Pathology/Lab Coding Alert

Question: A hospitalized patient developed a urinary tract infection following removal of a catheter. The urine culture resulted in presumptive identification of Enterococcus. The lab also performed screening for VRE. How should we code the case?

Louisiana Subscriber

Answer: You should report the urine culture and identification with 87086 (Culture, bacterial; quantitative colony count, urine) and 87088 (Culture, bacterial; with isolation and presumptive identification of each isolate, urine).

Because of the increased incidence of Vancomycin-resistant Enterococcus (VRE), physicians commonly order a Vancomycin-resistance test for patients with Enterococcus infection.

Do this: CPT 2008 introduced a new code for amplified-probe VRE identification that you should report when the lab performs the test on a direct source: 87500 (Infectious agent detection by nucleic acid [DNA or RNA]; vancomycin resistance [e.g., enterococcus species van A, van B], amplified probe technique). For instance, use 87500 when the source is a direct urine specimen or a rectal swab.

Don't miss: If the lab uses a nucleic acid probe to test for VRE on a culture isolate, you should not use the new code. A CPT note preceding these infectious agent identification codes states, "these codes are intended for primary source only."

Instead, you should continue to report 87149 (Culture, typing; identification by nucleic acid probe) when the lab performs the test on a culture, says William Dettwyler, MT-AMT, president of Codus Medicus, a laboratory coding consulting firm in Salem, Ore.

-- Reader Questions and You Be the Coder were prepared with the assistance of R.M. Stainton Jr., MD, president of Doctors- Anatomic Pathology Services in Jonesboro, Ark.