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WE DID A SKIN STREP TEST WITH A DX OF 691.0, WHAT WOULD BE THE CPT CODE? THANKS, KERRY (answered 05/04/2007) |
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I was refered to ASM as a source of CPT codes for many of the misc. procedures performed by Micro. such as Optichin, Tisse grinding, germtube, etc. Can you help? (answered 04/16/2007) |
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Another coding question: We set up Herpes in tissue cultures. Then when we see CPE we use 2 FA typing antisera to determine if type 1 or 2. We charge CPT code 87252. May we add 87140 x2 for the FA typing or use 87253 x1? (answered 03/06/2007) |
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The description for CPT code 87088 (Culture Urine with ID) has been changed from “presumptive identification of isolates, urine”, to “presumptive identification of each isolate, urine.” 1) Can CPT code 87088 now be used multiple times on a single urine culture? 2) Can both 87077 (definitive identification) and 87088 be used multiple times on a single urine culture? 3) Example: lactobacilli, diphtheroids, S.aureus, and E.coli are isolated on a urine culture. Would the coding be 87088 x2, 87077 x2, and 87086 (colony count on a urine culture)? (answered 01/19/2007) |
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A CTP coding question:We often receive synovial (and other fluids) in sterile tubes for culture and Gram stain as well as fluid collected in a blood culture set. We order a fluid culture/Gram stain, do a cytospin smear, and plate the spun fluid sediment, so we have both plates and blood culture bottles going at the same time. Sine we received 2 received samples/containers and the MD wants both cultured, can we we bill separately for a fluid culture and a fluid collected in blood culture bottles? Or since its the same fluid, can we only charge for 1 culture, and just do a ctyospin Gram stain (no plates) and incubate the bottles(for better recovery). (answered 01/02/2007) |
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What CPT code(s) to use when inducing Staph for another beta-lactamase test? (answered 11/14/2006) |
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We have 3 hospitals in our system and we share the same computer server (we can log in to the computer and put in results and view results on patients from one of the other hospitals). When we do testing in my facility on patient's from one of the other hospitals should we document on the report that the test was performed at our facility? The computer has been set up so this documentation will show up automatically on the printed report but you can not see this comment in the computer unless you manually put in the comment. Should we be adding this comment manually so that Dr's can see on the computer if that test was done in our facility or is the comment only on the printed report sufficient? Do we even have to state on the report if that test done in one of the other facilities? (answered 11/02/2006) |
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VRE screen Billing Question! We are doing VRE screen cultures on stool isolates. Our primary CPT code for the screening culture is 87081. Once we confirm the I.D. and MIC from a Microscan combo panel, we result out the I.D. (faecalis or faecium). Can I then charge the CPT code 87077 to the screening culture (87081) as an additional bill code for the "definitive ID" ? (answered 10/25/2006) |
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A couple of CPT coding questions: Are we allowed to charge for the latex testing done in our laboratory on a suspected streptococcal isolate if the isolate is ultimately referred for a definitive identification (and thus the patient is charged for that ID)? Also, we screen our Streptococcus pneumoniae isolates for penicillin susceptibility using an oxacillin disk. The probable resistant isolates are then forwarded to a reference laboratory for E-Test MIC testing with antibiotics including penicillin. Are we allowed to charge for our oxacillin disk testing on the probable resistant isolates? Thank you for your reply. (answered 10/25/2006) |
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What is the correct coding for an O&P exam? The last answer was in 2004 and I think it may have changed. We perform direct smears (saline and iodine), concentration and trichrome. Should we just use 87177 or can we also add in 87207. Or should 87207 only be used for special stains for coccidia or microsporidia etc.? (answered 10/24/2006) |
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If two blood cutlures are drawn from the same site, can this be charged as two separate cultures. (answered 05/12/2006) |
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Is it ok to have 5 charges for Strep grouping when using the Strep grouping Kit ( groups a,b, c,f & g)? |
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What diagnosis codes pay for Influenza A and Influenza B (87804) testing? (answered 04/04/2006) |
