Implementation of MALDI-TOF MS in

the Routine Clinical Laboratory

Robert C. Jerris Ph.D., D(ABMM)

Children’s Healthcare of Atlanta,
Emory University, Atlanta, GA

• Theresa Stanley
• Lars Westblade, Ph.D
• John Rogers, Eric Graves, Summer Interns
• Ankita DeSai, ID Fellow;
• Beverly Rogers, Chief
• Aurora Muhuza DB coordinator
• Maria Atuan-Lean, Six Sigma
• Jonelle McKey-Financial Analysis
 Disclosure:
2010, Database development Bruker
Reagent support
Children’s by the Numbers
3 Hospitals
520 staffed beds
17 neighborhood locations, including:
Four Immediate Care Centers
One Primary Care Center
Marcus Autism Center
More than 7,500 employees
Access to more than 1,600 pediatric physicians
6,500 volunteers
2nd Largest pop. of pediatric CF patients in US
 Objectives: MALDI-TOF
• Preanalytical
– Justification
– System selection
• Analytical
– How, What, Where, When, Why
• Postanalytical
– REPORTING
 5
Doern, 2013 Clinical Microbiology Newsletter 35:69-78
 Excellent Review

6
Clark et al., 2013 Clin Microbiol Rev 26:547-603
 Pre-Analytical
Cost Justification:

Direct comparison to phenotypic test

Assessment of outcomes

Reimbursement
 Cost-effectivenesss of switching to
MALDI-TOF MS for routine bacterial identification
Galliot O. e tal.JCM 2011. 49:4412

 September 2009 October 2008- October 2009-

September September
 Switched from conventional 2009 2010
biochemicals (Vitek 2 and API)
to MALDI-TOF MS (Bruker) Isolates Tested 33,320 38,624

 Cost analysis performed

Biochemical $193,754 $5,374
Costs
MALDI-TOF - $15,836

Annual Savings = $177, 090 TOTAL $193,754 $21, 210

“allowed decrease of 89.3% of the cost of bacterial
identification in the first year.”
In addition:
Decreased waste from 1,424kg to 44kg Avg Cost/ID $5.81 $.54
Decreased subculture media of $1,102
Decreased sequencing cost of $1,650
 Impact of MALDI-TOF MS on Time to Identification and
Cost-Effectiveness in the Microbiology Laboratory

Estimated annual costs for the standard protocol and MALDI protocol

Estimated reduction in reagent and labor costs of identification by $102,424

within 12 mo

9
Tan et al., 2012 J Clin Microbiol 50:3,301-8
 Impact of MALDI-TOF MS on Cost-Effectiveness
in the Microbiology Laboratory

• Impact of MALDI-TOF MS on cost of identification: reagent and technologist

• Compared conventional identification (e.g., biochemicals) to MALDI-TOF MS

identification over a 12 mo period

• 21,930 isolates: Gram-negative, Gram-positive and yeast

Reagents costs:
Conventional identification, $84,491.61
MALDI-TOF MS identification, $6,469.53
Net savings, $78,022.08

• Significant reduction (95.2%) in reagent costs when identifying Weirdobacter

species (Gram-negative glucose non-fermenters)

• Total savings including technologist time: $118,260.18

• Verification studies: $4,357.78

10
Tran et al., 2014 Presented at the 114th General Meeting of the ASM, Boston, May 17th-20th, 2014
 Desai and colleagues
• Analyzed 464 isolates from 24
unique CF specimens and
detailed 85% of complex organisms
(non-fermentative Gram-negative rods including
29 Burkholderia species) identified within 48 h
compared to only 34% by conventional methods.
• The cost per identification using lean six sigma
hand motion analysis was $1.25 by MALDI-ToF
MS compared to $28.00 by conventional methods
for these organisms

