Wiki 87077

[jbirnbaum68@gmail.com]

Coding outpatient, physician office labs. I am uncertain if coding 87077 x2 for the following scenario is accurate:

When 87077 is ordered by one of our physicians and lab results indicate:
1. positive for Staph Aureus, then 87077 bills x1 (using a Staph Latex test)
2. negative for Staph Aureus, then 87077 bills x2 because a neg result will automatically reflex to a Vitek ID to identify Staph species.

Per coding guidelines:

87077

Culture, bacterial; aerobic isolate, additional methods required for definitive identification, each isolate

This code reports definitive aerobic (87077) organism identification of an already-isolated anaerobic or aerobic bacterium. The pathogen has already been presumptively identified, but additional testing is required to identify the specific genus or species. The additional definitive testing methods include biochemical panels and slide cultures. Studies using chromatography, molecular probes, or specific immunological techniques may be employed for definitive testing, but are not included in this code and are reported separately.

Does anyone have experience coding 87077 in these cases?

 

[danachock]

Hello jbirnbaum68@gmail.com,
I have a little information to share with you on this.
Please review the NCCI manual - link https://www.cms.gov/files/document/medicare-ncci-policy-manual-2024-chapter-10.pdf
I'm reviewing page X-4 that states:
"CMS policy prohibits separate payment for duplicate testing or testing for the same analyte by
more than one methodology. (See definition of analyte in this chapter, Section N (General Policy
Statements), subsection 2.) If, after a test is ordered and performed, additional related procedures
are necessary to provide or verify the result, these would be considered part of the ordered test.
For example, if a patient with leukemia has a thrombocytopenia, and a manual platelet count
(CPT code 85032) is performed in addition to the performance of an automated hemogram with
automated platelet count (CPT code 85027), it would be inappropriate to report CPT codes
85032 and 85027 because the former provides verification for the automated hemogram and
platelet count (CPT code 85027). As another example, if a patient has an abnormal test result and
repeat performance of the test is done to verify the result, the test is reported as 1 unit of service
rather than 2."
I'm hopeful that I shared some light to your coding concerns.
Thank you for listening this evening,
Dana