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.

CPT-4 Code Primary Diagnosis Code Secondary Diagnosis Code
87186 S101-2, S201-2, S301-2, S401-2, S501-2, S701-2 5950, 5997, 7881, 78841, 78909

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

SOURCE: Source
INDUSTRY NEWS TAGS: California Medi-Cal

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