Urine Susceptibility Studies Reflex Testing Claims

Effective retroactively to August 1, 2006, claims for reflex testing with 87186 (susceptibility studies, antimicrobial agent; microdilution or agar dilution, per plate) that were erroneously denied will be automatically reprocessed. Providers need take no action.

Providers are reminded that a primary diagnosis S-code and a secondary diagnosis ICD-9-CM code listed in the table below must be entered on the claim form to qualify for reimbursement. Use of code 87186 as a reflex test is restricted to females subsequent to a positive result with code 87086 (culture, bacterial; quantitative colony count, urine). Claims submitted that do not follow these guidelines will be denied.

Note: Primary diagnosis codes S3032 and S7033 do not require a secondary diagnosis code.