Culture & Smear, AFB

Test Code

CXAFB

Alias/See Also

Acid Fast, Mycobacteria

CPT Codes
87116, 87206, 87015

Includes

AFB Smear, AFB Culture, AFB Specimen concentration (if applicable). Positive AFB cultures will reflex to identification and sensitivities as applicable.

Preferred Specimen

STERILE Container (X/M)

Other Acceptable Specimens

Sputum:
- Best diagnostic use of sputum collection is to have 3 specimens collected within 24 -72 hours At least 1 of the specimens must be a “First Morning” collection. It is very acceptable to have 3 specimens collected 8 hours apart instead of all 3 being first morning specimens.
- Sputums must have a volume of at least 5 ml. (5-10 ml preferred). It is acceptable to have outpatients collect 3 specimens within 24-72 hours and bring them in at one time provided they are kept refrigerated and they are dated and timed. One must be a “First morning” specimen.
- Sputum collection: Rinse mouth with water, minimize saliva contamination. Collect specimen from a deep cough into a sterile screw capped cup. Prefer 5-10 ml sputum. If unable to obtain >5 ml. respiratory department may need to collect an induced sputum specimen. Deliver to lab within 1 hour of collection.
- Induces Sputum: collect per physician order. Collected by RN or Respiratory therapist. Specimen should be > 5 ml. Deliver to lab within 1 hour of collection.
- BAL specimens: 2.0 ml; For multi-specimen Endoscopy samples—use the Bronchial Wash for the AFB culture.
Gastric aspirates: should be first AM fasting specimens. If swabs are used, at least 2 moist swabs per specimen should be submitted. Swabs must be transported in transport media (Amies or Stuarts) to keep moist. Dry swabs are not acceptable.
Blood specimens and bone marrow specimens. Collect specimen as required by reference lab.
Stool specimens: > 1 gm stool in sterile, wax-free, disposable container. Collect specimen directly into container or from bedpan, or plastic wrap stretched over toilet bowl. (Frozen specimens are not acceptable).
Tissue biopsy sample: 1 gm of tissue, if possible, in sterile container without fixative or preservative. Do not immerse in saline or other fluid or wrap in gauze. Do not freeze specimen. (Specimen submitted in formalin is not acceptable).
CSF: >2ml is preferred. Use maximum volume attainable.
Sterile fluids (peritoneal, pleural, etc.): 10-15 ml in sterile container or syringe – centrifuge then inoculate using sediment as instructed in the MGIT procedure. If less than 10 ml is available, inoculate directly into MGIT tube- no centrifuge step is needed.

Specimen Stability

Do not freeze specimens. Freezing decreases yield.
Specimens may be held up to 3 days in the refrigerator. It may be necessary to culture a specimen that is slightly older than 3 days, but a disclaimer should be added that delay in culture setup may decrease culture yield.
Do not reject a specimen for AFB culture without notifying physician or RN in charge of the patient – and preferably discussing with pathologist.
Do not reject “hard to recollect” specimens such as surgery specimens - FNA, biopsy, bone, bone marrow, etc.

Sputums, bronchial lavages and washes, sterile fluids and tissues can be held 24 hours in the refrigerator.

Gastric aspirates must have preliminary processing if planting will be delayed more than 5 hours.

Setup Schedule

24x7

Report Available

Positive culture results are called to physician.
Sensitivity will be performed by reference laboratory

Reference Range

Negative

Clinical Significance

AFB testing may be used to detect several different types of acid-fast bacilli, but it is most commonly used to identify an active tuberculosis (TB) infection caused by the most medically important AFB, Mycobacterium tuberculosis.

Why Get Tested?

To help diagnose tuberculosis (TB) and infections caused by other Mycobacterium species, which are known as acid-fast bacilli (AFB), in people at risk of developing mycobacterial infections; to monitor the effectiveness of treatment.

When To Get Tested?

When you have signs and symptoms of a lung infection, such as a chronic cough, weight loss, fever, chills, and weakness, that may be due to TB or a nontuberculous mycobacterial (NTM) infection; when you have a positive IGRA blood test or Tuberculin skin test (TST) and you are in a high-risk group for progressing to active TB; when you have a skin or other body site infection that may be due to mycobacteria; when you are undergoing treatment for TB

Performing Laboratory
CRMC Microbiology

The CPT Codes provided in this document are based on AMA guidelines and are for informational purposes only. CPT coding is the sole responsibility of the billing party. Please direct any questions regarding coding to the payor being billed. Any Profile/panel component may be ordered separately. Reflex tests are performed at an additional charge.