Posted on 28. Aug, 2009 by in Hot Coding Topics
You can’t afford to get the date of service (DOS) wrong on claims that undergo CMS edits — mistakes could mean you’ll face fraud charges. That’s because Correct Coding Initiative (CCI) edits and Medically Unlikely Edits (MUEs) control payment for procedures on the same DOS.
But for pathologists, choosing the date has never been clear-cut. “For instance, should you use the date the surgeon took the biopsy, the date the lab processed special-stain slides from the biopsy specimen, or the date the pathologist interpreted those slides?” asks Pamela Biffle, CPC, CPC-I, CCS-P, ACS-DE, principal for PB Healthcare Consulting and Education in Fort Worth, Tex.
Do this: If you’re billing for clinical laboratory tests or the technical component (TC) of physician pathology services, you’ll need to adhere to the following five rules.
Rule 1: Use Specimen Collection Date
CMS’s general rule is that the DOS is the date of specimen collection.
Example 1: A physician office draws blood on Sept. 1 and sends it to a laboratory for a lipid profile. The lab runs the profile on Sept. 3 and bills procedure code 80061 (Lipid panel). The lab should report Sept. 1 as the DOS.
Example 2: A surgeon performs a breast resection on June 4. Your pathology lab receives a tissue sample for IHC testing on June 6. Your lab performs a quantitative ER/PR, Her-2/neu breast tumor analysis using an automated platform on June 7.
You should bill for 88361 x 3 (Morphometric analysis, tumor immunohistochemistry [e.g., Her-2/neu, estrogen receptor/progesterone receptor, quantitative or semiquantitative, each antibody; using computer-assisted technology). “Because the code definition for 88361 designates ‘per antibody,’ each of the tests for ER, PR, and Her-2/neu warrants...
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