CPT® Code 86831

Official Description

Antibody to human leukocyte antigens (HLA), solid phase assays (eg, microspheres or beads, ELISA, Flow cytometry); antibody identification by qualitative panel using complete HLA phenotypes, HLA Class II

Common Language Description

The human leukocyte antigen (HLA) system is a critical component of the major histocompatibility complex (MHC), which plays a vital role in the immune system by facilitating self-recognition. This means that the MHC helps the body identify its own cells and tissues, distinguishing them from foreign substances, such as microorganisms and non-self cells. The HLA system is divided into two main classes: Class I and Class II. The testing associated with CPT® Code 86831 specifically focuses on HLA Class II phenotypes. These tests are essential for identifying the presence and characteristics of HLA alloantibodies, which are antibodies that the immune system produces against HLA antigens from another individual, often in the context of organ transplantation. By utilizing complete HLA phenotypes, the tests can predict the risk of an immunological response to organ transplants. The methodology for these tests typically involves solid phase assays, such as enzyme-linked immunosorbent assay (ELISA), which utilize fluorescent beads coated with HLA molecules. These beads can be analyzed using flow cytometry or Luminex instrumentation to detect the presence of antibodies. CPT® Code 86831 is specifically used when a complete panel of Class II HLA phenotypes is employed to identify antibodies against approximately 40 antigens using a bead array of 30 or more beads.

1. Indications

The testing associated with CPT® Code 86831 is indicated for several specific clinical scenarios, particularly in the context of organ transplantation and immunological assessments. The following conditions and situations warrant the use of this procedure:

Organ Transplantation: To assess the presence of HLA alloantibodies that may lead to an immunological response against transplanted organs.
Transfusion Reactions: To evaluate potential HLA incompatibilities that could result in adverse reactions during blood transfusions.
Autoimmune Disorders: To investigate the role of HLA antibodies in various autoimmune conditions, aiding in diagnosis and management.
Bone Marrow Transplantation: To determine compatibility between donors and recipients, minimizing the risk of graft-versus-host disease.

2. Procedure

The procedure for CPT® Code 86831 involves several detailed steps to ensure accurate identification of HLA Class II antibodies. The following outlines the procedural steps:

Sample Collection: A blood sample is collected from the patient, which will be used for the analysis of HLA antibodies.
Preparation of Beads: The laboratory prepares a solid phase assay using beads that are coated with specific HLA Class II antigens. These beads are designed to capture any antibodies present in the patient's serum.
Incubation: The patient's serum is incubated with the prepared beads, allowing any HLA antibodies to bind to the antigens on the beads.
Washing Steps: After incubation, the beads undergo washing to remove unbound antibodies, ensuring that only those antibodies that have specifically bound to the HLA antigens remain attached.
Detection: The bound antibodies are then detected using enzyme-linked immunosorbent assay (ELISA) techniques, which may involve fluorescent detection methods. This step may also utilize flow cytometry or Luminex instrumentation to quantify the antibodies present.
Data Analysis: The results are analyzed to identify the specific HLA Class II antibodies present, providing critical information for clinical decision-making.

3. Post-Procedure

Post-procedure care for patients undergoing testing with CPT® Code 86831 typically involves monitoring for any immediate reactions to the blood draw, although significant complications are rare. The results of the HLA antibody testing are usually available within a few days, and healthcare providers will discuss the findings with the patient. These results are crucial for guiding further management, especially in the context of organ transplantation, where the presence of specific HLA antibodies can significantly impact the success of the transplant. Patients may be advised on the implications of their results, including potential follow-up testing or treatments based on the identified antibodies.

Short Descr	HLA CLASS II PHENOTYPE QUAL
Medium Descr	ANTIBODY HLA CLASS II PHENOTYPE PANEL QUAL
Long Descr	Antibody to human leukocyte antigens (HLA), solid phase assays (eg, microspheres or beads, ELISA, Flow cytometry); antibody identification by qualitative panel using complete HLA phenotypes, HLA Class II
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.