Pathology/Lab Coding Alert

Reviewed on May 20, 2015

Thanks to NCCI, you can report a strep screen with another culture

If carriers have rejected your lab's efforts to report a strep-throat screen and a separate culture on the same day, the National Correct Coding Initiative (NCCI) edits, version 10.1, just made your life easier.

The latest version of NCCI edits , effective April 1, removed the edit pair for 87081 (Culture, presumptive, pathogenic organisms, screening only) and CPT 87070 (Culture, bacterial; any other source except urine, blood or stool, aerobic, with isolation and presumptive identification of isolates). Now you can report both services together, when performed, which will pay $9.02 for 87081 at the National Limit of Medicare's Clinical Lab Fee Schedule, and $11.72 for 87070.

Caution: "Only report 87081 and 87070 together if the screening culture and the 'other source' culture are from two separate sources," says William Dettwyler, MT-AMT, president of Codus Medicus, a laboratory coding consulting firm in Salem, Ore. "Regardless of NCCI edits, correct coding principles do not allow you to report the same culture with both a screening code and a presumptive identification code -- the culture is either one or the other."

Physicians Order Screen and Culture Together

"NCCI's 87081/87070 edit pair was a problem for some labs because physicians often order a screening culture and an 'other source' culture for the same patient on the same day," Dettwyler says.

Example: A patient presents with a sore throat and a painful ear with discharge. The physician orders a quick-strep test (commonly 87880 -- Infectious agent detection by immunoassay with direct optical observation; Streptococcus, group A), followed by a strep screening culture if negative (87081). But the physician may also request a separate culture of the ear discharge. You should report the ear discharge culture as 87070 because the test does not screen for a specific organism but could isolate a variety of different organisms.

When NCCI bundled 87081 and 87070, coders used modifier -59 (Distinct procedural service) to override the edit pair. "If a lab didn't use the -59 modifier, Medicare often denied both services," Dettwyler says. Now, coders can report the services without the modifier.