(Reproduced by permission from Medicare Focus, August, 1997, pp. 21-23.)

Medicare Part A
Local Medical Review Policy
Cultures

Policy Number: 96-05

Description

87081	Culture, bacterial, screening only, for single organisms
87082	Culture, presumptive, pathogenic organisms, screening only, by commercial kit(specify type); for single organisms
87083	multiple organisms
87084	with colony estimation from density chart
87085	with colony count

Type of Bill: 13X, 14X, 22X, 23X, 71X, 74X, 75X

Revenue Codes: 300-319

HCPCS Codes: 87081, 87082, 87083, 87084, 87085

Category: Pathology and Laboratory

Reason for Denial

Routine screening

Sources of Information

Medicare Carrier Manual, Section 2320
Laboratory and Diagnostic Tests, Fifth Edition, Lippincott, 1996
Other Carriers' Policies

Coding Guides

An appropriate CPT code should be used to indicate the type of specimen and culture being performed. The above codes are used for screening purposes only and will not be eligible for coverage.

Documentation Required

ICD-9 diagnosis codes are required on claim.

Medical records must clearly document the medical necessity for the test and the frequency of the test.

If documentation is requested for review, submit the following:

• History and Physical
• MD orders/progress notes
• Diagnosis/reason for test
• Test results
• Itemization of charges

Comments

HCFA has mandated that testing performed for screening purposes will not be eligible for coverage. For example, when the patient has no specific symptoms, complaints, injuries, or a chronic illness, the services are noncovered. When a screening culture results in an abnormal finding, the test is noncovered because the intent of performing the test was for routine, screening purposes.

This policy is being adapted from the Carrier policy. It does not represent the sole opinion of the Intermediary/Medical Director. This policy was developed in consultation with the medical community and the Carrier Advisory Committee.

Approval Dates