How To Use CPT Code 86821

CPT 86821 describes the process of HLA typing through lymphocyte culture, specifically mixed lymphocyte culture (MLC). This article will provide an overview of CPT code 86821, including its official description, the procedure involved, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes, and examples.

1. What is CPT Code 86821?

CPT 86821 is used to describe the laboratory procedure of HLA typing, specifically through lymphocyte culture known as mixed lymphocyte culture (MLC). This test involves culturing lymphocytes from both the transplant recipient and potential donor together and observing for a response that indicates an HLA incompatibility.

2. Official Description

The official description of CPT code 86821 is: ‘HLA typing; lymphocyte culture, mixed (MLC).’ This code specifically refers to the process of culturing lymphocytes from both the transplant recipient and potential donor together to determine HLA compatibility.

3. Procedure

1. The laboratory analyst collects lymphocytes from both the transplant recipient and potential donor.
2. The collected lymphocytes are cultured together for several days.
3. Radiolabeled thymidine, a DNA precursor, is added to the culture.
4. The culture is evaluated for thymidine uptake, which indicates the growth pattern and compatibility between the donor and recipient.
5. Active thymidine uptake suggests an incompatible donor and recipient, while slow thymidine uptake suggests compatibility.

4. Qualifying circumstances

CPT 86821 is typically ordered by clinicians to determine the compatibility between a prospective donor and recipient for tissue transplants. It is not commonly ordered for routine HLA typing due to its older, more complicated, and time-consuming nature. The test helps assess the similarity or dissimilarity of HLA between the donor and recipient cells.

5. When to use CPT code 86821

CPT code 86821 should be used when performing HLA typing through lymphocyte culture, specifically mixed lymphocyte culture (MLC). It is important to note that this code is specifically for serologic methods and should not be used for tissue typing performed by molecular methods, which have their own corresponding codes.

6. Documentation requirements

To support a claim for CPT code 86821, the documentation should include:

• Indication of the need for HLA typing
• Details of the lymphocyte culture process, including the use of mixed lymphocyte culture (MLC)
• Date and duration of the culture
• Results of the thymidine uptake evaluation
• Signature of the laboratory analyst performing the test

7. Billing guidelines

When billing for CPT code 86821, it is important to ensure that the test is performed using serologic methods and not molecular methods. Additionally, it is advisable to check with individual payers regarding any specific requirements or guidelines for reporting this code. It is also worth noting that some payers may separately reimburse for the collection of the specimen using a code such as 36415.

8. Historical information

CPT code 86821 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates or changes to the code since its addition.

9. Examples

1. A clinician orders HLA typing through mixed lymphocyte culture (MLC) to determine the compatibility between a kidney transplant recipient and a potential donor.
2. A laboratory analyst performs HLA typing using lymphocyte culture for a patient awaiting a bone marrow transplant.
3. HLA typing through mixed lymphocyte culture (MLC) is conducted to assess the compatibility between a heart transplant recipient and a potential donor.
4. A clinician requests HLA typing through lymphocyte culture for a patient in need of a liver transplant.
5. A laboratory performs HLA typing using mixed lymphocyte culture (MLC) to determine the compatibility between a lung transplant recipient and a potential donor.
6. HLA typing through lymphocyte culture is conducted to assess the compatibility between a cornea transplant recipient and a potential donor.
7. A clinician orders HLA typing through mixed lymphocyte culture (MLC) for a patient in need of a pancreas transplant.
8. A laboratory analyst performs HLA typing using lymphocyte culture to determine the compatibility between a small intestine transplant recipient and a potential donor.
9. HLA typing through mixed lymphocyte culture (MLC) is conducted to assess the compatibility between a skin graft recipient and a potential donor.
10. A clinician requests HLA typing through lymphocyte culture for a patient in need of a heart-lung transplant.