Lyme Disease, Western Blot, Cerebrospinal Fluid

CPT: 86617(x2)
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Test Details

Test Includes

Western blot, CSF; analysis and interpretation for IgG-specific and IgM-specific antibodies

Limitations

This procedure may be considered by Medicare and other carriers as investigational and, therefore, may not be payable as a covered benefit for patients.

Methodology

Western blot

Reference Interval

• Positive: Five of the following Borrelia-specific bands: P18, P23, P28, P30, P39, P41, P45, P58, P66, P93

• Negative: No bands or banding patterns that do not meet positive criteria

Specimen Requirements

Specimen

Cerebrospinal fluid (CSF)

Volume

2 mL

Minimum Volume

1 mL

Container

Sterile plastic tube

Storage Instructions

Refrigerate

LOINC® Map

Order Code Order Code Name Order Loinc Result Code Result Code Name UofM Result LOINC
160457 Lyme, Western Blot, CSF 160492 P93 Ab. IgG 28054-5
160457 Lyme, Western Blot, CSF 160460 P66 Ab. IgG 28039-6
160457 Lyme, Western Blot, CSF 160488 P58 Ab. IgG 28048-7
160457 Lyme, Western Blot, CSF 160493 P45 Ab. IgG 28055-2
160457 Lyme, Western Blot, CSF 160462 P41 Ab. IgG 28040-4
160457 Lyme, Western Blot, CSF 160455 P39 Ab. IgG 28036-2
160457 Lyme, Western Blot, CSF 160490 P30 Ab. IgG 28053-7
160457 Lyme, Western Blot, CSF 160494 P28 Ab. IgG 28056-0
160457 Lyme, Western Blot, CSF 160495 P23 Ab. IgG 28057-8
160457 Lyme, Western Blot, CSF 160506 P18 Ab. IgG 48500-3
160457 Lyme, Western Blot, CSF 160503 Lyme IgG WB Interp. 23979-8
160457 Lyme, Western Blot, CSF 160472 P41 Ab. IgM 28043-8
160457 Lyme, Western Blot, CSF 160456 P39 Ab. IgM 28037-0
160457 Lyme, Western Blot, CSF 160501 P23 Ab. IgM 28062-8
160457 Lyme, Western Blot, CSF 160504 Lyme IgM WB Interp. 23985-5

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CPT Statement/Profile Statement

The LOINC® codes are copyright © 1994-2018, Regenstrief Institute, Inc. and the Logical Observation Identifiers Names and Codes (LOINC) Committee. Permission is granted in perpetuity, without payment of license fees or royalties, to use, copy, or distribute the LOINC® codes for any commercial or non-commercial purpose, subject to the terms under the license agreement found at https://loinc.org/license/. Additional information regarding LOINC® codes can be found at LOINC.org, including the LOINC Manual, which can be downloaded at LOINC.org/downloads/files/LOINCManual.pdf