Urology Coding Alert

Question: We were using CPT code 87184 (sensitivity studies, antibiotic; disk method, per plate [12 or fewer disks]) for sensitivity studies, but because of special Bulletin 99-19 this can only be billed by a preferred lab. Can 87085 be used for the sensitivity study disc method?

Alabama Subscriber

Answer: No, you can not use 87085 (culture, presumptive, pathogenic organisms, screening only, by commercial kit [specify type]; with colony count) for sensitivity studies. However, it is possible for a urologist to do a culture using a specimen other than urine, although usually, that is not done.

CPT code 87085 is for a presumptive culture or screening test by commercial kit which includes a colony count. Note that if urine is the source, CPT 87086 (culture, bacterial, urine; quantitative, colony count) would be used instead of 87085. When performed, antibiotic sensitivity studies (CPT 87184) could be reported in addition to CPT 87085 or 87086. Whether your facility is allowed to perform specific lab tests under the Clinical Laboratory Improvement Amendment (CLIA) is a separate issue and should not affect the selection of the CPT procedure code to report the procedure performed. (Bulletin 99-19 appears to refer to a local policy.)

Answers to You Be the Coder and Reader Questions provided by Ray Painter, MD, president, PRS, Denver, Colo.; Laura Siniscalchi, CPC, RHIA, CCS, CCS-P, education coordinator for coding, Beth Israel Deaconess Medical Center, Boston; Lamon Willis, CPC, Lawtey, Fla.; Patricia Salmon, president, Patricia Salmon & Associates, Newtown Square, Penn.; Sandy Page, CPC, CCS-P, co-owner of Medical Practice Support Services, a coding, compliance and reimbursement consulting company based in Denver.