Pathology/Lab Coding Alert

Question: Our pathologist examined a lip biopsy specimen from outpatient surgery performed Dec. 17, but the hospital admitted the patient on Dec. 19. The hospital has referred to the "72- hour rule" stating that the outpatient services become part of a single inpatient claim. What is the date of service for the pathology exam?

Answer: The correct date of service for your pathologist's lip biopsy exam (88305, Level IV - Surgical pathology, gross and microscopic examination, lip, biopsy/wedge resection) is Dec. 17. Many payers follow Medicare's date of service (DOS) rule for clinical lab tests and the technical component (TC) of anatomic pathology procedures. The rule states that the date of service is the date of specimen collection, with the following exceptions:

• For multiple-day collections, use the last date
• For archived specimens (stored over 30 days), use the date the specimen is pulled from storage
• For specimens that have been "stored" at least 14 days but not "archived," use the date you perform the service, if you meet certain criteria.

If you're billing globally or only billing the TC, you need to follow these rules. If you're billing only for the professional component with modifier 26 (Professional component), you aren't required to follow there rules. But for simplicity, most labs choose to use a consistent policy for assigning service dates.

The 72-hour rule shouldn't affect your date selection. The rule states that services provided for Medicare patients within 72 hours of a hospital admission are considered part of the inpatient services, which you should bill on one hospital claim. But if you're an independent lab billing pathology services separately, the rule shouldn't impact you.