Inpatient Facility Coding & Compliance Alert

Question: How should we code if we perform HLA typing for multiple A and B antigens for a bone marrow transplant recipient and three possible donors from immediate family? We might also test for DR antigens. Is there ever a scenario where we would bill one of the single antigen codes?

Kansas Subscriber

Answer: Regarding donor testing for bone marrow transplant suitability, you should list four units of 86813 (HLA typing; A, B, or C, multiple antigens) if you perform HLA typing for multiple A and B antigens for the recipient and three potential donors. If you also perform HLA typing for multiple DR antigens for each of the same four individuals, you should also list four units of 86817 (HLA typing; DR/DQ, multiple antigens).

Notice: Codes 86813 and 83817 each have a Medically Unlikely Edit (MUE) limitation of one. You will need to follow payer instruction about how to bill the tests for four individuals together on the same day. Remember, you’ll need to follow payer rules for bone marrow transplant coverage, which typically involves payment via a facility revenue class.

Your final question was whether there is ever a situation in which you would bill a single antigen. The answer is yes, but not typically in the context of compatibility testing for bone marrow transplant. For instance, you would use 86812 (HLA typing; A, B, or C [e.g., A10, B7, B27], single antigen) if you’re testing for B27 to aid in the diagnosis of ankylosing spondylitis; or you would use 86816 (HLA typing; DR/DQ, single antigen) if you’re testing for DQ6 to aid in the diagnosis of narcolepsy. You would not expect a physician to request either of these single antigen tests as part of a bone marrow transplant compatibility test.