CPT CODE and description
87086 – Culture, bacterial; quantitative colony count, urine – average fee amount – $10 – $20
87088 – Culture, bacterial; with isolation and presumptive identification of each isolate, urine
87186 – Susceptibility studies, antimicrobial agent; microdilution or agar dilution (minimum inhibitory concentration [MIC] or breakpoint), each multi-antimicrobial, per plate
87184 – Susceptibility studies, antimicrobial agent; disk method, per plate (12 or fewer agents
Urine Culture, Bacterial
1. Specific coding guidelines:
A urine culture will be obtained to test for the presence of infection that may have been undetected in the mother.
a. Use CPT 87086 Culture, bacterial, urine; quantitative, colony count where a urine culture colony count is performed to determine the approximate number of bacteria present per milliliter of urine. The number of units of service is determined by the number of specimens.
b. Use CPT 87088 where a commercial kit uses manufacturer defined media for isolation, presumptive identification, and quantitation of morphotypes present. The number of units of service is determined by the number of specimens.
c. Use CPT 87088 where identification of morphotypes recovered by quantitative culture or commercial kits and deemed to represent significant bacteriuria requires the use of additional testing, for example, biochemical test procedures on colonies. Identification based solely on visual observation of the primary media is usually not adequate to justify use of this code. The number of units of service is determined by the number of isolates.
d. Use CPT 87184 or 87186 where susceptibility testing of isolates deemed to be significant is performed concurrently with identification. The number of units of service is determined by the number of isolates. These codes are not exclusively
used for urine cultures but are appropriate for isolates from other sources as well.
e. Appropriate combinations are as follows: CPT 87086, 1 per specimen with 87088, 1 per isolate and 87184 or 87186 where appropriate.
f. Culture for other specific organism groups not ordinarily recovered by media used for aerobic urine culture may require use of additional CPT codes (for example, anaerobes from suprapubic samples).
g. Identification of isolates by non-routine, nonbiochemical methods may be coded appropriately (for example, immunologic identification of streptococci, nucleic acid techniques for identification of N. gonorrhoeae).
h. While infrequently used, sensitivity studies by methods other than CPT 87184 or 87186 are appropriate. CPT 87181, agar dilution method, each antibiotic or CPT 87188, macrotube dilution method, each antibiotic may be used. The number of units of service is the number of antibiotics multiplied by the number of unique isolates.
Limitations
1. CPT 87086 may be used one time per encounter.
2. Colony count restrictions on coverage of CPT 87088 do not apply as they may be highly variable according to syndrome or other clinical circumstances (for example, antecedent therapy, collection time, and degree of hydration).
3. CPT 87088, 87184, and 87186 may be used multiple times in association with or independent of 87086, as urinary tract infections may be polymicrobial.
4. Testing for asymptomatic bacteriuria as part of a prenatal evaluation may be medically appropriate but is considered screening and therefore not covered by Medicare. The U.S. Preventive Services Task Force has concluded that screening for asymptomatic bacteriuria outside of the narrow indication for pregnant women is generally not indicated. There are insufficient data to recommend screening in ambulatory elderly patients including those with diabetes. Testing may be clinically indicated on other grounds including likelihood of recurrence or potential adverse effects of antibiotics, but is considered screening in the absence of clinical or laboratory evidence of infection
Commonly Used ICD-10 Codes Medical Necessity
Effective October 1, 2015, appropriate ICD-10 code(s) are required with each requisition.
Note: This is a partial listing of ICD-10 Codes and is no way indicative of all available codes. For complete list of codes, refer to www.cms.gov/medicare-coverage-database Medical Necessity guideline
CMS (Medicare) has determined that Bacterial Culture, Urine (CPT Codes 87086, 87088) is only medically necessary and, therefore, reimbursable by Medicare when ordered for patients with any of the diagnostic conditions listed below in the “ICD-9-CM Codes Covered by Medicare Program.” If you are ordering this test for a diagnostic condition other than those listed below, please have your patient sign and date an Advanced Beneficiary Notice (ABN). All ICD-9-CM codes provided must be consistent with the documentation in the patient’s medical records for the date of service.
URINE CULTURE (CPT 87086, 87088)
ICD-10 Description ICD-10 ICD-9
Abdominal Tenderness, Unspecified Site R10.819 789.6
Abdominal tenderness, Unspecified Site R10.819 789.69
Acute Cystitis without Hematuria N30.0 595.0
Acute Cystitis with Hematuria N30.01 595.0
Cystitis, Unspecified without Hematuria N30.90 595.9
Cystitis, Unspecified with Hematuria N30.91 595.9
Acute Prostatitis N41.0 601.0
Altered Mental Status, Unspecified R41.82 80.97
Bacteremia R78.81 790.7
Calculus in Bladder N21.0 594.0
Calculus of Lower Urinary Tract, Unspecified N21.9 594.9
Calculus of Prostate N42.0 602.0
Enlarged Prostate w/o Lower Urinary Tract Symptoms N40.0 600.0
Inflammatory Disease of the Prostate, Unspecified N41.9 601.9
Fever, Unspecified R50.9 780.6
Functional Urinary Incontinence R39.81 788.81
Hematuria, Unspecified R31.9 599.7
Hesitancy of Micturition R39.11 788.64
Other Amnesia R41.3 780.93
Other Difficulties with Micturition R39.19 788.69
Other Long-Term (Current) Drug Therapy Z79.899 V58.69
Other Symptoms & Signs Involving Genitourinary
System R39.89 788.99
Pain, Unspecified R52 780.96
Rebound Abdominal Tenderness, Unspecified Site R10.829 789.6
Rebound Abdominal Tenderness, Unspecified Site R10.829 789.69
Sepsis, Unspecified Organism A41.9 38.9
Streptococcal Sepsis, Unspecified A40.9 38.0
Tachycardia, Unspecified R00.0 785
Unspecified Abdominal Pain R10.9 789.00/ 789.09
Unspecified Renal Colic N23 788
Urethral Discharge without Blood R36.0 788.7
Urethral Discharge, Unspecified R36.9 788.7
Urgency of Urination R39.15 788.63
Urinary Tract Infection, Site Not Specified N39.0 599
