Oncology & Hematology Coding Alert

Only 86828 covers both HLA Class I and HLA Class II.

If your oncologist or hematologist treats patients with thrombocytopenia, reviewing CPT^® updates may help ensure his test orders line up with 2013 lab codes.

New codes 86828-86835 all begin with the same language: Antibody to human leukocyte antigens (HLA), solid phase assays (e.g., microspheres or beads, ELISA, flow cytometry) …

The codes describe "testing used in the assessment of patients with platelet transfusion refractory thrombocytopenia and in solid organ transplant candidates that may have alloantibodies to HLA antigens," explained Mark S. Synovec, MD, of the College of American Pathologists and an AMA CPT^® Editorial Panel Member, in the CPT^® and RBRVS 2013 Annual Symposium presentation, "Pathology Changes."

Defining the HLA proteins a patient reacts to helps the physician predict or understand the outcome of a donor/patient combination.

Antibody presence: The first two codes represent looking for the presence or absence of antibodies. Code 86828 applies to assessment of antibodies to both Class I and Class II HLA antigens. In contrast, 86829 is the appropriate option for assessment of antibodies to either Class I or Class II HLA antigens:

86828, Antibody to human leukocyte antigens (HLA), solid phase assays (e.g., 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

86829, … qualitative assessment of the presence or absence of antibody(ies) to HLA Class I or Class II HLA antigens.

Remember when testing both classes, coding two units of 86829 would be inappropriate. Code 86828 is the code that most directly describes the testing related to both classes. Inappropriately reporting 86829 twice, instead of 86828, would result in overpayment and refund requests from the payer.

Antibody ID: The next two codes both describe antibody identification by qualitative panel, but 86830 is specific to HLA Class I while 86831 is specific to HLA Class II:

86830, … antibody identification by qualitative panel using complete HLA phenotypes, HLA Class I

86831, … antibody identification by qualitative panel using complete HLA phenotypes, HLA Class II.

Antibody specificity ID: If you do a quick comparison, you’ll see that the previous two codes are for "antibody identification by qualitative panel," and the next two codes are for identification of antibody specificities with high definition qualitative panel. Again, one code is specific to HLA Class I and the other to HLA Class II:

86832, … high definition qualitative panel for identification of antibody specificities (e.g., individual antigen per bead methodology), HLA Class I

86833, … high definition qualitative panel for identification of antibody specificities (e.g., individual antigen per bead methodology), HLA Class II.

Semi-quantitative: The final two codes specify "semi-quantitative panel," making them different from all the other codes, which refer to "qualitative." These two codes also differ based on Class I and Class II:

86834, … semi-quantitative panel (e.g., titer), HLA Class I

86835, … semi-quantitative panel (e.g., titer), HLA Class II.

Final tip: A lab may perform these tests with untreated serum and then again with serum treated to remove interfering substances, such as IgM antibodies. The lab may report a code from 86828-86833 "once for each panel with the untreated serum and once for each panel with the treated serum," state CPT^® guidelines.