Pathology/Lab Coding Alert

Question: What is the correct way to code for urine cultures requiring a colony count and identification to the species level? It seems that the culture is reported twice by using the colony count and presumptive identification codes. This means that three codes may be reported to achieve a definitive identification of isolates from urine cultures, while only two describe the same service for isolates from other sources.

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Answer: The microbiology section in CPT 2002 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)."       
 
The key to reimbursement for any of the culture codes lies in understanding that if a test for presumptive identification is followed by a definitive test, both codes should be reported. If additional identification tests are conducted to more specifically type isolates, the appropriate code(s) (87140-87158) should also be reported.
 
The confusion for the urine culture codes stems from the fact that two codes may describe the original culture, while other specimens have only one code. For blood, the culture code is 87040 (Culture, bacterial; blood, with isolation and presumptive identification of isolates [includes anaerobic culture, if appropriate]), and for any other source it is 87070 (  any other source except urine, blood or stool, with isolation and presumptive identification of isolates). 
 
For urine, the codes are 87086 (Culture, bacterial; quantitative colony count, urine) and 87088 ( with isolation and presumptive identification of isolates, urine).  Even if the lab provides a quantitative colony count and presumptive identification of the isolate, the procedure usually involves one culture, but the service is described by two codes. The colony count is often the first analysis of a urine culture, to determine if significant bacteriuria is present (87086). If so, the lab typically proceeds with the presumptive identification of the isolate (87088).
 
If definitive identification of the culture isolates from any of these sources is carried out, an additional code is reported depending on the type of organism isolated. These codes are 87076 ( anaerobic isolate, additional methods required for definitive identification, each isolate) and 87077 ( aerobic isolate, additional methods required for definitive identification, each isolate).
 
Although 87086 and 87088 represent two separate services, Medicare's Correct Coding Initiative (CCI) edits contradict this. Beginning in CCI version 8.0, 87086 and 87088 are mutually exclusive, thus representing services that would not normally be performed together for the same patient. Based on the CCI edits and the understanding that it would not be accurate to report a single culture using two separate culture codes, do not report 87086 and 87088 together for the same culture. If a urine culture does not yield significant colonies for identification, report 87086. If a urine culture results in an isolate that is definitively identified, report 87088 and 87076 or 87077.