Desai, Stanley, LiPuma, Jerris. 2012. J Clin Path. 65:835

 Impact of MALDI-TOF MS Identification on Clinical Outcomes

• Impact of MALDI-TOF MS identification (from cultures) and antimicrobial stewardship team

intervention on outcomes in adult patients with bacteremia and candidemia

• 501 patients : 256 in preintervention group and 245 in intervention group

12
Huang et al., 2013 Clin Infect Dis 57:1,237-45
 Impact of MALDI-TOF MS Identification on Clinical Outcomes

Clinical and treatment-related outcomes

13
Huang et al., 2013 Clin Infect Dis 57:1,237-45
 Impact of MALDI-TOF MS Identification on Clinical Outcomes

• MALDI-TOF MS (Bruker RUO)-based identification of Gram-negative organisms directly from

positive blood cultures

• Gram-negative AST set up directly from positive blood cultures (BD Phoenix)

• Preintervention (112) and intervention (107) groups

• Interventions:
- Gram stain result called to appropriate member of the patient care team 24/7
(same for preintervention and intervention groups)

- MALDI-TOF MS identification and AST data called to on-call pharmacist 24/7

(only for intervention group)

• Significant reduction in length of hospitalization, 11.9 vs 9.3 days (P = 0.01)

• Significant reduction mean hospital costs/patient, $45,709 vs $26,126. (P = 0.009)

14
Perez et al., 2013 Arch Pathol Lab Med 137:1,247-54
 Pre-Analytical
• Selection of Instrument
Size/footprint
Electrical requirements
Data drops
Service contract
Connectivity
Workflow and volume
• Backup systems: plan for 3 days
 Commercially Available Platforms:
VITEK MS IVD System (bioMérieux)

Instrument: VITEK MS

Database (closed): Knowledge Base v2

Organisms claimed: clearance for 193 taxa with

performance claims
List available at http://clinicaltrials.gov/

(+ 562 non-claimed RUO species, Gram-negative, Gram-

positive, yeast, filamentous fungi [few])

Preparation:
- Bacteria, direct transfer
- Yeast, on target extraction

Target: Disposable
16
Image: David Pincus/Marc van Nuenen, bioMérieux
 Commercially Available Platforms:
VITEK MS RUO System (bioMérieux)

Instrument: VITEK MS

Database (open): SARAMIS SuperSpectra v4.13

Organisms contained: 1,427 taxa, Gram-negative, Gram-

positive, yeast, filamentous fungi [many], mycobacteria

Preparation:
- Bacteria, direct transfer
- Yeast, on target extraction

Target: Disposable

17
Image: David Pincus/Marc van Nuenen, bioMérieux
 Commercially Available Platforms:
VITEK MS IVD and RUO Systems Workflow

Patient samples

IVD database v2.0

Reporting & Billing
TM Connected to LIS
Myla
Server
Prep Station
Acquisition Station

RUO database v4.13

Research Applications Research only
Adding species to RUO database • Strain Typing
• Resistance testing
• Blood cultures

Connectivity to AST at Prep Station

18
Image: David Pincus/Marc van Nuenen, bioMérieux
 VITEK MS IVD Knowledge Base v2.0
• Uses a weighted bin matrix

• Features:

Peaks
 No spectra comparison
 No spectra embedded in the commercial software,
only a matrix of bins and weights

Bins
• Default manufacturer’s confidence 1 2 3 4 5 6 7 8 9 10 ………………………….

value:
 60.0% to 99.9% and a single identification: accept
identification (typically species level)
Peaks
bsence
Presence/A
 Low discrimination identification: >1 but not more
++ + + + + + +
than 4 organisms displayed (typically genus level)
 Unidentified organisms: >4 organisms 1 2 3 4 5 6 7 8 9 10

Weights for each bin:

++ : highly species-specific (+15, +20….)
+ : moderately species-specific (+3, +4….)
-: peak absent (-3, -4….)
--- : Absent and peak important for other species (-
15)
 Commercially Available Systems: IVD
MALDI Biotyper CA™ System (Bruker)
Instrument: Microflex LT

