The micro lab has numerous “add on” procedures that are routinely performed to complete the culture report. Frequently, add on charges are never captured. There are several reasons for this – some process driven (such as bill drop dates coming too soon for the completion of all testing) and human errors (not submitting charges in a timely manner). One BIG reason is simply because bacteria do not grow at the whim of human time lines.
One of the processes we microbiologists can’t fight (or understand) is the CCI edits for multiple cultures performed on a single date of service. The typical outpatient needing bacterial cultures on any given date of service will usually have only one “source” cultured. However, it is not unusual for outpatient surgery patients, observation patients, emergency room patients or even inpatients to have more than one culture on a single date of service. The table below lists the current code pairs with edits for Blood Cultures (87040), Wound Cultures (87070) and Urine Cultures (87088).
The majority of aerobic cultures (identified with CPT codes 87045, 87046, 87070, 87081, or 87088) can have colonies (think isolates) visible in 24 to 48 hours. Once growing, the isolates are evaluated by the microbiologist who may perform a battery of identification procedures based on the colony morphology, source of the specimen, potential pathogens and presumptive identification. Even if the identification procedure results in negative results, ie, a “non-pathogen”, the procedure was warranted, documented and necessary for the report conclusion. These add-on charges, (such as CPT code 87077 - aerobic identification - and if the organism is a genus with serotypes (like Streptococcus), CPT 87047 – serological typing per antisera used in the testing - and susceptibility testing (CPT code 87186)) are eligible to be billed.
Moral to the story, hold the bill drop on claims with micro cultures for another day or two and increase “real” money in the bank. While reimbursement (not revenue, but real $$) is less than $50 each claim, remember -- volume is high!
Written by: Betty Hatten, CPC-H, MHS, MT(ASCP)