To properly apply the urine culture codes subject to CMS'recent national coverage determination (NCD), it helps to know what each test entails.
Use CPT Codes 87086 (Culture, bacterial; quantitative colony count, urine) for the initial identification of a bacterial organism in a urine sample. 87086 is applicable when a urine culture colony count is performed to determine the approximate number of bacteria present per milliliter of urine. With this test, the number of units of service is determined by the number of specimens, according to CMS.
Urine culture code CPT 87088 ( with isolation and presumptive identification of isolates, urine) describes the use of a commercial kit that uses manufacturer-defined media for isolation, presumptive identification, and quantification of morphotypes present, according to the NCD. 87088 should be used only after 87086 has been performed on the urine specimen and a bacterial organism has been positively identified.
Codes 87184 (Susceptibility studies, antimicrobial agent; disk method, per plate [12 or fewer agents]) and 87186 ( microdilution or agar dilution [minimum inhibitory concentration (MIC) or breakpoint], each multiantimicrobial, per plate]) represent two types of susceptibility, or sensitivity, studies. These codes should only be used when susceptibility testing of isolates deemed to be significant is performed concurrently with identification to comply with CMS regulations. These codes don't apply only to urine cultures, but also to isolates from other sources.