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The CPT® Code 86635 refers to a laboratory test specifically designed to measure antibodies against Coccidioides, a type of fungus that can lead to an infection known as coccidioidomycosis, commonly referred to as Valley Fever. This fungus is predominantly found in soil in certain regions, including the Southwestern United States, parts of Mexico, and Central and South America. The infection occurs when individuals inhale airborne spores, which can result in flu-like symptoms. The incubation period for this infection typically ranges from 1 to 3 weeks, and it is noteworthy that many individuals may not exhibit any signs or symptoms during this time. When symptoms do occur, they can include fever, fatigue, cough, headache, night sweats, muscle and joint pain, and occasionally a rash on the upper body and legs. The presence of Coccidioides antibodies in the blood can indicate either a past or present infection. Specifically, Coccidioides IgM antibodies are usually detectable by the second week of infection but tend to disappear within four months; however, they may reappear in cases of relapse or persist in disseminated infections. On the other hand, IgG antibodies typically appear by the third week of infection and can remain elevated for many years, indicating a longer-term immune response. The test involves obtaining a blood sample through a procedure known as venipuncture, which is reported separately. The serum obtained from the blood sample is then analyzed for the presence of Coccidioides antibodies (both IgM and IgG) using methods such as semi-quantitative complement fixation or semi-quantitative enzyme-linked immunosorbent assay (ELISA), as well as qualitative immunodiffusion for Coccidioides immitis antibodies.
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The Coccidioides antibody test (CPT® Code 86635) is indicated for the following conditions:
The procedure for conducting the Coccidioides antibody test involves several key steps:
After the procedure, patients may experience minor discomfort or bruising at the venipuncture site, which typically resolves quickly. There are no specific post-procedure care instructions required for this test, but patients should be advised to report any unusual symptoms or prolonged discomfort. The results of the antibody test will be communicated to the healthcare provider, who will interpret the findings in the context of the patient's clinical presentation and history. Follow-up testing or additional diagnostic procedures may be recommended based on the results.
| Short Descr | COCCIDIOIDES ANTIBODY | Medium Descr | ANTIBODY COCCIDIOIDES | Long Descr | Antibody; Coccidioides | 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 | 4 | 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. | Q4 | Service for ordering/referring physician qualifies as a service exemption | 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. | 77 | Repeat procedure by another physician or other qualified health care professional: it may be necessary to indicate that a basic procedure or service was repeated by another physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 77 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 76 | Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | AY | Item or service furnished to an esrd patient that is not for the treatment of esrd | GA | Waiver of liability statement issued as required by payer policy, individual case | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | GW | Service not related to the hospice patient's terminal condition | 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 | GZ | Item or service expected to be denied as not reasonable and necessary |
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| 2021-01-01 | Note | Guidelines changed and first appeard in CPT book. |
| 2020-04-10 | Added | AMA guideline added |
| 1993-01-01 | Added | First appearance in code book in 1993. |
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