Ob-Gyn Coding Alert

Question: We recently learned that it's incorrect to use 87220 with 112.1 (Candidiasis of vulva and vagina) for a KOH and a wet mount. What should we replace it with?

Iowa Subscriber

Answer: Code 87220 (Tissue examination by KOH slide of samples from skin, hair, or nails for fungi or ectoparasite ova or mites [e.g., scabies]) existed since way before 1990, but then CPT revised it in 2001. Now this code specifies the sample source and the organism for examination, so there is no longer a correct link between the diagnosis you used and the lab code.
 
CPT also revised 87210 (Smear, primary source with interpretation; wet mount for infectious agents [e.g., saline, India ink, KOH preps]) to differentiate this code from code 87220, specifying examination for infectious agents. Therefore, you should use 87210, not 87220, to report a KOH or wet mount for a non-Medicare patient. For Medicare, you would use a Q code: Q0111 (Wet mounts, including preparations of vaginal, cervical or skin specimens) and Q0112 (All potassium hydroxide [KOH] preparations).