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Lyme Disease Antibody with Reflex to Immunoassay (IgG, IgM) (MTTT)
Test Code39733
CPT Codes
86618
Includes
If Lyme Disease Antibody is Positive or Equivocal (≥0.90), then Lyme Disease Supplemental Antibodies (IgG, IgM), Immunoassay will be performed at an additional charge (CPT code(s): 86617(x2)).
Preferred Specimen
1 mL serum
Minimum Volume
0.5 mL
Transport Temperature
Room temperature
Specimen Stability
Room temperature: 7 days
Refrigerated: 14 days
Frozen: 30 days
Refrigerated: 14 days
Frozen: 30 days
Reject Criteria (Eg, hemolysis? Lipemia? Thaw/Other?)
Gross hemolysis • Grossly lipemic • Grossly icteric
Methodology
Immunoassay (IA)
Setup Schedule
Set up: Mon, Wed-Sat; Report available: 1-3 days
Clinical Significance
This test is for the qualitative detection of antibodies against Borrelia burgdorferi, the causative agent of Lyme disease, using the modified two-tier testing (MTTT) algorithm. Initial testing is performed using a Lyme total (IgG and IgM) antibody assay and if positive or equivocal, the sample is then tested using separate IgG and IgM immunoassays. This algorithm differs from the STTT algorithm in that the second-tier assays are chemiluminescent immunoassays, not immunoblots. MTTT may be able to assist in the identification of Lyme disease with improved sensitivity earlier in infection compared to STTT.
Diagnostic testing for Lyme disease relies on a two-step algorithm to increase sensitivity and specificity. Testing is performed in patients presenting with signs and symptoms consistent with Lyme disease and with potential tick exposure in endemic regions. Most infections are transmitted by blacklegged ticks in the upper midwestern, northeastern, and mid-Atlantic states.
Negative results can occur in patient with recent infection (≤14 days). In persons with recent or past infection, both IgG and IgM can be detectable months to years after the infection has resolved. Therefore, it is recommended to interpret results in the context of the clinical picture, history, including exposure risk, and symptom onset.
References:
1. Mead, P. et al. Updated CDC Recommendation for Serologic Diagnosis of Lyme Disease. Wkly Rep. 2019 Aug 16;68(32):703. doi: 10.15585/mmwr.mm6832a4.
2. Suggested Reporting Language, Interpretation and Guidance For Lyme Disease Serologic Test Results. Association of Public Health Laboratories. April 2024.
3. Sfeir MM, Meece JK, Theel ES, et al. Multicenter clinical evaluation of modified two-tiered testing algorithms for Lyme disease using zeus scientific commercial assays. J Clin Microbiol 2022; 60:e0252821.
4. Tickborne Diseases of the United States. A Reference Manual for Healthcare Providers, Sixth Edition, 2022. Centers for Disease Control and Prevention.
Diagnostic testing for Lyme disease relies on a two-step algorithm to increase sensitivity and specificity. Testing is performed in patients presenting with signs and symptoms consistent with Lyme disease and with potential tick exposure in endemic regions. Most infections are transmitted by blacklegged ticks in the upper midwestern, northeastern, and mid-Atlantic states.
Negative results can occur in patient with recent infection (≤14 days). In persons with recent or past infection, both IgG and IgM can be detectable months to years after the infection has resolved. Therefore, it is recommended to interpret results in the context of the clinical picture, history, including exposure risk, and symptom onset.
References:
1. Mead, P. et al. Updated CDC Recommendation for Serologic Diagnosis of Lyme Disease. Wkly Rep. 2019 Aug 16;68(32):703. doi: 10.15585/mmwr.mm6832a4.
2. Suggested Reporting Language, Interpretation and Guidance For Lyme Disease Serologic Test Results. Association of Public Health Laboratories. April 2024.
3. Sfeir MM, Meece JK, Theel ES, et al. Multicenter clinical evaluation of modified two-tiered testing algorithms for Lyme disease using zeus scientific commercial assays. J Clin Microbiol 2022; 60:e0252821.
4. Tickborne Diseases of the United States. A Reference Manual for Healthcare Providers, Sixth Edition, 2022. Centers for Disease Control and Prevention.
