# KOH, whiff test and wet mount



## jcgiordano (Aug 20, 2010)

When a provider performs only a wet mount and a whiff test would I code 87210 x2 with a modifier 59?


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## MJ4ever (Aug 24, 2010)

Hi JC,

I see noone is daring to answer your question..

In my opinion, you would only code for one unit, not two.
I've seen providers do this. For the whiff test and then the confirmation under the microscope to verify the olfactory senses were right.

See, if anyone else wil reply : )
Hope this helps explain it.

Barbara


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## Lisa Bledsoe (Aug 25, 2010)

If you are preparing two slides why not code 87210, 87210-59?


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## preserene (Aug 25, 2010)

Wet Mount:  a sample of  the specimen mixed  with a salt solution(or KOH) on a microscopic slide and check for bacteria, WBC and unusual cell called clue cells.If CLUE cells are present- it is BV. A sort of a HANGING DROP preparation( for the shape and motiltiy, type)

Wiffs Test:Saline/KOH is added to a sample to see a strong fishy odor is produced-meaning BV. 
These two tests with PH >4.5 enough to confirm the diagnosis.

If want to be more grossly specific about the bacteria (Gram + or Gram –), take another slide Smear for *Grams Stain *( a dry  test method).eg, type of bacteria, fungi or Gardenella can be tentatively clued by this. This is a sort of a *gold standard test*.

So as Curtis said you have to report 2codes if two preprations  taken 1)Wet mount 2)  Smear for Grams Stain.
*Wet mount report  87210.  Grams stain Smear: 87205*.

The diagnosis Code:616.10/ .1x , if the doctor documented it. 

IF WET MOUNT AND WIFF TEST ARE THE ONLY DOCUMENTED PROCEDURES :

*My suggestions are:*
So far there is no code for Wiffs test  directly but I could find *odor Test  *which correlates well with: *the amine odor of the vaginal fluid qualitative -82120 – Vaginal fluid , Amines qualitative for reporting wiffs Test* *And  87210 for wet mount.*
Both these tests are done at the office visit by the treating Physician because these are basic tests for which they are already trained very well. 
Did your Physician perform PH value test? Then it also adds up to the diagnosis.
Hope it would help.


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## MJ4ever (Aug 26, 2010)

Ok, I've confirmed with one of our providers.

The whiff test, also called Amine 82120, is done when smelling the test after adding KOH to the slide.
The slide is covered and send to the lab to check for clue cells and so on.

Nevertheless, I would not feel comfortable for testing for both 82120 and 87220, because, the microscopic testing will just confirm what the provider has already confirmed through the whiff, including finding possible additional cells.

I would think the insurance of the civilian world would deny the whiff and specific insurance carriers would probably bundle this or consider it fraud.


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## MJ4ever (Aug 26, 2010)

Ok, I've confirmed with one of our providers.

The whiff test, also called Amine 82120, is done when smelling the test after adding KOH to the slide.
The slide is covered and send to the lab to check for clue cells and so on.

Nevertheless, I would not feel comfortable for coding for both 82120 and 87220, because, the microscopic testing will just confirm what the provider has already confirmed through the whiff, including finding possible additional cells.

I would think the insurance of the civilian world would deny the whiff and specific insurance carriers would probably bundle this or consider it fraud.

Have a great day.


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## preserene (Aug 26, 2010)

Thank you Barbara. Yes as your doctor decides, it is our final too.
So these 2 codes would suffice I think: 82120 and 87210 ( giving merits for the traditional and prevalently well accepted tests at the Physicians office settings).
87220 I never mentioned. It is for skin hair and nail
Just a brief note about Diagnosis of Vaginitis, to refresh our knowledge.
Vaginitis: 
The most common causes of vaginitis are trichomoniasis (Trichomonas vaginalis infection), vaginal candidiasis (Candida vaginalis ), and bacterial vaginosis (BV).
. The term vaginosis implies that infection is accompanied by little or no inflammation of the vagina; with overgrowth of anaerobic bacteria leading to replacement of lactobacilli and an increase in vaginal pH from less than 4.5 up to 7.0. Ideally, a diagnosis of BV is made if 3 out of 4 of 'Amsel's criteria' are met. 
Thin, white, homogenous discharge
Clue cells (vaginal epithelial cells heavily coated with bacilli) on microscopy
Vaginal pH greater than 4.5)
presence of an amine odor after the addition of potassium hydroxide (also known as the "whiff" test). 
Testing for amines and pH testing is a well-established practice traditionally, Several aspects of the diagnosis are subjective - e.g., the visual examination of the discharge, reading the pH paper, and evaluation of the odor as part of the whiff test. A strong fishy odor on adding alkali to vaginal fluid (positive Whiffs Test). 
Microscopic examination may also reveal motile trichomonads or candida hyphae.
Usually these tests are enough for diagnosis at the Physicians office settings, unless Grams score and BV Blue test like stuff are needed at the physicians discretion, mostly at the hospital settings.
Thank you


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