cpt code for urine culture, urine culture cpt code

CPT Codes For Urine Culture | Descriptions & Billing Guidelines

CPT’s manual describes urine culture CPT codes by CPT 87086, CPT 87088, CPT 87184, CPT 87186, and CPT 87081. Urine culture CPT codes describe investigative procedures used in urology and renal medicine.

When To Use A Urine Culture CPT Code Procedure

Urine culture CPT codes describe standard laboratory procedures to detect and isolate the aetiological organism of a urinary tract infection.

Urinary tract infection is any part of the urinary tract, such as the urethra, bladder, ureters, and kidney.

Urinary tract infections can be classified into different types based on their location, such as cystitis (bladder), pyelonephritis(kidneys), and urethritis (urethra).

Urinary tract infections can be classified into upper and lower urinary tract infections. Upper urinary tract infection symptoms include fever, chills, rigor, body weakness, flank (side) pain, abdominopelvic pain, and lower urinary tract infection symptoms.

Lower urinary tract infection symptoms include urgency, frequency, nocturia, dysuria, discharge, or incontinence. 

Understanding urinary tract infections and symptoms benefit urine culture tests’ effective and efficient coding. 

Urine culture tests can be done as a routine investigation in evaluating and managing other urological diseases. It is usually done after a urinalysis test. 

Urine Culture CPT Code Procedure Explained

In a Urine culture CPT code procedure, at least 4 mL of midstream urine is collected in a sterile container and stored at 4⁰C.

The urine sample is then cultured in a specified culture media to detect and isolate different microorganisms in urine samples through an agar-based culture media, with subsequent quantification of the microorganisms detected based on their morphology.

Usually, a diagnosis of urinary tract infection is made when there is the presence of at least 10⁵ CFU/mL of urine. 

A urine culture procedure also includes the antimicrobial susceptibility test for the isolated microorganism, as requested by the physician in charge of the patient. 

Description Of The CPT Codes For Urine Culture

Each component of the urine culture procedure highlighted above is appended with different CPT codes for urine culture.

Tip: We also wrote a billing guide about the CPT codes for urinalysis. You can find it here.

The urine culture CPT codes are described below.

CPT 87086

The 87086 CPT code for urine culture describes the quantitative analysis of bacteria in a urine sample to determine the colony count and the appropriate number of bacteria in a millimeter of urine.  

CPT code 87086 is officially described in CPT’s manual as: “Culture, bacterial; quantitative colony count, urine.”

CPT 87088

The 87088 CPT code for urine culture describes the culture, isolation, and presumptive identification of bacteria in urine samples with the aid of a manufacturer-specified media in a commercial kit.

CPT 87088 also involves quantitative analysis of the bacteria based on their morphological criteria. It is usually done after quantitatively analyzing the bacteria colony.

CPT code 87088 is officially described in CPT’s manual as: “Culture, bacterial; with isolation and presumptive identification of each isolate, urine.”

CPT 87081

The 87081 CPT code for urine culture describes the presumptive identification of pathogens and microorganisms in a urine culture.

It is a basic urine culture test, mainly used as a screening method before the physician moves on to formal urine culture studies, such as CPT 87086 and CPT 87088.

The 87081 CPT code is used mainly in facilities with lower clinical laboratory improvement amendment (CLIA) certificates. 

CPT code 87081 is officially described in CPT’s manual as: “Culture, presumptive, pathogenic organisms, screening only.”

CPT 87184

The 87184 CPT code for urine culture describes the sensitivity of isolated organisms in a culture media to up to 12 different antimicrobial agents, also called antibiotics.

It is used to understand the most effective antibiotic against isolated microorganisms. This procedure is done by placing a disk containing the antibiotics into the culture media containing the isolated microorganism. 

CPT code 87184 is officially described in CPT’s manual as: “Culture, presumptive, pathogenic organisms, screening only; with colony estimation from density chart.”

CPT 87186

The 87186 CPT code for urine culture describes the test for sensitivity of isolated organisms in a culture media to antimicrobial agents. This is done by examining the effect of antimicrobial agents’ concentration on the isolated microorganism’s growth by an agar dilution method.

In addition, the microdilution method can also evaluate a minimal inhibitory concentration of the antimicrobial agents. 

These two antimicrobial sensitivity tests are not exclusive to urine cultures, as lab scientists can also use them for antimicrobial susceptibility tests of isolates of body fluids from other sources.

CPT code 87186 is officially described in CPT’s manual as: “Culture, bacterial; quantitative colony count, urine.”

