How To Use CPT Code 86485

CPT 86485 describes the procedure for a skin test using candida antigen to evaluate a patient’s immunological response. This article will cover the official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 86485?

CPT 86485 can be used to describe the procedure for a skin test that evaluates a patient’s immunological response to a candida antigen injection. This code is used when a healthcare provider injects the candida antigen under the patient’s skin and evaluates the reaction at the injection site after 48 to 72 hours.

2. Official Description

The official description of CPT code 86485 is: ‘Skin test; candida.’

3. Procedure

1. The healthcare provider injects a candida antigen reagent under the patient’s skin, typically on the arm.
2. The provider evaluates the injection site 48 to 72 hours after the injection to assess the patient’s immunological response.
3. A normal induration response, indicated by the formation of a hard, raised bump of 5 mm or greater, suggests an appropriate delayed-type hypersensitivity reaction and an adequate cell-mediated immune response.
4. The candida antigen is used for this test because most patients have been exposed to the organism.

4. Qualifying circumstances

CPT 86485 is typically ordered to evaluate a patient’s cell-mediated immune response or to assess diminished cellular immunity in HIV patients. It may also aid in developing a prognosis for certain cancer patients. This test is not limited to a specific condition and can be performed by a healthcare provider.

5. When to use CPT code 86485

CPT code 86485 should be used when a healthcare provider performs a skin test using candida antigen to evaluate a patient’s immunological response. It is important to note that this code includes the candida antigen injection, so there is no need to separately report an administration code.

6. Documentation requirements

To support a claim for CPT 86485, the healthcare provider must document the following information:

• Reason for performing the skin test and the patient’s condition
• Date of the test and the injection site
• Details of the patient’s immunological response, including the size of the induration and any relevant observations
• Signature of the healthcare provider performing the test

7. Billing guidelines

When billing for CPT 86485, ensure that the healthcare provider performs the skin test using candida antigen and evaluates the patient’s immunological response. There is no need to report an administration code separately. It is important to follow any specific guidelines provided by the payer or coding guidelines.

8. Historical information

CPT 86485 was added to the Current Procedural Terminology system on January 1, 1993. There have been no updates to the code since its addition.

9. Examples

1. A healthcare provider performs a skin test using candida antigen to evaluate a patient’s immunological response.
2. A patient with HIV undergoes a skin test using candida antigen to assess their cellular immunity.
3. A healthcare provider orders a skin test using candida antigen to aid in developing a prognosis for a cancer patient.
4. A clinician performs a skin test using candida antigen to evaluate a patient’s immunological response after exposure to the organism.
5. A healthcare provider performs a skin test using candida antigen to assess a patient’s delayed-type hypersensitivity reaction.
6. A patient with a suspected immunological disorder undergoes a skin test using candida antigen to evaluate their cell-mediated immune response.
7. A healthcare provider performs a skin test using candida antigen to assess a patient’s immune response before initiating a specific treatment.
8. A clinician orders a skin test using candida antigen to evaluate a patient’s immunological response as part of a diagnostic workup.
9. A patient with a history of recurrent infections undergoes a skin test using candida antigen to assess their immune function.
10. A healthcare provider performs a skin test using candida antigen to evaluate a patient’s immunological response after receiving a vaccination.