Revenue Cycle Insider

Question: We received a saliva specimen for a genetic screening test that had been stored for 14 days from June 10, which is the date the buccal swab was taken. I recall something about a “14-day rule” — would that impact the date of service for this test?

Texas Subscriber

Answer: The “14-day rule” you refer to is the Centers for Medicare & Medicaid Services (CMS) laboratory date of service (DOS) rule. The policy explains, “in general ... the date of service (DOS) for clinical diagnostic laboratory tests is the date of specimen collection unless the physician orders the test at least 14 days following the patient’s discharge from the hospital.” In this case, the “14-day rule” comes into effect, and “the DOS is the date the test is performed, instead of the date of specimen collection.” 

That means the DOS in your case would be June 10.

Note these exceptions for advanced diagnostic laboratory tests (ADLTs), molecular pathology tests, cancer-related protein-based multianalyte assays with algorithmic analyses (MAAAs), and 81490 (Autoimmune (rheumatoid arthritis), analysis of 12 biomarkers using immunoassays, utilizing serum, prognostic algorithm reported as a disease activity). For these tests, CMS regards the DOS as the date of the actual test, providing:

• “The test was performed following … a discharge from the hospital outpatient department”, 
• “The specimen was collected from a hospital outpatient during an encounter”,
• “It was medically appropriate to have collected the sample from the hospital outpatient during the hospital outpatient encounter”, 
• “The results of the test do not guide treatment provided during the hospital outpatient encounter”, and
• “The test was reasonable and medically necessary for the treatment of an illness.”

Bruce Pegg, BA, MA, CPC, CFPC, Managing Editor, AAPC