Pathology/Lab Coding Alert

Question: Our physician-office lab sometimes tests skin, hair or nail specimens for fungal infection, but we get denials when we report 87101 -- why?


Indiana Subscriber

Answer: CPT provides several codes for tests that can identify fungal infection in hair, nail and skin specimens -- so you have to be sure you-re using the code that most accurately describes the test procedure you use in your physician-office lab.

The code you mentioned is for a culture: 87101 (Culture, fungi [mold or yeast] isolation, with presumptive identification of isolates; skin, hair or nail). As a physician-office lab, you probably operate as a waived lab or a provider-performed microscopy (PPM) lab under the Clinical Laboratory Improvement Amendments. You could not perform 87101 under that certification.

The test your lab performs for dermatophyte fungal infection is more likely a KOH/wet mount from a direct skin, hair or nail sample. For a CLIA PPM lab, you can report this service as Q0111 (Wet mounts, including preparations of vaginal, cervical or skin specimens) or Q0112 (All potassium hydroxide [KOH] preparations).

The CPT code for the service is 87220 (Tissue examination by KOH slide of samples from skin, hair, or nails for fungi or ectoparasite ova or mites [e.g., scabies]), but you cannot report this code with a PPM certification.