87086

Culture, bacterial; quantitative, urine

A laboratory procedure involving the quantitative bacterial culture of a urine specimen. This test is performed to detect and enumerate bacteria present in a measured quantity of urine, typically to diagnose urinary tract infections (UTIs) and differentiate true infection from specimen contamination. A calibrated loop or other quantitative method is used to inoculate a culture medium, which is then incubated. The number of colony-forming units (CFUs) is counted, providing a quantitative result (e.g., CFU/mL), and the predominant organism(s) are identified. This process is crucial for guiding appropriate antimicrobial therapy.

Clinical Indications

  • Symptoms suggestive of urinary tract infection (e.g., dysuria, urinary frequency, urgency, suprapubic pain, flank pain, fever).
  • Diagnosis of suspected urinary tract infection (UTI).
  • Evaluation of recurrent or complicated urinary tract infections.
  • Monitoring efficacy of antimicrobial treatment for UTIs.
  • Screening for asymptomatic bacteriuria in specific populations (e.g., pregnant women, patients prior to urological procedures or kidney transplantation).
  • Suspected pyelonephritis or other kidney infections.

Procedure Steps

  1. Receive and accession urine specimen, ensuring proper collection (e.g., clean-catch midstream, catheterized, suprapubic aspirate) and transport.
  2. Using a calibrated loop (e.g., 0.001 mL or 0.01 mL), quantitatively inoculate appropriate selective and non-selective agar media (e.g., blood agar, MacConkey agar).
  3. Incubate inoculated media plates at 35-37°C for 18-24 hours in a non-CO2 atmosphere.
  4. Examine plates for bacterial growth, count colony-forming units (CFUs) to determine bacterial concentration (e.g., >10^5 CFU/mL, 10^4-10^5 CFU/mL, <10^4 CFU/mL).
  5. Perform Gram stain on representative colonies for initial morphological and Gram reaction assessment.
  6. Identify predominant bacterial isolates using appropriate methods (e.g., biochemical tests, automated identification systems, mass spectrometry).
  7. Report final results including bacterial concentration and identified organism(s).

Coding Guidelines

  • CPT code 87086 describes a quantitative bacterial urine culture. It specifically includes the enumeration of bacterial colonies.
  • Do not report 87086 if CPT code 87088 (Culture, bacterial; urine, with isolation and presumptive identification of isolates, any method, and susceptibility if indicated) is performed, as 87088 typically includes quantitative culturing and further workup.
  • If additional definitive identification beyond presumptive methods is required (e.g., for uncommon or complex isolates), separate CPT codes for identification (e.g., 87101, 87102, 87103, 87140, 87143, 87147, 87150, 87152, 87153) may be reported in addition to 87086 if medically necessary and separately performed.
  • Antibiotic susceptibility testing (AST) is reported separately using appropriate CPT codes (e.g., 87184 for disk diffusion, 87186 for microdilution, 87187 for gradient strip) if performed based on laboratory protocol and clinical indication.
  • Documentation must clearly support the medical necessity for performing a quantitative urine culture, detailing patient symptoms, suspected condition, or screening purpose.

Associated ICD-10 Codes