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The CPT® Code 86628 refers to the laboratory test for antibodies to Candida, a type of fungus that is typically found on the skin and in mucous membranes, including areas such as the vagina, mouth, and rectum. Under normal circumstances, Candida exists harmlessly; however, it can become pathogenic and lead to an infection known as Candidiasis or moniliasis when there is a disruption in the body's chemical balance. This disruption can occur in individuals who are taking antibiotics, those with weakened immune systems, and infants, making them particularly vulnerable to Candida infections. The infections are most commonly localized to areas such as the mouth, skin, nails, or vagina, but in more severe cases, they can affect the esophagus and gastrointestinal tract. In rare instances, Candida can enter the bloodstream, leading to systemic infections that may impact vital organs such as the kidneys, heart, lungs, eyes, or brain. To diagnose a Candida infection, various testing methods are employed, including immunodiffusion and enzyme-linked immunosorbent assay (ELISA). The ELISA method is particularly notable as it measures different classes of immunoglobulins—IgA, IgG, and IgM—each of which is reported separately, providing a comprehensive overview of the immune response to the Candida fungus.
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The antibody test for Candida (CPT® Code 86628) is indicated for the following conditions:
The procedure for testing antibodies to Candida involves several key steps:
Post-procedure care for patients undergoing the Candida antibody test is generally minimal, as the blood draw is a routine procedure. Patients may be advised to drink plenty of fluids and to monitor the site of the blood draw for any signs of excessive bleeding or infection. Results from the test will typically be reviewed by the healthcare provider, who will discuss the findings with the patient and determine if any further action or treatment is necessary based on the results.
| Short Descr | CANDIDA ANTIBODY | Medium Descr | ANTIBODY CANDIDA | Long Descr | Antibody; Candida | 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 | Conditionally packaged laboratory tests | Type of Service (TOS) | 5 - Diagnostic Laboratory | Berenson-Eggers TOS (BETOS) | T1H - Lab tests - other (non-Medicare fee schedule) | MUE | 3 | CCS Clinical Classification | 235 - Other Laboratory |
| 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. | GY | Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit | GA | Waiver of liability statement issued as required by payer policy, individual case | 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. | F9 | Right hand, fifth digit | G8 | Monitored anesthesia care (mac) for deep complex, complicated, or markedly invasive surgical procedure | GW | Service not related to the hospice patient's terminal condition | GX | Notice of liability issued, voluntary under payer policy | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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| 1993-01-01 | Added | First appearance in code book in 1993. |
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