Could it also be the ease of diagnosis? Iron stains are usually easy -
there's usually iron, or there isn't, with a slight variation as to how much
iron. And because they are ordered every day, the pathologists have a lot of
experience with diagnosing with the Prussian blue. And tissue is usually
bone marrow, with an occassional lung (heart failure cells) or spleen thrown
in, except in cases of looking for old hemhorrages. But in these cases, low
power is good enough - just a quick look is often all that is needed.

On the other hand, the amount of copper can be minimal. And if there is
cirrhosis, is it caused by the copper (Wilson's), or is any copper found in
cirrhotic liver (alcoholism, hepatitis) due to being trapped by the
cirrhosis, rather than causing the cirrhosis (Wilson's).  If it is Wilson's,
the minimal amount of copper can be in any tissue (we used a kidney for
years as our control). It takes more time, on higher power, to find these
minimal deposits.

It seems to me that one criteria for the codes appear to be based on how
much time a pathologist has to look at a slide to make a diagnosis. After
all, a PAS for fungus is a different code (and billing/reimbursement) than
PAS for mucin or glycogen. PAS for Mucin and glycogen are - yes it's there,
no it's not. PAS for basement membrane is - yes it's there, but how thick.
PAS for fungus is not only is it there or not, but which fungus, and some
fungi are harder to find than others (size, number, background).

Yet for histotechs - basically, a PAS is a PAS is a PAS. Any variations we
do are minor (we leave PAS for basement membrane in the Schiff longer, but
we're doing it on 3 um kidney, rather than 5 um for mucin/glycogen/fungus).
Hands-on time - it's the same.

Peggy Wenk

-----Original Message-----
From: histonet-bounces@lists.utsouthwestern.edu
[mailto:histonet-bounces@lists.utsouthwestern.edu] On Behalf Of Rene J Buesa
Sent: Tuesday, January 23, 2007 10:17 AM
To: Weems, Joyce; Histonet
Subject: Re: [Histonet] Iron and copper code question

It is probably because iron is almost a routine stain for bone marrow smears
and biopsies, while copper (and zinc) are seldom done and always as
histochemical stains for specific cases. Any lab may have several iron
stains daily, but copper (for Wilson's disease) is perhaps done once every 1
or 2 months.
  Frecuency in usage may determine the different code.
  Just an "educated guess" though!
  René J.

"Weems, Joyce"  wrote:
  What is the difference in iron and copper staining that would cause copper
and zinc, to to be listed as 88318 and iron listed in 88313 in CPT codes?
Seems iron is a histochemical stain also. 

Thanks, j



Joyce Weems
Pathology Manager
Saint Joseph's Hospital
5665 Peachtree Dunwoody Rd NE
Atlanta, GA 30342
404-851-7376 - Phone
404-851-7831 - Fax



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