Pathology/Lab Coding Alert
87077, 87081 Vie for CLO Test
Question: When the pathology report lists a CLO test for H. pylori from a stomach biopsy specimen, how should we code the test?
Michigan Subscriber
Answer: For Medicare beneficiaries, you should code the lab test that screens a stomach biopsy for Helicobacter pylori (H. pylori) using the "campylobacter like organism" (CLO) test as 87077 (Culture, bacterial; aerobic isolate, additional methods required for definitive identification, each isolate).
The CPT® code that more accurately describes the CLO test is 87081 (Culture, presumptive, pathogenic organisms, screening only), but a quirk of coding history led CMS to list the CLO test as 87077-QW (CLIA waived test) for "presumptive identification of H. pylori in gastric biopsy tissue, which has been shown to cause chronic active gastritis (ulcers)," according to the list of tests approved for waived-status labs under the Clinical Laboratory Improvement Amendments (CLIA).
Why it's wrong: Code 87077 actually describes additional biochemical methods -- such as urease activity -- to definitively identify a culture specimen. Although the CLO test involves a test for direct-source urease activity, it is not an additional test for definitive identification. Rather, the CLO test screens for urease activity for the presumptive identification of a single organism -- H. pylori, which 87081 better describes.
Back story: When CPT® deleted the CLO test code (87072, Culture or direct bacterial identification method, each organism, by commercial kit, any source except urine), it directed coders to use code 87077 instead. That's why CMS now lists all CLIA-waived CLO tests as 87077-QW.
What to do: CLIA waived labs must report 87077-QW for the CLO test. For higher-CLIA complexity labs and non-Medicare payers, you may report 87081.
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