Pathology/Lab Coding Alert

Question: We received a request for urine culture (87086) and expressed prostatic secretions (EPS) culture (87070) for the same patient on the same day. The payer denied the claim. What can we do to get this paid? 

Codify Subscriber

Answer: You’ve identified the appropriate codes for the two distinct services: 87086 (Culture, bacterial; quantitative colony count, urine) for the urine culture, and 87070 (Culture, bacterial; any other source except urine, blood or stool, aerobic, with isolation and presumptive identification of isolates) for the EPS culture.

The problem is that the Correct Coding Initiative (CCI) bundles these two codes, intending that you choose just the single most appropriate code for a single culture. But in your case, you’re dealing with two distinct cultures from separate specimen sources. That means you can legitimately override the edit pair.

Choose modifier: To “unbundle” 87086 and 87070 and earn appropriate pay for both cultures, you’ll need to append a modifier to 87070. You might use a modifier such as 59 (Distinct procedural service), XU (Unusual non-overlapping service), or XS (Separate structure). You should follow payer instruction regarding the use of those modifiers.

Don’t miss: Remember that if the urine culture is positive and the lab goes on to presumptively identify the isolated organism, you should bill 87088 (Culture, bacterial; with isolation and presumptive identification of each isolate, urine) in addition to 87086.