Pathology/Lab Coding Alert

Treat pathology technical component like lab specimen.

Don't get caught unawares when CMS implements the new laboratory "date of service" (DOS) policy on Jan. 5, 2009. Pathology practices take note -- for the first time, this lab policy applies to you.

Getting the date right is critical for compliance with edit programs such as the Correct Coding Initiative (CCI), so you don't want to miss out on this information.

Scrutinize Pathology Service Dates

CMS announced the revised DOS policy in a recent change request (CR 6018). Strictly for clinical laboratory in the past, CMS now states that the policy revision is for "laboratory tests, or the technical component of physician pathology services."

"Until now, pathology practices have not had written instruction from CMS, so you need to familiarize yourself with this update and make sure your DOS practices align with this policy," says Ernest J. Conforti, M.S., SCT(ASCP)MT, director, patient financial services for North Shore-Long Island Jewish Health System headquartered in Great Neck, N.Y.

Look to fee schedules: In addition to lab tests paid under the clinical laboratory fee schedule, the revised DOS policy will apply to pathology services listed with modifier TC (Technical component) on the Medicare physician fee schedule.

In other words, "the DOS policy will affect most of your anatomic pathology billing if you bill the technical component," Conforti says.

For instance: You-ll have to follow the CMS DOS guidance for the TC of surgical pathology tissue exams (88302-88309) and non-gynecological cytopathology (88104-88112, and 88160-88162). The policy also will apply for billing the TC of adjunct services such as special stains (88313-88314), immunohistochemistry (IHC) (88342, 88360-88361), and in situ hybridization (ISH) (88365-88368).

Follow This General Rule

CMS says that, in general, "The DOS of the test/service must be the date the specimen was collected."

That means if the dates are different, you should use the date the phlebotomist drew the blood, not the date the lab processed the sample and ran the test. And you should use the date that the surgeon removed the tissue biopsy, not the date that the histotechnologist prepared the slides (under pathologist supervision).

Some pathology practices have used as the DOS the date that the pathologist ordered additional studies, such as IHC, rather than the surgery date. "Those pathologists will need to change their practice to report the specimen-collection date as the date of service," says R.M. Stainton Jr., MD, president of Doctors- Anatomic Pathology Services in Jonesboro, Ark

Know the corollary: According to CMS, a variation on this rule involves specimens collected over a period spanning multiple calendar days. "Then the DOS must be the date the collection ended," according to the revised policy.

Treat -Archived Specimens- Differently

If your lab performs a test on a specimen that was in storage for more than 30 days -- the definition of an archived specimen -- "the DOS of the test/service must be the date the specimen was obtained from storage," according to CMS.

Stored but not archived: What if you perform a service on a specimen that was in storage for 30 days or fewer? You should still use the specimen-collection date unless you fulfill the following criteria:

- the physician orders the test/service at least 14 days following the date of the patient's discharge from the hospital

- the physician collected the specimen while the patient was undergoing a hospital surgical procedure

- it would be medically inappropriate to have collected the sample other than during the hospital procedure for which the patient was admitted

- the results of the test/service do not guide treatment provided during the hospital stay, and

- the test/service was reasonable and medically necessary for treatment of an illness.

Do this: If you meet the criteria, then the DOS for that test is the date that you performed the service, not the specimen-collection date.

Note: Similar rules apply for the DOS for chemotherapy sensitivity tests on live tissue, according to the revised CMS policy.

For further details on the policy, you can view the CMS MLN Matters regarding CR 6018 on the Internet at http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6018.pdf.