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Molecular genetic testing, specifically chimerism analysis, is a critical procedure performed to assess the extent of chimerism following hematopoietic stem cell transplantation. This analysis is essential for monitoring the success of the transplant and determining the proportion of donor versus recipient cells in the patient's body. The procedure involves the preparation of specific cell populations, namely CD3+ and CD33+ cells, which are isolated using monoclonal antibody-coupled magnetic beads. Once isolated, these cells are lysed to release their genetic material for further analysis. The engraftment testing is conducted through gene amplification techniques that target variable number tandem repeat (VNTR) or short tandem repeat (STR) loci, which are specific regions of DNA that can vary between individuals. The testing process is divided into three distinct parts: initially, a pre-transplant analysis is performed to establish a baseline by identifying the loci that will be used to differentiate between the recipient's and donor's alleles. Following this, a post-transplant sample is collected and separated into the CD3+ and CD33+ fractions. Finally, a post-transplant analysis is conducted to quantify the presence of recipient and donor DNA in various biological samples, such as blood, bone marrow, or other tissues. It is important to report CPT® Code 81268 for each cell type analyzed, ensuring accurate documentation and billing for the services rendered.
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The chimerism analysis is indicated for the following conditions:
The chimerism analysis procedure consists of several critical steps that ensure accurate results:
After the chimerism analysis is completed, the results are interpreted to provide insights into the engraftment status of the transplant. The findings can indicate whether the transplant was successful, the degree of donor cell engraftment, and any potential complications such as graft versus host disease. Follow-up care may involve additional monitoring and testing based on the results of the chimerism analysis. It is essential for healthcare providers to communicate the results to the patient and discuss any necessary next steps in their treatment plan.
| Short Descr | CHIMERISM ANAL W/CELL SELECT | Medium Descr | CHIMERISM W/COMP TO BASELINE W/CELL SELECTION EA | Long Descr | Chimerism (engraftment) analysis, post transplantation specimen (eg, hematopoietic stem cell), includes comparison to previously performed baseline analyses; with cell selection (eg, CD3, CD33), each cell type | 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 | Service Paid under Fee Schedule or Payment System other than OPPS | Type of Service (TOS) | 5 - Diagnostic Laboratory | Berenson-Eggers TOS (BETOS) | T1H - Lab tests - other (non-Medicare fee schedule) | MUE | 4 | CCS Clinical Classification | 234 - Pathology |
| 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. | 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. | 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. |
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| 2012-01-01 | Added | Added |
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