Practice Management Alert

You can bill multiple units of 80788 for presumptive organism identification

Don't allow standard lab billing rules to overshadow a Medicare anomaly that allows you to report two or more codes for one urine test.

Most lab culture codes include a presumptive organism identification, says William Dettwyler, MT-AMT, president of Codus Medicus, a laboratory coding consulting firm in Salem, Ore. Urine culture code 87086 (Culture, bacterial; quantitative colony count, urine) is unique, however. Medicare will allow you to report presumptive identification "in addition to the regular code," he says.

How it works: Half of all urine cultures "are practically sterile or they don't have any significant growth," Dettwyler says. When this is the case, you only code 87086 to recoup for the test.

But if the culture grows and there is an organism that a provider or lab technician can presumptively identify, such as E-coli, you can report 87088 (Culture, bacterial; with isolation and presumptive identification of isolates, urine) in addition to 87086. In order to bill both codes, you must have documentation of the presumptive identification.

You don't need any modifiers to receive payment for both codes - and reporting 87088 will up your reimbursement because it pays about the same as 87086, Dettwyler says.

There's more: Not only will Medicare pay you for a presumptive identification, it will pay you for more than one. You can report multiple units of 87088, Dettwyler says.

For example, if there's documentation of two presumptively identified organisms in the urine culture, you can bill 87086 and 87088 x 2.

Bottom line: You're missing out on due payment if you're neglecting to report 87088.