Summary & Overview
CPT 87045: Aerobic Bacterial Stool Culture for Salmonella and Shigella
CPT code 87045 represents the laboratory procedure for aerobic bacterial stool culture, specifically targeting the identification of pathogens such as Salmonella and Shigella. This code is widely utilized in clinical settings to diagnose gastrointestinal infections, which are common and significant public health concerns across the United States. The procedure is classified under Pathology and Laboratory Procedures and is most often performed in independent laboratory facilities.
Major national payers, including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare, provide coverage for services billed under CPT code 87045. This publication offers a comprehensive overview of payer coverage, clinical context, and relevant billing practices. Readers will gain insights into the clinical indications for the test, typical sites of service, and associated coding practices. The summary also highlights related codes and modifiers commonly used in laboratory billing, as well as the taxonomies linked to this service. Benchmarks and policy updates are included to inform stakeholders about current trends and requirements in laboratory billing for stool cultures.
This resource is designed to support healthcare professionals, laboratory administrators, and policy analysts in understanding the national landscape for CPT code 87045, including payer coverage, clinical relevance, and coding considerations.
CPT Code Overview
CPT code 87045 is used for laboratory analysis involving an aerobic bacterial stool culture. This procedure is performed to isolate potential pathogens and includes a preliminary examination to determine the presence of Salmonella or Shigella species. The service falls under Pathology and Laboratory Procedures and is typically conducted in an Independent Laboratory setting (Place of Service 81). This test plays a crucial role in diagnosing gastrointestinal infections and guiding appropriate clinical management.
Clinical & Coding Specifications
Clinical Context
A patient presents to their healthcare provider with symptoms such as acute diarrhea, abdominal pain, and possibly fever. The provider suspects a bacterial cause for the gastrointestinal symptoms, such as Salmonella or Shigella infection. A stool sample is collected and sent to an independent laboratory (Place of Service 81) for analysis. The laboratory performs an aerobic bacterial stool culture using CPT code 87045, isolating possible pathogens and conducting a preliminary examination to determine the presence of Salmonella or Shigella species. The results assist the provider in diagnosing and managing the patient's condition.
Coding Specifications
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Modifiers:
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26: Used to indicate the professional component of the laboratory service, typically when the interpretation is performed separately from the technical work. - Modifier
90: Used when the laboratory test is performed by a reference (outside) laboratory rather than the provider's own facility.
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Associated Provider Taxonomies:
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