Microbiology Code Changes in CPT 2001 Get Optimal Reimbursement
Published on Mon Jan 01, 2001
pathology Coder need to be aware of the significant changes in the microbiology section of CPT 2001 to gain appropriate reimbursement. In updating the codes to more accurately reflect current practice and coding conventions, 32 new codes and 41 revisions were added, while 16 existing codes were deleted, says Laurie Castillo, MA, CPC, CPC-H, CCS-P, member of the National Advisory Board of the American Academy of Professional Coders (AAPC) and president of its northern Virginia chapter. More than ever, it is imperative that laboratory coders get the updated version of the CPT Codes and familiarize themselves with the changes.
A significant addition to the section involves the clarification of presumptive versus definitive identification of organisms, explains William Dettwyler, MT-AMT, coding analyst for Health Systems Concepts, laboratory coding and compliance consultants in Longwood, Fla. New language in the introduction to the microbiology section defines presumptive identification of microorganisms as identification by colony morphology, growth on selective media, gram stains or up to three tests (e.g., catalase, oxidase, indole, urease). Definitive identification is defined as identification to the genus or species level that requires additional tests (e.g., biochemical panels, slide cultures). Many of the code revisions and additions clarify whether that specific test is for presumptive or definitive identification. The key to using these 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, Dettwyler says. If additional identification tests are conducted to more specifically type isolates, the appropriate code(s) 87140-87158 should be reported as well.
Presumptive Codes
For example, revised code 87101 (culture, fungi [mold or yeast] isolation, with presumptive identification of isolates; skin, hair, or nail) would be used to determine whether a fungal organism is present. If a followup test is conducted to specifically identify the organism, coders would additionally report either revised code 87106 (culture, fungi, definitive identification, each organism; yeast) or new code 87107 (culture, fungi, definitive identification, each organism; mold). Bacterial throat or nose cultures should now be reported using 87070 (culture, bacterial; any other source except urine, blood or stool, with isolation and presumptive identification of isolates) or 87081 rather than the deleted code 87060.
In codes 87071 (... quantitative, aerobic with isolation and presumptive identification of isolates, any source except urine, blood or stool) and 87073 (... quantitative, anaerobic with isolation and presumptive identification of isolates, any source except urine, blood or stool) different culture sets are required for anaerobes and aerobes. If both are performed, report both 87071 and 87073.
Use 87081 (culture, presumptive, pathogenic organisms, screening only) in place [...]
