CPT® Code 86833

Official Description

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 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's ability to recognize self from non-self. This system is essential for the identification of specific characteristics of an individual's cells and tissues, thereby enabling the body to defend against foreign substances, including microorganisms and non-self cells and tissues. The HLA system is divided into two main classes: Class I and Class II. The testing associated with CPT® Code 86833 focuses on the identification of HLA Class II alloantibodies, which are antibodies that can develop against HLA antigens following organ transplantation or blood transfusion. The procedure involves the use of high definition qualitative panels that utilize solid phase assays, such as microspheres or beads, enzyme-linked immunosorbent assay (ELISA), and flow cytometry. These methodologies allow for the precise detection and characterization of HLA alloantibodies, which is crucial for predicting the risk of immunological responses in transplant scenarios. Specifically, this test identifies antibody specificities to individual HLA antigens, including DRB1/3/4/5, DQA1, DQB1, DPA1, and DPB1, using an array of up to 98 beads, each coated with specific HLA molecules. This detailed identification process is essential for ensuring compatibility in organ transplantation and improving patient outcomes.

1. Indications

The procedure associated with CPT® Code 86833 is indicated for the following conditions:

Organ Transplantation: To assess the presence of HLA alloantibodies that may lead to an immunological response against transplanted organs.
Blood Transfusion: To identify potential HLA antibodies that could cause transfusion reactions in patients receiving blood products.
Autoimmune Disorders: To evaluate patients with autoimmune conditions where HLA antibodies may play a role in disease progression or treatment response.

2. Procedure

The procedure for CPT® Code 86833 involves several key steps to ensure accurate identification of HLA Class II antibody specificities:

Sample Collection: A blood sample is collected from the patient, which will be used for the assay. Proper collection techniques must be followed to avoid contamination and ensure sample integrity.
Preparation of Beads: Fluorescent beads are coated with specific HLA Class II antigens, including DRB1/3/4/5, DQA1, DQB1, DPA1, and DPB1. This step is crucial as it allows for the binding of any HLA 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 their corresponding antigens on the beads. This incubation period is essential for maximizing the interaction between antibodies and antigens.
Detection: After incubation, the beads are analyzed using flow cytometry or Luminex instrumentation. This technology enables the detection of bound antibodies by measuring the fluorescence emitted from the beads, which correlates with the presence and quantity of specific HLA antibodies.
Data Analysis: The results are interpreted to identify the specificities of any HLA antibodies present in the sample. This analysis is critical for determining the risk of immunological responses in transplant candidates or recipients.

3. Post-Procedure

Post-procedure care for patients undergoing testing with CPT® Code 86833 typically involves monitoring for any immediate reactions to the blood draw. Patients may be advised to hydrate adequately and can resume normal activities following the procedure. The results of the HLA antibody testing will be communicated to the healthcare provider, who will interpret the findings in the context of the patient's clinical situation, particularly regarding organ transplantation or transfusion compatibility. Follow-up consultations may be necessary to discuss the implications of the test results and any further actions required based on the findings.

Short Descr	HLA CLASS II HIGH DEFIN QUAL
Medium Descr	ANTIBODY HLA CLASS II 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 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	1
CCS Clinical Classification	235 - Other Laboratory

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.
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.
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.
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