Database (closed): v1

Organisms claimed: clearance for 100 species (in 40

claimed groups) with performance claims, Gram-
negative

v2 in preparation: submission (Sept. 2014) of additional 190 species

(in 170 claimed groups), Gram-negative, Gram-positive, (aerobic and
anaerobic) and yeast
List available at http://clinicaltrials.gov

(+ 940 non-claimed RUO species; Gram-negative, Gram-positive and

yeast)

Preparation:
- Direct transfer  on target extraction  full extraction
- Direct transfer  full extraction

20
Image: Markus Kostrzewa, Bruker Target: Non-disposable
 Commercially Available Systems: RUO
MALDI Biotyper™ System (Bruker)
Instrument: Microflex LT

Databases (open):
- Main 5627
- Select agent v1
- Mycobacteria v2
- Fungi v1

Organisms contained:
- Main, 2,297 species (Gram-negative, Gram-positive, yeast,
filamentous fungi [few] and mycobacteria [few])
- Select agent, 11 species
- Mycobacteria, 131 species
- Filamentous fungi, 128 species

Preparation:
- Direct transfer  on target extraction  full extraction
- Direct transfer  full extraction

Target: Non-disposable and disposable 21

Image: Markus Kostrzewa, Bruker
 Commercially Available Platforms:
Bruker IVD and RUO Systems Workflow
MBT RUO
• RUO main database 2,297 species
(+ specialized databases)
• Open, user library generation and utilization
• Sepsityper module (blood cultures) MBT Pilot MBT Galaxy
• Beta-lactamase module
• Spectra analysis and statistical tools Prepartation guidance and matrix spotting

Identical software architecture and

pattern matching algorithm,
spectra acquisition control

MBT CA (US IVD System)

• FDA cleared
• Simplified user inteface Connectivity to various AST and LIS
• Closed system systems via adopted solutions
• MBT CA specific database

22
Slide: Markus Kostrzewa, Bruker
• Pickolo-MI, Robotic sampling, TECAN (Morrisville, NC);
• Copan WASP (Murrietta,CA);
• Copan, MALDI-Trace (Murrietta, CA)
• Becton Dickinson(BD) Kiestra (Franklin Lakes, NJ)

• These systems facilitate paperless, guided target preparation

through one of several mechanisms including: up front data
entry into a traceable log (e.g., BD Kiestra); bar coded sample
entry (e.g., Bruker Pilot), or; radio frequency identification
(RCID)(e.g., Copan MALDI Trace).
 MALDI Biotyper™ System Database
Uses pattern matching: Features: Spectra comparison
Spectra embedded in a database that is connected to the commercial software

Default manufacturer’s score value:

- 2.000 to 3.000: High confidence identification (species level)

-1.700 to 1.999: Low confidence identification: progress to on target/full extraction

(report to genus/group/species based on available/additional [clinical/phenotypic] information)

- 0.000-1.699: No identification Slide (source): MALDI Biotyper 3.0 User Manual Revision 2
Be aware of differing versions when comparing data-current 3.1 !! 24
 Optimizing Identification
• Gram positives: on plate formic acid >= 1.7
– (Patel- Mayo, Burnham-Wash U [JCM 51: 1421])
• Gram negative and non-fermenters >=1.9
– (Ford [JCM 51:1412])
• Yeast >=1.7
– (Jerris [ASM 2013])
• Rapidly Growing Mycobacteria >=1.7
– (Jerris [ASM 2014])
 Can Different Databases Make a Difference?
• S. pneumoniae, 25; S. mitis, 34; S. oralis, 3 (62 isolates)

• Software:
- Visual inspection of spectra: FlexAnalysis 2.4
- Comparison and identification of spectra: Biotyper 3.0
- Database processing: ClinProTools 2.1 (perhaps not for the routine laboratory)

