Pathology/Lab Coding Alert

Question: Our lab performed a urine culture that resulted in presumptive identification of greater than 100,000 Gram-negative bacilli, Klebsiella. Further testing using biochemical panels produced a definitive identification of K. pneumoniae. The lab then performed a minimum inhibitory concentration test for drug susceptibility. How should we code this?

New Mexico Subscriber

Answer: You should code the culture isolation, quantification and presumptive identification using two codes:

- 87086 -- Culture, bacterial; quantitative colony count, urine

- 87088 -- ... with isolation and presumptive identification of each isolate, urine.

Although culture codes from sources other than urine involve only one code for the culture and presumptive identification, the same is not true for urine. CPT provides two distinct codes for urine culture isolation, quantification and presumptive identification.

For the additional testing that resulted in definitive identification to the species level (K. pneumoniae), you should report an additional code: 87077 (Culture, bacterial; aerobic isolate, additional methods required for definitive identification, each isolate).

Finally, you should list the susceptibility (MIC) test as 87186 (Susceptibility studies, antimicrobial agent; microdilution or agar dilution [minimum inhibitory concentration (MIC) or breakpoint], each multi-antimicrobial, per plate).