CPT 87076: Definitive Identification of Anaerobic Isolate
CPT code 87076 designates additional laboratory procedures performed to definitively identify a presumptively identified anaerobic isolate, often to the species level. Accurate anaerobic identification supports targeted antimicrobial therapy, infection control, and public health surveillance, making this code relevant across hospitals, clinical laboratories, and reference testing networks nationwide. Key national payers evaluated include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the clinical role of the service, common billing and coding context, and what to expect in payer coverage patterns and reimbursement benchmarks. The publication outlines the procedural scope of 87076, explains typical sites of service (hospital and reference microbiology laboratories), and highlights the operational and clinical implications of definitive anaerobic identification. It also summarizes coverage considerations and typical modifiers in use. Where specific payer policies or national benchmarks are unavailable, the report flags data gaps as "Data not available in the input." The content is intended for laboratory managers, billing specialists, and policy analysts seeking a concise national summary of the code's purpose, clinical relevance, and reimbursement context.
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Billing Code Overview
CPT code 87076 describes additional laboratory testing performed by a lab analyst on a presumptively identified anaerobic isolate to provide definitive identification, often to the species level. This service involves specialized microbiology methods that go beyond initial presumptive tests to characterize anaerobic organisms more specifically.
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Service type: Microbiology identification / confirmatory organism identification
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Typical site of service: Clinical laboratory, hospital microbiology laboratory, or reference laboratory
Data not available in the input for payers, associated taxonomies, ICD-10 diagnoses, and related codes.
Clinical & Coding Specifications
Clinical Context
A 62-year-old inpatient with a recent abdominal abscess undergoes drainage and culture. Initial anaerobic culture growth yields a presumptive anaerobic organism on basic phenotypic tests. The clinical microbiology laboratory performs 87076 when the lab analyst proceeds to additional, definitive testing—such as biochemical panels, automated identification systems, MALDI-TOF confirmation, or targeted molecular assays—to identify the anaerobic isolate to the species level. Typical workflow: specimen receipt and anaerobic culture setup, preliminary Gram stain and colony morphology assessment, presumptive identification (e.g., Bacteroides spp.), followed by performance of 87076 for definitive species identification to guide targeted antimicrobial therapy. Typical site of service is the hospital clinical microbiology laboratory or a reference laboratory receiving isolates from inpatient or outpatient settings. Common scenario modifiers include professional or technical component reporting when identification involves laboratory instrumentation or reference lab interpretation.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when only the professional component (interpretation) is billed separate from technical processing. |
TC | Technical component | Use when only the technical component (laboratory processing) is billed. |
90 | Reference (outside) laboratory | Use when testing is performed by an outside/reference laboratory. |
91 | Repeat clinical diagnostic laboratory test | Use when test is repeated on the same day to obtain a valid result. |
59 | Distinct procedural service | Use when this identification is distinct from other procedures on the same day (e.g., separate isolate testing). |
22 | Increased procedural services | Use when additional work beyond the usual identified to perform definitive species identification justifies increased payment. |
52 | Reduced services | Use when the service was partially reduced or not completed as originally planned. |
53 | Discontinued procedure | Use if testing started but discontinued due to specimen issues or contamination. |
78 | Unplanned return to the operating/procedure room | Rarely used; applicable if isolate collection was obtained during an unplanned return procedure and linkage is needed. |
59 | Distinct procedural service | Use when required to indicate a distinct lab procedure separate from other billed tests. |
XU | Unusual non-overlapping service (separate/anatomic site) | Use to indicate distinctness when laboratory bundling edits might apply and services are non-overlapping. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 207R00000X | Pathology & Laboratory – Anatomic & Clinical Pathology | Clinical microbiologists and pathologists who supervise or interpret advanced organism identification. |
| 3336S0001X | Clinical Laboratory – Microbiology | Laboratory technologists and microbiologists performing anaerobic cultures and identifications. |
| 208000000X | Pathology & Laboratory – Anatomic Pathology | Physicians involved in oversight and consultative interpretation of complex microbiology results. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
K65.0 | Acute peritonitis | Peritoneal infections often yield anaerobic isolates requiring species-level ID for targeted therapy. |
K35.80 | Acute appendicitis without perforation or abscess | Intra-abdominal infections from appendicitis frequently involve anaerobes needing definitive identification. |
K57.20 | Diverticulitis of large intestine with perforation and abscess | Diverticular abscesses commonly grow anaerobic organisms identified by 87076. |
J15.8 | Pneumonia due to other specified bacteria | Aspiration or necrotizing pneumonias can include anaerobes where species ID guides treatment. |
A41.9 | Sepsis, unspecified organism | When sepsis is suspected and anaerobic bloodstream isolates are recovered, 87076 may be performed to identify the species. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
87075 | Culture, presumptive; anaerobic organism, isolation and presumptive identification | Often performed immediately before 87076 when initial presumptive identification is obtained. |
87081 | Culture for pathogenic organisms, water, legionella, isolation and presumptive identification | Performed for environmental or special organism cultures when broader testing is needed; not routine but may accompany complex workflows. |
87491 | Infectious agent detection by nucleic acid (DNA or RNA); direct probe technique, each organism | May be used after 87076 for molecular confirmation or when rapid species-level identification is required. |
87498 | Infectious agent detection by nucleic acid (DNA or RNA), multiple organisms, multiplex amplified probe technique | Used when simultaneous molecular testing for multiple anaerobic pathogens complements species identification. |
87070 | Culture, bacterial; urine, automated, with isolation and presumptive identification | Different specimen type culture codes that may be part of the lab's panel of services; demonstrates related culture workflows. |