CPT® Code 86885

Official Description

Antihuman globulin test (Coombs test); indirect, qualitative, each reagent red cell

Common Language Description

The CPT® Code 86885 refers to the Antihuman globulin test, commonly known as the Coombs test, specifically the indirect qualitative variant. This test is crucial for detecting clinically significant antibodies present in a patient's blood. In this context, the term "indirect" indicates that the test is performed on in vitro specimens, meaning that the blood sample is analyzed outside the body. The process involves incubating the specimen at a controlled temperature of 37 degrees Centigrade, which facilitates the reaction between antibodies in the serum and red blood cells. During the test, some red blood cells may become coated with complement proteins or IgG antibodies, which can prevent agglutination when the cells are centrifuged. To enable agglutination, an additional antibody that reacts with the IgG or complement is introduced. The indirect antihuman globulin test is particularly significant in transfusion medicine, as it helps identify the presence of clinically relevant antibodies that could lead to adverse reactions during blood transfusions. The qualitative nature of this test means it determines whether antibodies are present but does not quantify their levels. If antibodies are detected, further testing is necessary to identify the specific types of antibodies involved. The test is reported using the code 86885 for each reagent red cell tested. It is important to note that this code is distinct from 86886, which is used for antibody titers that measure the strength or potency of previously identified antibodies.

1. Indications

The indirect antihuman globulin (Coombs) test is performed for several specific indications, primarily related to the detection of clinically significant antibodies in the blood. These indications include:

Pre-Transfusion Testing: The test is commonly conducted prior to blood transfusions to ensure compatibility and to identify any antibodies that may react with transfused blood.
Hemolytic Disease of the Newborn: It is used to assess the risk of hemolytic disease in newborns, which can occur when maternal antibodies attack fetal red blood cells.
Autoimmune Hemolytic Anemia: The test helps in diagnosing autoimmune conditions where the body produces antibodies against its own red blood cells.
Monitoring Patients: It is also indicated for monitoring patients who have previously been identified with antibodies to ensure that no new antibodies have developed.

2. Procedure

The procedure for conducting the indirect antihuman globulin test involves several critical steps to ensure accurate results. The following steps outline the process:

Step 1: Specimen Collection: A blood sample is collected from the patient, typically using venipuncture, and is prepared for testing.
Step 2: Incubation: The collected specimen is incubated at 37 degrees Centigrade. This temperature is optimal for allowing antibodies present in the serum to react with the red blood cells in vitro.
Step 3: Washing Cells: After incubation, the red blood cells are washed to remove unbound antibodies and other serum components, ensuring that only the antibodies that are bound to the cells remain.
Step 4: Addition of Antiglobulin Reagent: An antiglobulin reagent is then added to the washed cells. This reagent is designed to detect any antibodies that may be coating the red blood cells.
Step 5: Centrifugation: The mixture is centrifuged to facilitate the agglutination process. If agglutination occurs, it indicates the presence of clinically significant antibodies.
Step 6: Reading the Test: Finally, the test results are read. The presence of agglutination confirms that antibodies are present, while the absence of agglutination indicates no clinically significant antibodies were detected.

3. Post-Procedure

After the indirect antihuman globulin test is completed, the results are analyzed and interpreted by qualified healthcare professionals. If antibodies are detected, further testing may be required to identify the specific antibodies present. This may involve additional tests, such as antibody identification panels or titer tests, to determine the strength and clinical significance of the antibodies. It is essential for healthcare providers to communicate the results to the patient and to consider any necessary follow-up actions, especially in the context of pre-transfusion testing or managing conditions like autoimmune hemolytic anemia. Proper documentation of the test results and any subsequent actions taken is also crucial for maintaining compliance and ensuring patient safety.

Short Descr	COOMBS TEST INDIRECT QUAL
Medium Descr	ANTIHUMAN GLOBULIN INDIR QUAL EA REAGENT CELL
Long Descr	Antihuman globulin test (Coombs test); indirect, qualitative, each reagent red cell
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	STV-Packaged Codes
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

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.
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.
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.
GA	Waiver of liability statement issued as required by payer policy, individual case
XU	Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service