AMA reinstates 'per-plate' coding instruction
You just adjusted your stool culture coding to accommodate CPT 2004 changes, and now the AMA errata send you back to the old way. Once again, you can bill separately for each additional stool culture plate using CPT 87046 (Culture, bacterial; stool, aerobic, additional pathogens, isolation and presumptive identification of isolates, each plate).
After removing "per plate" from the code definition, the AMA returned those words to 87046 in the errata posted to their Web site at
http://www.ama-assn.org/ama/pub/article/3896-8059.html. Based on the errata, our experts have revised some advice offered in "Don't Code Extra Cultures for Stool and Blood" and "Think You'll See $13.52 for Each Stool Isolate?" in the May 2004 issue of
Pathology/Lab Coding Alert .
Returning "per plate" to the code definition allows labs to capture all additional stool cultures. "Without 'per plate' in the definition, we could not bill when our lab tested for more than one additional enteric pathogen -- returning 'per plate' to the definition allows us to account for each additional plate we inoculate to identify additional pathogens," says Vickie Baselski, PhD, department of pathology, University of Tennessee Health Science Center in Memphis. Enjoy 4 Times the Pay in 2004 Because the service described by 87046 remains unchanged from the 2003 definition, your lab should get the full benefit of Medicare's national limit payment increase for the code, from $3.36 in 2003 to $13.52 in 2004.
When the lab performs a stool culture for Salmonella/Shigella, report 87045 (Culture, bacterial; stool, aerobic, with isolation and preliminary examination [e.g., KIA, LIA], Salmonella and Shigella species). If the lab performs additional tests for other enteric pathogens, you should also report 87046 for each plate.
Example: The physician orders a routine stool culture, which includes Salmonella/Shigella and Campylobacter. The physician also orders additional tests for Yersinia, and E. coli 0157. "Our laboratory includes Salmonella, Shigella and Campylobacter as a routine stool culture, based on studies of pathogen prevalence, but also allows the physician to order analyte-specific tests for Yersinia, Vibrio, and enterohemorragic E. coli," Baselski says.
Old way: Before the AMA issued the errata, our experts advised you to report this example with one unit of 87045 for the Salmonella/Shigella, and one unit of 87046 for the combined Campylobacter, Yersinia and E. coli 0157 testing. "That meant we had to bill 87045 and 87046 for a routine stool culture that included Salmonella, Shigella and Campylobacter, and we could not bill for the additional plates for Yersinia and E. coli," Baselski says.
New way: Now you should report this example using 87045 for the Salmonella/Shigella culture and three units of 87046. "Because the AMA reinstated 'per plate' in the code definition, you should report [...]
