How To Use CPT Code 87081

CPT 87081 is a code for culture, presumptive, pathogenic organisms, screening only, and this article will cover its description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples.

1. What is CPT 87081?

CPT 87081 is a code used to describe a laboratory procedure that involves culturing a patient specimen on a test medium designed to grow only a specific pathogenic organism. This test is a screening method for a specific pathogen, allowing the lab analyst to determine if the patient specimen is positive or negative for the specific organism. It is often ordered by clinicians when the clinical presentation suggests a specific organism and the clinician wants to affirm or rule out that organism.

2. 87081 CPT code description

The official description of CPT code 87081 is: “Culture, presumptive, pathogenic organisms, screening only.”

3. Procedure

1. The lab analyst collects the patient specimen from any source, such as urine or a throat swab.
2. The specimen is applied to a growth medium, such as a test dish containing agar and nutrients.
3. The test dish is held in controlled conditions for a specific period of time, such as 24 hours or a week, to see if any microorganisms grow in colonies on the medium.
4. If growth is observed, the lab analyst determines if the patient specimen is positive or negative for the specific organism based on the growth or absence of colonies on the specific selective medium.

4. Qualifying circumstances

Patients eligible to receive CPT code 87081 services are those who present with clinical symptoms suggesting a specific organism, and the clinician wants to affirm or rule out that organism. This test is not limited to a specific condition but can be used to identify the presence of a specific organism in a patient specimen, such as Vibrio, Streptococcus, or Legionella.

5. When to use CPT code 87081

It is appropriate to bill the 87081 CPT code when a clinician orders a culture test to screen for a specific pathogenic organism based on the patient’s clinical presentation. This test is used to confirm or rule out the presence of the specific organism in the patient specimen, without providing an estimation of the degree of colony growth.

6. Documentation requirements

To support a claim for CPT 87081, the following information needs to be documented:

• Patient’s demographic information, including name, date of birth, and insurance information.
• Clinical presentation and symptoms suggesting a specific organism.
• Order for the culture test from the clinician, specifying the suspected organism.
• Source of the patient specimen (e.g., urine, throat swab).
• Results of the culture test, indicating positive or negative for the specific organism.
• Any additional relevant clinical information or test results.

7. Billing guidelines

When billing for CPT code 87081, it is essential to follow the appropriate billing guidelines and rules. Some tips and codes that apply to CPT code 87081 include:

• Ensure that the documentation supports the medical necessity of the test.
• Verify that the patient’s insurance covers the specific test.
• Include the appropriate diagnosis code(s) on the claim form to support the need for the test.
• Bill the test separately from other laboratory services provided on the same day, if applicable.

8. Historical information

CPT 87081 was added to the Current Procedural Terminology system on January 1, 1990. There have been updates to the code description since then:

• Code Changed on 01-01-2010: Culture, presumptive, pathogenic organisms, screening only.
• Code Changed on 01-01-2001: Culture, bacterial, screening only, for single organisms.

9. Similar codes to CPT 87081

Five similar codes to CPT 87081 and how they differentiate from CPT 87081 are:

1. CPT 87070: This code is for a culture of any source, with isolation and identification of potential pathogens, but not limited to a specific organism.
2. CPT 87075: This code is for a culture of any source, with isolation and identification of anaerobic organisms.
3. CPT 87076: This code is for a culture of any source, with isolation and identification of aerobic and facultative organisms.
4. CPT 87077: This code is for a culture of any source, with isolation and identification of aerobic and facultative organisms, including susceptibility testing.
5. CPT 87084: This code is similar to CPT 87081 but includes an estimation of the degree of colony growth in addition to a positive or negative result.

10. Examples

Here are 10 detailed examples of CPT code 87081 procedures:

1. A patient presents with symptoms of a Vibrio infection, and the clinician orders a culture test to confirm or rule out the presence of Vibrio in the patient’s stool sample.
2. A patient with a sore throat and fever is suspected of having a Streptococcus infection, and the clinician orders a throat swab culture to screen for the presence of Streptococcus.
3. A patient with pneumonia symptoms is suspected of having a Legionella infection, and the clinician orders a culture test to screen for the presence of Legionella in the patient’s sputum sample.
4. A patient with a urinary tract infection is suspected of having an Escherichia coli infection, and the clinician orders a urine culture to screen for the presence of E. coli.
5. A patient with a skin infection is suspected of having a Staphylococcus aureus infection, and the clinician orders a culture test to screen for the presence of S. aureus in the patient’s wound swab.
6. A patient with meningitis symptoms is suspected of having a Neisseria meningitidis infection, and the clinician orders a culture test to screen for the presence of N. meningitidis in the patient’s cerebrospinal fluid sample.
7. A patient with a respiratory infection is suspected of having a Bordetella pertussis infection, and the clinician orders a culture test to screen for the presence of B. pertussis in the patient’s nasopharyngeal swab.
8. A patient with a gastrointestinal infection is suspected of having a Salmonella infection, and the clinician orders a culture test to screen for the presence of Salmonella in the patient’s stool sample.
9. A patient with an eye infection is suspected of having a Chlamydia trachomatis infection, and the clinician orders a culture test to screen for the presence of C. trachomatis in the patient’s conjunctival swab.
10. A patient with a genital infection is suspected of having a Neisseria gonorrhoeae infection, and the clinician orders a culture test to screen for the presence of N. gonorrhoeae in the patient’s genital swab.