• Peak 6,949 m/z specific for nonpneumococcal mitis group species

• Differentiated between all S. pneumoniae and nonpneumococcal mitis group species

27
Ikryannikova et al., 2013 Clin Microbiol Infect 19:1,066-71
Analytical
 MEDIA
• Culture condition environment (aerobic, anaerobic,
microaerophilic, microaerobic) , temperature, and
media have little effect on accuracy of identification
of organisms by MALDI-Tof MS.
• Organisms can be tested after storage:
5 days of storage at 35oC and 4o (McElvania, 2013).
our experience extends this to
10 days post routine incubation
(but not directly from the cold)
 Preparation of Specimens: Direct Transfer

1. 2.

Colony applied to target,

Isolated colony less is more (~5 s)

4. 3.
Air Dry
(~60s)

Mass spectrometric analysis Matrix (1 μL) overlaid (~15 s)

30
Image: David Pincus/Marc van Nuenen, bioMérieux
 VITEK MS™ Target Slides

Disposable slides:
• Barcoded for traceability
• Three acquisition groups per
slide
• 1-16 samples per group
• Calibration spots embedded in
each acquisition group
• No cleaning
• Low cost/test
 VITEK MS™ Prep Station – Integrating ID+AST

Target plate
assignment
for VITEK MS

Smart
Carrier
assignment
For VITEK2
 VITEK MS™ Streamlined Workflow
• Flexibility:
– Multiple Benches (Urine, Stool, TB,….)
– Separate setup stations possible
– 1 – 4 slides analyzed per run.
• High Throughput:
– 4 x 48 spots = 192 samples/run
• Significant Time Savings
Three Steps for Microorganism Identification via MALDI
BioTyper

TARGET TOF
IDENTIFICATION
PREPARATION MEASUREMENT

Research use only – not for use in diagnostic procedures

BRUKER

• Utilize (96, 48, 24) Spot Polished steel Target (reusable)

or 48 Spot Disposable Target
• Different methods for spotting target:
 Direct smear method for routine bacteria
 Ethanol-formic acid extraction for Molds, Mycobacteria, and Yeast
 On-target (plate) formic acid extraction

Clean with ethanol;

monthly TFA
(hazard disposal $200/qtr)
Research use only – not for use in diagnostic procedures
 Formic Acid Extraction

Pick

70% Formic Acid

Matrix

Direct Plate Technique

Recommended for Nocardia, Yeast, GPR
Ethanol-Formic Acid Extraction
(if required - e.g. yeast)

Inactivation of
pathogens
Formic acid, Analyze
dH2O Ethanol Ethanol
acetonitrile supernatant

10 min

$0.80 an isolate; 15 minutes for ID

Research use only – not for use in diagnostic procedures

 Performing a MALDI Sepsityper
run

Positive blood culture

Analyze supernatant
Lysis Buffer Wash Buffer
Supernatant Supernatant Ethanol
Supernatant FA/ACN

1 ml

~20 min.
Mycobacteriology
 Sample Preparation
Positive culture

75% Water
Water EtOH Water
50ul
95°C
30 min

2 ml

50ul
100% ACN + silica FA
EtOH beads, vortex 1 50ul
min.
5% sBAP,
3-5d, 35oC, 5-7% CO2

~60 min.
Intens. [a.u.] Effect of Bead-Beat on MALDI Spectrum

AFB15-A 0:A9 MS, BaselineSubtracted, Smoothed

8000
No Bead-beat step

6000

4000

2000

0
Intens. [a.u.]

Mycobacterium sp AFB015 MCW 0:H8 MS, BaselineSubtracted, Smoothed

5000 Bead-beat step
4000

3000

2000

1000

0
5400 5600 5800 6000 6200 6400 6600 6800
m/z
Filamentous fungi – liquid culture

Modified liquid broth cultivation

→ new cultivation
recommendation
 ID Filamentous Fungi, NIH -
workflow
1. Direct Transfer of “Front Mycelium“ (1 min)
if successful: ID is FINISHED

Intens. [a.u.]

