In medical billing, accuracy is everything. From proper documentation to CPT coding, every detail affects reimbursement and compliance. One commonly billed laboratory test is the urine culture, often ordered to diagnose urinary tract infections (UTIs). But which CPT code should you use when billing for this test? Let’s explore the correct code, when to use additional ones, and how accurate coding supports a smooth revenue cycle.
Current Procedural Terminology (CPT) codes, developed by the American Medical Association (AMA), are essential identifiers for medical, surgical, and diagnostic services. They allow healthcare providers and insurers to communicate uniformly for claim processing, reimbursement, and reporting.
Accurate CPT coding ensures:
For a broader understanding of how CPT codes function within healthcare billing, explore our guide on medical billing and coding.
The primary CPT code for a urine culture test is CPT 87086 “Culture, bacterial; quantitative, colony count, urine.”
This code applies when a urine specimen is cultured to identify bacterial presence and report the colony count.
If the initial culture grows bacteria, additional testing may be necessary to identify the organism(s). That’s where CPT 87088 comes in “Culture, bacterial; with isolation and presumptive identification of each isolate, urine.”
If two different bacterial strains are found, the following codes would apply:
You can verify the full coding details via the AAPC official CPT code listing.
In some cases, further testing is performed on isolates obtained from the culture. Depending on your lab’s workflow and payer policy, codes like 87184 (susceptibility test) may also apply.
To avoid confusion, always check your laboratory’s documentation and payer rules before submitting multiple CPT codes. Accurate pairing with ICD-10 diagnosis codes such as N39.0 (Urinary tract infection, site not specified)—is crucial for approval.
It’s easy to confuse a urinalysis with a urine culture, but they’re billed separately:
For a detailed breakdown of urinalysis CPT codes, visit Urinalysis CPT Codes Explained.Why Accurate Coding Matters
Precise CPT coding for urine culture tests has a direct impact on your revenue cycle. Incorrect or incomplete coding can lead to:
By maintaining accuracy in your coding, you help ensure every service is properly captured and reimbursed. Learn how it all connects in our detailed guide on revenue cycle management in medical billing.
Understanding the correct CPT code for urine culture (87086) and related codes like 87088 ensures accuracy, compliance, and optimal reimbursement. Whether you’re managing billing for a small practice or a large healthcare organization, accurate coding plays a vital role in financial success.
At EZ Settle Solutions, we specialize in helping healthcare providers streamline their medical billing and coding processes, minimize denials, and improve cash flow efficiency.
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