Fungal Culture (Non Dermal)




Test Mnemonic

FCUL

Primary CPT Codes

  • 87102 - QTY (1), Culture, Fungal Isolation

Variable CPT Codes (dependent on findings)

  • 87186 - QTY (1), Susceptibility, Multi-antimicrobial Phoenix
  • 87186 - QTY (1), Susceptibility, Multi-antimicrobial Vitek
  • 87106 - QTY (1), Identification, Yeast
  • 87107 - QTY (1), Identification, Mold
  • 87153 - QTY (1), Identification, Nucleic Acid Sequencing
  • 87176 - QTY (1), Processing, Tissue Homogenization
  • 87015 - QTY (1), Processing, Fluid Concentration
  • 87186 - QTY (1), Susceptibility, Multi-antimicrobial Sensititre

LOINC ®

580-1

Aliases

  • Culture for mold
  • Culture for yeast
  • Fungal culture
  • Fungus culture
  • Mold
  • Mold culture
  • Mould
  • Mycology
  • Yeast
  • Yeast culture

Includes

  • Specimens may include some pre-processing steps such as concentration and use of mucolytic agents to aid in the recovery of fungal organisms.

Performing Laboratory

Cleveland Clinic Laboratories


Specimen Requirements

Volume Type Container Collect Temperature Transport Temperature Special Instructions
1 - 5 gTissueSterile container RefrigeratedBiopsy specimens should be collected in a sterile screw-top container with a small amount of sterile saline to prevent specimen from drying out. Specimens from periphery of a cutaneous lesion for recovery of fungal organisms. Specimen for Histopathology should be collected and sent separately.
1-2 mL min (prefer 20-50 mL)Fluid, bodySterile container RefrigeratedSpecimen source is required for processing. Larger volumes are preferred to improve recovery of fungal organisms. Specimen should be collected using sterile technique in a leakproof sterile screw-top container. If specimen volumes are small especially from lesion aspirates- instilling a small volume of sterile saline may aid collection. Specimen may be submitted in a sterile syringe only after removing needle and capping. Swabs are not preferred for fungal cultures; E-swabs are ONLY acceptable for hard-to-collect specimen sources such as ear canal. Specimen for Histopathology should be collected and sent separately.
VariableEyeSterile container See noteCorneal scrapings may be submitted in a sterile container but due to the scarcity of material, it is preferred that non-inhibitory fungal plates such as Potato Dextrose Agar (PDA) be inoculated at time of collection. Scrapings should be placed in two or three places on the plate, using an X or C shaped motion. Vitreous fluid may be submitted in a sterile container. If irrigation fluid used to aid in collection submit entire collection to aid in recovery of fungal organisms.

Minimum Specimen Requirements

Volume Type Container Collect Temperature Transport Temperature Special Instructions
0.5 mL     

Stability

Environmental Condition Description
Ambient72 hours
Refrigerated7 days
FrozenUnacceptable

Days Performed

Sun - Sat

Turnaround Time

6 weeks

Methodology

Name Description
Culture 

Special Info

Fungal smears - direct detection of fungi from clinical specimens will NOT be performed. Please order FCULSM if fungal smears are needed. Clinical specimens for fungal cultures are processed and plated on selective fungal media to optimize recovery of fungal organisms. Cultures are incubated for 28 days; negative results are auto-updated daily. Any fungal organisms recovered will be isolated and identified by various methods. Yeast from respiratory specimen will be ruled for Cryptococcus species and Candida auris and will be reported with minimal ID (Yeast not Cryptococcus); full genus and species ID will only be reported if clinically indicated and requested by clinicians. Additional CPT codes may be applicable for recovery and identification of fungal organisms - 87176sub- Tissue processing, 87015 - concentration of specimen, 87102 Fungal culture, 87106 - ID by MALDI-TOF Mass Spec for yeast, 87107 - ID by MALDI-TOF Mass Spec for Mold, 87153 - DNA sequencing. Fungal susceptibility testing for yeast recovered ONLY from sterile sites will be performed automatically (CPT 87186). Yeast susceptibility testing is determined by colorimetric microdilution broth. A standardized inoculation of test organism is incubated with appropriate dilutions of antifungal agents; minimum inhibitory concentration (MIC) are determined by inhibition of growth at the lowest antifungal concentration. MIC are determined and interpreted according to CLSI standards. For yeasts recovered from non-sterile sites are performed in-house by request only - by contacting the lab. Filamentous mold susceptibility testing is a send-out test and can be requested by contacting the lab. Additional billing is applied for sequencing, identification, and susceptibility testing. CPT codes vary based on methodology.

Clinical Info

For optimal recovery of organisms - specimen should be collected using sterile technique, reduce contamination and transported immediately to the microbiology laboratory. Isolation and identification of fungi in the clinical laboratory can help guide patient care. However, fungi can be pathogens, colonizers and/or contaminants. Clinical correlation with patient symptoms is necessary to determine significance of recovered organism. If specific fungi are suspected the "rule out" feature in Epic can be utilized. If fungal smears are needed order FCULSM; for fungal blood cultures HISTCL; for CSF order FUNCSF; for dermal samples of hair, skin and nail order ACFSC or FHSNSM (with smear); for candidiasis on vaginal and oral samples order fungal screen FUNGSC.

Clinical Limitation

Not all fungal organisms recovered in cultures may be significant; clinical correlation needed to determine significance.

Clinical Reference

Westblade et. al. Larone’s Medically Important Fungi, 7th edition, ASM press, Washington DC., 2024. Leber et al., Clinical Microbiology Procedures Handbook, 5th edition, ASM press, Washington, DC. 2023. Carroll, et al. Manual of Clinical Microbiology, 13th Edition, Volume 3, ASM Press, Washington, DC. 2024. Ashbee HR: General approaches for direction detection and identification of fungi. In: Carroll KC, Pfaller MA, Landry ML, et al, eds. Manual of Clinical Microbiology. 12th ed. Vol 1. ASM Press; 2019:2035-2055