Pathology/Lab Coding Alert

Don't miss the chance to report 87088 per isolate

When urine cultures resulted in more than one isolate, coders were in a quandary--until now.

Although coding principles allowed reporting cultures per isolate, that's not what the urine culture code said.

Code Presumptive Identification per Isolate

CPT 2007 changed -identification of isolates- to -identification of each isolate- in the definition of 87088 (Culture, bacterial; with isolation and presumptive identification of each isolate, urine). That change allows you to report 87088 more than once if your lab identifies more than one isolate from a urine culture.

-The change is significant because the new wording clarifies that you can bill for each organism presumptively identified from a urine culture,- says Anne Pontius, MBA, CMPE, MT (ASCP), president of Laboratory Compliance Consultants Inc. in Raleigh, N.C. -Prior to the code change, the wording led coders to report just one unit of 87088 for all organisms identified from a single urine culture.-

Urine Culture Takes 2 Codes
 
Unlike cultures from other sources, CPT provides two codes to describe a urine culture and presumptive identification: 87086 (Culture, bacterial; quantitative colony count, urine) and 87088.

Most lab culture codes include both the isolation and presumptive organism identification, says William Dettwyler, MT-AMT, president of Codus Medicus, a laboratory coding consulting firm in Salem, Ore.

For instance: To report a culture from another source, such as a throat swab, use 87070 (Culture, bacterial; any other source except urine, blood or stool, aerobic, with isolation and presumptive identification of isolates). You should report this one code whether the culture is negative or results in presumptive identification of an isolate.

Urine culture code 87086 is unique because another code is available to report presumptive identification in addition to 87086 for the isolation, Dettwyler says.

How it works: As many as half of all urine cultures are virtually sterile or don't show any significant colony growth, Dettwyler says. But if the culture grows and the lab presumptively identifies an organism, such as Proteus sp, you can report 87088 in addition to 87086. To bill both codes, you must have documentation of the presumptive identification.

You don't need any modifiers to receive payment for both codes--and reporting 87088 will increase your reimbursement because it pays about the same as 87086, Dettwyler says.

Use 87086 for Negative Urine Culture

What about those urine cultures that don't result in isolation of an organism? -Report 87086 for a negative urine culture,- Dettwyler says. Don't report 87088  alone or in addition to 87086 for when the urine culture is negative.

Don't Stop at Presumptive Identification

If your lab provides a presumptive identification of a urine culture isolate, you would report 87086 plus 87088. But the lab work may not stop there. If additional tests identify the infectious organism  more specifically or provide information about the organism's susceptibility to antibiotic treatment, you should be able to assign additional codes. Look at the following story, -Microbiology Primer: Don't Lose Identification Pay,- to learn more about how to gain pay for additional tests.