Pathology/Lab Coding Alert

Question: When the pathology report lists a CLO test for H. pylori from a stomach biopsy specimen, how should we code the test? Michigan Subscriber Answer: For Medicare beneficiaries, you should code the lab test that screens a stomach biopsy for Helicobacter pylori (H. pylori) using the "campylobacter like organism" (CLO) test as 87077 (Culture, bacterial; aerobic isolate, additional methods required for definitive identification, each isolate). The CPT® code that more accurately describes the CLO test is 87081 (Culture, presumptive, pathogenic organisms, screening only), but a quirk of coding history led CMS to list the CLO test as 87077-QW (CLIA waived test) for "presumptive identification of H. pylori in gastric biopsy tissue, which has been shown to cause chronic active gastritis (ulcers)," according to the list of tests approved for waived-status labs under the Clinical Laboratory Improvement Amendments (CLIA). Why it's wrong: Code 87077 actually describes additional biochemical methods -- such [...]