6585,21
e.g. A.niger

6744,05
4000

6016,93
3000

2000

8049,55
1000

4536,96

9074,52
0

4000 5000 6000 7000 8000 9000 10000 11000 12000

m/z

2. Ethanol Extraction of “Front Mycelium“ (10 min)

if successful: ID is FINISHED

3. Broth Cultivation (approx. 1 additional day) & extraction

 ID is possible for agar adhering filamentous fungi
 ID is possible for slow or fast sporulating fungi
 ID is possible for every kind of filamentous fungi

 ALL matches against the SAME Filamentous Fungi DB

 Integration, Bruker
Phoenix, [EpiCenter]
• The order is automatically transferred
to BD EpiCenter™ and can be used for
worklist management.
Sample EpiCenter – MBT Plate
 Integration:
MicroScan LabPro-MBT
• Interface software seamlessly integrates MALDI
Biotyper processing with MicroScan® panel results to
simplify mass spectrometry ID workflow.
• Combines MALDI Biotyper IDs with MicroScan® AST in
LabPro, applying LabPro AlertEX Rules and
interpretations to results
• Performs MALDI Biotyper Target assignment in LabPro
with electronic transfer to MALDI Biotyper
• Allows for one LIS connection for MicroScan® and
MALDI Biotyper systems
• No additional middleware or computer required
48
 LabPro-MBT Overview
LabPro-MBT Bruker MALDI Biotyper*
System
MALDItrace
(optional)

MALDI target
MALDI order assignment
LIS
ID/MIC results MALDI ID

Combines Bruker MALDI Biotyper® identification with MicroScan® MIC values

• Performs target assignment
• Transfers high-confidence Bruker identifications to LIS
• Displays Bruker identification, biotype, organism text, score, and comments
• Applies AlertEX System rules to final identification
*MALDI Biotyper is a trademark of Bruker Daltonics. Bruker MALDI Biotyper System is Research use only-USA.
MALDItrace is a product of Copan Diagnostics Inc.
 Integration:
Sensititre, Aris, ThermoFisher
 MALDI Biotyper 3.0 – tablet PC project setup

Project setup at every workplace using tablet PCs

with MALDI Biotyper RTC client

New Orleans, 05/22/2011

MALDI Trace
 Does MALDI Trace Help?
• Ran urine bench in duplicate for 3 days with
one tech running IDs on MALDI with Trace and
one on MALDI with manual plate mapping
– Time to set up 30 cultures
Decreased in Trace
Technologist P value
Set-Up Time
1 2.74 min <0.05
2 1.70 min <0.05
3 0.89 min 0.1

– Use of MALDI Trace saves 3.54 seconds per

culture
• Overall savings of ~100 technologist hours per
year
Automated Spotting – Copan WASP
Property
User friendliness Bruker Biotyper vs Vitek MS
Ready-to use Matrix solution
Microflex LT

No
Vitek MS RUO

Yes
Vitek MS IVD

Yes
Remarks

Facility of preparing smear Very easy Easy Easy For Vitek-MS systems, matrix
solution must be deposed each
Disposable targets Yes Yes Yes two spots
Reusable targets Yes No No
Software Easy to use Not easy to use Very easy to use
Time for 96 identifications
Time to prepare work list
<5 5–10 NDa
(min)
Time to load target and make
2 5
vacuum
Time for analysis (min) 40 55
Time for 16 identifications No ID before success of QC at end
ND ND 15
(min) of run (each 16 IDs)
Quality
IVD Yes No Yes
Need for validation before clinical
RUO Yes Yes No
reporting
Quality management Easy Easy Very easy
Costc
Device + NAb ++
Reactants +++ NA + Based on catalog prices
Maintenance ++ NA +++
Implementation
Noise Silent Noisy Noisy
Size Smaller Bulkier Bulkier
Connectivity Via LIS NA Via Myla 57
Capacity 1 × 96 4 × 48 4 × 48 Martiny, et al, JCM, 2012, 50
 Post-Analytical
• Reporting is the deal
 CHOA and friends
• Shigella is not identified by MALDI-TOF mass spectrometry. Organisms
identified as “Escherichia coli” should be examined for lactose
fermentation and subjected to spot indole test and, if negative, an identity
of Shigella species should be considered. An agglutination assay with
Shigella antisera Group D should be performed; colony morphology and
lactose fermentation should also be observed and taken into consideration
when making a species level identification. Serotyping in group D antisera
is needed to call Shigella sonnei. If the isolate does not serotype in Group
D antiserum, perform Microscan identification and discuss next steps with
supervisor.

