How To Use CPT Code 87086

CPT 87086 is a code used for bacterial urine culture and quantitative colony count procedures. This article will cover the description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 87086.

1. What is CPT 87086?

CPT 87086 is a code used in medical billing and coding to represent a specific laboratory procedure, which involves the culturing of a urine sample to determine the presence and quantity of bacterial colonies. This test is typically ordered for patients exhibiting symptoms of a urinary tract infection (UTI) and helps clinicians identify the causative bacteria and determine the appropriate treatment.

2. 87086 CPT code description

The official description of CPT code 87086 is: “Culture, bacterial; quantitative colony count, urine.”

3. Procedure

  1. The patient provides a clean catch or catheterized urine specimen.
  2. The lab analyst or microbiologist cultures the urine specimen using a calibrated microbiology loop to inoculate the appropriate media with approximately one-thousandth of a milliliter of the urine sample.
  3. The cultured sample is incubated for approximately 18 hours.
  4. The lab analyst or microbiologist quantitates the number of bacterial colonies present, which is the colony count.
  5. If there is bacterial growth, the microbiologist proceeds with identification and antibiotic sensitivity testing, which may involve additional reportable codes.
  6. If no growth is observed after additional incubation, the report will show no growth, and the procedure is complete, allowing for the reporting of CPT 87086.

4. Qualifying circumstances

Patients eligible to receive CPT code 87086 services are those who exhibit symptoms of a urinary tract infection, such as frequent urination, pain or burning during urination, cloudy or strong-smelling urine, and lower abdominal pain. Clinicians order the quantitative urine culture to confirm the presence of a bacterial infection and determine the appropriate treatment plan.

5. When to use CPT code 87086

It is appropriate to bill the 87086 CPT code when a urine culture and quantitative colony count procedure have been performed on a patient exhibiting symptoms of a urinary tract infection. The code should be used to report the laboratory procedure and the resulting colony count, whether growth is observed or not.

6. Documentation requirements

To support a claim for CPT 87086, the following information should be documented:

  • Patient’s demographic information, including name, date of birth, and insurance information.
  • Relevant clinical history and symptoms indicating the need for a urine culture and colony count.
  • Details of the urine specimen collection method (clean catch or catheterized).
  • Results of the urine culture, including the presence or absence of bacterial growth and the colony count.
  • Any additional testing performed, such as bacterial identification and antibiotic sensitivity testing, along with the corresponding CPT codes.

7. Billing guidelines

When billing for CPT code 87086, it is essential to ensure that the documentation supports the medical necessity of the procedure and that all required information is included in the patient’s medical record. Additionally, if further testing is performed, such as bacterial identification or antibiotic sensitivity testing, the appropriate CPT codes should be reported alongside CPT 87086.

8. Historical information

CPT 87086 was added to the Current Procedural Terminology system on January 1, 1990. The code was changed on January 1, 2001, with the previous descriptor being “Culture, bacterial, urine; quantitative, colony count.”

9. Similar codes to CPT 87086

Five similar codes to CPT 87086 and how they differentiate are:

  1. CPT 87088: This code is used for urine culture presumptive identification of each isolate.
  2. CPT 87077: This code is used for urine culture definitive bacterial identification, aerobic isolate, with additional methods required for definitive identification, for each isolate.
  3. CPT 87184: This code is used for susceptibility studies by disk method on urine culture isolates, with 12 or fewer agents.
  4. CPT 87186: This code is used for susceptibility studies by MIC technique on urine culture isolates.
  5. CPT 87070: This code is used for culture, bacterial, any other source except urine, blood, or stool, with isolation and presumptive identification of isolates.

10. Examples

Here are 10 detailed examples of CPT code 87086 procedures:

  1. A patient presents with symptoms of a UTI, and the clinician orders a urine culture and colony count. The lab analyst performs the procedure, and the colony count is reported as 100,000 CFU/mL.
  2. A patient with a history of recurrent UTIs provides a clean catch urine sample for culture and colony count. The lab analyst reports no growth after incubation.
  3. A patient with diabetes and suspected UTI undergoes a urine culture and colony count. The lab analyst reports a colony count of 50,000 CFU/mL.
  4. A patient with a spinal cord injury and suspected UTI provides a catheterized urine sample for culture and colony count. The lab analyst reports a colony count of 200,000 CFU/mL.
  5. A pregnant patient with symptoms of a UTI undergoes a urine culture and colony count. The lab analyst reports a colony count of 25,000 CFU/mL.
  6. A patient with a history of kidney stones and suspected UTI provides a clean catch urine sample for culture and colony count. The lab analyst reports a colony count of 75,000 CFU/mL.
  7. A patient with an indwelling urinary catheter and suspected UTI undergoes a urine culture and colony count. The lab analyst reports a colony count of 150,000 CFU/mL.
  8. A patient with a recent urinary tract surgery and suspected UTI provides a clean catch urine sample for culture and colony count. The lab analyst reports a colony count of 10,000 CFU/mL.
  9. A patient with a history of bladder cancer and suspected UTI undergoes a urine culture and colony count. The lab analyst reports a colony count of 500,000 CFU/mL.
  10. A patient with a neurogenic bladder and suspected UTI provides a catheterized urine sample for culture and colony count. The lab analyst reports a colony count of 250,000 CFU/mL.

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