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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 while also defending against 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 for HLA antibodies is essential in various clinical scenarios, particularly in the context of organ transplantation. The presence and characteristics of HLA alloantibodies can significantly influence the risk of an immunological response to transplanted organs. CPT® Code 86832 specifically refers to the use of solid phase assays, such as microspheres or beads, enzyme-linked immunosorbent assay (ELISA), and flow cytometry, to conduct a high definition qualitative panel aimed at identifying antibody specificities related to HLA Class I antigens. This test utilizes advanced methodologies, including the individual antigen per bead approach, allowing for the identification of antibodies against a comprehensive panel of cloned Class I HLA antigens. The assay can detect specificities for as many as 80 HLA A/B/C antigens by employing up to 98 beads in the testing array. This detailed identification process is crucial for predicting potential immunological responses in patients undergoing organ transplantation.
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The antibody to human leukocyte antigens (HLA) testing is indicated in several clinical scenarios, particularly related to organ transplantation and immunological assessments. The following conditions and situations warrant the use of this test:
The procedure for conducting the HLA antibody test using CPT® Code 86832 involves several key steps, which are outlined below:
Post-procedure care for patients undergoing HLA antibody testing is generally minimal, as the test is non-invasive and involves only a blood draw. Patients may resume normal activities immediately following the sample collection. However, it is essential to monitor for any adverse reactions related to the blood draw, such as bruising or discomfort at the puncture site. The results of the test will typically be available within a specified timeframe, and healthcare providers will discuss the findings with the patient to determine any necessary follow-up actions or treatments based on the identified HLA antibody specificities.
| Short Descr | HLA CLASS I HIGH DEFIN QUAL | Medium Descr | ANTIBODY HLA CLASS I HIGH DEFINITION PANEL QUAL | Long Descr | Antibody to human leukocyte antigens (HLA), solid phase assays (eg, microspheres or beads, ELISA, Flow cytometry); high definition qualitative panel for identification of antibody specificities (eg, individual antigen per bead methodology), HLA Class I | 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. | 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. | 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. | 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. | CR | Catastrophe/disaster related | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | Q3 | Live kidney donor surgery and related services |
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