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Clinical Policy Bulletin:
Broth Culture Testing for Interstitial Cystitis
Number: 0695


Policy

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.

 
CPT Codes / HCPCS Codes / ICD-9 Codes
Other CPT codes related to the CPB:
87086
87088
87181 - 87190
Other HCPCS codes related to the CPB:
P7001 Culture, bacterial, urine; quantitative, sensitivity study
ICD-9 codes not covered for indications listed in the CPB:
595.1 Chronic interstitial cystitis


The above policy is based on the following references:
  1. Hanno PM. Interstitial cystitis and related disorders. In: Campbell's Urology. 8th ed. PC Walsh, et al, eds. Philadelphia, PA: W.B. Saunders Co.; 2002; Ch. 16:631-660.
  2. Stenchever MA, Droegemueller W, Herbst A, et al. Urogynecology. Physiology of micturition, diagnosis of voiding dysfunction and incontinence: Surgical and nonsurgical treatment. In: Comprehensive Gynecology. 4th ed. St. Louis, MO: Mosby Inc.; 2001; Ch. 21:607, 618.
  3. Epstein JI. The lower urinary tract and male genital system. In: Robbins and Cotran: Pathologic Basis of Disease, 7th ed. V Kumar, AK Abbas, N Fausto, eds. Philadelphia PA: W.B. Saunders Co.; 2005; Ch. 21:1027.
  4. Bicknell SL, McCallum O, Wright LF. Urinary tract disorders. In: Textbook of Family Practice. 6th ed. RE Rakel, ed. Philadelphia, PA: W.B. Saunders Co.; 2002; Ch. 47:1300.
  5. Sant GR, Hanno PM. Interstitial cystitis: Current issues and controversies in diagnosis. Urology. 2001;57(6 Suppl 1):82-88.
  6. Nipkow L, Chai TC. Interstitial cystitis: Modern tools for an accurate diagnosis. Curr Urol Rep. 2003;4(5):381-384.
  7. Selo-Ojeme DO, Onwude JL. Interstitial cystitis. J Obstet Gynaecol. 2004;24(3):216-225.
  8. Parsons CL. Diagnosing chronic pelvic pain of bladder origin. J Reprod Med. 2004;49(3 Suppl):235-242.
  9. Nickel JC. Interstitial cystitis: A chronic pelvic pain syndrome. Med Clin North Am. 2004;88(2):467-481, xii.
  10. Chancellor MB, Yoshimura N. Treatment of interstitial cystitis. Urology. 2004;63(3 Suppl 1):85-92.
  11. MaLossi J, Chai TC. Interstitial cystitis: Diagnosis and treatment options. Curr Womens Health Rep. 2002;2(4):298-304
  12. Oberpenning F, van Ophoven A, Hertle L. Interstitial cystitis: an update. Curr Opin Urol. 2002;12(4):321-332.
  13. National Institutes of Health (NIH), National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Interstitial cystitis. National Kidney and Urologic Diseases Information Clearinghouse. NIH Publication No. 03-3220. Bethesda, MD: NIH; July 2003. Available at: http://kidney.niddk.nih.gov/kudiseases/pubs/interstitialcystitis/index.htm. Accessed November 1, 2004.
  14. Keay SK, Warren JW. Is interstitial cystitis an infectious disease? Int J Antimicrob Agents. 2002;19(6):480-483.
  15. Duncan JL, Schaeffer AJ. Do infectious agents cause interstitial cystitis? Urology. 1997;49(5A Suppl):48-51.
  16. Warren JW. Interstitial cystitis as an infectious disease. Urol Clin North Am. 1994;21(1):31-39.
  17. Ratliff TL, Klutke CG, McDougall EM. The etiology of interstitial cystitis. Urol Clin North Am. 1994;21(1):21-30.
  18. Burkman RT. Chronic pelvic pain of bladder origin: Epidemiology, pathogenesis and quality of life. J Reprod Med. 2004;49(3 Suppl):225-229.
  19. Gousse AE, Tiguert R, Madjar S. Current investigations and treatment of interstitial cystitis. Curr Urol Rep. 2000;1(3):190-198.
  20. Interstitial Cystitis Information Center (ICIC). IC research - Star Project [website]. Richmond, VA: ICIC; 2002. Available at: http://www.moonstar.com/~icickay/starproject.html. Accessed November 3, 2004.
  21. Fugazzotto P. Urinary tract infections: Need for pure culture technology in clinical laboratory diagnosis. South Med J. 1991;84(4):539-540.
  22. Wilkins EG, Payne SR, Pead PJ, et al. Interstitial cystitis and the urethral syndrome: A possible answer. Br J Urol. 1989;64(1):39-44.
  23. Hampson SJ, Christmas TJ, Moss MT. Search for mycobacteria in interstitial cystitis using mycobacteria-specific DNA probes with signal amplification by polymerase chain reaction. Br J Urol. 1993;72(3):303-306.
  24. Evans RJ, Stanford EJ. Current issues in the diagnosis of painful bladder syndrome/interstitial cystitis. J Reprod Med. 2006;51(3 Suppl):241-252.
  25. Hanno PM, Burks DA, Clemens JQ, et al. Diagnosis and treatment of interstitial cystitis/bladder pain syndrome. Linthicum, MD: American Urological Association (AUA); January 2011.
  26. Fall M, Peeker R. Methods and incentives for the early diagnosis of bladder pain syndrome/interstitial cystitis. Expert Opin Med Diagn. 2013;7(1):17-24.
  27. Clemens JQ. Pathogenesis, clinical features, and diagnosis of interstitial cystitis/bladder pain syndrome. UpToDate [serial online]. Waltham, MA: UpToDate; reviewed June 2013a.
  28. Clemens JQ. Management of interstitial cystitis/bladder pain syndrome. UpToDate [serial online]. Waltham, MA: UpToDate; reviewed June 2013b.


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Copyright Aetna Inc. All rights reserved. Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. This Clinical Policy Bulletin contains only a partial, general description of plan or program benefits and does not constitute a contract. Aetna does not provide health care services and, therefore, cannot guarantee any results or outcomes. Participating providers are independent contractors in private practice and are neither employees nor agents of Aetna or its affiliates. Treating providers are solely responsible for medical advice and treatment of members. This Clinical Policy Bulletin may be updated and therefore is subject to change.
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