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I have some CPT coding questions that came up as a result of the "Correct Coding in Clinical Micro" audioconference 12/14/2005. 1. If I understood correctly, coag was given as an example of a presumptive test which could not be charged for. Wouldn't it be a definitive aerobic ID (87077) because it gives a genus and species; it does the identification as well as the Staph latex does and that can be charged for. 2. I believe the same was said for the germ tube and rapid trehalose. However the CLSI M35-A document says that the germ tube test IDs C. albicans and the rapid trehalose test IDs C. glabrata. 3. It was stated that we could not bill for a resistant S. pneumo oxacillin screen because the "real" result would be done by MIC. But what about when the client does not want additional susceptibility testing done or when the oxacillin screen result is susceptible? A susceptible result with the accompanying interpretation give useful clinical info without additional testing. My understanding was that we were to evaluate the prevalence of penicillin R S. pneumo in our population and from that make a determination of whether to start with the screen or go directly to the MIC (except for blood and CSF which always get an MIC). 4. If we do an MIC panel but then the physican requests testing for additional antibiotics not on the panel so we set up a KB or e-test - can we charge for both the MIC and the KB/e-test? (answered 04/04/2006) |
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You may have answered this already, I just need it to be more clear. When is it ok to bill 87086, 87088, and 87077, all together, all for urine? (answered 04/04/2006) |
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A CPT coding question for when the Remel Haemophilus Quad plate is used - Should the X,V, and XV factor sectors plus the horse blood sector be counted as 1 test or 2 tests (factors plus hemolysis) or individually towards the greater than 3 tests (and thus coded as a definitive ID)? Thank you for your help. (answered 04/04/2006) |
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If a gram stain and catalase and PYR are performed on an isolate from a non-urine source can a definitive ID (87077) be billed? Kathy_j_brown@ssmhc.com (answered 04/04/2006) |
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What cpt codes should be used for MRSA screen. I feel that, a charge for culture, agglutination reaction and disc susceptibility ( Vitek?) are the appropriate charges. (answered 03/31/2006) |
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when there is a discrepency between cpt codes e.g., RSV detection: 87807 vs. 87420, is there a difference and which should be used? (answered 03/29/2006) |
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If an antibiotic is used for identification purposes only,can it be cahrged, i.e., polymin b and/or novobiocin for staphylococci (answered 03/07/2006) |
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For an AFB culture, is it correct to bill for culture (CPT 87116), Concentration (CPT 87015),AFB Smear (CPT 87206) and AFB ID (CPT 87149) (answered 03/02/2006) |
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What is the proper 2006 CPT coding for occult blood? Often times we in the lab do not know if the test is ordered as a cancer screen (CPT 82270) versus a single specimen (CPT code 82272). Can you offer some insight? Thank you! (answered 01/08/2006) |
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What CPT code should we use to charge for identifying Staph saprophticus in a urine culture if we do a Staph latex and a Novobiocin disk? (answered 11/06/2005) |
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Compliance question: If we report out a urine culture as mixed gram positive flora, probable contamination should we charge for a presumptive ID (CPT code 87088). Thank you. (answered 10/28/2005) |
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3. Reimbursement for waived CLO tests as 87077-QW: The current listing of tests granted waived status under CLIA (www.cms.hhs.gov/clia/waivetbl.pdf) indicates that the Campylobacter Like Organism (CLO) test for Helicobacter pylori produced urease enzyme in gastric biopsy tissue, should be billed as 87077QW. Code 87077 has the descriptor “Culture, bacterial; aerobic isolate, additional methods required for definitive identification, each isolate.” Questions have arisen from ASM members regarding the appropriateness of this code for the CLO procedure. Code 87077 is used for the definitive biochemical identification of aerobic isolates, defined in the Microbiology Section preamble as requiring panels with more than 3 unique biochemical reactions. Definitive biochemical identification is of a significantly higher complexity and cost than the CLO test which measures a single biochemical reaction. While no specific CPT code exists for the “CLO” urease test, code 87081 “Culture, presumptive, pathogenic organisms, screening only” is a more appropriate descriptor for this procedure. While code 87077 has an NLA $11.29, 87081 is set at $9.26. ASM requests that CMS review the most appropriate code and reimbursement for this assay and issue a specific guidance statement. Again, thank you for the opportunity to provide comments on the 2004 Clinical Laboratory Fee Schedule Did you ever receive verification from CMS on this request for the CLO Test to use 87077 or 87081, or did they respond with another code? Thank you. (answered 10/28/2005) |
