Pathology/Lab Coding Alert

Having a hard time applying the National Coverage Determination (NCD) urine culture coding rules? Check out these scenarios and solutions, prepared with the help of Kenneth Wolfgang, MT (ASCP), CPC, CPC-H, director of coding and analysis for National Health Systems Inc., a coding consultation company in Camp Hill, Pa. Scenario: Patient presents with urgency, frequency and dysuria. Physician orders urine culture quantification and identification with susceptibility study to suggest antibiotic treatment for suspected lower urinary tract infection. The lab streaks two plates blood and Maconkey. After 24 hours, the plates show no growth. How should you code this?

Solution: Report CPT 87086 (Culture, bacterial; quantitative colony count, urine), but do not report the other ordered tests. Labs must have an isolate to proceed with identification and susceptibility studies.
Scenario: Assume the same situation, except that after 24 hours, the Maconkey plate shows colony growth pattern consistent with a lactose fermenting organism. The lab performs a colony count and a positive indole test on the isolate, allowing identification of E. coli. The lab proceeds with a minimum inhibitory concentration (MIC) test on the isolate. How should you code this?

Solution: Report 87086 for the colony count and 87088 ( with isolation and presumptive identification of isolates, urine) for the E. coli identification based on growth on selective media, colony morphology and indole test. Also report 87186 (Susceptibility studies, antimicrobial agent; microdilution or agar dilution [minimum inhibitory concentration (MIC) or breakpoint], each multi-antimicrobial, per plate) for the MIC test on the isolate.
Scenario: Prior to surgical removal of kidney stones, the physician orders a preoperative urine culture to rule out occult infection that may contraindicate surgery. The culture is positive, and the lab performs a colony count and presumptive identification of organism as Proteus sp. Based on the initial culture results, the physician requests a definitive identification and sensitivity test because some species of Proteus are more invasive than others. The lab then performs a biochemical panel, identifying the organism as Proteus mirabilis, and a Kirby-Bauer susceptibility test for antibiotic resistance. How should you code this?

Solution: Report 87086 for the original culture colony count and 87088 for the identification of the organism as Proteus sp. Additionally, report 87184 (Susceptibility studies, antimicrobial agent; disk method, per plate [12 or fewer agents]) for the Kirby-Bauer disk diffusion susceptibility test. You should also submit 87077 (Culture, bacterial; aerobic isolate, additional methods required for definitive identification, each isolate) for the definitive identification of the isolate as Proteus mirabilis.