How To Use CPT Code 86828

CPT 86828 describes the process of assessing the presence or absence of antibodies to human leukocyte antigens (HLA) Class I and Class II antigens using a solid phase immunoassay. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 86828?

CPT 86828 can be used to determine the presence or absence of antibodies to HLA Class I and Class II antigens in patient serum. This code is used when a solid phase immunoassay is performed by a lab analyst to assess the reaction between patient serum and antigen-coated beads or test wells. The presence of a marker, such as a fluorescent immunoglobulin, indicates an antibody/antigen reaction, which is reported as a qualitative result.

2. Official Description

The official description of CPT code 86828 is: ‘Antibody to human leukocyte antigens (HLA), solid phase assays (eg, microspheres or beads, ELISA, flow cytometry); qualitative assessment of the presence or absence of antibody(ies) to HLA Class I and Class II HLA antigens.’

3. Procedure

1. The lab analyst mixes patient serum with antigen-coated beads or test wells containing HLA Class I and Class II antigens.
2. A marker, such as a fluorescent immunoglobulin, is added to the mixture.
3. If there is an antibody/antigen reaction, the marker becomes visible.
4. The lab analyst evaluates the reaction using a special instrument and process, such as flow cytometry or enzyme-linked immunosorbent assay (ELISA).
5. A qualitative result is reported indicating the presence or absence of antibodies to HLA Class I and Class II antigens.

4. Qualifying circumstances

CPT 86828 is typically ordered by clinicians to further identify compatibility between a potential organ or bone marrow transplant donor and recipient. This test helps screen recipient blood for antibodies to donor HLA antigens that may cause transplant rejection despite a good tissue type match. The presence of antibodies to HLA Class I or Class II antigens indicates sensitization to those specific antigens.

5. When to use CPT code 86828

CPT code 86828 should be used when there is a need to assess the presence or absence of antibodies to HLA Class I and Class II antigens in patient serum. This code is specifically for the qualitative assessment using a solid phase immunoassay. It is important to note that this code should not be reported in addition to flow cytometry method codes (88184-88189).

6. Documentation requirements

To support a claim for CPT 86828, the following documentation is required:

• Patient’s clinical indication for the test
• Details of the solid phase immunoassay method used
• Date of the test
• Qualitative result indicating the presence or absence of antibodies to HLA Class I and Class II antigens

7. Billing guidelines

When billing for CPT 86828, ensure that the test is performed using a solid phase immunoassay method and that the qualitative result is reported. Do not report flow cytometry method codes (88184-88189) in addition to CPT 86828. It is also important to note that some payers may separately reimburse for specimen collection using a code such as 36415 for venipuncture.

8. Historical information

CPT 86828 was added to the Current Procedural Terminology system on January 1, 2013. There have been no updates to the code since its addition.

9. Examples

1. A lab analyst performs a solid phase immunoassay using patient serum to assess the presence or absence of antibodies to HLA Class I and Class II antigens.
2. A clinician orders CPT 86828 to screen recipient blood for antibodies to donor HLA antigens before a potential organ transplant.
3. A patient’s serum shows an antibody/antigen reaction for HLA Class II antigens, indicating sensitization to those specific antigens.
4. A lab analyst uses a solid phase immunoassay method involving antigen-coated beads to evaluate the presence or absence of antibodies to HLA Class I and Class II antigens.
5. A qualitative result is reported, indicating the absence of antibodies to HLA Class I and Class II antigens in patient serum.
6. A clinician orders CPT 86828 to assess the compatibility between a potential bone marrow transplant donor and recipient.
7. A lab analyst performs a solid phase immunoassay using test wells covered with HLA Class I and Class II antigens to determine the presence or absence of antibodies in patient serum.
8. A qualitative result shows the presence of antibodies to HLA Class I antigens, indicating sensitization to those specific antigens.
9. A clinician orders CPT 86828 to screen recipient blood for antibodies to donor HLA antigens before a potential bone marrow transplant.
10. A lab analyst evaluates the antibody/antigen reaction using flow cytometry and reports a qualitative result indicating the presence of antibodies to HLA Class II antigens.