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 less than lower reference range, 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
Sjőgren'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

10.5 mL

Instructions

See individual tests
Multiple tubes required for testing

Cryoglobulin Screen and reflex: 3 mL serum required: 2 mL minimum.

Since multiple tubes are needed for this panel, designate one tube exclusively for cryoglobulin and treat it differently from the other tubes collected. Allow blood in the tube designated for cryoglobulin to clot for one (1) hour in a 37° C water bath, incubator, heat block, or heel warmer. After clotting, centrifuge the specimen as quickly as possible. It is not necessary to use a warm centrifuge but do not use a refrigerated one. Decant all of the cryoglobulin serum into one screw-cap vial (do not aliquot any of the cryoglobulin serum into any other tube). Transport at room temperature.

Note: If the sample is not kept at 37° C during clotting, the cryoglobulin, if present, can precipitate during centrifugation and be lost in the clot resulting in a false negative result.

Avoid hemolysis. Avoid lipemia. Avoid freezing and thawing.

Transport Container

Transport tubes

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
See individual tests

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 FDA. 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

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

Last Updated: May 19, 2016

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.