How to Properly Use CPT Code for Urine Culture for Accurate Reimbursement

Understanding CPT Code for Urine Culture: A Guide to Accurate Reimbursement

For healthcare providers, accurately billing for services provided is crucial for proper reimbursement. This is especially true when it comes to laboratory tests such as urine culture. In order to receive the appropriate reimbursement for this service, it’s important to understand the correct CPT code to use and how to properly document the test.

The CPT Code for Urine Culture

The current CPT code for a urine culture is 87086. This code covers the examination of urine to identify the presence of bacteria, fungi, or viruses. It’s important to note that this code is for a routine culture only, and not for a comprehensive culture or testing for specific pathogens. These types of cultures would require different codes.

Documentation Requirements

In order to receive proper reimbursement for a urine culture, it’s essential to document the test accurately. This includes documenting the reason for the test, the method used to collect the sample, and the results of the culture.

It’s important to note that some payers may require additional documentation such as the patient’s symptoms or medical history. It’s important to check with the payer’s specific requirements to ensure accurate and complete documentation.

Coding for Multiple Cultures

In some cases, multiple urine cultures may be necessary to properly diagnose a patient’s condition. In these situations, it’s important to use the correct CPT code for each test performed.

If a patient requires multiple urine cultures on the same day, the CPT code 87086 should only be used once. For subsequent tests, the correct code to use is 87088. It’s important to properly document the reason for each additional test and to include the results of each culture in the patient’s medical record.

Conclusion

Properly documenting and coding for a urine culture is essential for accurate reimbursement. Understanding the correct CPT code to use and the required documentation can help healthcare providers ensure they receive the appropriate payment for their services. By following best practices for urine culture testing and documentation, healthcare providers can maintain compliance with payer requirements and provide the highest quality of care to their patients.

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