RE: [Histonet] Patient slide send-out

From:"Julia Dahl"

I agree that there are different categories of send-outs.

As a consultant pathologist who is receiving the "send-out" - an 88321 
(pathology second opinion on slides prepared elsewhere) is a professional 
component only CPT code and does not include any TC reimbursement (including 
shipping of slides and/or blocks).

The cost of shipping, then, should be born by the party requesting the 
slides.  If a pathologist is requesting a consultation, then their 
department pays for the shipping.  If it is a patient, then it's the 
patient... what about a clinician requesting the send out?  Do you want to 
be telling your clinicians that they will have to pay for shipping?  It's an 
imporant and difficult question to answer.

For BOTH sides - the originating pathology institution and the receiving 
pathology institution - second opinion pathology consultations are 
UNFORTUNATELY not economically feasible within the current CPT code and 
reimbursement schedules.  Less than 60% of insurance companies actually will 
pay the consultant pathologist for the consultation.   This is ridiculous 
given that the SAME insurance company will require a physician second 
opinion for patients with many medical conditions and surgeries PRIOR to 
paying for a surgical procedure or lengthy medical treatment...  AND the 
insurance company does pay for that second opinion.

As is evidenced by the literature and through anecdotal experience  - second 
opinion in anatomic pathology is a valuable means to ensuring pathology 
accuracy.  Nonetheless, this valuable service is neither convenient for the 
home institution nor the consultant... much less economically feasible for 
either institution.

In the time that it takes for our organization to provide a consultation on 
an IBD with dysplasia or collagenous colitis with co-existent IBD (a 
sampling of today's consultations), our pathologists can sign out at least 
ten 88305 gastridites or adenomas.  As an organization, do we dedicate our 
resources to primary diagnoses (more $$/less time) or to assisting our 
colleagues with their challenging cases (more time/less $$)?

Something that should be separated from the current discussion is  the 
instance of a send-out for a patient who is undergoing surgery at another 
institution.  This is a quality assurance activity.

Any institution in which a patient is undergoing DEFINITIVE therapy MUST 
review the pathologic material upon which the definitive therapy is rendered 
as a matter of ensuring the proper treatment and complete medical record for 
that patient within the treating institution.  What would be the consequence 
of a sclerosing papilloma on biopsy called invasive carcinoma in Institution 
A, with the patient sent to Institution B for lumpectomy or mastectomy with 
sentinel node dissection?  If Institution B requests the slides PRIOR to 
definitive therapy, and the diagnostic error is detected - the patient does 
not undergo an unnecessary surgical procedure and NONE of the physicians or 
medical institutions are sued.  If Institution B fails to re-review the 
slides prior to definitive therapy, the patient has an unnecessary surgery 
with the resultant M&M - and EVERYONE (Institution A, Institution B, 
Pathologist A, Pathologist B and Surgeons) gets sued and will settle out of 

With this in mind - for second opinions prior to definitive therapy,  the 
requesting institution must pay for the "consultation" if the patient's 
insurance will not.  The down-side for the requesting institution is that in 
the absence of the insurance company paying for the "second opinion" - the 
hospital incurs the expense, and has no mechanism for recovering this 
expense as the DRG is not changed.

Until this service is more equitably reimbursed - all parties are in a 
difficult situation.

Julia Dahl MD

>To: "Zajic Kari" ,"Richard Cartun" 
>Subject: RE: [Histonet] Patient slide send-out
>Date: Tue, 22 Aug 2006 19:27:43 +0000

>When we receive a request to send blocks or slides to another facility for 
>any reason we send the patients insurance information to the facility.  In 
>the letter we send we include the reason why the slides/blocks are being 
>sent and to charge the patient's insurance not us.  If they send us a bill 
>we fight it.  In the documentation that we keep I have different category 
>for why the consult was done.  Pathologist: is when our pathologist send 
>out for a second opinion and we pay the cost.  Physician, Patient or 
>Treatment: These we will not pay for.  The other facility eats the cost or 
>charges the patient's insurance.  We use priority mail because it usually 
>arrives in about 3 days, we can track the shipment and it is a minimal 
>Becky Barnhart
>-------------- Original message --------------
>From: "Zajic Kari" 
> > Richard, you are not alone! We have also seen an increase in patient and
> > physician requests for "send-outs". I am not sure of charging, but I 
>have made a
> > "send-out" policy for our department that all requests be put in writing
> > (scripts for physicians)and faxed,inform the patient/office that it will 
> > least be 48 hours before it can be sent out, they must provide a 
> > service account (FEDEX, UPS) or physically pick up the slides. We have 
>also been
> > being charged for these consults by the other facility so we also inform 
> > that if the insurance cannot be charged, they are responsible for the 
>bill. It
> > seems to work but we do run into some problems now and again. If they 
> > provide an overnight shipping service, we will USPS mail them certified 
>but that
> > seems to take too long for their liking (here it's around a week).
> > Not having enough staff to handle the sendouts is always a problem, 
>hence the 48
> > hours..helps slightly.
> >
> > Kari :)
> >
> > Kari Marie Zajic HTL,MLT
> > Histology Supervisor
> > Palms West Hospital
> > Pathology Department
> > 13001 State Road Eighty
> > Loxahatchee, Florida 33470
> > phone: (561)798-6036
> > telefax: (561)753-4298
> > voicemail: (561)753-4299
> > pager: (561)610-4949
> > email:
> >
> > This email and any files transmitted with it may contain PRIVILEGED or
> > information and may be read or used only by the intended recipient. If 
>you are
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> >
> >
> > -----Original Message-----
> > From:
> > []On Behalf Of Richard
> > Cartun
> > Sent: Tuesday, August 22, 2006 2:49 PM
> > To:
> > Subject: [Histonet] Patient slide send-out
> >
> >
> > Our Anatomic Pathology Office is overwhelmed with requests from patients
> > asking for their pathology slides to be sent to another medical
> > institution (for second opinion, additional surgery or therapy, etc.).
> > Is it legal to charge patients for this service? We don't have the
> > personnel to handle these requests in a timely fashion and we can no
> > longer afford to "eat" the shipping costs. Thank you.
> >
> > Richard
> >
> > Richard W. Cartun, Ph.D.
> > Director, Immunopathology & Histology
> > Assistant Director, Anatomic Pathology
> > Hartford Hospital
> > 80 Seymour Street
> > Hartford, CT 06102
> > (860) 545-1596
> > (860) 545-0174 Fax
> >
> >
> >
> >
> >
> > _______________________________________________
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> >
> >
> >
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> >
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