Autoimmune Hepatitis Diagnostic Panel [19873X]

Test Code

19873

CPT Codes
86038, 86381, 86015, 86376

Includes

ANA Screen, IFA, with Reflex to Titer and Pattern
Mitochondrial Antibody with Reflex to Titer
Actin (Smooth Muscle) Antibody (IgG)
Liver Kidney Microsome (LKM-1) Antibody (IgG)

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

2.5 mL serum

Minimum Volume

0.6 mL

Transport Container

Transport tube

Transport Temperature

Refrigerated (cold packs)

Specimen Stability

Room temperature: 4 days
Refrigerated: 7 days
Frozen: 28 days

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

Hemolysis • Lipemia

Methodology
Immunoassay (IA)

Setup Schedule

Set up and Report available: See individual assays

Reference Range

See individual tests

Clinical Significance

This panel may be helpful in the diagnostic evaluation of individuals with suspected autoimmune hepatitis (AIH). 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; actin (smooth muscle) antibody (SMA); liver kidney microsome type 1 (LKM-1) antibody (IgG); and anti-mitochondrial antibody (AMA) with reflex to titer.

The diagnosis of AIH is based on clinical features, serologic profile, and exclusion of resembling diseases such as viral hepatitis [1]. The detection of antibodies associated with AIH helps establish the diagnosis and differentiate AIH types. ANA and SMA are characteristic of type 1 AIH, while LKM-1 antibody is characteristic of type 2 AIH [2]. ANAs are detected in 75% of patients with type 1 AIH but are also common in many other autoimmune diseases [1]. 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 [1]. 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 antibodies associated with AIH, such as AMA, may help support the diagnosis [2]. AMA is the serologic hallmark of primary biliary cholangitis (PBC) but can also be detected in PBC-AIH overlap syndrome and type 1 AIH [1].

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

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

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.