Urine Culture, Bacterial - Diagnostic Laboratory Services, Inc.

2020 MEDICARE NATIONAL COVERAGE DETERMINATION (NCD) - 190.12

PROCEDURE CODES: 87086, 87088

URINE CULTURE, BACTERIAL

6260 6266 58230 5870 5880 5930 5960 5980 5990

DLS TEST CODES AND NAMES CULTURE, URINE (Proc Code: 87086) CATH URINE CULTURE (Proc Code: 87086) PROSTATITIS CULTURE (Proc Code: 87086) ID, ORGANISM, URINE 1 - orderable by DLS Micro only (Proc Code: 87088) ID, ORGANISM, URINE 2 - orderable by DLS Micro only (Proc Code: 87088) ID, ORGANISM, URINE 3 - orderable by DLS Micro only (Proc Code: 87088) ID, ORGANISM, URINE 4 - orderable by DLS Micro only (Proc Code: 87088) ID, ORGANISM, URINE 5 - orderable by DLS Micro only (Proc Code: 87088) ID, ORGANISM, URINE 6 - orderable by DLS Micro only (Proc Code: 87088)

ICD-10 CODE

DESCRIPTION

A02.1

Salmonella sepsis

A18.14

Tuberculosis of prostate

A34

Obstetrical tetanus

A40.0

Sepsis due to streptococcus, group A

A40.1

Sepsis due to streptococcus, group B

A40.3

Sepsis due to Streptococcus pneumoniae

A40.8

Other streptococcal sepsis

A40.9

Streptococcal sepsis, unspecified

A41.01

Sepsis due to Methicillin susceptible Staphylococcus aureus

A41.02

Sepsis due to Methicillin resistant Staphylococcus aureus

A41.1

Sepsis due to other specified staphylococcus

A41.2

Sepsis due to unspecified staphylococcus

A41.3

Sepsis due to Hemophilus influenzae

A41.4

Sepsis due to anaerobes

A41.50

Gram-negative sepsis, unspecified

A41.51

Sepsis due to Escherichia coli [E. coli]

A41.52

Sepsis due to Pseudomonas

A41.53

Sepsis due to Serratia

A41.59

Other Gram-negative sepsis

A41.81

Sepsis due to Enterococcus

A41.89

Other specified sepsis

A41.9

Sepsis, unspecified organism

A42.7

Actinomycotic sepsis

A56.01

Chlamydial cystitis and urethritis

A56.02

Chlamydial vulvovaginitis

A56.11

Chlamydial female pelvic inflammatory disease

D65

Disseminated intravascular coagulation [defibrination syndrome]

D70.0

Congenital agranulocytosis

D70.1

Agranulocytosis secondary to cancer chemotherapy

Source: cms.mcd Effective date: 10-01-2016, last updated 10-1-2020

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2020 MEDICARE NATIONAL COVERAGE DETERMINATION (NCD) - 190.12

PROCEDURE CODES: 87086, 87088

D70.2 D70.3 D70.4 D70.8 D70.9 D72.10 D72.110 D72.111 D72.118 D72.119 D72.12 D72.18 D72.19 D72.89 E09.21 E09.22 E09.29 E11.10 E11.11 E87.2 E87.4 F45.8 G93.3 I50.814 I50.82 I50.84 I50.89

