Candida Antigen?

JamieGalloway

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Help!

One of the clinics I'm coding for is injecting something called Candida Antigen- I can't find a drug code for this anywhere! Is this something I would use an unspecified code for?

Thanks!
 

kevbshields

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Your description of the service sounds like 86485--called DHT (Delayed Hypersensitivity Test), where the product is injected in the skin to test for allergy; but--I've never heard that referred to as "antigen."

Maybe run that by the clinical staff and see what kind of response you get. I'm a little lost as to what else they could be doing by inserting the product intradermally. Obviously, then, they aren't screening fluids/specimens for the Candida antigen . . .

Hope this helps some.

Good luck & let us know what you find out.
 

JamieGalloway

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Sorry...should have been a little more specific!

They're actually injecting a candida antigen into lesions like viral warts, etc.
This is the first I've seen this used in this way. I'm a remote coder, and I did e-mail the clinical staff about it-2 days ago!

Thanks for your help, and as soon as I find something, I'll certainly let you know :)

Jamie Galloway, CPC, CPC-E/M
 

kevbshields

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That's a new thing to me! I'm wondering if that's considered lesion destruction then. I was curious why you were referring to the drug code, but now I see.

Although I never encourage clinical staff to take the information verbatim, sometimes the manufacturer will have reimbursement (coding) information. As a coder, I want to screen that information before it goes out the door, but it will at least give me something to go on.

Good luck. Yeah, Derm's not one of my coding specialties, but I've been to enough of them over the years that I feel like it is. This is certainly something I'm fascinated to hear about.

Thanks,
 

jek521

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We have docs that inject candida into warts as a treatment. There isn't a J-code for it. When we looked at the actual cost of the substance used, it didn't support trying to bill for it under an unlisted code.

We just bill for CPT 11900/11901.
 

tedapplegate

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Candida as an antigen

In our dermatology clinic, we use Candida antigen for warts at times. The codes that usually are used: 11900 or 11901, and J7599. Some payers pay okay. United Healthcare is paying the injection code but not the Candida since that is not specific for Candida. So we're going to try to send records with a description of Candida and its use.

Ted
 

PEiden

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Candida Injection for wart treatment

Hi all...

Since Candida Antigen doesn't have a HCPCS code, there seems to be some confusion as to what unspecified code (J7599 vs J3490) to use especially for wart treatment. Since Candida's not an immunosuppressant agent but an immunostimulatory agent, the better code choice would be the J3490. It's use for warts is still not approved by the FDA and is questionable if covered by insurance.
As coders/billers, we need to clarify the unspecified drug on the CMS 1500 in item 19 by adding the drug name, NDC#, strenght, and dose.
Also note that 11900/11901, Injection, interlesional lesions up to 7 or over 7 lesions (not the amount of needle sticks per lesion).

Thanks
Peg Eiden, CPC, CPCD, CCS-P
Coding and Reimbursement Specialist
American Academy of Dermatology
 
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