Aetna considers broth culture testing for interstitial cystitis experimental and investigational because there is inadequate evidence of the effectiveness of this test in the diagnosis and management of interstitial cystitis.Background
Interstitial cystitis (IC) is a treatable but essentially incurable chronic condition of the bladder manifested by urinary urgency, frequency, and bladder pain. It is of unknown etiology. Researchers are working to understand the causes of IC and to find effective treatments; however, no compelling evidence for any hypothesized cause is available at this time (Stenchever, 2001; Hanno, 2002).
The diagnosis of IC is primarily one of exclusion, made from the combination of symptoms, cystoscopic findings and bladder biopsies (Hanno, 2002; Selo-Ojeme, 2004). Hanno (2002) recommends a bladder biopsy only if necessary to rule out other disorders that might be suggested by the cystoscopic appearance. Some of the symptoms of IC resemble those of bacterial infection, but medical tests reveal no organisms in the urine of patients with IC and antibiotic therapy is of no therapeutic benefit (Hanno, 2002; Chancellor, 2004).
Using a specific broth culturing method developed by a microbiologist, a team of Virginia medical researchers are investigating a theory that IC is caused by gram-positive bacteria. This view is contrary to the peer-reviewed published literature that IC is of non-bacterial origin. The broth culturing method is based on pure culture technology and requires initial culture of urine specimens in broth culture to allow all microbial strains from the specimens to emerge. By transfer aliquots to appropriate differential media, the etiologic agent can then be isolated for further study and reported to the physician along with the appropriate antibiotic sensitivity pattern (Interstitial Cystitis Information Center website). Results by this team of researchers have not been published.
According to Duncan (1997) and Hanno (2002), attempts to show an infectious etiology for IC have been made for a number of years; however, none of these approaches has provided convincing evidence that micro-organisms or viruses are associated with IC. Thus, there are little data to support the role of an infectious etiology for IC or the use of antibiotics in treatment of IC.
The American Urological Association’s clinical practice guideline on “Diagnosis and treatment of interstitial cystitis/bladder pain syndrome” (Hanno et al, 2011), a review on “Methods and incentives for the early diagnosis of bladder pain syndrome/interstitial cystitis” (Fall and Peeker, 2013), as well as UpToDate reviews on “Pathogenesis, clinical features, and diagnosis of interstitial cystitis/bladder pain syndrome” (Clemens, 2013a) and “Management of interstitial cystitis/bladder pain syndrome” (Clemens, 2013b) do not mention the use of broth culture testing.
Smith et al (2014) noted that surgeons frequently obtain intra-operative cultures at the time of revision total joint arthroplasty. The use of broth or liquid medium before applying the sample to the agar medium may be associated with contamination and false-positive cultures; however, the degree to which this is the case is not known. These investigators (i) calculated the performance characteristics of broth-only cultures (sensitivity, specificity, positive predictive value [PPV], and negative predictive value [NPV]) and (ii) characterized the organisms identified in broth to examine if a specific organism showed increased proclivity for true-positive periprosthetic joint infection (PJI). These researchers performed a single-institution retrospective chart review on 257 revision total joint arthroplasties from 2009 through 2010. A total of 190 (74 %) had cultures for review. All culture results, as well as treatment, if any, were documented and patients were followed for a minimum of 1 year for evidence of PJI. Cultures were measured as either positive from the broth only or broth negative. The true diagnosis of infection was determined by the Musculoskeletal Infection Society criteria during the pre-operative work-up or post-operatively at 1 year for purposes of calculating the performance characteristics of the broth-only culture. The sensitivity, specificity, PPV, and NPV were 19 %, 88 %, 13 %, and 92 %, respectively. The most common organism identified was coagulase-negative Staphylococcus (16 of 24 cases, 67 %). Coagulase-negative Staphylococcus was present in all 3 true-positive cases; however, it was also found in 13 of the false-positive cases. The authors concluded that broth-only positive cultures showed poor sensitivity and PPV but good specificity and NPV. The good specificity indicated that it can help to rule in the presence of PJI; however, the poor sensitivity makes broth-only culture an unreliable screening test. The authors recommended that broth-only culture results be carefully scrutinized and decisions on the diagnosis and treatment of infection should be based specifically on the Musculoskeletal Infection Society criteria. This study provided Level 4 evidence.
|CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes.  Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|Other CPT codes related to the CPB:|
|87086||Culture, bacterial; quantitative colony count, urine|
|87088||with isolation and presumptive identification of each isolate, urine|
|87181 - 87190||Susceptibility studies, antimicrobial agents|
|Other HCPCS codes related to the CPB:|
|P7001||Culture, bacterial, urine; quantitative, sensitivity study|
|ICD-10 codes not covered for indications listed in the CPB:|
|N30.10 - N30.11||Interstitial cystitis (chronic)|