CPT® Code 86806

Official Description

Lymphocytotoxicity assay, visual crossmatch; without titration

Common Language Description

The CPT® Code 86806 refers to a laboratory test known as the lymphocytotoxicity assay with a visual crossmatch, performed without titration. This assay is crucial in the field of transplantation medicine, as it evaluates the compatibility between a recipient's and a donor's blood. Specifically, it measures the lymphocytotoxicity, which is the ability of the recipient's immune cells to react against the donor's cells, thereby identifying patients who may be at risk for antibody-mediated damage to organ or tissue grafts. The test is particularly relevant for individuals undergoing solid organ transplants, such as kidney, heart, and lung transplants, as well as for patients being considered for refractory platelet and/or bone marrow transplants who may possess human leukocyte antigen (HLA) antibodies. HLAs are essential glycoproteins found on cell membranes that play a significant role in the immune response. The presence of specific HLAs can hinder the success of organ and tissue transplants, 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 targeting 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 result from this crossmatch indicates an increased risk of graft rejection, highlighting the importance of this test in pre-transplant evaluations. For cases where a titration process is necessary, the CPT® Code 86805 should be utilized, which involves adding a known volume of a titrant to a specific quantity of the analyte solution to determine the concentration of antibodies present.

1. Indications

The lymphocytotoxicity assay with visual crossmatch (CPT® Code 86806) is indicated for the following conditions:

Solid Organ Transplants This test is performed on patients who are candidates for solid organ transplants, including kidney, heart, and lung transplants, to assess compatibility between the donor and recipient blood.
Refractory Platelet Transplants It is also indicated for patients being considered for refractory platelet transplants, where the risk of antibody-mediated rejection is a concern.
Bone Marrow Transplants The assay is relevant for individuals undergoing bone marrow transplants who may have human leukocyte antigen (HLA) antibodies that could complicate the transplant process.

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, which are the white blood cells that will be tested for their reaction to the donor's cells.
Mixing of Samples The recipient's lymphocytes are mixed with the donor's cells in a controlled laboratory environment. This step is crucial as it allows for the observation of any immune response that may occur.
Complement Activation A complement-dependent method is employed, where complement proteins are added to the mixture. If the recipient's lymphocytes recognize the donor's cells as foreign, they will activate the complement system, leading to cell lysis.
Visual Assessment After the reaction, the samples are visually assessed for signs of cytotoxicity. A positive reaction indicates the presence of IgG antibodies against the donor's HLA, suggesting a higher risk of graft rejection.

3. Post-Procedure

Following the lymphocytotoxicity assay, the results are analyzed and interpreted by laboratory professionals. A positive crossmatch result indicates that the recipient has antibodies against the donor's HLA, which may necessitate further evaluation or alternative donor options to minimize the risk of transplant rejection. Patients may be monitored for any potential complications or follow-up testing as deemed necessary by their healthcare provider. It is essential for the healthcare team to discuss the implications of the test results with the patient, including the potential need for additional immunosuppressive therapy or alternative transplant strategies.

Short Descr	LYMPHOCYTOTOXICITY ASSAY
Medium Descr	LMPHOCYTOTOXICITY ASSAY VIS CROSSMTCH W/O TITRAT
Long Descr	Lymphocytotoxicity assay, visual crossmatch; without 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.