Although the CPT 2001 revisions, additions and deletions of the microbiology codes for culturing pathogenic organisms (87040-87158) systematized coding based on the culture source, type of organism and level of identification, many
pathology Coder have questions about how to use these codes. The key to using the microbiology codes for appropriate reimbursement lies in understanding that if a test for presumptive identification is followed by a definitive test, both codes should be reported. If additional identification tests are conducted to type isolates more specifically, the appropriate code(s) should be reported as well.
Twenty-three of the 28 culture codes in the 87040-87158 range are new or revised in CPT 2001. Additionally, 11 codes were deleted from that code range. Most of the changes differentiate presumptive and definitive identification and specify the source and type of organism being cultured, says William Dettwyler, MT-AMT, coding analyst for Health Systems Concepts, laboratory coding and compliance consultants in Longwood, Fla.
Coding Bacterial Cultures
1. Source: Blood. Report isolation and presumptive identification of either aerobic and/or anaerobic bacterial cultures from blood using 87040 (culture, bacterial; blood, with isolation and presumptive identification of isolates [includes anaerobic culture, if appropriate]). This culture typically involves aerobic and anaerobic test bottles that are analyzed for bacterial growth by various laboratory methods. Following isolation and presumptive identification, if the bacteria are then definitively identified, coders should also report either 87076 ( anaerobic isolate, additional methods required for definitive identification, each isolate) for anaerobes, or 87077 ( aerobic isolate, additional methods required for definitive identification, each isolate) for aerobes. These codes should be reported for each isolate definitively identified. These same two codes are used for definitive identification of bacteria from sources other than blood. The methods for these two tests involve standard techniques of special media and biochemical testing. Culture typing by other methods is reported using 87140-87158.
2. Source: Stool. Report identification of Salmonella and Shigella species from stool samples using 87045 ( stool, with isolation and preliminary examination [e.g., KIA, LIA], Salmonella and Shigella species). This test involves plating the organism onto specific types of agar that encourage growth of these two enteric organisms, Dettwyler explains. So this test is a presumptive identification based on growth on selective media, although CPT doesnt use that terminology for this code.
If the lab cultures for additional stool pathogens, report 87046 ( stool, additional pathogens, isolation and preliminary examination [e.g., Campylobacter, Yersinia, Vibrio, E. coli 0157]) for each plate. Based on the wording additional pathogens, 87046 should only be reported following the initial stool culture (87045), Dettwyler says. If the physician orders only a screening for a specific organism such as pathogenic E. coli, that service should [...]
