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Pathology/Lab

Kathy Posted Mon 02nd of February, 2015 15:02:03 PM

Can you please explain the CMS policy for DOS (42 CFR 414.510). We are confused regarding the 30 days or less for storage and that the test/service is ordered by the patient's physician at least 14 days following the date of patient's discharge from the hospital.

SuperCoder Answered Wed 04th of February, 2015 09:35:19 AM

We are researching and will get back to you ASAP. Thanks !!

SuperCoder Answered Wed 04th of February, 2015 09:35:19 AM
Mail sent to CE.
SuperCoder Answered Fri 06th of February, 2015 09:21:55 AM

First, realize that the CMS DOS rule applies to clinical lab tests and the facility technical component of anatomic pathology services/procedures. The policy does not apply to the professional component of anatomic pathology.

That said, the DOS policy for applicable services is as follows:
1. General rule - DOS is the date the specimen is obtained from the patient, with the following exceptions:

2. If the specimen has been stored more than 30 days, the DOS is the date the specimen is obtained from storage.

The following 2 rules apply only to procedures on specimens obtained from hospital inpatients or outpatients and stored 30 days or fewer (for non-hospital patients, just abide by rules 1 and 2):

3. If the physician orders a test on a stored specimen on the 1st through 13th day after a hospital patient’s discharge, use the date the specimen is obtained.

4. If the physician orders a test on a store specimen on the 14th through 30th day after a hospital patient’s discharge, use the date that you perform the procedure.

Thanks !!

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