.

Setup Schedule

Tuesday Morning
Report available: 14 Days

Reference Range

See Laboratory Report

Clinical Significance

Anti-GM1, anti-GD1a, anti-Asialo GM1, anti-GD1b
antibodies, and PMP22 gene deletions are found in
patients with slowly progressive, predominantly distal,
asymmetric weakness with no sensory symptoms or signs.
Weakness is sometimes present in one upper extremity in
80% of patients; muscle atrophy is common.

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.