The clinical presentation
does not always tell the whole story
While many tick-borne diseases have overlapping symptoms that include fever, rash, body aches, fatigue, headaches, and chills, some patients are asymptomatic and/or experience a delay in the appearance of symptoms.
With the likelihood of overlapping symptoms and coinfections, identifying a specific tick-borne illness can be challenging, although it’s essential to initiating the right treatment. Selecting and using the right laboratory test can help uncover actionable insights, sooner.
Tick-borne disease:
a growing problem across the country
Tick-borne diseases primarily spread in the spring, summer, and fall. They are especially prevalent in the Northeast and Mid-Atlantic, and their incidence is on the rise.
Accurate, timely differential diagnosis
When it comes to diagnosing a tick-borne disease, the timing and selection of the appropriate test is critical. Depending upon the patient’s initial exposure, onset, and presence of symptoms, Quest Diagnostics offers more than 30 tick-borne disease tests and panels to help make an informed diagnosis and initiate the right treatment, which could lead to better outcomes for your patients.
Test code: 36942
When: Days/months/years after disease onset. This may confuse result interpretation in a couple of different ways (specific to Lyme):
- IgM antibodies in some individuals are known to persist for much longer than 2-3 months
- CDC does not recommend testing for IgM with STTT if signs or symptoms exceed 30 days
The science: Detection of IgM and IgG antibodies 4-7 days or later after disease onset
Panel information:
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Test code |
36942 |
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Preferred specimen |
2 mL serum collected in a serum separator tube (SST) and transferred to a plastic transport tube |
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Turnaround time |
1-3 days |
Panel components:
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TEST CODE |
TEST NAME |
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Lyme Disease Ab with Reflex to Blot (IgG, IgM) Includes: If Lyme Disease Antibody Screen is ≥0.90, then Lyme Disease Antibodies (IgG, IgM), Immunoblot will be performed at an additional charge (TC: 8593)(CPT code(s): 86617 (x2))
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a Components of panels can be ordered separately.
b This test was developed, and its analytical performance characteristics have been determined by Quest Diagnostics. It has not been cleared or approved by FDA. This assay has been validated pursuant to the CLIA regulations and is used for clinical purposes.
Test code: 94322
When: 1-2 weeks after disease onset
The science: Real-time polymerase chain reaction
Panel information:
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Test code |
94322 |
|
Preferred specimen |
3 mL whole blood collected in an EDTA (lavender-top) tube |
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Turnaround time |
2-3 days |
Panel components:
|
TEST CODE |
TEST NAME |
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Borrelia burgdorferi DNA, Qualitative, Real-Time PCR, Miscellaneousb |
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a Components of panels can be ordered separately.
b This test was developed, and its analytical performance characteristics have been determined by Quest Diagnostics. It has not been cleared or approved by FDA. This assay has been validated pursuant to the CLIA regulations and is used for clinical purposes.
A general pattern for molecular vs serologic testing7
A comprehensive menu for tick-borne illness testing
With its acquisition of the US laboratory services of Imugen, Quest has created a more powerful and comprehensive testing portfolio for tick-borne diseases. With the addition of Imugen’s tick-borne illness test menu, healthcare providers now have access to:
Updated CDC guidance for Lyme disease testing
Quest Diagnostics offers both of the CDC-recommended 2-step testing processes for the serological diagnosis of Lyme disease.
The standard two-tier test (STTT) includes an enzyme immunoassay (EIA) or immunofluorescence assay (IFA) that detects antibodies against the B burgdorferi bacterium, followed by a second immunoblot that is used for confirmation.5
Step 1: EIA or IFA—if negative, no further testing is recommended; if positive or indeterminate, the second step should be performed
Step 2: Immunoblot test—results are considered positive only if the EIA/IFA and immunoblot are both positive
Test: Lyme Disease Ab with Reflex to Blot (IgG, IgM)a (TC: 6646)
Includes: If Lyme Disease Antibody Screen is ≥0.90, then Lyme Disease Antibodies (IgG, IgM), Immunoblot will be performed at an additional charge (TC: 8593) (CPT code(s): 86617 (x2))
a Components of panels may be ordered separately.
A modified two-tier test (MTTT) is part of an updated recommendation from the CDC for earlier detection and diagnosis of the disease. MTTT utilizes immunoassays rather than immunoblots in the second tier of the algorithm and may be able to assist in the identification of early Lyme disease within the first 30 days of infection.6
Step 1: Test serum in an immunoassay measuring combined IgG and IgM antibodies to specific borrelial proteins
Step 2: Verify the results using a separate IgG and IgM immunoassay in place of a Western blot (immunoblot)
Test: Lyme Disease Antibody with Reflex to Immunoassay (IgG, IgM)a (TC: 39733)
Includes: If Lyme Disease Antibody is Positive or Equivocal (≥0.91), then Lyme Disease Supplemental Antibodies (IgG, IgM), Immunoassay will be performed at an additional charge (CPT code(s): 86617 (x2))
a Components of panels may be ordered separately.
It’s easy to get started with Quest
Featured resources
As an industry leader in tick-borne testing, Quest Diagnostics provides a diverse selection of information and resources to help you make more informed decisions for your patients.
Insights you can count on
Quest offers you and your patients the tests, tools, and expertise you need to make more informed healthcare decisions:
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Innovative testing options, ranging from routine to highly specialized tests |
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Seamless EHR/IT integration with over 600 EHR systems |
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Dedicated, national subject-matter experts are available for consultation and results interpretation |
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Tools and services to optimize patient care |
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One-stop convenience: ordering tests and supplies, scheduling specimen pickup, and obtaining test results with Quanum® Lab Services Manager |
We make testing simple for your patients
Quest Diagnostics is here for your patients with access to testing, tools, and services that encourage engagement and promote compliance:
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Broad, in-network access with most major health plans |
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Low out-of-pocket costs |
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Payment Assistance Program for patients who are underinsured or uninsured |
References:
- Johnson L, Wilcox S, Mankoff J, et al. Severity of chronic Lyme disease compared to other chronic conditions: a quality of life survey. PeerJ. 2014;2:e322. doi: 10.7717/peerj.322
- CDC. Tickborne disease surveillance data summary. Reviewed August 11, 2022. Accessed February 24, 2023. https://www.cdc.gov/ticks/data-summary/index.html
- CDC. Overview of tickborne diseases. Reviewed August 5, 2022. Accessed February 24, 2023. https://www.cdc.gov/ticks/tickbornediseases/overview.html
- Kugeler KJ, Farley GM, Forrester JD, et al. Geographic distribution and expansion of human Lyme disease, United States. Emerg Infect Dis. 2015;21(8):1455-1457. doi:10.3201/eid2108.141878
- APHL. Suggested reporting language, interpretation and guidance regarding Lyme disease serologic test results. May 2021. Accessed February 3, 2023. https://www.aphl.org/aboutAPHL/publications/Documents/ID-2021-Lyme-Disease-Serologic-Testing-Reporting.pdf
- Mead P, Petersen J, Hinckley A. Updated CDC recommendation for serologic diagnosis of Lyme disease. MMWR Morb Mortal Wkly Rep. 2019;68(32):703. doi:10.15585/mmwr.mm6832a4
- CDC. Public Health Grand Rounds: Emerging tickborne diseases. Reviewed September 2019. Accessed March 3, 2023. https://www.cdc.gov/grand-rounds/pp/2017/20170321-tickborne-diseases.html
The CPT® codes provided are based on American Medical Association 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.
Test codes may vary by location. Please contact your local laboratory for more information.
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