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Pathology Procedure Code Separation

Effective for dates of service on or after August 1, 2008, Medi-Cal is adopting Medicares requirement of separating pathology procedure codes related to microbiology services into the following categories.

  • Presumptive identification of microorganisms is defined as identification by the colony morphology, growth on selective edia, gram stains, or up to three tests (eg, catalase, oxidase, indole and urease).
  • Definitive identification of microorganisms is defined as identification to the genus or species level that requires additional tests (eg, biochemical panels, slide cultures). If additional studies involve molecular probes, chromatography, orimmunologic techniques, these should be separately coded in addition to definitive identification codes CPT-4 codes 87140 87158.

CPT-4 codes 87046, 87070, 87071, 87073, 87075 87077, 87088, 87101 87103, 87106 and 87107 may be billed to a maximum quantity of up to three isolates on the same date of service, for the same recipient, and by the same rendering provider.


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INDUSTRY NEWS TAGS: California Medi-Cal


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