[Histonet] Who can perform Histology Duties

[Terri Braud]

CLIA considers "grossing" to be a high complexity test.  The transference of the all tissue received in a container to a cassette, using a standard dictation is not defined as grossing, but as "processing", which is not a high complexity test.  CLIA uses this clarification but it must be clearly defined in your procedure.  

-----Original Message-----
From: Bonnie Whitaker [mailto:bwhitaker <@t> brownpathology.com]
Sent: Thursday, January 10, 2008 11:37 AM
To: Terri Braud; histonet <@t> lists.utsouthwestern.edu
Subject: RE: [Histonet] Who can perform Histology Duties


Hi Terri,

CAP has changed it's definition of grossing but most CAP labs are also
required to follow CLIA, even though they aren't inspected by CLIA.  Don't
forget about that if you bill Medicare.  They COULD come in and do an
unannounced inspection and zap you if your grossers don't meet the CLIA
standards for high complexity testing one way or another.

Bonnie Whitaker


-----Original Message-----
From: histonet-bounces <@t> lists.utsouthwestern.edu
[mailto:histonet-bounces <@t> lists.utsouthwestern.edu] On Behalf Of Terri Braud
Sent: Thursday, January 10, 2008 9:55 AM
To: histonet <@t> lists.utsouthwestern.edu
Subject: [Histonet] Who can perform Histology Duties



"Sharon.Davis-Devine" <Sharon.Davis-Devine <@t> carle.com> wrote:
  Ok, all of you Histonetters I have another question for you. Who the
histology laboratory can perform these job functions: embedding, cutting,
performing special stains and IHC? Can a lab assistant perform these duties
if properly trained or do you have to be classified as a Histotech in
training? Can a Cytotech or Med Tech perform such duties, again if properly
trained? All opinions and references to such requirements would be greatly
appreciated.

Though some may not like to admit it, ANYONE properly trained and documented
as competent can perform the duties listed above.  The only exception is for
those states that have licensure requirements for the performance of
Histological duties, and then, the licensure requirements must be met. IHC
is still a stain.  The interpretation of that stain by the pathologist is
the high complexity part of the test.  Anyone properly trained and
documented as competent can stain IHC. Even grossing has now been re-defined
by CAP to allow submission of smaller tissues by personnel without the
qualifications for High Complexity Testing (see below)  
(CAP checklist question and notes: ANP.11600)
1) Processing is defined as a tissue examination limited to description,
inking and cutting of the specimen (if applicable), and submission of the
entire specimen to histology.  Tissue processing can be performed according
to standardized protocols.  Processing is generally limited to small
specimens (skin ellipses, small biopsies, curettings, etc.) and does not
require knowledge of anatomy.
2) Grossing (or gross examination) is defined as a tissue examination
requiring a greater exercise of judgment and a knowledge of anatomy.
Dissection of the specimen and selection of tissue samples for submission to
histology are generally required.  The specimen description is not
necessarily standardized.

Please save your flames.  The scenerio of a Non-Histotech embedding,
cutting, and staining my surgical tissue does not thrill me, but that was
not her question.  Maybe the reality of the answer is why many Histology
Labs have always been considered the evil red-headed stepchildren of the
Lab.

Terri
Terri L. Braud, HT(ASCP)
Anatomic Pathology Supv.
Laboratory, Holy Redeemer Hospital
1648 Huntingdon Pike
Meadowbrook, PA 19046
(215) 938-3689

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