CPT® Code 86808

Official Description

Serum screening for cytotoxic percent reactive antibody (PRA); quick method

Common Language Description

The CPT® Code 86808 refers to a laboratory test specifically designed for serum screening of cytotoxic percent reactive antibody (PRA) using a quick method. This test is crucial in the context of organ transplantation, as it assesses the presence of human leukocyte antigen (HLA) antibodies in the serum of the organ recipient. The detection of these antibodies is vital because they can trigger an immune response that may lead to hyperacute rejection of the transplanted organ. Human leukocyte antigens are glycoproteins located on the surface of cell membranes, and they play a significant role in the body's immune response. There are two main classes of HLA antigens: Class I antigens, which primarily activate killer T-cells, and Class II antigens, which activate helper T-4 cells, macrophages, and B-cells. The screening process involves mixing the recipient's serum with leukocytes from a donor pool and employing various testing methods, such as flow cytometry, enzyme-linked immunosorbent assay (ELISA), complement-dependent cytotoxicity, or anti-human globulin augmentation. The outcome of this test is expressed as a percentage of reactions observed within the sample panel; a higher percentage indicates an increased risk of organ rejection for the patient. It is important to note that when a quick method is utilized for this screening, the CPT® Code 86806 should be used instead.

1. Indications

The serum screening for cytotoxic percent reactive antibody (PRA) using CPT® Code 86808 is indicated for the following conditions:

Organ Transplant Evaluation This test is performed prior to organ transplantation to assess the risk of hyperacute rejection by identifying the presence of HLA antibodies in the recipient's serum.
Assessment of Immune Response The test helps evaluate the immune response of the recipient, which is critical for determining compatibility with potential organ donors.

2. Procedure

The procedure for conducting the serum screening for cytotoxic PRA involves several key steps:

Sample Collection A blood sample is drawn from the organ recipient to obtain serum, which will be used for the screening test.
Preparation of Donor Pool A pool of donor leukocytes is prepared, which will be mixed with the recipient's serum to assess the potential immune response.
Mixing Serum with Donor Leukocytes The recipient's serum is combined with the pooled leukocytes from donors. This mixture is crucial for determining the presence of HLA antibodies that may react with the donor cells.
Testing Methodology The mixed sample is subjected to one of several testing methods, including flow cytometry, enzyme-linked immunosorbent assay (ELISA), complement-dependent cytotoxicity, or anti-human globulin augmentation. These methods help quantify the percentage of reactions between the recipient's serum and the donor leukocytes.
Result Interpretation The results are analyzed to determine the percentage of cytotoxic reactions. A higher percentage indicates a greater risk of organ rejection, guiding further clinical decisions regarding transplantation.

3. Post-Procedure

After the serum screening for cytotoxic PRA is completed, the results are reviewed by the healthcare provider to assess the recipient's risk for organ rejection. If a high percentage of cytotoxic reactions is detected, further evaluation and potential alternative donor options may be considered. The recipient may also be monitored for any signs of immune response or complications related to the transplant process. It is essential for the healthcare team to communicate the results effectively to the recipient and discuss the implications for their transplant journey.

Short Descr	CYTOTOXIC ANTIBODY SCREENING
Medium Descr	SERUM SCREENING % REACTIVE ANTIBODY QUICK METH
Long Descr	Serum screening for cytotoxic percent reactive antibody (PRA); quick method
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	1
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.