ANTI MITOCHONDRIAL ANTIBODIES, SERUM

Additional Codes

Software	Test Code
Label Text	AMA
EPIC	LAB10010

Performing Laboratory

NorDx Laboratories

Useful For

Helping in the diagnosis of autoimmune diseases.

Includes AMA screen. If the screen is positive, a titer will automatically be performed at an additional charge.

Method Name

Indirect Immunofluorescence (IF)

Reference Values

Negative

If positive, titer will be performed.

Days and Times Test Performed

Mondays and Thursdays

Report Available

Up to 4 days

Specimen Type

Serum

Preferred Container

Serum Separator Tube (SST)

Preferred Volume

Serum: 2 mL (Serum Separator Tube (SST))

Minimum Volume

Serum: 0.5 mL (Serum Separator Tube (SST))

Specimen Collection and Handling

Spin specimen, separate from clot and send refrigerated.

Specimen Stability Information

Specimen Type: Serum

Frozen: 3 Months

Refrigerated: 7 Days

Must be spun/separated within: 2 Hours

Note: Avoid freeze-thaw cycles

Add On Capable

Yes

Advance Beneficiary Notice Requirements

This test, when ordered on Medicare patients, is subject to the National Coverage Determination (NCD) policies. Please verify that the diagnosis code (ICD code) you have chosen demonstrates medical necessity for the test as documented in the physician’s patient record. The CMS web site is available to assist you with this verification. A properly executed Advance Beneficiary Notice (ABN) must be submitted with the specimen if medical necessity is not demonstrated by the ICD code chosen.

CPT Code Information

CPT Code	CPT Description	CPT Disclaimer
86381	Mitochondtrial antibody (eg, M2) each
86256	Fluorescent Noninfectious Agent Antibody, Titer, Each Antibody

Performing Laboratory Location