CPT® Code 86834

Official Description

Antibody to human leukocyte antigens (HLA), solid phase assays (eg, microspheres or beads, ELISA, Flow cytometry); semi-quantitative panel (eg, titer), HLA Class I

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 semi-quantitative analysis of HLA, specifically through the use of titer, is essential for monitoring pre-transplant desensitization protocols for potential transplant recipients who have developed sensitization. This sensitization can occur when a patient has been exposed to foreign antigens, making it more challenging to find compatible organ donors. Additionally, HLA testing is crucial for monitoring the treatment of antibody-mediated rejection in patients who have already undergone transplantation. The testing is typically conducted using enzyme-linked immunosorbent assay (ELISA) techniques on fluorescent beads that are coated with HLA molecules. These beads can be detected using conventional flow cytometry or in conjunction with advanced Luminex instrumentation. For the specific procedure of conducting a semi-quantitative panel with titer for HLA Class I, the appropriate code to use is 86834, while code 86835 is designated for the semi-quantitative panel with titer for HLA Class II.

1. Indications

The semi-quantitative panel for HLA Class I testing is indicated for several specific clinical scenarios, particularly in the context of transplantation. The following conditions warrant the use of this procedure:

Pre-Transplant Sensitization Monitoring This test is performed to assess potential transplant recipients who have developed sensitization, which can complicate the matching process for organ donation.
Antibody-Mediated Rejection Monitoring The procedure is also utilized to monitor patients who have undergone transplantation and are experiencing antibody-mediated rejection, allowing for timely intervention and management of the condition.

2. Procedure

The procedure for conducting a semi-quantitative panel for HLA Class I involves several key steps that ensure accurate testing and results. The following outlines the procedural steps:

Sample Collection Blood samples are collected from the patient, which will be used for the analysis of HLA antibodies. Proper collection techniques must be followed to ensure sample integrity.
Preparation of Beads Fluorescent beads coated with specific HLA molecules are prepared. These beads are essential for the detection of antibodies present in the patient's serum.
Assay Execution The enzyme-linked immunosorbent assay (ELISA) is performed using the prepared beads. The patient's serum is incubated with the beads, allowing any HLA antibodies present to bind to the corresponding antigens on the beads.
Detection After incubation, flow cytometry is employed to detect the bound antibodies. This step involves analyzing the fluorescence emitted by the beads, which indicates the presence and quantity of HLA antibodies.
Data Analysis The results are interpreted semi-quantitatively, providing a titer that reflects the level of HLA antibodies in the patient's serum. This information is crucial for assessing the patient's sensitization status and guiding further clinical decisions.

3. Post-Procedure

Post-procedure care involves monitoring the patient for any immediate reactions to the blood draw, although significant complications are rare. The results of the HLA testing will be analyzed and reported to the healthcare provider, who will use this information to make informed decisions regarding transplant eligibility and management of sensitization or rejection. Follow-up appointments may be scheduled to discuss the results and any necessary next steps in the patient's care plan.

Short Descr	HLA CLASS I SEMIQUANT PANEL
Medium Descr	ANTIBODY HLA CLASS I SEMIQUANTITATIVE PANEL
Long Descr	Antibody to human leukocyte antigens (HLA), solid phase assays (eg, microspheres or beads, ELISA, Flow cytometry); semi-quantitative panel (eg, titer), 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	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.
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.