Pathology/Lab Coding Alert

Don't lose out when it comes to Medicare's new urine culture guidelines. Medicare's National Coverage Determination (NCD) clarifies once and for all that you can report together codes for colony count and culture presumptive identification a much-debated question since CPT overhauled the microbiology section. When CPT 2001 instituted the presumptive and definitive identification paradigm, urine source stood alone with two codes for the initial culture: 87086 (Culture, bacterial; quantitative colony count, urine) and CPT 87088 ( with isolation and presumptive identification of isolates, urine). Coders wondered if they should report both codes when the lab provides a colony count and presumptive identification but has performed only one culture.

"Adding to the confusion came an NCCI [National Correct Coding Initiative] edit for 87086 and 87088 that was later removed, and some local medical review policies (LMRPs) directing labs not to report 87086 and 87088 concurrently," says Larry Small, MS, MT(ASCP), director of compliance and billing services for PCS Laboratory Service Group in Ann Arbor, Mich. Because it referenced the old codes, the NCD published in the Nov. 23, 2001, Federal Register shed no light on the matter. Now CMS clears all that up with the bacterial urine culture NCD, updated and available on the Internet at http://www.cms.hhs.gov/ncd/searchdisplay.asp?NCD_ID=25&NCD_vrsn_num=2.

"By updating the codes and the coding instructions in the NCD, Medicare clarifies that under some circumstances, coders can report 87086 and 87088 together," Small says. Report 87086 for Initial Urine Culture and Colony Count "The primary bacterial urine culture code is 87086, regardless of the results," Small says. When a physician orders a urine culture, the lab typically performs an initial culture to determine the presence of pathogenic bacteria and estimate the number of organisms present per milliliter of urine. You should report this service as a colony count (87086). Even if the culture is negative, showing no colony growth, you should report 87086 for the initial culture. If you take that same culture and separately perform other services such as identification and susceptibility studies, you should report those procedures in addition to 87086. Add 87088 for Presumptive Identification of Initial Culture "When the culture is positive and the lab presumptively identifies the organism on the colony count plate, report 87088 in addition to the initial 87086," Small says. You should not report 87088 if the 87086 is negative.

"Presumptive identification uses methods such as colony morphology, Gram stain, and catalase, oxidase, indole or urease tests," Small explains. According to the NCD coding guidelines, "identification based solely on visual observation of the primary media is usually not adequate to justify use of this code."

If the lab identifies multiple organisms from a urine culture, report multiple units of 87088. The NCD states that 87088 [...]