subject: Unlock Culture and Shiga Toxin Antigen test Pay with These Tips [print this page] Stool testing for patients with diarrhea might involve screening, cultures, and/or antigen tests. Here are some expert tips to help you sort through the lab methods and payer coverage rules to ensure you're not leaving money on the table.
Distinguish stool culture from screening culture
To identify enteric organisms that could be the reason behind diarrhea, the lab might culture a stool specimen to encourage growth of several possible causative organisms. For example, the doctor might request a routine stool culture, which would likely include cultures for Salmonella/ Shigella and Campylobacter. Or the doctor could request a thorough enteric pathogen culture, which might additionally culture for Yersinia and Vibrio and possibly enterohemorragic E. coli.
Watch out for CCI bundles
Now that you understand the distinction between a culture and a screening culture, you will understand why CMS imposes coding restrictions for these services in the CCI edits.
CCI bundles 87081 as a column 2 code with 87046 and also bundles 87045 as a column 2 code with 87081 on the ME edits table. CCI lists a 1' modifier indicator for both edit pairs.
Capture additional identification or antigen test
Following a culture, the lab might carry out additional studies to further identify the isolated organism(s) and you will need to code those services separately. If the lab tests an aerobic stool culture isolate for definitive identification using procedures such as biochemical panels, report 87077 for the additional tests.
Do not let negative culture stop you
Coders often think if they can report a culture or screening culture if the lab doesn't isolate an organism in other words, if the results are negative.
Yes: You can report the right base code like 87045, 87046 (for stools) or 87081 even if no growth occurs in the culture.
Likewise, if the lab processes an isolate using additional identification method, however determines that the isolate is a nonpathogen and doesn't identify the organism to the species level, you should still use 87077. CPT coding represents the work the lab carries out, not whether the lab reports a pathogen.
For more on this and other pathology coding tips, sign up for a one-stop medical coding website. When you sign up for one, you'll get free coding updates pertaining to pathology coding.
Unlock Culture and Shiga Toxin Antigen test Pay with These Tips
