Pathology/Lab Coding Alert

Question: Our lab receives two urine specimens from a urologist, one labeled -express prostatic secretion- (EPS). We microscopically examine a urine-sediment smear with methylene blue/eosin stain and perform a urine culture on each specimen. What exactly is EPS, and how should we code for it?

Arkansas Subscriber

Answer: Urologists sometimes perform EPS for patients with suspected chronic prostatitis to determine whether the inflammation is bacterial or nonbacterial, or whether the patient simply has prostatodynia. EPS may be a better alternative to needle biopsy for obtaining samples, in some cases, and also may have therapeutic value.

How it works: The patient gives a clean-catch urine sample. Then the doctor manually milks the prostate until it secretes, and finally the patient gives another urine sample. The lab examines urine sediment from both specimens for presence of inflammatory cells (leukocytes) and bacteria using a Giemsa stain (methylene blue and eosin), and also cultures each urine specimen.

Why it's done: Although clinical symptoms and a urine culture can often help diagnose acute prostatitis, chronic prostatitis or prostatodynia are more difficult to analyze. By comparing inflammatory cells and bacteria in urine before and after prostate secretion, physicians can pinpoint the prostate as a source of chronic inflammation and get an indication if there is any underlying bacterial cause.

Consider: Code 87205 (Smear, primary source with interpretation; Gram or Giemsa stain for bacteria, fungi, or cell types) is the correct code for the urine sediment smear stained with methylene blue and eosin. For the centrifugation to concentrate the urine and obtain the sediment, also report 87015 (Concentration [any type], for infectious agents). Report both of these codes for each urine sediment specimen (two in the case of EPS).

Culture is separate: For the urine cultures, report 87086 (Culture, bacterial; quantitative colony count, urine) for each specimen (two urine specimens for EPS). If the lab isolates organisms, also report 87088 (- with isolation and presumptive identification of each isolate, urine) for each isolate identified.