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I have been told by Binax to use CPT codes 87804 AND 87804-59 for Binax Now Influenza A and B as 2 separate antigens are tested,2 results etc. Is this acceptable ? If not, what would be correct ? (answered 10/28/2005) |
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Urine culture have been giving me headaches in regards to CPT coding. Specifically do all urine culture get the coded with 87086. If pathogens are found, you can add 87076 and 87186-if an ID and susceptibilities are needed? If you have a yeast:87086,87106 abd 87102? If you isolate a MRSA: 87088,87186 and how do you add-on Cefoxitin and Vancomycin screen agar plate? Are the rapid methods of identification considered definitive? Yeast such as C. glabrata and C. albicans, if identified-is the coding 87106 and 87102 if not from blood. Can we code anaerobe cultures different from aerobe cutlures? (answered 10/28/2005) |
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We are using a rapid Influenza antigen test that detects both A and B virus. The physician orders one test, and receives two answers - pos or neg for A, pos or neg for B. Are we supposed to use CPT code 87400 and charge for each answer - even though only one test was ordered? I don't think it is practical to offer the physician the choice to order either an Influenza A rapid screen or a B rapid screen. October (answered 10/25/2005) |
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CAN YOU CHARGE FOR A BACTERIAL IDENTIFICATION IF YOU ONLY PERFORM A GERM TUBE ON YEASTS? (answered 10/19/2005) |
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This is a policy and procedure question. I have recently been hired as the Microbiology Supervisor and I have noticed and complained about specimens from er, surgery, and the floors not being properly labeled. They come to us with no names on them, and if they have names of the patients the nurses do not put their initials, time and date of collection,nor the source that it came from (i.e. cath urine or clean catch, wound site, type of body fluid). In our policy and procedure manual we are to reject these specimens, but this has never been inforced by the Lab Manager, Lab Medical Director, nurse managers,or the Director of nurseing. It has always been said not to upset the nurses by telling them what to do and what is right. We even got a spinal fluid the other day that only had numbers on the tubes (1,2,3,4) in a bag that wasn't labeled either. We were told to do the tests anyway and the nurse that brought it down was not responsible if we rejected it. My question is if CAP inspectors or JCAHO inspectors were to walk in the hospital tomorrow and see these specimens not labeled, what actions would they take? You can see how frustrated I am, coming from a hospital that this was strickly not tolerated. Thank you (answered 09/19/2005) |
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if culture and sensitivity , Reflex test is done with specimen source being urine. ORG 1: Escherichia coli and the susceptiblity results are ampicillin R Cefazolin S cedtriaxone S Ciprofloxacin S Levofloxacin S Nitrofurantoin S Tobramycin S Trimethroprim/sulfa S how many units of 87186 would be allowed to be billed? (answered 09/16/2005) |
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What CPT codes are appropriate for use in the scenario: Rapid strep neg, set follow-up strep culture, and perform a phadebact beta strep typing. We currently use 87880 for rapid strep, 87071 for follow-up culture, and 87147 for strep typing if appropriate. We seem to be denied one of these as "content of service" to another one but not always the same denial. Any suggestions? (answered 07/29/2005) |
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Compliance question: In our laboratory, there are protocols outlining when an isolate should be "worked up" (ID and sensitivity) and when isolates should be "listed" with a comment "Further ID by physician request". Also, there are extensive protocols for referring isolates to previous cultures that were worked up. For a variety of reasons, techs may go ahead and workup and report isolates that, per protocol, could have been "referred" or just "listed". Should associated charges be cancelled to the patient for this work since the protocol was not strictly followed? What would be more problematic during an audit- work performed, reported and not billed (cancelled) or work performed that did not match the lab protocols? (answered 07/26/2005) |
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Compliance - In the CPT Micro preamble, what is "slide culture"? Is an optochin alone considered definitive for coding purposes, or would 3 additional biochemical tests have to be performed? (answered 07/26/2005) |
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Would the use of 91 modifier be appropriate when you are billing multiple 87071? Or should we use the -59 modifier? Could you answer using same culture site and different culture sites? Thank you for your time. (answered 07/26/2005) |
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What CPT code(s) should be used for quantitative BAL cultures? Suzanne Landry, Summit Hospital Baton Rouge, LA (answered 07/06/2005) |