J80 J82.81 J82.82 J82.83 J82.89

J84.170

J84.178 K72.00 K72.01 K76.2 M04.1 M32.14 M32.15 M35.04 M54.89

URINE CULTURE, BACTERIAL

Other drug-induced agranulocytosis Neutropenia due to infection Cyclic neutropenia Other neutropenia Neutropenia, unspecified Eosinophilia, unspecified (add effective 10-1-2020) Idiopathic hypereosinophilic syndrome [IHES] (add effective 10-1-2020) Lymphocytic Variant Hypereosinophilic Syndrome [LHES] (add effective 10-1-2020) Other hypereosinophilic syndrome (add effective 10-1-2020) Hypereosinophilic syndrome [HES], unspecified (add effective 10-1-2020) Drug rash with eosinophilia and systemic symptoms syndrome (add effective 10-1-2020) Eosinophilia in diseases classified elsewhere (add effective 10-1-2020) Other eosinophilia (add effective 10-1-2020) Other specified disorders of white blood cells Drug or chemical induced diabetes mellitus with diabetic nephropathy Drug or chemical induced diabetes mellitus with diabetic chronic kidney disease Drug or chemical induced diabetes mellitus with other diabetic kidney complication Type 2 diabetes mellitus with ketoacidosis without coma Type 2 diabetes mellitus with ketoacidosis with coma Acidosis Mixed disorder of acid-base balance Other somatoform disorders Postviral fatigue syndrome Right heart failure due to left heart failure Biventricular heart failure End stage heart failure Other heart failure Acute respiratory distress syndrome

Chronic eosinophilic pneumonia (add effective 10-1-2020)

Acute eosinophilic pneumonia (add effective 10-1-2020)

Eosinophilic asthma (add effective 10-1-2020)

Other pulmonary eosinophilia, not elsewhere classified (add effective 10-1-2020)

Interstitial lung disease with progressive fibrotic phenotype in diseases classified elsewhere

(add effective 10-1-2020)

Other interstitial pulmonary diseases with fibrosis in diseases classified elsewhere

(add effective 10-1-2020)

Acute and subacute hepatic failure without coma Acute and subacute hepatic failure with coma Central hemorrhagic necrosis of liver Periodic fever syndromes Glomerular disease in systemic lupus erythematosus Tubulo-interstitial nephropathy in systemic lupus erythematosus Sicca syndrome with tubulo-interstitial nephropathy

Other dorsalgia

Source: cms.mcd Effective date: 10-01-2016, last updated 10-1-2020

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2020 MEDICARE NATIONAL COVERAGE DETERMINATION (NCD) - 190.12

PROCEDURE CODES: 87086, 87088

M54.9 N00.0 N00.1 N00.2 N00.3 N00.4

N00.5

N00.6

N00.7

N00.8

N00.9 N00.A N01.0

N01.1 N01.2 N01.3 N01.4 N01.5 N01.6

N01.7

N01.8 N01.9

N01.A N02.A N03.A N04.A N05.0 N05.1 N05.2 N05.3 N05.4 N05.5 N05.6 N05.7 N05.8 N05.9 N05.A N06.0 N06.1 N06.2 N06.3 N06.4 N06.5 N06.6

URINE CULTURE, BACTERIAL

Dorsalgia, unspecified Acute nephritic syndrome with minor glomerular abnormality Acute nephritic syndrome with focal and segmental glomerular lesions Acute nephritic syndrome with diffuse membranous glomerulonephritis Acute nephritic syndrome with diffuse mesangial proliferative glomerulonephritis Acute nephritic syndrome with diffuse endocapillary proliferative glomerulonephritis

Acute nephritic syndrome with diffuse mesangiocapillary glomerulonephritis

Acute nephritic syndrome with dense deposit disease

Acute nephritic syndrome with diffuse crescentic glomerulonephritis

Acute nephritic syndrome with other morphologic changes

Acute nephritic syndrome with unspecified morphologic changes Acute nephritic syndrome with C3 glomerulonephritis (add effective 10-1-2020) Rapidly progressive nephritic syndrome with minor glomerular abnormality

Rapidly progressive nephritic syndrome with focal and segmental glomerular lesions Rapidly progressive nephritic syndrome with diffuse membranous glomerulonephritis Rapidly progressive nephritic syndrome with diffuse mesangial proliferative glomerulonephritis Rapidly progressive nephritic syndrome with diffuse endocapillary proliferative Rapidly progressive nephritic syndrome with diffuse mesangiocapillary glomerulonephritis Rapidly progressive nephritic syndrome with dense deposit disease

