Wiki 87086 and 87088

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diann

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Good morning!
Hope someone can help me with this one. Our biller billed a claim with 87086 and 87088. The insurance (Healthcare USA) came back stating there was a "global code" that includes urine, culture, identification and sensitivity test. They stated they follow Medicare guidelines but when she bills these two codes together to Medicare it pays both codes. She asked our consultants and they stated the global code is 87088, however reimbursement is better if both codes are used and that Medicare and all third party payers are reimbursable. I see in the CPT book that 87088 is the hierarchy of the two codes. so the question is should she use a modifier on the 87086 to get it reimbursed?

thanks,
Diann DoBran CPC, CPC-H
 
87086 and 87088 can be billed together. However
87086 is the culture itself
87077 is the definitive isolate identification for each isolate (which is unusual on urine cultures)
87088 should also be added to this particular bill as it is the presumptive ID of each isolate
87186 is the susceptibilities for each isolate provided
 
Hi, reviewing our CPT book this evening I can see why 87086 and 87088 may possibly have a billing issue (even though no modifier is required). May I please assume a few things happening for this occasion, okay? 87086 Culture, bacterial, quantitative colony count, urine.
I am simply betting that something was absolutely "abnormal", and it created a "reflex" for some deep diving into what it the patient dealing with so 87088 is billed based on further testing billing 87088 "with isolation and presumptive identification of each isolate, urine.
As a coder I would review the original 87086 charge to identify what was absolutely so abnormal to create a reflex. From those findings I "may" possibly add a "procedure description" (AND from those VERY same notes you will utilize to appeal this) to add that something was abnormal. We are not clinicians to provide a diagnosis but only review records and reflexes to code accordingly as the clinician provided us.
Thank you for listening, I am hopeful I provided some of your answers this evening,
Dana Chock, CPC, CANPC, CHONC, CPMA, CPB, RHIT
 
How many units are you guys billing of 87186 on a susceptibility patient? 1 isolate, multiple antibiotics tested on a single plate (card) such as Vitek. CPT Assistant in Dec 2024 below makes it sound like you can bill per antibiotic, per plate but it kind of contradicts everything else but there is really not any other way to interpret it.

Question: Would it be appropriate to report code 87186 if antimicrobial susceptibility testing using microdilution or agar dilution is performed on two isolates?



Answer: Yes, if antimicrobial susceptibility testing using microdilution or agar dilution is performed on two isolates with each isolate per plate, it would be appropriate to report code 87186, Susceptibility studies, antimicrobial agent; microdilution or agar dilution (minimum inhibitory concentration [MIC] or breakpoint), each multi-antimicrobial, per plate. For example, if two different bacterial strains are isolated from a urine culture and each strain is tested with serial dilutions of six different antimicrobial agents, then it would be appropriate to report 12 units of code 87186.
 
Hello, How many units can be billed for codes 87147 and 87077, insurance is denying. What documentation supports more units for these tests?
 
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