Pathology/Lab Coding Alert

Code separate stains, cultures and biopsies

Physicians routinely perform tuberculosis (TB) screening for patients with symptoms or increased risk for TB infection--but that's just the beginning. Don't miss out on additional pay when the lab performs other tests to confirm the patient's diagnosis. See Beyond Screening Although the first line of testing is usually either the TB skin test 86580 (Skin test; tuberculosis, intradermal) or the gamma interferon antigen response test 86480 (Tuberculosis test, cell-mediated immunity measurement of gamma interferon antigen response), a positive result from either of these tests does not confirm a TB diagnosis. Rather, the physician will use clinical symptoms and the results of other tests, such as chest x-ray and sputum stains and cultures, to reach a final diagnosis.
 
Don't miss: If the lab performs some of these additional tests to assist in TB diagnosis, you'll need to report each service separately:

Direct smear: For an acid-fast bacillus (AFB) stain on a sputum or bronchial alveolar lavage (BAL) specimen to identify potential mycobacterium, use 87206 (Smear, primary source with interpretation; fluorescent and/or acid fast stain for bacteria, fungi, parasites, viruses or cell types). For more specific identification or quantification, the lab may also perform one of these services: 87555 (Infectious agent detection by nucleic acid [DNA or RNA]; mycobacteria tuberculosis, direct probe technique), 87556 (... mycobacteria tuberculosis, amplified probe technique) or CPT 87557 (... mycobacteria tuberculosis, quantification).

Specimen concentration: Labs often concentrate a BAL specimen before culturing. Don't forget to report 87015 (Concentration [any type], for infectious agents) if your lab performs the concentration step.

Culture: If the lab cultures the sputum or BAL specimen to aid in TB diagnosis, use 87116 (Culture, tubercle or other acid-fast bacilli [e.g., TB, AFB, mycobacteria] any source, with isolation and presumptive identification of isolates). If the lab proceeds with definitive identification of isolates from the culture, also report 87118 (Culture, mycobacterial, definitive identification, each isolate).

Biopsy: A pathologist typically performs an acid-fast stain based on observed granulomas in a tissue biopsy, says  R. M. Stainton Jr., MD, president of Doctors' Anatomic Pathology Services in Jonesboro, Ark. For example, if the pathologist examines a transbronchial lung biopsy and performs an AFB stain due to granulomas, report 88305 (Level IV--Surgical pathology, gross and microscopic examination, lung, transbronchial biopsy) and +88312 (Special stains [list separately in addition to code for primary service]; group I for microorganisms [e.g., Gridley, acid fast, methenamine silver], each).