72-hour Rule Shouldn't Affect Your Date Selection

By Author: erinarticle
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Our pathologist examined a lip biopsy specimen from outpatient surgery carried out on March 2; however the hospital admitted the patient on March 4. The hospital has referred to the '72-hour rule' stating that the outpatient services become part of a single inpatient claim. What's the date of service (DOS) for the pathology exam?


The correct DOS for your pathologist's biopsy exam 88305, Level IV - Surgical pathology, gross and microscopic examination, lip, biopsy/wedge resection) is March 2. Many payers follow Medicare's DOS rule for clinical lab test and the TC of anatomic pathology procedures. According to the rule, the DOS is the date of specimen collection, with these 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 are billing globally or only billing the TC, you need to follow these rules. If ...
... you are billing only for the PC with modifier 26 (PC), you are not required to follow these rules. However for simplicity, most labs choose to use a consistent policy for assigning service dates.


The 72-hour rule shouldn't impact your date selection. According to the rule, 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. However, if you are an independent lab billing pathology services separately, the rule should not affect you.


For more on this and for other specialty-specific articles to assist your pathology coding, sign up for a good medical coding resource like Coding Institute.