Pathology/Lab Coding Alert

Question: Our lab ran a urine culture for a nursing home patient with an indwelling catheter. The culture returned positive for Proteus sp. and Escherichia coli. After reviewing the results, the physician requested a definitive identification and sensitivity test for the Proteus, which we performed. How should we code the case?

California Subscriber

Answer: For the initial positive urine culture, you should code 87086 (Culture, bacterial; quantitative colony count, urine) and two units of 87088 (...with isolation and presumptive identification of each isolate, urine), one for the Proteus identification and one for the E. coli identification.

Distinct: Urine is the only culture substrate that involves two codes to report the colony isolation/count and the presumptive identification. Most other culture sources involve one code for both services, such as 87040 (Culture, bacterial; blood, aerobic, with isolation and presumptive identification of isolates (includes anaerobic culture, if appropriate)). Also notice that the 87088 urine code allows you to report one unit for each isolate identification, while the codes for other-source cultures, such as 87040, include identification of"isolates."

Key: The distinction means that you should report a positive or negative urine culture differently. The positive culture requires both codes 87086 and 87088, but you should report only 87086 for a negative culture. On the other hand, you would code a positive or negative aerobic blood culture the same, using 87040.

Additional tests: You stated that the lab then performed additional tests for definitive identification and sensitivity. You don't state exactly what testing you performed, but we'll assume you performed a biochemical panel to definitively identify the organism, such as Proteus mirabilis. You should code that test as 87077 (Culture, bacterial; aerobic isolate, additional methods required for definitive identification, each isolate). For a sensitivity (susceptibility) test for antibiotic resistance, you should report a code such as 87184 (Susceptibility studies, antimicrobial agent; disk method, per plate (12 or fewer agents)).