CPT® Code 86362

Official Description

Myelin oligodendrocyte glycoprotein (MOG-IgG1) antibody; cell-based immunofluorescence assay (CBA), each

Common Language Description

The CPT® Code 86362 refers to the testing for Myelin oligodendrocyte glycoprotein (MOG-IgG1) antibody using a cell-based immunofluorescence assay (CBA). This antibody is specifically associated with myelin oligodendrocyte glycoprotein antibody disease (MOGAD), which is classified as an idiopathic inflammatory demyelinating disease affecting the central nervous system (CNS). MOGAD is characterized by the presence of antibodies that target oligodendrocytes, the cells responsible for the formation of myelin in the CNS. The significance of this test lies in its ability to assist healthcare providers in diagnosing MOGAD and distinguishing it from other similar conditions such as multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD). The MOG-IgG1 antibody is particularly notable because it can be present in a subset of NMOSD patients who do not have the AQP4 antibody, which is typically used to identify this disorder. The clinical presentations of MOGAD can overlap with those of NMOSD and MS, including symptoms such as optic neuritis and transverse myelitis. However, MOGAD is associated with distinct features, a different treatment response, and a generally better prognosis compared to these other demyelinating diseases. To perform the test, a venous blood sample is collected from the patient, and the serum is subjected to a cell-based indirect immunofluorescence assay (CBA). This method utilizes human embryonic kidney (HEK) cells that have been genetically modified to express green fluorescent protein (GFP)-tagged MOG-IgG1 as the antigen substrate. The patient’s serum is incubated with these modified cells, followed by the addition of a secondary anti-human IgG antibody that is conjugated with fluorescein isothiocyanate. After the labeling process, the cells undergo washing and are examined under a fluorescent microscope. The presence of MOG-IgG1 is determined by scoring the fluorescent signal, which provides a qualitative result. Additionally, titration studies may be conducted to ascertain the dilution factor at which the specific fluorescence can be identified, yielding a semi-quantitative result. This test can be performed alongside other separately reportable tests, particularly those for AQP4 antibodies, to further support the diagnostic process.

1. Indications

The MOG-IgG1 antibody test is indicated for the evaluation of patients suspected of having myelin oligodendrocyte glycoprotein antibody disease (MOGAD) or other related demyelinating disorders. The following conditions and symptoms may warrant the use of this test:

Suspected MOGAD: Patients presenting with clinical features suggestive of MOGAD, such as optic neuritis or transverse myelitis, may require this test for diagnosis.
Differentiation from MS: The test is useful in distinguishing MOGAD from multiple sclerosis (MS), particularly in cases where the clinical presentation overlaps.
Assessment of NMOSD: It aids in differentiating MOGAD from neuromyelitis optica spectrum disorder (NMOSD), especially in patients who are seronegative for the AQP4 antibody.

2. Procedure

The procedure for testing MOG-IgG1 antibody using a cell-based immunofluorescence assay (CBA) involves several detailed steps:

Step 1: Sample Collection A venous blood sample is collected from the patient. This sample is essential for obtaining serum, which will be tested for the presence of MOG-IgG1 antibodies.
Step 2: Serum Preparation The collected blood sample is processed to separate the serum, which contains the antibodies that will be analyzed in the subsequent steps.
Step 3: Cell Preparation Human embryonic kidney (HEK) cells are transfected with green fluorescent protein (GFP)-tagged MOG-IgG1 to create the antigen substrate necessary for the assay.
Step 4: Incubation The prepared serum is incubated with the transfected HEK cells. This allows any MOG-IgG1 antibodies present in the serum to bind to the antigen on the cells.
Step 5: Antibody Labeling After incubation, a secondary anti-human IgG antibody conjugated with fluorescein isothiocyanate is added to the mixture. This step labels any bound antibodies, facilitating detection.
Step 6: Washing The cells are washed to remove any unbound antibodies, ensuring that only specifically bound antibodies remain for observation.
Step 7: Microscopic Examination The cells are then examined under a fluorescent microscope. The presence of MOG-IgG1 antibodies is determined by scoring the fluorescent signal emitted from the labeled cells.
Step 8: Result Interpretation A qualitative result is obtained based on the fluorescent signal. Further titration studies may be performed to determine the dilution factor at which the specific fluorescence is identifiable, yielding a semi-quantitative result.

3. Post-Procedure

After the completion of the MOG-IgG1 antibody test, the patient may not require any specific post-procedure care, as the test involves a standard blood draw. However, it is important for healthcare providers to communicate the results to the patient and discuss any further diagnostic steps or treatment options based on the findings. If the test is performed alongside other tests, such as AQP4 antibody testing, the results should be interpreted in conjunction with those findings to provide a comprehensive assessment of the patient's condition. Follow-up appointments may be necessary to monitor the patient's clinical status and response to any initiated treatment plans.

Short Descr	MOG-IGG1 ANTB CBA EACH
Medium Descr	MOG-IGG1 ANTIBODY CELL-BASED IMFLUOR ASSAY EACH
Long Descr	Myelin oligodendrocyte glycoprotein (MOG-IgG1) antibody; cell-based immunofluorescence assay (CBA), each
Status Code	Statutory Exclusion (from MPFS, may be paid under other methodologies)
Global Days	XXX - Global Concept Does Not Apply
PC/TC Indicator (26, TC)	9 - Not Applicable
Multiple Procedures (51)	9 - Concept does not apply.
Bilateral Surgery (50)	9 - Concept does not apply.
Physician Supervisions	09 - Concept does not apply.
Assistant Surgeon (80, 82)	9 - Concept does not apply.
Co-Surgeons (62)	9 - Concept does not apply.
Team Surgery (66)	9 - Concept does not apply.
Diagnostic Imaging Family	99 - Concept Does Not Apply
CLIA Waived (QW)	No
APC Status Indicator	Conditionally packaged laboratory tests
Type of Service (TOS)	5 - Diagnostic Laboratory
Berenson-Eggers TOS (BETOS)	none
MUE	1

90	Reference (outside) laboratory: when laboratory procedures are performed by a party other than the treating or reporting physician or other qualified health care professional, the procedure may be identified by adding modifier 90 to the usual procedure number.
59	Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25.
91	Repeat clinical diagnostic laboratory test: in the course of treatment of the patient, it may be necessary to repeat the same laboratory test on the same day to obtain subsequent (multiple) test results. under these circumstances, the laboratory test performed can be identified by its usual procedure number and the addition of modifier 91. note: this modifier may not be used when tests are rerun to confirm initial results; due to testing problems with specimens or equipment; or for any other reason when a normal, one-time, reportable result is all that is required. this modifier may not be used when other code(s) describe a series of test results (eg, glucose tolerance tests, evocative/suppression testing). this modifier may only be used for laboratory test(s) performed more than once on the same day on the same patient.
GW	Service not related to the hospice patient's terminal condition