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Compliance question. In our laboratory, there are protocols outlining when an isolate should be "worked up" (ID and sensitivity) vs when isolates should be "listed" with a comment "Further ID by physician request". Also, there are extensive protocols for referring isolates to previous positive cultures that were worked up. For a variety of reasons, techs may opt to work up and report isolates that,per protocol, could have been "referred" or just "listed". Should charges to the patient be cancelled for this worked performed and reported since the protocol was not strictly followed? What would be more problematic during an audit- work performed, reported and not billed (charges cancelled) or work performed and billed that did not match lab protocols? (answered 06/29/2005) |
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can you charge for doing an Identicult AE to id Enterococcus? If so, what CPT code would I need to use (answered 05/13/2005) |
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What CPT code(s) can be used for bacterial identification by 16S sequencing?
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Yet another CPT coding question... If we isolate a Staph on a urine
culture that turns out to be coag negative, we are billing for 87086 and
87088. Can we also bill for 87147 (or should we bill 87147 instead of
87088)? |
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I have some CPT coding questions about staph. If you perform a staph
agglutination test can you bill 87147 whether the result is positive or
negative or would this test be considered a presumptive as it does not
incorporate mutliple biochemicals to meet the >3 test requirement.Also
if you have a staph aureus on which you performed a cefoxitin disc to
check for MRSA but at the same time performed a VITEK MIC, can you bill
for both or would this be considered verification of the MIC result and
not allowed as it would be duplicate billing? |
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For Acinetobacter baumannii, our physicians want Pip/Tazo and Meropenem
sensitivity results. When setting an ID on the Vitek 2, we also set a MIC.
The Vitek 2 is not accurate for this organism and drug combinations, so we
set a Kirby sens for them. We are already charging 87186 for the MIC, can we
charge a 87184 for the Kirby drugs tested or because this is a limitation of
the Vitek, we cannot charge for the Kirby sens? Thanks Katie Itschner
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I've read the questions and answers from 6/13/03 and 10/10/03 and had
additional comment and question. 1) We do screen tests to back up other
tests in the event that the screen shows a VERY useful and reportable
result. This back up isn't because we, at our respective hospital, are
having problems with our instrument. This is a mandated back up test that
has to be done. CDC has mandated that users of automated susceptibility
testing perform a backup test for Vancomycin that can reliably detect the
VISA and VRSA strains. Since this is mandated and could provide reportable
and useful information, wouldn't it make sense to bill for the vanco screen?
Thanks |
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Could you explain MIC.21920 Are tolerance limits for potency of
antimicrobials established" What does this actually mean and how do I do
what they are asking? |
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We currently perform the Binax NOW RSV and Binax NOW FLUAB kits. If they are
positive we stop and charge (87420 or 87400 x 2). If the EIA is negative
then we go on to perform a Chemicon DFA. For RSV we stop and charge (87280)
for Influenza we charge (87276 and 87275) and stop if positive. If the
Influenza DFA is negative we send it to ARUP for culture which is an
additional charge. Are we compliant? May we charge for both DFA and Viral
culture? May we bill for all 3 tests - EIA, DFA and Culture? |
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Is it appropriate to charge for organism identification when much work,
including identification systems, was done but a definitive
identification could not be determined. The final report may go out
stating what has been ruled out. Our most common scenerios are aerobic
Gram positive rods where we report "Aerobic Gram positive Bacillus NOT
Bacillus, Listeria, or Erysipelothrix". In other situations the report
may go out as "most closely resembling...". |
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What CPT code should be used for the D test? |
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With regard to RPR testing and CPT coding, if we have a an RPR order
(86592) and it turns out to be positive and we do titers, should we
credit the original CPT and then charge for the quantitative (86593) or
can they both be charged? |
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Urine Culture Screen Our department is considering using a rapid urine
screen procedure from Coral Biotechnology. Specimens that are negative
would be completed the same day, and positive specimens would be plated
and worked up as our usual urine culture protocol. What is the suggested
CPT code that we should use for the screen and can we charge for the
urine culture along with the screen for those that are positive?
