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For hours, walk-ins and appointments.Hepatitis B Virus (HBV) Screening and Diagnosis (Triple Panel)
CPT:
86704; 86706; 87340
Test Includes
Hepatitis B Surface Antigen (HBsAg) Screen; Hepatitis B Surface Antibody (anti-HBs); Hepatitis B Core Antibody, Total (anti-HBc); reflexes to Hepatitis B Core Antibody, IgM (IgM anti-Hbc) when indicated
Reflex criteria: If Hepatitis B Core Antibody, Total [006718] is positive and Hepatitis B Surface Antibody, Qualitative [006395] is non-reactive (NR), reflexes to Hepatitis B Core Antibody, IgM [016881]
Special Instructions
If reflex test is performed, additional charges/CPT code(s) may apply.
This test may exhibit interference when sample is collected from a person who is consuming a supplement with a high dose of biotin (also termed as vitamin B7 or B8, vitamin H, or coenzyme R). It is recommended to ask all patients who may be indicated for this test about biotin supplementation. Patients should be cautioned to stop biotin consumption at least 72 hours prior to the collection of a sample.
Expected Turnaround Time
1 - 2 days
Turnaround time is defined as the usual number of days from the date of pickup of a specimen for testing to when the result is released to the ordering provider. In some cases, additional time should be allowed for additional confirmatory or additional reflex tests. Testing schedules may vary.
Related Documents
Specimen Requirements
Specimen
Serum or EDTA plasma
Volume
5 mL
Minimum Volume
2.5 mL (Note: This volume does not allow for repeat testing.)
Container
Gel-barrier tube, red top tube, or lavender-top (EDTA) tube
Collection
If tube other than a gel-barrier tube is used, transfer separated serum or plasma to a plastic transport tube.
Storage Instructions
Room temperature
Stability Requirements
Temperature | Period |
|---|---|
Room temperature | 14 days |
Refrigerated | 14 days |
Frozen | 14 days |
Freeze/thaw cycles | Stable x3 |
Patient Preparation
No special preparation required.
Causes for Rejection
Specimens other than serum or EDTA plasma; PST gel-barrier tube; specimens with visible gross microbial contamination
Test Details
Use
This is a triple test panel intended for screening and diagnosis of hepatitis B virus (HBV) infection. This panel can be used to identify different phases of HBV infection and to determine whether a patient has acute or chronic HBV infection, is immune to HBV as a result of prior infection or vaccination, or is susceptible to infection. This panel aligns with current CDC recommendations for HBV screening and testing.
Limitations
The performance of the assays included in this panel has not been established with cadaveric specimens, heat-inactivated specimens or body fluids other than serum and EDTA plasma.
Methodology
Immunochemiluminometric assay (ICMA)
Additional Information
Hepatitis B surface antigen (HBsAg) is a protein on the surface of hepatitis B virus that can be detected in high levels in serum during acute or chronic hepatitis B virus infection. The presence of HBsAg indicates that the person is infectious. HBsAg can typically be detected in an infected person's blood an average of 4 weeks (range: 1-9 weeks) after exposure to the virus. Persistence of HBsAg, without anti-HBs, with combinations of positivity of anti-HBc, HbeAg, or anti-HBe indicates infectivity and the need for investigation for chronic persistent or chronic aggressive hepatitis.
The presence of Hepatitis B surface antibody (anti-HBs) is generally interpreted as indicating recovery and immunity from hepatitis B virus infection. Anti-HBs also develops in a person who has been successfully vaccinated against hepatitis B.
Total hepatitis B core antibody (anti-HBc) appears at the onset of symptoms in acute hepatitis B and persists for life. The presence of anti-HBc indicates previous or ongoing infection with hepatitis B virus in an undefined time frame. IgM antibody to hepatitis B core antigen (IgM anti-HBc) positivity indicates recent infection with hepatitis B virus (< 6 months) and its presence is consistent with acute infection.
Interpretation | HBsAg | anti-HBs | anti-HBc | IgM anti-HBc |
|---|---|---|---|---|
* Multiple possibilities: resolved infection (most common); false-positive anti-HBc (susceptible); "low-level" chronic infection; resolving acute infection. | ||||
Susceptible/no evidence of infection | - | - | - | TNI |
Immune due to natural resolved infection | - | + | + | TNI |
Immune due to vaccination | - | + | - | TNI |
Acute infection | + | - | + | + |
Chronic infection | + | - | + | - |
Interpretation unclear* | - | - | + | ± |
References
Abara WE, Oaseem A, Schillie S. McMahon BJ, Harris AM, High Value Care Task Force of the American College of Physicians and the Centers for Disease Control and Prevention. Hepatitis B Vaccination, Screening, and Linkage to Care: Best Practice Advice from the American College of Physicians and the Centers for Disease Control and Prevention. Ann Intern Med. 2017 Dec 5;167(11):794-804.29159414
Centers for Disease Control and Prevention. Hepatitis B. CDC web site: www.cdc.gov/hepatitis/hbv/index.htm. Accessed May 2021.
Terrault NA, Lok ASF, McMahon BJ, et al. Update on Prevention, Diagnosis, and Treatment of Chronic Hepatitis B: AASLD 2018 Hepatitis B Guidance. Hepatology. 2018 Apr;67(4):1560-1599.29405329
LOINC® Map
| Order Code | Order Code Name | Order Loinc | Result Code | Result Code Name | UofM | Result LOINC |
|---|---|---|---|---|---|---|
| 144473 | HBV Screening and Diagnosis | 77190-7 | 006510 | HBsAg Screen | 5196-1 | |
| 144473 | HBV Screening and Diagnosis | 77190-7 | 006408 | Hep B Surface Ab, Qual | 22322-2 | |
| 144473 | HBV Screening and Diagnosis | 77190-7 | 006718 | Hep B Core Ab, Tot | 13952-7 | |
| 144473 | HBV Screening and Diagnosis | 77190-7 | 006719 | Rfx to HBc IgM | 77202-0 | |
| 144473 | HBV Screening and Diagnosis | 77190-7 | 006720 | Interpretation | 56850-1 |
| Reflex Table for HBsAg Screen | ||||||
|---|---|---|---|---|---|---|
| Order Code | Order Name | Result Code | Result Name | UofM | Result LOINC | |
| Reflex 1 | 016105 | HBsAg Confirmation | 016105 | HBsAg Confirmation | 7905-3 | |
| Reflex Table for Rfx to HBc IgM | ||||||
|---|---|---|---|---|---|---|
| Order Code | Order Name | Result Code | Result Name | UofM | Result LOINC | |
| Reflex 1 | 016881 | Hep B Core Ab, IgM | 016881 | Hep B Core Ab, IgM | 24113-3 | |
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