[Histonet] Re: Receiving all placentas

[rsrichmond <@t> aol.com]

Kari Breal, the Histology Supervisor Alexian Brothers Medical Center at 
847-437-5500 ext. 5155 (I'm going to assume this is in the USA - my 
Internet access is limited today) asks:

>>Our OB/GYN department is requesting we accession/receive all 
placentas. They want us to continue with the gross and micro for the 
one that meet the criteria for examination. For the normal placentas, 
they want us to gross the placenta, take a few sections and store these 
sections (uncut) for up to 20 years.<<

Did your pathologists have no input into this decision? If they're 
allowed an opinion, I'd suggest they work with your hospital's 
perinatal committee on this issue.

The gross-only examination (CPT code 88300) pays very much less than 
the microscopic (88307 for placentas). Whether insurance companies pay 
either of these - and how much they pay - varies from state to state - 
remember that in most states 80% of deliveries are on Medicaid or its 
local equivalent.

By "store these sections uncut" I suppose you mean store the uncut 
paraffin blocks. Since in most places paraffin blocks are retained for 
at most ten years, this policy would require separate storage of 
placenta blocks. (Actually 20 years is a little short - as much as 25 
years would probably be required - if your kid flunks out of college, 
sue the obstetrician that delivered him.)

I'm seeing increasing numbers of hospitals where all placentas get 
microscopic examinations, and apparently the third parties are paying. 
Placentas are submitted for examination entirely without history, with 
hissy-fits following the pathologist's attempts to get any, so that the 
quality of the examinations is quite low.

If the OB-GYN's want a gross examination only, they should do the 
examination themselves.

My advice - which I've never seen followed - would be to have all 
placentas submitted in adequate quantities of formalin, with the 
pathology department holding them for a week. If the OB-GYN wants a 
placental examination, they can order it, with a special history sheet 
included. If they don't order an examination, the charts are reviewed 
by somebody in the Risk Management department when mother and baby are 
discharged, and examination is ordered by the Risk Management 
department if guidelines indicate it's needed. (Remember that some 
indications for examination are not apparent at the time of the 
delivery.)

Bob Richmond
Samurai Pathologist
Knoxville TN
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