Pathology/Lab Coding Alert

Question: A physician performed incision and drainage of a subareolar breast abscess and submitted 3 ml of pus in a universal bottle for lab culture. The lab performed aerobic and anerobic culture and gram stain. The culture was positive for presumptive identification of Staphy­lococcus, so the lab reflexed to definitive identification to S. aureus, followed by typing by genome sequencing, and finally to antibiotic MIC susceptibility testing. How should we code the case?

Texas Subscriber

Answer: This case requires multiple codes to capture all the work the lab performs. Without more specific information, the following codes represent the most likely coding scenario for the case you describe:

• Gram stain: 87205 (Smear, primary source with interpretation; Gram or Giemsa stain for bacteria, fungi, or cell types) 
• Aerobic culture: 87070 (Culture, bacterial; any other source except urine, blood or stool, aerobic, with isolation and presumptive identification of isolates)
• Anaerobic culture: 87075 (Culture, bacterial; any source, except blood, anaerobic with isolation and presumptive identification of isolates) 

Because the isolate is aerobic S. aureus, you would proceed with the definitive identification and culture typing by genome sequencing using the following codes:

• Definitive identification: 87077 (Culture, bacterial; aerobic isolate, additional methods required for definitive identification, each isolate)
• Culture typing: 87153 (Culture, typing; identification by nucleic acid sequencing method, each isolate (eg, sequencing of the 16S rRNA gene))

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