Urology Coding Alert

Question: When the urologists in our office perform prostate cultures, how should we code?

New York Subscriber  
Answer: On occasion a urologist will massage the prostate to obtain prostatic secretions. The urologist can look at the smear right in the office. If billing Medicare, code Q0111 (wet mounts, including preparations of vaginal, cervical, or skin specimens). Most urologists have adequate CLIA certification to perform this test. To bill Medicare for looking at the smear, the urologist needs a higher-level CLIA certification: level 3 or 4. When billing a private payer for looking at the smear, code 87210 (smear, primary source with interpretation; wet mount for infectious agents [e.g., saline, India ink, KOH preps). If you stain the smear, code 87205 (smear, primary source with interpretation; Gram or Giemsa stain for bacteria, fungi, or cell types). If you want to grow bacteria to screen presumptively for infection, code 87081 (culture, presumptive, pathogenic organisms, screening only). If there is positive growth, and you want to test it against antibiotics with susceptibility studies using a disk, code 87184 (susceptibility studies, antimicrobial agent; disk method, per plate [12 or fewer agents]). The diagnosis code for these tests is prostatitis (601.x).