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I have a print out that i got from searching on internet clearly
indicating the changes to microbiology QC requirements (CFR/vol. 68, No.
16/ Friday january 24,2003/ Rules and Regulations, Pg. 3693). Please
tell me more about the new changes that have been in effect in the
microbiology QC. If possible,I would like to get a copy of the above or
any similar article that can be used as a reference guide and
documentation purposes? |
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Compliance- we have been charging a yeast ID when we identify Candida
albicans on cultures (fungus cultures, urine cultures, wound cultures)--we
use the Remel Candida albicans screen kit. We use Microscan Yeast ID panels
for other yeasts or to confirm C. albicans from sterile sources. Is charging
for a yeast identification correct from the rapid screen test? Thanks
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Once again, another question about CPT coding on urine cultures. If we
use a Microscan panel to identify a urine isolate, can we charge for a
definitive ID (CPT 87077? Also, can organisms such as lacto, alpha
strep, Coryne, etc (no biochemical tests performed) be charged as a
presumptive ID (CPT 87088)? Thanks |
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Can cpt code 87086-87088 be used with a urine dip paddle? Since it is a
semi -quantitative test for enumeration and presumptive identification
of uropathogens. Thanks |
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CAP requires that the humidity be monitored in the microbiology laboratory.
What is the acceptable range for humidity? |
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Can we bill for the rapid Trehalose test used to identify Candida
glabrata or is this considered a "simple" test and included in the
original isolation and presumptive identification code? |
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1. IF WE PERFORM AN ID/MIC ON AN ISOLATE AND THE ID AND/OR MIC IS
UNACCEPTABLE. WE WOULD PERFORM ADDITIONAL STUDIES/REPEATS TO OBTAIN AN
ACCEPTABLE RESULT. HOW SHOULD WE CODE TO CAPTURE MAXIMUM WORKLOAD CREDIT
FOR THE ADDITIONAL TESTING WE PERFORMED TO OBTAIN AN ACCEPTABLE ID/MIC
RESULT? ARE WE ALLOWED TO ONLY CODE FOR 1 DEFINITIVE ID 87077 AND MIC
87186? 2. WHAT IS THE PROPER WAY TO CODE FOR THE D TEST OR THE ESBL
CONFIRMATION DISC TEST TO COMPLETE AN MIC RESULT(87186)? |
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I attended the ASM Sunrise session on coding and reimbursement, and want
to make sure I am interpreting my notes correctly. 1) Is it now OK to
bill for an aerobic and anaerobic culture together again (87070 and
87075)? 2. Can you explain the use of the urine codes 87086 and 87088.
Should they ever be used together? 3. Is there a way to code CF Cultures
to reflect their complexity? I have something in my notes about using
87081 x 2 for B. cepacia and S. aureus screen? 4. Can I bill for ID of
nonpathogen from stool? Is documentation of work-up in the electronic
worksheet sufficient for audits? Thanks for your help Jodi Garrett
Microbiology Manager The Nebraska Medical Center Omaha NE |
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Compliance question: We identify Group B strep on urine, routine vaginal
cultures and GBS screens for OB patients by gram stain, catlase and a
positive latex w/ Group B reagent. If I understand correctly, we may
charge 87147 for the vag. culture and GBS screen. We currently use this
code for charging for the urine isolates as well. My questions are: 1)
Should we be charging a presumptive ID for reporting GBS on urine
cultures? 2) A previous Ask It response mentioned you should always do
at least 2 latex agglutintions (GAS or GAC) in addition to the GBS to
rule out a cross reaction. Do you charge 87147 for each latex reagent
used? For non-hemolytic Strep B, we set up a bile esculin slant and a
salt broth (to rule out enterococcus). We do not charge anything if the
isolate is an enterococcus. 4) We perform disk diffusion for Erythro & Clindamcyin on pencillin allergic OB patients. We presently charge for
one disk diffusion- should we charge 1 for each antibiotic tested?
