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ANA Screen, IFA, Reflex Titer/Pattern, and Reflex to Multiplex 11 Ab Cascade

Test Code


CPT Code(s)



The ANA Screen,IFA, Reflex Titer/Pattern,and Reflex to Multiplex 11 Ab Cascade begins with an ANA Screen, IFA.

If ANA Screen, IFA is positive, then ANA Titer and Pattern will be performed at an additional charge (CPT code(s): 86039).
Additionally, five antibodies will be performed at an additional charge: dsDNA (CPT code(s): 86225), Sm/RNP (CPT code(s): 86235), RNP (CPT code(s): 86235), Sm (CPT code(s): 86235), and Chromatin (CPT code(s): 86235).
If any of those five antibodies are positive, the cascade stops and the results are reported.
If all five of those antibodies are negative, four additional antibodies will be performed at an additional charge: SSA (CPT code(s): 86235), SSB (CPT code(s): 86235), Scl-70 (CPT code(s): 86235), Jo-1 (CPT code(s): 86235).
If any of those four antibodies are positive, the cascade stops and the results are reported.
If all four of those antibodies are negative, the following two additional antibodies will be performed at an additional charge: Ribosomal P (CPT code(s): 83516) and Centromere B (CPT code(s): 86235).

Please note the cascade stops upon the first positive antibody result(s) found in a group and an interpretive message is applied based on this information. It is possible that antibodies in subsequent groups are also positive, but will not be added, billed, or reported. Please contact your local Quest Diagnostics Laboratory if you are interested in adding this additional testing.

Preferred Specimen(s)

1 mL serum

Minimum Volume

0.2 mL

Specimen Container

Plastic screw-cap vial

Transport Temperature

Room temperature

Specimen Stability

Room temperature: 4 days
Refrigerated: 7 days
Frozen: 30 days

Reject Criteria

Gross hemolysis • Grossly lipemic • Grossly icteric • Microbial contamination may interfere


Immunofluorescent Assay (IFA)

Performing Laboratory

Quest Diagnostics Nichols Institute
14225 Newbrook Drive
Chantilly, VA 20153

Setup Schedule

Set up: Mon-Sat a.m.; Report available: Next day

Reference Range(s)

ANA Screen Negative
  ANA Titer  
  <1:40 Negative
  1:40-1:80 Low antibody level
  >1:80 Elevated antibody level

Clinical Significance

Antinuclear antibodies are associated with rheumatic diseases including Systemic Lupus Erythematous (SLE), mixed connective tissue disease, Sjogren's syndrome, scleroderma, polymyositis, CREST syndrome, and neurologic SLE.

Alternative Name(s)

Systemic Lupus Erythematosus (SLE), Fluorescent ANA, Dermatomyositis, MCTD, Hep-2, Calcinosis, Mixed Connective Tissue Disease, FANA, Progressive ANA, Sclerodactyly, CREST, Telangiectasia, Raynaud's phenomena, Multiplex Cascade, Esophageal dysmotility, Antinuclear Antibody Screen

LOINC®' Code(s)

The Result and LOINC information listed below should not be used for electronic interface maintenance with Quest Diagnostics. Please contact the Quest Diagnostics Connectivity Help Desk for more information at 800-697-9302.

NOTE: The codes listed in the table below are not orderable Test Codes.

Result NameLOINC CodeComponent Name
132812Sm/RNP Antibody14030-1Smith extractable nuclear Ab+Ribonucleoprotein extractable nuclear Ab
132822Sm Antibody43182-5Smith extractable nuclear Ab
137032Chromatin (Nucleosomal) Ab34416-8Nucleosome Ab
18167AANA Titer5048-4Nuclear Ab
18167BANA Pattern13068-2Nuclear Ab pattern
19887RNP Antibody29374-6Ribonucleoprotein extractable nuclear Ab
38318AANA Screen, IFA42254-3Nuclear Ab
5962DNA (ds) Antibody5130-0DNA double strand Ab

Reference ranges are provided as general guidance only. To interpret test results use the reference range in the 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.

LOINC assignment is based on a combination of test attributes, including the method used by the performing laboratory. For tests not performed by Quest Diagnostics, codes are assigned by the performing laboratory.

* The tests listed by specialist are a select group of tests offered. For a complete list of Quest Diagnostics tests, please refer to our Directory of Services.