Date of Service When Services Last More than One Day
In most cases, the appropriate date of service when services last more than one day is the day the service concluded.
Radiology services typically have two components: professional and technical. The DOS for the technical component is the date the patient received the service. Professional claims for “reading” are billed the day the physician provided the interpretation and report. The two dates of service may not match.
Many pathology services also have two components. The DOS for the technical component is the date the specimen is collected (e.g., the date of surgery/biopsy). If the specimen collection spans multiple days, use the date of service that the collection is completed. The professional component is billed on the date the physician interprets and creates the report. Again, the dates of service may not match.
The above rules differ for stored specimens. If the test is performed on a specimen stored less than or equal to 30 calendar days, the date of service must be the date the test was performed only if:
- The test is ordered by the patient’s physician at least 14 days following the date of the patient’s discharge from the hospital
- The specimen was collected while the patient was undergoing a hospital procedure
- It would be medically inappropriate to have collected the specimen other than during the hospital procedure for which the patient was admitted (i.e. surgical biopsy performed incidentally to the reason for surgery)
- The results of the test do not guide treatment provided during the hospital stayThe test was reasonable and medically necessary for treatment of illness or injury
Per the Medicare Benefit Policy Manual, Chapter 15, Section 20, “If the test is ordered on a specimen stored more than 30 days, the date of service for the technical service is the date the specimen is retrieved from storage. The professional component is billed on the date the physician provided the interpretation and report (include appropriate modifiers).”
Care plan oversight (CPO), home health certification/recertification, and transitional care management (TCM) claims are billed on the date the physician provided supervision or completed the plan of care. For example, CPO and TCM are billed once, per month. The DOS on the claim should be the date the physician provided the 30 minutes of supervision. The physician should legibly sign and date the documentation.
Physician ESRD services are provided either daily or monthly. When billing a monthly capitated rate, the DOS is the first through the last day of the month. For transient patients, or less than a full month, bill the DOS per diem. The date of service is the date the billing physician becomes responsible for the patient. This includes instances when a patient expires during the month.
Diagnostic psychological and neuropsychological testing (96101/96127) may be performed during multiple sessions, on different dates. If services last more than one day, the DOS is the day when the service(s) (based on CPT® code description) is concluded. The clinical documentation should reflect both the start and end date of the services.
Maternity services are bundled using the appropriate CPT® code for the maternity package. Use the date of delivery/termination as the DOS. Any charges for services unrelated to the delivery should be billed using the DOS the service was provided.
Using the above tips, you should be able to determine the date of service when services last more than one day.