• Salmonella species identified by MALDI-TOFA Microscan identification

should be performed on all. If identified as Salmonella Typhi, report as
Salmonella Typhi. All other Salmonella species should be reported as
Salmonella species .
Acinetobacter baumanii-calcoaceticus complex
Acinetobacter genomospecies 3 Enterobacter cloacae
Acinetobacter genomospecies 13 complex =
Enterobacter asburiae
Acinetobacter lwoffi report as such
Enterobacter kobei
Acinetobacter ursingii report as such Enterobacter ludwigii
Enterobacter hormaechei
Citrobacter freundii complex = Enterobacter nimipressuralis
Citrobacter braakii
Citrobacter freundii
Citrobacter gillenii
Citrobacter murliniae
Citrobacter rodenticum
Citrobacter sedlakii
Citrobacter wekmanii
Citrobacter youngae
• Stenothrophomonas maltophilia • Burkholderia cepacia complex[C1]
The following organisms are The following organisms will
synonyms and will be called S. be called B. cepacia complex if
maltophilia if obtained from the obtained from the MALDI-TOF
MALDI-TOF with an acceptable with an acceptable score:
score: Burkholderia cepacia
Pseudomonas hibiscicola Burkholderia multivorans
Pseudomonas beteli Burkholderia cenocepacia
Pseudomonas geniculata Burholdieria stabilis
Burkholderia vietnamiensis
Burkholderia dolosa
Burkholderia ambifaria
Burkholderia anthina
Burkholderia pyrrocinia
Pseudomonas fluorescens Group
The following organisms will be called Pseudomonas fluorescens Group if obtained from the
MALDI-TOF with an acceptable score:
Pseudomonas antarctica
Pseudomonas azotoformans
Pseudomonas blatchfordae
Pseudomonas brassicacearum
Pseudomonas brenneri
Pseudomonas cedrina
Pseudomonas corrugate
Pseudomonas fluorescens
Pseudomonas gessardii
Pseudomonas libanensis
Pseudomonas mandelii
Pseudomonas marginalis
Pseudomonas mediterranea
Pseudomonas meridiana
Pseudomonas migulae
Pseudomonas mucidolens
Pseudomonas orientalis
Pseudomonas panacis
Pseudomonas proteolytica
Pseudomonas rhodesiae
Pseudomonas synxantha
Pseudomonas thivervalsensis
Pseudomonas tolaasii
Pseudomonas veronii
 Pseudomonas aeruginosa Group Pseudomonas putida Group
The following organisms will be called Pseudomonas The following organisms will be called
aeruginosa Group if obtained from the Pseudomonas putida Group if obtained from the
MALDI-TOF with an acceptable score MALDI-TOF with an acceptable score:
Pseudomonas alcaligenes P. putida
Pseudomonas anguilliseptica P. fulva
Pseudomonas argentinensis P. oryzihabitans
Pseudomonas borbori P. plecoglossicida
Pseudomonas citronellolis P. monteilii
Pseudomonas flavescens P. mosselii
Pseudomonas jinjuensis P. cf. putida CH-B107
Pseudomonas mendocina P. cf. monteilii
Pseudomonas nitroreducens/multiresinivorans group P. syncyanea
Pseudomonas ochraceae
Pseudomonas oleovorans
Pseudomonas pseudoalcaligenes
Pseudomonas resinovorans
Pseudomonas straminea
MALDI-TOF is unable to distinguish Streptococcus mitis group and Streptococcus pneumoniae.
Colony morphology, bile solubility , and optochin disk susceptibility should be performed prior to
reporting an isolate as S. pneumoniae or S. mitis.

