| Test code: | 1287 |
| Type of disorder: | Multiple Sclerosis |
| Disease(s) tested for: | Neuromyelitis Optica, Demyelinating Disease, Myelin Disorder |
| Tests included: | Aquaporin-4 (AQP4) (NMO-IgG) Antibody, CBA with Reflex to Titer Myelin Oligodendrocyte Glycoprotein (MOG) Antibody, CBA with Reflex to Titer |
| Special Notes: | If the AQP4 Antibody, CBA ( 86052) is positive a semi-quantitative titer will be performed at an additional charge (CPT code 86052). If the AQP4 Antibody, CBA is negative the MOG Antibody, CBA will be performed at an additional charge (CPT code 86362). If the MOG Antibody, CBA is positive a semi-quantitative titer will be performed at an additional charge (CPT code 86362). |
| Clinical Significance: | NMO (neuromyelitis optica, Devic disease) is an immune-mediated chronic inflammatory disease that predominantly affects the optic nerve and spinal cord and presents with optic neuritis (ON) and myelitis. Limited forms of this disease, such as isolated ON, brainstem encephalitis and longitudinal extensive transverses myelitis (LETM), have been referred to as NMO spectrum disorders (NMOSD). NMO was originally thought to be a variant of multiple sclerosis but is now recognized as a distinct disease. The presence of serum antibodies against aquaporin-4 (AQP4) or myelin oligodendrocyte glycoprotein (MOG-IgG) is associated with NMO and NMOSD. |
| Methodology: | Cell-based Immunofluorescence Assay |
| Reference Range: | See Laboratory Report |
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.
| CPT: | 86052 |
Please label each specimen tube with two forms of patient identification. These forms of identification must also appear on the requisition form.
| Specimen Type: | Serum |
| Specimen Stability: | Room temperature: 72 hours, Refrigerated: 30 days, Frozen: 30 days, |
| Specimen Requirements: | 2 mL (0.5 mL minimum) serum in a Red-top tube or Serum Separator Tube (SST) |
| Instructions: | Serum must be separated from whole blood within 48 hours of collection. Please label each specimen tube with two forms of patient identification. These forms of identification must also appear on the requisition form. |
| Alternate Specimen Type: | Cerebrospinal Fluid (CSF) |
| Alternate Specimen Stability: | Room temperature: 72 hours, Refrigerated: 30 days, Frozen: 30 days, |
| Alternate Specimen Requirements: | 2 mL (0.5 mL minimum) CSF collected in a plastic screw cap vial |
| Transport Temperature: | Refrigerated |
| Reject Criteria | Turbid and/or any suggestion of bacterial contamination |
| Set-up/Analytic Time: | 7-14 days |
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