CPT® Code 86363

Official Description

Myelin oligodendrocyte glycoprotein (MOG-IgG1) antibody; flow cytometry (ie, fluorescence-activated cell sorting [FACS]), each

Common Language Description

The CPT® Code 86363 refers to the testing for Myelin oligodendrocyte glycoprotein (MOG-IgG1) antibodies using flow cytometry, specifically fluorescence-activated cell sorting (FACS). MOG-IgG1 antibodies are associated with a condition known as Myelin Oligodendrocyte Glycoprotein Antibody Disease (MOGAD), which is classified as an idiopathic inflammatory demyelinating disease affecting the central nervous system (CNS). This disease is characterized by the presence of antibodies that target the myelin oligodendrocyte glycoprotein, a protein found in the oligodendrocytes of the CNS. The presence of these antibodies can aid in the diagnosis of MOGAD and help differentiate it from other demyelinating diseases such as multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD). MOGAD can present with symptoms similar to those of MS and NMOSD, including optic neuritis and transverse myelitis, but it has distinct features, treatment responses, and generally a better prognosis. The testing process involves collecting a venous blood sample from the patient, which is then analyzed using flow cytometry techniques. FACS is a specialized method that allows for the sorting of individual cells based on their characteristics, particularly their fluorescence. In this procedure, human embryonic kidney (HEK) cells are genetically modified to express a green fluorescent protein (GFP) tagged version of MOG-IgG1. When the patient's serum is introduced, any MOG-IgG1 antibodies present will bind to these modified cells. A secondary anti-human antibody, which is conjugated with fluorescein isothiocyanate, is then added to facilitate the detection of the bound antibodies. As the cells pass through a laser beam, their fluorescence is measured, allowing for the identification and separation of cells that are positive for the MOG-IgG1 antibody. This process may also include further titration studies to determine the dilution factor at which the specific fluorescence remains detectable, providing a semi-quantitative result for the presence of the antibody.

1. Indications

The MOG-IgG1 antibody test is indicated for the following conditions:

Myelin Oligodendrocyte Glycoprotein Antibody Disease (MOGAD) - This test is utilized to help diagnose MOGAD, an idiopathic inflammatory demyelinating disease of the central nervous system.
Multiple Sclerosis (MS) - The test aids in differentiating MOGAD from multiple sclerosis, which can present with overlapping symptoms.
Neuromyelitis Optica Spectrum Disorder (NMOSD) - It is also used to distinguish MOGAD from NMOSD, particularly in patients who are seronegative for the AQP4 antibody.

2. Procedure

The procedure for testing MOG-IgG1 antibodies using flow cytometry involves several detailed steps:

Step 1: Sample Collection - A venous blood sample is collected from the patient. This sample serves as the source of serum for the subsequent testing process.
Step 2: Preparation of HEK Cells - Human embryonic kidney (HEK) cells are transfected with a green fluorescent protein (GFP)-tagged version of MOG-IgG1. This modification allows the cells to express the MOG-IgG1 protein, which is crucial for the detection of antibodies in the patient's serum.
Step 3: Mixing Serum with HEK Cells - The patient’s serum sample is added to the mixture of transfected and untransfected HEK cells. This step allows any MOG-IgG1 antibodies present in the serum to bind to the modified HEK cells.
Step 4: Addition of Secondary Antibody - A secondary anti-human antibody that is conjugated with fluorescein isothiocyanate is introduced. This antibody binds to the human antibodies that are attached to the HEK cells, facilitating their detection.
Step 5: Flow Cytometry Analysis - The mixture is then analyzed using flow cytometry, specifically fluorescence-activated cell sorting (FACS). As the cells pass through a laser beam, their fluorescence is measured. Cells that have bound the fluorescently tagged human antibody are given a positive charge, while those that do not are given a negative charge.
Step 6: Cell Sorting - Based on their charges, the cells are sorted, allowing for the identification of those that are positive for the MOG-IgG1 antibody.
Step 7: Titration Studies - Further titration studies may be conducted to determine the dilution factor at which the specific fluorescence remains detectable, yielding a semi-quantitative result for the presence of the MOG-IgG1 antibody.

3. Post-Procedure

After the procedure, the patient may not require any specific post-procedure care as the blood sample collection is minimally invasive. However, it is essential to monitor for any potential adverse reactions at the venipuncture site, such as bruising or discomfort. The results of the MOG-IgG1 antibody test will be analyzed and reported, providing critical information for the diagnosis and management of conditions such as MOGAD, MS, and NMOSD. Clinicians should interpret the results in conjunction with clinical findings and other diagnostic tests to ensure accurate diagnosis and appropriate treatment planning.

Short Descr	MOG-IGG1 ANTB FLO CYTMTRY EA
Medium Descr	MOG-IGG1 ANTIBODY FLOW CYTOMETRY EACH
Long Descr	Myelin oligodendrocyte glycoprotein (MOG-IgG1) antibody; flow cytometry (ie, fluorescence-activated cell sorting [FACS]), 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.
26	Professional component: certain procedures are a combination of a physician or other qualified health care professional component and a technical component. when the physician or other qualified health care professional component is reported separately, the service may be identified by adding modifier 26 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.
GA	Waiver of liability statement issued as required by payer policy, individual case