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94955: Encephalitis Antibody Evaluation with Reflex to Titer and Line Blot, Serum Print View
Tissue IFA Observation(s) IFA     
ANNA1 (Hu) Ab, IFA IFA     
ANNA2 (Ri) Ab, IFA IFA     
ANNA3 Ab, IFA IFA     
PCA1 (Yo) Ab, IFA IFA     
PCA2 AB, IFA IFA     
PCA-Tr (DNER) Ab, IFA IFA     
AGNA/SOX1 Ab, IFA IFA     
Amphiphysin Ab, IFA IFA     
CRMP5/CV2 Ab, IFA IFA     
GAD65 Ab, IFA IFA     
Ma2/Ta Ab, IFA IFA     
Myelin Ab, IFA IFA     
Aquaporin 4 (NMO) Ab, IFA IFA     
Aquaporin-4 Ab (IgG),CBA CBA IFA     
NMDAR1 Ab, CBA CBA IFA     
AMPAR1 Ab, CBA CBA IFA     
AMPAR2 Ab, CBA CBA IFA     
GABABR Ab, CBA CBA IFA     
LGI1 Ab, CBA CBA IFA     
CASPR2 Ab, CBA CBA IFA     
DPPX Receptor Ab, CBA IFA CBA IFA     
AChR Ganglionic(Alpha3)Ab RIA    pmol/L 
VGCC Type P/Q Ab RIA    pmol/L 
VGCC Type N Ab RIA    pmol/L 
VGKC Ab RIA    pmol/L 

PRIMARY
1 Serum 6 (3.5) mL   Room Temperature - 24 Hour(s)/Refrigerated - 48 Hour(s)/Frozen - 21 Day(s)  
ALTERNATE

The Encephalitis Antibody Panel provides an evaluation of possible autoantibodies in patients with suspected autoimmune encephalitis, and optimizes the likelihood of detecting neuronal specific autoantibodies, whether present singly or occurring as multiple autoantibodies.
Setup Schedule
Tuesday-Saturday

Reported (Analytical Time)
14 days

CPT Codes
86255x20,86341,83519x4

The CPT codes provided 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 payer being billed.

Notes
Transport Temperature: Frozen
Reject Criteria: Received room temperature; received refrigerated
Reflex Criteria:
1) A line blot consisting of 10 analytes will be performed at an additional charge (CPT codes(s): 84182 x10) as a reflex for tissue mosaic IFA suggesting one or more of the analytes on the line blot:
ANNA1 (Hu), ANNA2 (Ri), PCA1 (Yo), Ma2/Ta, CV2 (CRMP5), Amphiphysin, AGNA1 (SOX1), GAD65, DNER, and Zic4. If the tissue mosaic pattern suggests ANNA3, titer will be performed at an additional charge (CPT
code(s): 86256). 2) If the tissue mosaic pattern suggests PCA-2, titer will be performed at an additional charge (CPT code(s): 86256). 3) If the tissue mosaic IFA suggests PCA-Tr (DNER) and Western Blot shows DNER negative and Yo negative, then cell based assay IFA for DNER will be performed at an additional charge (CPT code(s): 86255) a. If DNER CBA is positive, titer will be performed at an additional charge (CPT code(s): 86256). 4) If the tissue mosaic IFA suggests myelin antibody, then a. Myelin antibody IFA titer will be performed at an additional charge (CPT code(s): 86256). b. Myelin Associated Glycoprotein (MAG) Antibody, in turn reflexing to MAG-SGPG and MAG ELISA for quantitation, will be performed at an additional charge (CPT code(s): 83520 x2) 5) If the Mosaic CBA is positive for any given analyte (NMDAR1, AMPAR1, AMPAR2, GABA-B Receptor, LGI-1, CASPR2), and the individual CBAs DPPX and Aquaporin 4 antibody, then that analyte will be titered at an additional charge (CPT code(s): 86256 per titer). 6) If DPPX is positive, titer will be performed at an additional charge (CPT code(s): 86256). 7) If the Aquaporin 4 (NMO, neuromyelitis optica) CBA is positive, then Aquaporin 4 CBA titer will be performed at an additional charge (CPT code(s): 86256).






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