Thanks for your help. |
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Can we charge for 87086 (culture, bacterial: quant colony count, urine) and
87088 (with isolation and presump id of isolate, urine) together? |
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I
need information on charging in the Microbiology Lab. Is there a concise
publication on this issue. |
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1. Is code 87207 the appropriate CPT code for a direct wet mount from
stool for an ova and parasite exam? This is my interpretation from the
information under code 87177 "To report direct smears from a primary
source, consult CPT code 87207" We currently pass codes 87177 (although
it says direct smear I believe it refers to the wet mount performed from
the concentration, doesn't it?) and 88313 for the trichrome. 2. Re:
Malaria - We currently only pass code 87207, but are adding 87015 for
thick smear preparation. Does anyone pass code 87207 X2 for examining
thick and thin smears? It occurred to me that it would be a fair
practice since both exams are time consuming to read (and with the new
CAP requirement we will have to quantitate them as well), but I don't
know that it is "permissible" or common practice. |
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In regard to CPT coding for Microscan combo panels that contain biochemicals
for organism ID as well as MIC testing, what would be the correct coding for
this panel. Should we be coding for the ID (87077) and MIC (87186) or for
the MIC only since this is a combined panel? If we use the later approach,
we would be shorting ourselves workload credit (RVU) and since that is what
makes the world turn these days in terms of staffing our department....
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I
am struggling with the correct way to bill our Viral Respiratory Panel. We
set a tissue culture that is held 14 days and perform hemadsorption at day 4
and day 10. In addition 3 R-mix shell vials are set. Using a polyvalent
fluorescent stain, one shell vial is stained at 24 and 48 hours. If
polyvalent stain is positive, a shell vial is scraped and cells spotted to a
multi-well slide, and stained for Parainfluenza 1, 2, 3, Influenza A, B,
RSV, and Adenovirus. Can I bill 87252 for tissue culture, 87253 x 2 for
hemadsorption, 87254 for shell vial, and 87140 for each immunofluorescent
stain? |
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Our Infetious Disease dotors have requested we report our direct sensitivity
performed from positive blood culture bottles. We back up and report the
direct with a standard test, and add a comment regarding the limitations of
the direct test. Can the laboratory charge for 2 senstivities? |
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Billing for primary culture code and definitive ID: If you have a
culture with 2 (or more organisms) and you do a definitive IDs, can you
bill for the primary code (eg. 87070) and then also bill for 2
definitive IDs (87077)? |
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Can you please generate a list of CLIA waived tests that may be performed by
a lab assistant in the Microbiology Laboratory |
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How is the supervisor tested for competence? Who should do it? |
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I was recently approached by our blood bank supervisor to participate in an
initial monitor to help meet new AABB standards that require examination of
random platelet units for bacterial contamination. They are required to do a
one time pH monitor on "seeded" platelet units to demonstrate that measuring
a drop in pH is an effective way of detecting platelet units that are
bacterially contaminated. Several sites that we know of have used Staph
aureus as a gram positive organism seed and Klebsiella pneumoniae as a gram
negative organism seed but no one seems to have defined what the colony
forming units of the initial bacterial seed should be. I would like to know
if anyone else has participated in this sort of a onetime monitor and what
the cfu seed was that was used and how that cfu inoculum was achieved. |
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Is
it appropriate to code a urine specimen with a vre screen cpt 87081? |
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I
have a question about the CPT 2004 update on stool culture. Currently, we
use 2 CPT codes, 87045 and 87046, for a stool culture. We screen for
Salmonella, Shigella and Campylobacter routinely, therefore, a campy plate
is always set up as part of our routine stool culture request. Our
negative report says "No Salmonella, Shigella or Campylobacter
isolated". If it is a special request for Yersinia and E.coli 0157, we
add 2 additional plates and CPT 87046 x 2 are added as add-on billings.