Rapidly progressive nephritic syndrome with diffuse crescentic glomerulonephritis

Rapidly progressive nephritic syndrome with other morphologic changes Rapidly progressive nephritic syndrome with unspecified morphologic changes

Rapidly progressive nephritic syndrome with C3 glomerulonephritis (add effective 10-1-2020) Recurrent and persistent hematuria with C3 glomerulonephritis (add effective 10-1-2020) Chronic nephritic syndrome with C3 glomerulonephritis (add effective 10-1-2020) Nephrotic syndrome with C3 glomerulonephritis (add effective 10-1-2020) Unspecified nephritic syndrome with minor glomerular abnormality Unspecified nephritic syndrome with focal and segmental glomerular lesions Unspecified nephritic syndrome with diffuse membranous glomerulonephritis Unspecified nephritic syndrome with diffuse mesangial proliferative glomerulonephritis Unspecified nephritic syndrome with diffuse endocapillary proliferative glomerulonephritis Unspecified nephritic syndrome with diffuse mesangiocapillary glomerulonephritis Unspecified nephritic syndrome with dense deposit disease Unspecified nephritic syndrome with diffuse crescentic glomerulonephritis Unspecified nephritic syndrome with other morphologic changes Unspecified nephritic syndrome with unspecified morphologic changes Unspecified nephritic syndrome with C3 glomerulonephritis (add effective 10-1-2020) Isolated proteinuria with minor glomerular abnormality Isolated proteinuria with focal and segmental glomerular lesions Isolated proteinuria with diffuse membranous glomerulonephritis Isolated proteinuria with diffuse mesangial proliferative glomerulonephritis Isolated proteinuria with diffuse endocapillary proliferative glomerulonephritis Isolated proteinuria with diffuse mesangiocapillary glomerulonephritis Isolated proteinuria with dense deposit disease

Source: cms.mcd Effective date: 10-01-2016, last updated 10-1-2020

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2020 MEDICARE NATIONAL COVERAGE DETERMINATION (NCD) - 190.12

PROCEDURE CODES: 87086, 87088

N06.7 N06.8 N06.9 N06.A

N07.0 N07.1

URINE CULTURE, BACTERIAL

Isolated proteinuria with diffuse crescentic glomerulonephritis Isolated proteinuria with other morphologic lesion Isolated proteinuria with unspecified morphologic lesion Isolated proteinuria with C3 glomerulonephritis (add effective 10-1-2020) Hereditary nephropathy, not elsewhere classified with minor glomerular abnormality Hereditary nephropathy, not elsewhere classified with focal and segmental glomerular lesions

N07.2

Hereditary nephropathy, not elsewhere classified with diffuse membranous glomerulonephritis

N07.3 N07.4 N07.5 N07.6 N07.7 N07.8 N07.9 N07.A

N08 N10 N11.0 N11.1 N11.8 N11.9 N12 N13.0 N13.1 N13.2 N13.4 N13.5 N13.6 N13.70 N13.71 N13.721 N13.722 N13.729 N13.731 N13.732 N13.739 N13.8 N13.9 N14.0 N14.1 N14.2 N14.3

Hereditary nephropathy, not elsewhere classified with diffuse mesangial proliferative Hereditary nephropathy, not elsewhere classified with diffuse endocapillary proliferative Hereditary nephropathy, not elsewhere classified with diffuse mesangiocapillary Hereditary nephropathy, not elsewhere classified with dense deposit disease Hereditary nephropathy, not elsewhere classified with diffuse crescentic glomerulonephritis Hereditary nephropathy, not elsewhere classified with other morphologic lesions Hereditary nephropathy, not elsewhere classified with unspecified morphologic lesions Hereditary nephropathy, not elsewhere classified with C3 glomerulonephritis

