Sensory-Motor Neuropathy Complete Antibody Panel

Test Code
90136

CPT Codes
84181, 86255, 82595, 86334, 82784 (x3), 86431, 86235 (x2), 86038, 86021 (x2), 86036, 86364, 83520 (x9)

Includes
ANA Screen,IFA, with Reflex to Titer and Pattern
If ANA Screen, IFA is positive, then ANA Titer and Pattern will be performed at an additional charge (CPT code(s): 86039).

ANCA Screen with Reflex to ANCA Titer
If ANCA Screen is positive, then C-ANCA Titer and/or P-ANCA Titer, and/or atypical P-ANCA Titer will be performed at an additional charge (CPT code(s): 86037 for each titer performed).

Cryoglobulin Screen with Reflex to Cryoglobulin Reflex
If Cryoglobulin Screen is positive, then Cryoglobulin Reflex will be performed at an additional charge (CPT code(s): 86334, 86329).

Ganglioside Asialo-GM-1 Antibodies (IgG, IgM), EIA
Ganglioside GD1a Antibodies (IgG, IgM), EIA
Ganglioside GD1b Antibodies (IgG, IgM), EIA
Ganglioside GM-1 Antibodies (IgG, IgM), EIA
Ganglioside GQ1b Antibody (IgG), EIA

Hu Antibody Screen with Reflex to Titer and Western Blot
If Hu Antibody Screen, IFA is positive, then Hu Antibody, WB will be performed at an additional charge (CPT code(s): 84181).
If Hu Antibody, WB is positive, then Hu Antibody Titer will be performed at an additional charge (CPT code(s): 86256).

Immunofixation (IFE), Serum

Immunoglobulins (IgG, IgA and IgM)
If IgA (Immunoglobulin A) is abnormal, then Tissue Transglutaminase (tTG) Antibody (IgG) will be performed at an additional charge (CPT code(s): 86364).

Myelin Associated Glycoprotein (MAG) Antibody, with Reflex to MAG-SGPG and MAG, EIA
If MAG Antibody (IgM), WB is positive, then MAG-SGPG Antibody (IgM), EIA and MAG Antibody (IgM), EIA, will be performed at an additional charge (CPT code(s): 83520 x2).

Myeloperoxidase Antibody (MPO)
Proteinase-3 Antibody
Rheumatoid Factor
Sjögren's Antibodies (SS-A, SS-B)

Tissue Transglutaminase (tTG) Antibody (IgA)
If Tissue Transglutaminase (tTG) Antibody (IgA) is positive (≥15.0 U/mL), then Endomysial Antibody Screen (IgA) with Reflex to Titer will be performed at an additional charge (CPT code(s): 86231).
If Endomysial Antibody Screen (IgA) is positive, then Endomysial Antibody Titer will be performed at an additional charge (CPT code(s): 86231).

Preferred Specimen
23.2 mL serum collected in a red-top tube (no gel)

Patient Preparation
Overnight fasting is preferred

Minimum Volume
9.7 mL

Instructions
See individual assays.
*** Multiple tubes required for testing - See note ***

Note:
Cryoglobulin Screen and reflex: Collect 20 mL of fasting whole blood specimen in a red-top tube (no gel). 10 mL serum required: 3.5 mL minimum.

Allow serum sample to clot for one (1) hour in a 37° C water bath, oven, incubator, or heat block. After clotting, centrifuge the specimen for 10 minutes at 1600 RCF(G) utilizing one of the 3 options below:
1) In a "warm" centrifuge at 37° C.
2) In a bench-top centrifuge placed in a "warm room" at 37° C.
3) At room temperature, in a bench-top centrifuge prewarmed by running it for 10 minutes at 1600 RCF(G).
After centrifuging, decant serum into a screw-cap vial.
Transport at room temperature in separate transport tube clearly marked "CRYO" since sample will not be viable for other testing.
Avoid hemolysis
Avoid lipemia
Avoid freezing and thawing


Transport Container

Plastic screw-cap vial(s)



Transport Temperature
See individual assays

Specimen Stability
See individual assays

Reject Criteria (Eg, hemolysis? Lipemia? Thaw/Other?)
Gross hemolysis • Grossly lipemic • Icteric • Serum separator tube for cryoglobulin • Plasma • Microbial contamination may interfere

Methodology
Western Blot • Immunofluorescence Assay • Cryocrit • Immunodiffusion • Electrophoresis • Immunoassay • Immunoturbidimetric

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

Setup Schedule
Set up and Report available: See individual assays

Reference Range
See individual tests

Clinical Significance
Sensory-motor neuropathies may occur by various mechanisms. These include development of autoantibodies to neuronal structures such as myelin associated glycoprotein (MAG) antibody, Hu antibody, and the ganglioside antibodies. Sensory-motor neuropathies may also occur via antibody cross-reactivity or local immune complex deposition as seen in autoimmune disease with primarily non-neuronal targets including Sjogren's syndrome (SSA/SSB), systemic lupus erythematosus and related conditions (ANA IFA), celiac disease (tTG antibody), vasculitis (ANCA), and immune complex deposition (cryoglobulins, rheumatoid factor). Motor-sensory neuropathy may be associated with monoclonal gammopathy (serum immunofixation and serum immunoglobulins).

Performing Laboratory
Quest Diagnostics Nichols Institute-San Juan Capistrano, CA
33608 Ortega Highway
San Juan Capistrano, CA 92675-2042




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.