Our negative report says "No Salmonella, Shigella, Campylobacter,
Yersinia or E.coli 0157 isolated". With the new description of CPT 87046
in CPT 2004 (see below), does it mean that we can only bill 87046 if
Campylobacter or Yersinia or E.coli 0157 is isolated? Could we bill for
aerobic ID, 87077 in addition to 87046 if an isolate is identified as
Campylobacter or Yersinia or E. coli 0157 because additional plates are
set up and identification is performed? Can we bill for additional plates
for additional pathogens requested even though the culture is negative?
Can we bill for identification work-up such as Vitek ID or API 20 E on
suspicious colonies of Yersinia if it turns out not to be Yersinia? CPT
DESCRIPTIONS OF CPT 87046: CPT 2003: stool, additional pathogens,
isolation and preliminary examination (eg. Campylobacter, Yersinia, Vibrio,
E. coli 0157) EACH PLATE. CPT 2004: stool, aerobic, additional pathogens,
isolation and PRESUMPTIVE IDENTIFICATION OF ISOLATES. |
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We "screen" cultures for various organisms upon request (e.g.,
nares for MRSA, vaginal for Group B Strep)& identify them if they are
present. Any other potential pathogen is NOT identified or reported. What
would be the appropriate CPT code(s) for this type of culture & identification? |
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In
regards to CPT code 87186 - could you explain it to me. I can do 3
different antibiotics per microtiter plate. Do I charge 87186 3 times for
each antibiotic testing or just once. |
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I
am trying to determine the correct CPT codes to use for every situation in
our clinical microbiology laboratory. As you know this is not always clear
when reading the CPT Coding manuals, after talking with several hospitals
in my area, it seems there are differing interpretations of how the codes
should be applied. Are there any publications or articles available that
give clear explanations and examples? I am in the process of wading
through the NCCI and NCD policies but I am concerned that I may be
misinterpretating. |
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What
is the proper CPT code to use for cryptococcal antigen testing. The 2003
CPT book says to use 86403 however our consultant says that that should
not be used because it is only for antibody. she said we should use 87899.
also what would we use for positives that are titered. |
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What
is the proper CPT coding for presumptive detection of H.pylori by means of
urease detection? |
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We
are receiving denials when billing CPT 87176. Sometimes it is billed once
with CPT's 87077 and 87070 and the 87176 gets denied. It is also getting
denied when billed multiple times for the same patient. These are not
being used to confirm an ID but are being used as distinct procedural
services. 1. 87186 with 87077 & 87070: Wound culture (87070) along
with charge ID aerobe and mic gram positive card. 2. 87186 for mic gram
negative and one for mic gram positive cards. These too are billed along
with 87070 and 87077. I am not a micro person as you can tell but am
responsible for billing our micro testing. Could you shed some light on
this problem for us. |
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If
a culture is performed on all negative rapid group A strep antigen tests,
can you bill for both the Rapid and the culture ? |
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CAN
THE RAPID TESTS DESCRIBED IN NCCLS M35A BE CHARGED UNDER CPT CODING AND IF
SO WHAT CODING CAN BE USED? |
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I
have a question regarding CPT coding. I was under the impression that
87181 can be used when for a vancomycin or oxacillin screen plate. I was
also under the impression that it can be billed along with 87186 for the
MIC panel these screening plates confirm. Is 87181 the correct code to be
used for these screening plates AND can it be billed along with 87186? |
|
sputum
gram stains Our lab is going through a charging audit. Currently we are
charging all gram stains on sputum specimens. If the gram-stain shows >25 epis and <10WBC's we reject the culture and cancel the culture
charge. We still charge for the Gram Stain. They auditors told us that we
cannot charge for the Gram Stain, since this is a specimen quality control
issue since we are not doing the culture. Does this sound resonable?
Perhaps, we should continue with the culture and put a disclaimer in that
the specimen is suboptimal based on gram stain results. What would you
recommend. |
|
We
have been told that we cannot charge for a gram stain on a sputum specimen
when we report out ">25 epi/lpf <10wbc/lpf. Repeat specimen
suggested." Since this is indicative of not a good sputum specimen.
We cancel the culture charge since we do not procede with culturing. What
is your opinion on cancelling the Gram Stain charge. We do the gram stain
and report as above. |
|
Medicare
is now using NCD's for medical necessity. CPT code 87186 has medical
necessity applied only for a urine culture scenerio. Is there a separate
CPT for sensitivities on all other sites or does medicare need to update
their medical necessity for NCD's? |
|
COMPLIANCE
ISSUE SPECIATING STAPH USING LATEX AGGLUTINATION TECHNIQUES. CAN THIS BE
CHARGED GETTING A NEGATIVE LATEX, REPORTING COAGULAGE NEGATIVE
STAPHYLOCOCCUS, AND IF SO, WHAT CPT CODE SHOULD BE USED? |
|
What
is the CPT code that should be used for PBP2' assay? Can it be charged
under a Microbiology code, or perhaps an Immunology code? |
|
A
couple of coding questions: 1. With the new Binax NOW RSV test, should we
charge 87240 enzyme immunoassay, multiple step method, specific for RSV or
87450 enzyme immunoassay, single step method, NOS? 2. It was my
understanding that CPT codes 87810 - 87899 Immunoassay with direct optical
observation are only to be used for procedures or results obtained from
the Thermo BioStar products. |
|
I
have another question in reference to a question that was answered
12/10/02. The question is concerning charging for Gram smears performed on
positive blood cultures. Can we charge for each positive culture even if
smears are done on multiple positive blood cultures from same patient? Or
should the patient only be charged for a Gram smear one time? |
|
When
is it appropriate to bill for CPT code 87015 Concentration (any type), for
infectious agents.? Does this include centrifugation for body fluids such
as CSF, etc.? |
|
CPT
codes: Is there a CPT code to use when it is necessary to ship an isolate
to another facility? The shipping containers required for use to comply
with IATA regulations are expensive. It would also be good to be able to
allow a charge for the time required to prepare the package for shipment. |
|
What
is the current thought on charging for organism ID's that turn out to be
normal flora, so are not really reported out? An example would be an H2S
pos. gram neg rod in a stool culture that is beng screened by a vitek EPS
card and it ends up being a Citrobacter and not a Salmonella. |
|
Compliance,
CPT coding, Virology. Our FI is rejecting charges if 87254 (shell vial)
and 87253 (hemabsorption) are billed on the same date of service. We offer
a rapid respiratory viral culture which uses both conventional cell lines
(87252) and shell vials. We use the hemabsortion test on our tubes, not
the shell vials. However, the charges reject because they are billed on
the same date of service. This seems unreasonable to reject charges for
work that seems to be appropriately coded. What is the solution? Would a
letter of explanation to the FI be warranted, or are there some CPT coding
rules that I am missing? |
|
When
ordering wound cultures for both aerobic and anaerobic cultures which CPT
codes should be used? It appears that the combination of 87070 and 87075
or 87073 are mutually exclusive, therefor, cannot be used together. What
codes are appropriate under medicare guidelines? |
|
If
we isolate a yeast from blood, and do a definitive ID, do we use code
87106? |
|
I
am setting up a new Micro lab in a LTAC Rehab hospital and need input on a
billing question. What is the most appropriate way to handle charges for
gram stains on blood cultures, i.e., do you charge for false positives or
do you charge for gram stain on culture where an organism is worked up? |
|
Compliance,
CPT coding question: Is it acceptable to offer the "composite"
N. gonorrhoeae and Clamydia trachomatis amplified probes (we use Roche
Amplicor) as long as we also offer the individual tests? The physician has
the choice of checking the box for the composite or the individual tests.
Or is this considered a "panel" which is not CMS (HCFA) approved
and docs should be required to order both individual tests if they want
both? |
|
Under
the new NCD definitions and CPT coding, can you bill 87088 for presump ID
(<=3 simple tests) and/or 87088 for defin ID (complex method, i.e.
Vitek, Microscan, API20E) depending on methods used? |
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