ANA Screen,IFA,with Reflex to Titer and Pattern/Rheumatoid Arthritis Panel1

Test Code

90071

CPT Codes
86038, 86200, 86431

Includes

ANA Screen, IFA, with Reflex to Titer and Pattern
Rheumatoid Factor
Cyclic Citrullinated Peptide (CCP) Antibody IgG

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

Preferred Specimen

3 mL serum

Minimum Volume

1.5 mL

Transport Temperature

Room temperature

Specimen Stability

Room temperature: 4 days
Refrigerated: 7 days
Frozen: 30 days

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

Gross hemolysis • Grossly lipemic • Microbial contamination may interfere • Plasma

Methodology
Immunoassay (IA) • Immunofluorescence Assay (IFA) • Immunoturbidimetric

Setup Schedule

See individual assays

Clinical Significance

This panel can be helpful in the diagnosis of autoimmune diseases with a focus on rheumatoid arthritis (RA) by simultaneously testing for antinuclear antibodies (ANAs) with an immunofluorescence assay (IFA), performed on human epithelial type 2 (HEp-2) cells, as well as the RA markers rheumatoid factor (RF) and cyclic citrullinated peptide (CCP) antibody (IgG). For specimens with positive ANA IFA results, reflex testing for ANA titer and pattern is performed.

The laboratory evaluation for individuals with clinical suspicion of autoimmune diseases often begins with an ANA screen. The classic ANA IFA on HEp-2 cells is considered by the American College of Rheumatology (ACR) as the current gold standard because of its overall high sensitivity for several autoimmune diseases [1]. Although RA is not generally associated with ANA, occasional patients may present with features of RA and SLE ("rhupus") and be positive for ANA and RA markers [2].

This panel includes RF and CCP IgG antibody, 2 widely used laboratory markers that are included in the ACR/ European League Against Rheumatism classification (EULAR) criteria for RA [3]. The combination of RF and CCP antibody provides greater sensitivity than either assay alone [4] and is commonly used in the diagnostic evaluation of suspected RA.

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

References
1. Methodology of testing for antinuclear antibodies (position statement). 2009. American College of Rheumatology. Updated December 2019. Accessed May 15, 2023. https://assets.contentstack.io/v3/assets/bltee37abb6b278ab2c/blta48818378bc89445/acr-position-statement-methodology-testing-antinuclear-antibodies.pdf
2. Antonini L, et al. Autoimmun Rev. 2020;19(9):102612.
3. Aletaha D, et al. Arthritis Rheum. 2010;62(9):2569-2581.
4. Maksymowych WP, et al. J Rheumatol. 2014;41(11):2104-2113.

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.