Billing Guidelines and Reimbursements

In the past, CPT 87086 and 87088 could not be reported together. However, due to the changes made by CMS, both codes can be billed and reimbursed together.

Medical coders can only report CPT 87088 after the 87086 CPT code procedure, and bacteria growth has been detected in urine samples. 

Adequate documentation for the CPT codes for urine culture is vital to the reimbursement of these procedures.

Therefore, the ordering/referring physician or qualified non-physician practitioner should keep accurate medical records, such as office/progress reports and lab findings, to demonstrate the medical necessity for the procedures described by the CPT codes for urine culture. It takes about two days to see results after planting a culture.

If the urine culture test services are not provided by the same physician or medical center, the medical center that rendered the service should maintain documentation of the test results and the interpretation of the results along with copies of the form used to order the test in the patient’s medical record.

 After documenting a positive result in the patient’s file, a hard copy, including the claim, should be printed.

Since claims for CPT 87086 and CPT 87088 can be reimbursed together, Medicare requires verification of the documentation of presumptive identification of microorganisms. 

Medical coders can report CPT 87088, CPT 87184, and CPT 87186 in association with or independent of CPT 87086. Also, CPT 87086 can only be used once per encounter by coders.

Documentation Required For Billing Urine Culture CPT Codes

A CPT code for urine culture will be denied if not considered medically necessary. There are indications specified by the CMS in which at least one of them must be present in the patient’s documentation before a urine culture test is considered medically necessary.

They include: 

  • Abnormal urinalysis results point to a possible urinary tract infection. For example, the presence of hematuria, pyuria, positive leukocytes esterase, nitrite, and protein;
  • A patient presenting with signs and symptoms suggesting a possible urinary tract infection.
  • Evaluation of patients for suspected sepsis or fever of unknown origin;
  • While urine culture tests aren’t used for uncomplicated urinary tract infections, urine culture can determine response to antimicrobial therapy in patients with coexisting urinary tract abnormalities, foreign body in situ, and urinary tract stents. These abnormalities further predispose them to recurrent urinary tract infections. 
  • In the preoperative evaluation of patients who is to undergo a surgical procedure that involves the manipulation of the genitourinary tract for infection or transurethral resection of the prostate in a case of prostate cancer or benign prostatic hypertrophy; and 
  • To evaluate a patient who has had a renal transplant and is on immunosuppressive medications for infection.

Urine culture CPT code procedures for prenatal tests for asymptomatic bacteriuria are considered a screening procedure and medically appropriate.

However, it is not considered medically necessary. Therefore, urine culture tests (presumptive, isolated identification, and antimicrobial susceptibility test) are not reimbursable when done for an asymptomatic urinary tract infection or asymptomatic bacteriuria. 

Urine culture culture tests done as a follow-up in patients whose urinary tract infection is clinically resolving or has resolved are not reimbursable. 

When urine culture tests (presumptive, isolated identification, and antimicrobial susceptibility test) are done as part of routine assessment and screening service for asymptomatic prostatitis and prognosis of prostate biopsy, it is not reimbursable. 

The billing costs for urine culture CPT code procedures are described below.

CPT 87086$8.07
CPT 87088$8.09
CPT 87081$6.63
CPT 87184$7.48
CPT 87186$8.65
Reimbursement for the CPT codes for urine culture

Modifiers

Modifier 22 and modifier 59 are typically not indicated in urine culture CPT code procedures. Even when you are reporting CPT 87086 and CPT 87088 together.

CPT codes for urine culture tests are not clinical laboratory improvement amendment (CLIA) waived tests. They have a reasonable risk of error, so they can only be performed in a certified laboratory. Hence, modifier QW is not indicated when reporting these procedures. 

Example 1

A patient presents to the emergency room with a history of frequency, urgency, nocturia, fever, and chills.

The urologist performed a urinalysis for the patient, which showed positive white blood cells, microscopic hematuria, and nitrite.

With the suspicion of urinary tract infection in mind, the urologist ordered a urine culture with a quantitative colony count, which showed over 100,000 bacteria per 1 millimeter of urine). 

The urine culture CPT code 87086 it reported for this test. 

Example 2

With the above tests confirming a urinary tract infection diagnosis, the urologist then orders for presumptive identification of the bacteria causing this infection. 

The urine culture CPT code 87088 it reported for this case. 

Example 3

With the bacteria causing the infection identified, the urologist then orders an antimicrobial susceptibility test using a disk method involving 12 antimicrobial agents to determine the most effective antibiotics for treating this patient. 

CPT code 87088 for urine culture is billed for this case. 

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