Wiki Professional Component DOS

[DermBillers]

Dermatology practice that bills out professional component (26 modifier) for the pathologist that interprets in office - what date of service is to be used? Is it the date of service or date of interpretation?

Thank you-

 

[Narobo]

We use the actual date of service for our practice.

 

[danachock]

The date your facility receives the specimen is the date you will bill.

 

[Narobo]

Dermatology practice that bills out professional component (26 modifier) for the pathologist that interprets in office - what date of service is to be used? Is it the date of service or date of interpretation?

Thank you-

Below is from CMS so honestly either choice is correct. Either the date of collection or the date of interpretation:

Surgical and anatomical pathology services may have two components: a professional and a technical component. These services will have a PC/TC indicator of "1" on the MPFS Relative Value File. The technical component is billed on the date the specimen was collected. This would be the surgery date. When billing a global service, the provider can submit the professional component with a date of service reflecting when the review and interpretation is completed or can submit the date of service as the date the technical component was performed. This will allow ease of processing for both Medicare and the supplemental pavers. If the provider did not perform a global service and instead performed only one component, the date of service for the technical component would the date the patient received the service and the date of service for the professional component would be the date the review and interpretation is completed.

 

[DermBillers]

Thank you - I did see that from CMS but did want to see what other offices were doing when they only bill out the one component (in this case professional). We have a claim that Medicare is requesting a refund due to the patient being in a Part A stay on the date the interpretation was done -

 

[MrsSpiney]

The date your facility receives the specimen is the date you will bill.

new to pathology, doing only professional billing. I am finding this confusing based on the CMS text. For a professional 26 interpretation, wouldn't the DOS be date of interpretation vs date specimen was received? thank you! I appreciate your insight

 

[Narobo]

new to pathology, doing only professional billing. I am finding this confusing based on the CMS text. For a professional 26 interpretation, wouldn't the DOS be date of interpretation vs date specimen was received? thank you! I appreciate your insight

Yes, I think for -26 interpretation you could use either the DOS that the interpretation was completed OR the date the technical component was performed.

 

[SMatsu]

Below is from CMS so honestly either choice is correct. Either the date of collection or the date of interpretation:

Surgical and anatomical pathology services may have two components: a professional and a technical component. These services will have a PC/TC indicator of "1" on the MPFS Relative Value File. The technical component is billed on the date the specimen was collected. This would be the surgery date. When billing a global service, the provider can submit the professional component with a date of service reflecting when the review and interpretation is completed or can submit the date of service as the date the technical component was performed. This will allow ease of processing for both Medicare and the supplemental pavers. If the provider did not perform a global service and instead performed only one component, the date of service for the technical component would the date the patient received the service and the date of service for the professional component would be the date the review and interpretation is completed.

@Narobo - our lab is using the date we sent the Pathology Report back to the ordering provider. Have you ever heard of this being allowed?

I haven’t been able to find any guideline to support using that as the DOS and it seems very bizarre to me. That date is not listed anywhere on the Path Report and basically allows us to choose our own DOS.