CPT® Code 86805

Official Description

Lymphocytotoxicity assay, visual crossmatch; with titration

Common Language Description

The CPT® Code 86805 refers to a laboratory test known as the lymphocytotoxicity assay with visual crossmatch, which includes a titration process. This assay is crucial for assessing the compatibility between recipient and donor blood, particularly in the context of organ and tissue transplantation. The primary purpose of this test is to identify transplant patients who may be at risk for antibody-mediated damage to grafts, which can lead to rejection of the transplanted organ or tissue. It is particularly relevant for solid organ transplants, such as kidney, heart, and lung transplants, as well as for patients being evaluated for refractory platelet and/or bone marrow transplants who may have human leukocyte antigen (HLA) antibodies. Human leukocyte antigens are glycoproteins found on the surface of cells that play a significant role in the immune system's ability to recognize self from non-self. The presence of specific HLAs can pose a challenge to successful transplantation, as they may trigger an immune response against the transplanted material. The lymphocytotoxicity assay employs a complement-dependent method to detect immunoglobulin G (IgG) antibodies against Class I HLA (-A, -B, -C) found on nucleated cells, as well as Class II HLA (-DR, -DQ, -DP) expressed on various immune cells, including B-cells, monocytes, macrophages, dendritic cells, and activated T-cells. A positive crossmatch result indicates that the recipient has antibodies that may react against the donor's HLA, thereby increasing the risk of graft rejection. The titration aspect of the test involves systematically adding a known volume of a titrant solution to a specific quantity of the analyte solution, which helps in determining the concentration of antibodies present in the recipient's blood, further informing the transplant decision-making process.

1. Indications

The lymphocytotoxicity assay with visual crossmatch (CPT® Code 86805) is indicated for the following conditions:

Transplant Evaluation This test is performed to assess compatibility between the recipient and donor blood in patients undergoing solid organ transplants, such as kidney, heart, and lung transplants.
Refractory Platelet and Bone Marrow Transplant It is utilized for patients being considered for refractory platelet and/or bone marrow transplants who may have human leukocyte antigen (HLA) antibodies.

2. Procedure

The procedure for conducting the lymphocytotoxicity assay with visual crossmatch involves several key steps:

Sample Collection Blood samples are collected from both the recipient and the potential donor. These samples are essential for testing the compatibility of their immune systems.
Preparation of Cells The collected blood samples are processed to isolate the lymphocytes from both the recipient and donor. This step is crucial as it allows for the examination of the immune response between the two samples.
Complement-Dependent Cytotoxicity Assay The isolated lymphocytes are then exposed to a complement system along with the serum from the recipient. This step is designed to identify any IgG antibodies present in the recipient's serum that may react with the donor's HLA antigens.
Visual Crossmatch After the incubation period, the cells are examined visually to determine if there is any cytotoxic reaction. A positive reaction indicates that the recipient has antibodies against the donor's HLA, suggesting a risk for transplant rejection.
Titration Process If a titration process is indicated, a known volume of a titrant solution is added to a specific quantity of the analyte solution (recipient serum) to facilitate a reaction. This step helps in quantifying the concentration of antibodies present, providing further insight into the compatibility of the transplant.

3. Post-Procedure

After the lymphocytotoxicity assay with visual crossmatch is completed, the results are analyzed and interpreted by the laboratory personnel. A positive crossmatch result indicates a heightened risk for graft rejection, which may necessitate further evaluation or alternative transplant options. The healthcare provider will discuss the findings with the patient and may recommend additional testing or monitoring based on the results. It is essential for the patient to understand the implications of the test results on their transplant eligibility and the potential need for immunosuppressive therapy if a transplant proceeds.

Short Descr	LYMPHOCYTOTOXICITY ASSAY
Medium Descr	LYMPHOCYTOTOXICITY ASSAY VIS CROSSMATCH TITRATJ
Long Descr	Lymphocytotoxicity assay, visual crossmatch; with titration
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)	T1H - Lab tests - other (non-Medicare fee schedule)
MUE	2
CCS Clinical Classification	235 - Other Laboratory

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.