(add effective 10-1-2020)

Glomerular disorders in diseases classified elsewhere Acute pyelonephritis Nonobstructive reflux-associated chronic pyelonephritis Chronic obstructive pyelonephritis Other chronic tubulo-interstitial nephritis Chronic tubulo-interstitial nephritis, unspecified Tubulo-interstitial nephritis, not specified as acute or chronic Hydronephrosis with ureteropelvic junction obstruction Hydronephrosis with ureteral stricture, not elsewhere classified Hydronephrosis with renal and ureteral calculous obstruction Hydroureter Crossing vessel and stricture of ureter without hydronephrosis Pyonephrosis Vesicoureteral-reflux, unspecified Vesicoureteral-reflux without reflux nephropathy Vesicoureteral-reflux with reflux nephropathy without hydroureter, unilateral Vesicoureteral-reflux with reflux nephropathy without hydroureter, bilateral Vesicoureteral-reflux with reflux nephropathy without hydroureter, unspecified Vesicoureteral-reflux with reflux nephropathy with hydroureter, unilateral Vesicoureteral-reflux with reflux nephropathy with hydroureter, bilateral Vesicoureteral-reflux with reflux nephropathy with hydroureter, unspecified Other obstructive and reflux uropathy Obstructive and reflux uropathy, unspecified Analgesic nephropathy Nephropathy induced by other drugs, medicaments and biological substances Nephropathy induced by unspecified drug, medicament or biological substance Nephropathy induced by heavy metals

Source: cms.mcd Effective date: 10-01-2016, last updated 10-1-2020

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2020 MEDICARE NATIONAL COVERAGE DETERMINATION (NCD) - 190.12

PROCEDURE CODES: 87086, 87088

N14.4 N15.0 N15.1 N15.8 N15.9 N16 N17.1 N17.2 N18.6 N20.0 N20.1 N20.2 N20.9 N21.0 N21.1 N21.8 N21.9 N22 N23 N28.0 N28.1 N28.81 N28.82 N28.83 N28.84 N28.85 N28.86 N28.89 N28.9 N29 N30.00 N30.01 N30.10 N30.11 N30.20 N30.21 N30.30 N30.31 N30.40 N30.41 N30.80 N30.81 N30.90 N30.91 N34.0

URINE CULTURE, BACTERIAL

Toxic nephropathy, not elsewhere classified Balkan nephropathy Renal and perinephric abscess Other specified renal tubulo-interstitial diseases Renal tubulo-interstitial disease, unspecified Renal tubulo-interstitial disorders in diseases classified elsewhere Acute kidney failure with acute cortical necrosis Acute kidney failure with medullary necrosis End stage renal disease Calculus of kidney Calculus of ureter Calculus of kidney with calculus of ureter Urinary calculus, unspecified Calculus in bladder Calculus in urethra Other lower urinary tract calculus Calculus of lower urinary tract, unspecified Calculus of urinary tract in diseases classified elsewhere Unspecified renal colic Ischemia and infarction of kidney Cyst of kidney, acquired Hypertrophy of kidney Megaloureter Nephroptosis Pyelitis cystica Pyeloureteritis cystica Ureteritis cystica Other specified disorders of kidney and ureter Disorder of kidney and ureter, unspecified Other disorders of kidney and ureter in diseases classified elsewhere Acute cystitis without hematuria Acute cystitis with hematuria Interstitial cystitis (chronic) without hematuria Interstitial cystitis (chronic) with hematuria Other chronic cystitis without hematuria Other chronic cystitis with hematuria Trigonitis without hematuria Trigonitis with hematuria Irradiation cystitis without hematuria Irradiation cystitis with hematuria Other cystitis without hematuria Other cystitis with hematuria Cystitis, unspecified without hematuria Cystitis, unspecified with hematuria Urethral abscess

Source: cms.mcd Effective date: 10-01-2016, last updated 10-1-2020

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