Wiki Candida Injection for Warts

[pegjoh5746]

I am coding for an incident to clinic and was wondering if its possible to bill out the J3490 with 17110? Or is it considered an integral part of 17110.

 

[thomas7331]

I am coding for an incident to clinic and was wondering if its possible to bill out the J3490 with 17110? Or is it considered an integral part of 17110.

Not quite sure what you mean by an 'incident to clinic', but yes, you can bill the drug charge for this; drugs aren't bundled to the administration codes. However, I think CPT codes 11900/11901 are probably the more appropriate choice for this treatment.

 

[ellzeycoding]

Thomas is correct. 11900/11901 are used for injecting Candida antigen into warts.

 

[CatchTheWind]

But is an off-label use, so expect a denial for that reason.

 

[ny2scgirl]

We bill CPT 17110 with 11900 but we do not use the J-code since it doesn't get paid anyway.

 

[ellzeycoding]

We bill CPT 17110 with 11900 but we do not use the J-code since it doesn't get paid anyway.

That is 100% incorrect and fraudulent of your are billing both for wart destructions and using candida antigen on the same wart(s).

You cannot perform an intralesional injection (11900) on a wart that you also destroyed (17110). These codes are also bundled according to the National Correct Coding Initiative.

11900 would require modifier 59 or XS indicating to the carrier that the intralesional injection was on a separate lesion or site.

Be very careful and review your coding/billing practices. If audited, you will have extreme difficulty defending it.

 

[m.edwards]

Yes, if you are injecting Candida into a wart, you should be billing 11900/11901 with J3490 with the correct NDC code and miscellaneous text indicating the drug used. You should not be billing 17110 in conjunction with the J3490 or 11900/11901 if the only treatment is the intralesional injection. If multiple warts/lesions are treated with a different method, then you can bill both with the appropriate modifier (XS).

Our practice does receive payment for the J3490, but again, you must be sure to have the NDC number, dosage information, and drug information listed on the claim. For example, I will indicate in the miscellaneous text something like, "CANDIDA ANTIGEN, TOTAL OF 0.2CC INJECTED INTO 3 LESIONS."

 

[nlbarnes]

96372 cannot be billed with 11900, correct as the 11900 is an injection of the candida?

 

[CatchTheWind]

Correct; it is one or the other.

 

[ashalaylaylay]

Do you have the resource?

Thomas is correct. 11900/11901 are used for injecting Candida antigen into warts.

Do you have the AMA or other resource for this coding standard? I'm trying to have my company update their billing guidelines.

Thank you!

 

[ellzeycoding]

Do you have the AMA or other resource for this coding standard? I'm trying to have my company update their billing guidelines.

Thank you!

Attached is a page from the American Academy of Dermatology's Derm Coding Consult, Summer 2010. See gray box