Pathology/Lab Coding Alert

Question: Due to increased number of whooping cough cases, we’re starting to perform a screening test from NP swab at our in-office lab. How should we code the test?

Texas Subscriber

Answer:

You don’t provide a lot of information about the test, so it’s difficult to narrow the answer down to one specific code. You’ll have to consider several options based on the lab method and your lab certification.

Because you state that this is a screening test, let’s assume that the procedure tests only for the presence or absence of the whooping cough organism, Bordetella pertussis, in the nasopharyngeal (NP) swab. There are several lab tests that will do this, such as those represented by the following codes:

• 87081 — Culture, presumptive, pathogenic organisms, screening only)
  
• 87798 — Infectious agent detection by nucleic acid (DNA or RNA), not otherwise specified; amplified probe technique, each organism
  
• 87265 — Infectious agent antigen detection by immunofluorescent technique; Bordetella pertussis/parapertussis.
  

You’re probably not performing the direct fluorescent antibody (DFA) test (87265), because this test is not recommended by the Centers for Disease Control and Prevention (CDC) for the diagnosis of pertussis due to low test sensitivity. CDC’s recommended first-line tests for pertussis are polymerase chain reaction (PCR) (87798) and/or culture.

Note other culture codes: Although 87081 is the correct code for a culture that screens for a specific organism (such as Bordetella pertussis), you should use a different code if you’re taking a culture to presumptively identify any pathogens present, not just screen for one organism. For instance you should report 87070 (Culture, bacterial; any other source except urine, blood or stool, aerobic, with isolation and presumptive identification of isolates) for aerobic isolates from an NP swab.