| Reprinted from October 2004 CAP TODAY
Q: What date of service should we report for archived specimens?
A: Do not report the date the specimen was collected as the date
of service. Guidelines from the Centers for Medicare and Medicaid Services
specify the correct date of service is the date the specimen is obtained
from archives. The final rule, published Nov. 23, 2001, states that “for
laboratory tests that require a specimen from stored collections, the
date of service should be defined as the date the specimen was obtained
from the archives.” However, the final rule does not define how
long a specimen must be stored before it is considered to be archived.
CMS has received numerous requests from laboratories to issue a national
standard that clarifies when a stored specimen can be considered ar chived.
CMS proposed to further clarify the date of service provisions related
to archived specimens that appear in the proposed ruling issued Dec. 24,
2003. Those provisions are that a specimen must be stored for more than
30 calendar days to be considered archived—specimens stored 30 days
or less would have a date of service of the date the specimen was collected.
This provision is under review and is not expected to be finalized until
early 2005.
Q: What is the appropriate use for the new ICD-9 code 795.08? Should
it be billed when the Pap smear is unsatisfactory and interpreted or when
the Pap smear is unsatisfactory and reported as such with no interpretation
possible?
A: The publication ICD-9-CM 2005 contains several changes
for cervical cytology to differentiate between diagnoses based on Pap
test results and those based on biopsy results. Classifications under
diagnosis code 795.0 were expanded to more accurately reflect the terminology
used in the revised Bethesda system for ASC-US, AGUS, dysplasia, and unsatisfactory
and nonspecific abnormalities.
Unsatisfactory specimens can be billed if they are pro cess ed completely
and examined by the laboratory. Specimens that are unsatisfactory for
evaluation are reportable with diagnosis code 795.08. If the sample was
unsatisfactory and another Pap test needs to be taken, clinicians should
report 795.08 as the primary diagnosis to justify that the service is
medically necessary. Labs should use code 795.08 as a secondary diagnosis
with the appropriate Pap screening test to indicate the cytologic service
was performed but the specimen was unsatisfactory. The reason for inadequacy
must be specified if the specimen is processed and examined. Those unsatisfactory
Pap tests that are rejected—for example, if there is no label or
a slide is broken beyond repair—should not be billed because they
have not been processed completely and examined.
CMS no longer allows the 90-day grace period for annual ICD-9-CM updates,
effective for dates of service on and after Oct. 1, 2004. Providers must
bill using the diagnosis code that is valid for the date of service.
Frequently asked questions about CPT are published bimonthly in “Capitol
Scan.” This section of CAP TODAY is a product of the CAP Economic Affairs
Committee.
The codes and descriptions listed here are from Current Procedural
Terminology, 4th ed., CPT 2004. CPT 2004 is copyrighted by the American
Medical Association. To purchase CPT books, call the AMA at 800-621-8335.
For more information about CPT coding, visit the CPT Coding Resource Center on the CAP Web
site. |
