Urology Coding Alert

If you don't know the new guidelines for coding urine cultures, you won't get squat the next time you submit 87086, 87088, 87184 and 87186 for a Medicare patient.

CMS'new national coverage determination (NCD) for urine cultures became effective Nov. 25, 2002, and carriers begin editing for the newly designated covered diagnosis codes Jan. 1, 2003.

Bacterial urine cultures are performed on urine specimens as a means of establishing the probability of the presence of a urinary tract infection (UTI), says Kimberly Hodges, CPC, coding specialist for Guerrero & Salib, MDs, in Titusville, Fla. Urine cultures are also performed to diagnose urine-related conditions as part of an evaluation and management service, according to CMS.

Urine culture studies 87086, 87088, 87184 and 87186 are performed depending on what the urologist has ordered and the results of the initial test, 87086, says Morgan Hause, CCS, CCS-P, privacy and compliance officer for urology of Indiana LLC in Indianapolis.

Hodges cites the example of a patient who presents with hematuria: "We would use bacterial urine culture studies to determine whether the hematuria is a result of a standard infection, in which case the results of the urine culture studies will come back positive." If the results of the bacterial urine culture studies are negative, the urologist will typically perform an IVPor cystoscopy to find the source of the hematuria, she says.

Here's how urine culture coding works. Let's suppose a 55-year-old female patient presents with urgency, frequency and dysuria (symptoms of acute lower UTI). The urologist orders a bacterial identification of the patient's urine specimen, quantitative identification of isolates, and susceptibility/sensitivity studies. No organism is identified by procedure 87086, so the quantitative identification of isolates (87088) and the susceptibility portions (87184 or 87186) of the urine culture studies ordered by the physician are not performed. You proceed to code 87088, 87184 and 87186 only if the results of 87086 are positive for bacteria presence.

Now suppose a 65-year-old woman presents with symptoms of a urinary tract infection, the urologist orders identification, quantification of isolates and sensitivity studies, and a bacterium is identified growing on her urine specimen. In this case, 87088 and either 87184 or 87186 would then be performed on the specimen.

Make sure you know the results of 87086 before reporting the urine culture services rendered, Hodges says.

The national determination, which has a mandated adoption policy for all Medicare carriers, outlines the indications, limitations and specific coding guidelines for urine culture codes 87086 (Culture, bacterial; quantitative colony count, urine), 87088 ( with isolation and presumptive identification of isolates, urine), 87184 (Susceptibility studies, antimicrobial agent; disk method, per plate [12 or fewer agents]) and 87186 ( microdi-lution or agar dilution [minimum inhibitory concentration (MIC) or breakpoint], each multiantimicrobial, per plate]).

The NCD outlines six indications for urine cultures including but not limited to abnormal urinalysis, signs and symptoms of suspected urosepsis, clinical signs and symptoms of an acute lower UTI or upper UTI, and a means of detecting occult infection in renal transplant recipients on immunosuppressive therapy.

"Prior to the release of the national coverage determination, Medicare would not allow 87088 to be billed per organism identified by 87086," Hause says.

Billing 87088 per organism will really help increase reimbursement for the urine culture studies, Hodges adds.

The following national limitations for urine culture coding are also outlined in the determination: