CPT 2004 updates how you get paid for 87040-87075
Minor changes to microbiology codes 87040-87075 mean major changes for coding and reimbursement. Removing two little words -- "each plate" -- from 87046 changes the way you code a standard stool culture. And adding two little words -- "except blood" -- to CPT 87075 ensures you don't erroneously code separately for anaerobic blood cultures.
Clean Up Stool Culture Coding
You can no longer report 87046 (Culture, bacterial; stool, aerobic, additional pathogens, isolation and presumptive identification of isolates) for each plate. If a physician orders a stool culture for a patient with diarrhea, you should report 87045 (Culture, bacterial; stool, aerobic, with isolation and preliminary examination [e.g., KIA, LIA], Salmonella and Shigella species).
What to do: "If the lab performs additional stool culture presumptive identification beyond Salmonella and Shigella, you should report that service with 87046 once, regardless of the number of plates," says William Dettwyler, MT-AMT, president of Codus Medicus, a laboratory coding consulting firm in Salem, Ore. Before CPT 2004 changed the code definition, you could report 87046 for each additional isolate plated for a stool culture.
CPT 2004 also cleans up the 87046 language to accommodate the microbiology section's distinction between presumptive and definitive identification. "While the old code definition used the term 'preliminary examination,' the new definition uses the term 'presumptive identification,' " says Diane Liles, MT (ASCP), laboratory manager for business and business development at Penrose-St. Francis Healthcare/Centura Health in Colorado Springs, Colo. The term "preliminary examination" remains in the 87045 definition, however. (See "Examine These CPT 2004 Culture Code Changes" on page 35 for new and old code definitions of these and other culture codes).
CPT Adds 'Aerobic' to Code Definitions
For codes 87040-87070 (Culture, bacterial; ...), CPT 2004 added "aerobic" to the code descriptor. "The addition doesn't change how you'll report services; it just clarifies how you should have been using the codes all along -- to describe presumptive identification of aerobic cultures," Dettwyler says.
Code 87075 describes presumptive identification of anaerobic cultures from various sources. Codes 87040-87070 describe presumptive identification of aerobic cultures, each from a specific source.
"Because 87075 specified 'anaerobic,' coders understood that, by default, codes 87040-87070 involved aerobic cultures," Dettwyler says.
Blood Culture Includes Anaerobic
Exception: Although 87040 now specifies "aerobic," it also includes an anaerobic culture (87040, Culture, bacterial; blood, aerobic, with isolation and presumptive identification of isolates [includes anaerobic culture, if appropriate]). "The 2004 code definition clarifies that 87040 describes presumptive identification of both aerobic and anaerobic blood cultures," Dettwyler says.
To further clarify that 87040 includes anaerobic culture, the new CPT 2004 definition for 87075 (Culture, bacterial; any source, except blood, anaerobic with isolation and presumptive [...]