Streptococcus anginosus Group

The following organisms will be called Streptococcus anginosus Group if obtained from the MALDI-
TOF with an acceptable score and is clinically relevant:
S. anginosus
S. constellatus
S. intermedius

Streptococcus gallolyticus subspecies gallolyticus (formerly Streptococcus bovis biotype I) and

Streptococcus gallolyticus subspecies pasteurianus (formerly S. bovis biotype II.2).
Any MALDI-TOF identification of S. gallolyticus, S. gallolyticus subsp. gallolyticus, or S. gallolyticus
subsp. pasteurianus should be confirmed with Microscan to determine mannitol fermentation. If
mannitol fermentation positive, report S. gallolyticus subsp. gallolyticus (formerly Streptococcus
bovis group). If negative, consult with supervisor or medical director.
Bacteroides fragilis Group
The following organisms will be called Bacteroides fragilis Group if obtained from the
MALDI-TOF with an acceptable score:

B. caccae
B. eggerthii
B. finegoldii
B. fragilis
B. intestinalis
B. massililensis
B. nordii
B. ovatus
B. salyersiae
B. stercoris
B. thetaiotaomicron
B. uniformis
B. vulgatus

MALDI-TOF detection of carbapenemase in B. fragilis

Carbapenem resistance in B. fragilis in most cases is due to the presence of
cfiA gene responsible for metallo-ß-lactamse production. Nagy et al.
 CAP MIC.11375
• If an organism identification result is noted to be
discrepant with current standard
nomenclature (e.g., as represented in proficiency
testing results), taxonomic conventions used in
organism identification reporting will be changed on
a continuous basis.
• On a yearly basis (January 1st of each year), and
concurrent with databse updates, the medical
directors will review clinically relevant taxonomic
changes to validly published names in the
International Journal of Systematic and Evolutionary
Microbiology. In the case of homotypic changes, the
new name will receive priority. For heterotypic
changes, names will revert to the previously
accepted name. Orthographic corrections will be
incorporated for individual species.
When necessary, changes
in organism nomenclature
will be incorporated into
the organism cascades
when antimicrobials
choices or interpretive
breakpoints are affected.
 PCC January 16, 2015
• The Pathology Coding Caucus met on January
16, 2015. A unique code for matrix assisted
laser desorption ionization mass spectrometry
(MALDI-TOF MS) was presented for microbial
identification. The decision was made that
existing codes would accommodate MALDI-
TOF MS coding. The recommendations are
below.
 4386/ Robert C. Jerris Microbial The PCC believes that current codes
tab 67 ASM Identification ●87XXX Microbial exist to codify this service
1752 N Street NW (MALDI-ToF- identification by (culture definitive identification
Washington, DC 20036 MS) Matrix Assisted Laser codes and
202-942-9262 Desorption Ionization 87015 [concentration (any type),
[email protected] Time of Flight Mass for infectious agents] and
( [email protected] ) Spectrometry hence does not support the proposal .
(MALDI-ToF-MS)

●87XXX1 Matrix
Assisted Laser
Desorption Ionization
Time of Flight
(MALDI-ToF)
extraction

HCPCS Code CPT DECRIPTION (Anotated) Comments

87015 Concentration To be used as additional code when full
extraction required
87076 Anaerobe identification
87077 Aerobic identification
87106 Organism identification, yeast

87107 Organism identification, mould

87118 Organism identification,

mycobacteria
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