Stool Routine Cpt Code

[Mariela Laflam]

Cultureisolation and identification (at an additional charge) of Salmonella, Shigella, and Campylobacter, and detection of enterohemorrhagic E coli (EHEC) Shiga toxin by EIA. If culture results warrant, susceptibility testing (additional charges/CPT code[s] may apply) may be performed. CPT coding for microbiology and virology procedures often cannot be determined before the culture is performed. Requests with only a written order and no test number indicated will be processed according to Default Testing for Routine Microbiology.

Fecal specimens for different tests often need different transport containers and different transport conditions (eg, frozen, raw stool). Specimens should be portioned out to separate devices of each type for each test requested before sending to the laboratory. Stool for bacterial culture and enterohemorrhagic E coli Shiga toxin by EIA should be submitted in the C&S transport vial. Only a thumbnail-size portion of stool, about 1 g or 1 mL, should be added to the vial. Overfilling the vial will reduce recovery of stool pathogens.

Specimens from sources, such as genital, stool, urine, and upper and lower respiratory specimens, cannot be cultured under the aerobic bacterial culture test number. If specimens are incorrectly submitted with an order for aerobic bacterial culture, the laboratory will process the specimen for the test based on the source listed on the request form. The client will not be telephoned to approve this change, but the change will be indicated on the report.

Stool culture transport vial is required; diapers are not acceptable. Culture collection swab may be used to collect rectal swabs or a swab of fecal material, then swab should be placed in stool culture transport vial (Para-Pak C&S orange).

A single stool specimen cannot be used to rule out bacteria as a cause of diarrhea. It is recommended that two or three stool specimens, collected on separate days, be submitted to increase the probability of isolating a bacterial pathogen. Hospitalized patients who develop diarrhea while hospitalized and more than 72 hours after admission should be tested for Clostridium difficile by detection of either toxin A and/or toxin B.

Stool: Specimen should be collected in sterile bedpan, not contaminated with urine, residual soap, or disinfectants. Those portions of stool that contain pus, blood, or mucus should be transferred to a sterile specimen container.

Stool specimen can be divided for other types of cultures by the laboratory. Miscellaneous tests and ova and parasites tests should be split into appropriate containers and transport devices prior to shipping to the laboratory.

Specimen received in grossly leaking transport container; diapers; dry specimen; specimen submitted in fixative or additive; specimen received in expired transport media or incorrect transport device; inappropriate specimen transport conditions (not in a C&S vial or in an overfilled C&S vial); specimen received after prolonged delay in transport (usually more than 72 hours); specimen stored or transported frozen; wooden shaft swab in transport device; unlabeled specimen or name discrepancy between specimen and request label

Yersinia sp and Vibrio parahaemolyticus will not be isolated unless specifically requested; these will each be done with an additional charge. These organisms are fastidious and have very specific requirements for growth.

In acute or subacute diarrhea, three common syndromes are recognized: gastroenteritis, enteritis, and colitis (dysenteric syndrome). With colitis, patients have fecal urgency and tenesmus. Stools are frequently small in volume and contain blood, mucus, and leukocytes. External hemorrhoids are common and painful. Diarrhea of small bowel origin is indicated by the passage of few large volume stools. This is due to accumulation of fluid in the large bowel before passage. Leukocytes indicate colonic inflammation rather than a specific pathogen. Bacterial diarrhea may be present in the absence of fecal leukocytes and fecal leukocytes may be present in the absence of bacterial or parasitic agents (ie, idiopathic inflammatory bowel disease).2 See table. Although most bacterial diarrhea is transient (1 to 30 days) cases of persistent symptoms (10 months) have been reported. The etiologic agent in the reported case was Shigella flexneri diagnosed by culture of rectal swab.3 In infants younger than one year of age, a history of blood in the stool, more than 10 stools in 24 hours, and temperature greater than 39C have a high probability of having bacterial diarrhea.4,5 Diarrhea is also a common side effect of long-term antibiotic treatment. Although often associated with Clostridium difficile, other bacteria and yeasts have been implicated.6

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Isolation and identification (additional CPT codes) of potential aerobic pathogens and drug susceptibility tests (additional charge). Gram stain (additional test) is recommended. CPT coding for microbiology and virology procedures often cannot be determined before the culture is performed. Requests with only a written order and no test number indicated will be processed according to Default Testing for Routine Microbiology.

The test request form must state specific site of specimen, age of patient, and time of collection. Inclusion of current antibiotic therapy and clinical diagnosis may aid the laboratory in evaluating the specimen and work-up of the culture. If an unusual organism is suspected, this information must be specifically noted on the test request form (eg, Nocardia) and may result in additional charges. For extended incubation, order Aerobic Culture, Extended Incubation [180803].

Specimens from other sources, such as genital, stool, urine, upper and lower respiratory specimens, cannot be cultured under the aerobic bacterial culture test number. If specimens are incorrectly submitted with an order for aerobic bacterial culture, the laboratory will process the specimen for the test based on the source listed on the test request form. The client will not be telephoned to approve this change, but the change will be indicated on the report.

Disinfect contiguous areas of skin or mucous membrane containing resident normal flora prior to culture collection. Collect exudates from the interior of productive lesions. Tissue samples must be kept moist. A thin, air-dried smear for Gram stain obtained from the same site as the culture is strongly recommended (additional test).

Only rapid-growing, nonfastidious aerobic organisms can be recovered and identified by routine methods. Only organisms that predominate will be identified. Unless specifically requested by the physician, fastidious organisms may not be isolated. Anaerobic, fungal, and mycobacterial pathogens should be considered, and appropriate cultures requested if clinically indicated. The procedure will not detect Chlamydia, viruses, fungi, or mycobacteria.

Eye: The major modes of transmission of disease to the conjunctiva include the hands, airborne fomites, and spread for adjacent adnexal infections. Eye infections include eyelid infections, blepharitis, dacryocystitis, orbital cellulitis, conjunctivitis, keratitis, endophthalmitis retinitis, and chorioretinitis. Pinkeye is caused by adenovirus. It presents as bilateral conjunctivitis with a sudden onset. Herpes simplex and zoster present as periorbital or corneal infections. Nontuberculous mycobacterial keratitis may occur following trauma or surgery accompanied by the use of local corticosteroids.1

Do not refrigerate. Specimen should be submitted in stool O&P preservative vial. Mix sample well. Fresh stool specimens in a sterile leak-proof container can be submitted and should reach the lab within 1 hour after collection.

Stool specimens placed in 5% or 10% Buffered Formalin, SAF, MIF fixative or ATS Proto-fix must be in the fixative for a minimum of 60 minutes to assure adequate fixation of the sample prior to concentration. The appropriate volume of sample is up to the red fill line on the preservative vial with approximately 13-15 ml of fixative. Always mix the sample well. (Please note: specimens in formalin or SAF cannot be used for the trichrome stain, so if only one vial is sent the test has to be cancelled. Specimens in PVNA cannot be used for the concentrate, so if only this vial is sent the test has to be cancelled.)

Per literature review, stool specimens for ova and parasite testing from inpatients hospitalized longer than 3 days yield very few positive results. However, the test may be run if the physician notifies the Microbiology Lab verbally that there is a special reason for the request (for example if patient was traveling or had food brought to hospital from outside).

The CPT codes included in this publication are in accordance with Current Procedural Terminology, a publication of the American Medical Association. CPT codes are provided here for the convenience of our clients; however, correct coding often varies from one carrier to another, and HealthLab may bill specific carriers using codes other than those shown. Clients who bill for services should verify the code(s) with the applicable payor to confirm that their use is appropriate in each case.

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