Pathology/Lab Coding Alert

Question: The lab received an infected tissue specimen and smeared a slide for a Gram stain, immediately identifying a Gram positive coccus bacteria. The lab then homogenized and diluted the specimen for a calibrated loop culture to definitively identify and quantify bacteria using biochemical panels. Finding Staphylococcus aureus, the lab performs genomic sequencing to rule out MRSA, and minimum inhibitory concentration (MIC) susceptibility testing on the culture isolate. How should we code this?

Arkansas Subscriber

Answer: For the Gram stain on the direct smear, you should code 87205 (Smear, primary source with interpretation; Gram or Giemsa stain for bacteria, fungi, or cell types).

Report the quantitative aerobic culture and definitive identification using the following two codes:

• 87071 (Culture, bacterial; quantitative, aerobic with isolation and presumptive identification of isolates, any source except urine, blood or stool)
• 87077 (Culture, bacterial; aerobic isolate, additional methods required for definitive identification, each isolate)

Report the culture sequencing to rule out methicillin resistant Staphylococcus aureus (MRSA) as 87153 (Culture, typing; identification by nucleic acid sequencing method, each isolate (eg, sequencing of the 16S rRNA gene)).

Finally, capture the MIC testing by billing 87186 (Susceptibility studies, antimicrobial agent; microdilution or agar dilution (minimum inhibitory concentration [MIC] or breakpoint), each multi-antimicrobial, per plate).