[Histonet] Re: Peripheral smear

Robert Richmond rsrichmond <@t> gmail.com
Wed Mar 30 11:22:15 CDT 2011

Gary Martin (where?) asks: >>Our pathologist[s] review peripheral
smears for the clinical lab, and I'm wondering how other facilities
handle the reporting. We presently receive the smear from a tech, the
pathologist provides a comment and returns it to the lab.<<

I take these VERY seriously. First, how NOT to do it: 1. Pathologist
scribbles a tiny note in a space the size of a postage stamp, which
then gets posted to the chart, or maybe doesn't. 2. Pathologist
scribbles a note, which a technologist then types into the system
(pathologist doesn't have access to the system). 3. Pathologist
dictates a note, which is typed by a transcriptionist unfamiliar with
the vocabulary, then put in the chart where the attending physician
will never find it.

Peripheral smear reviews are requests for consultation and should be
treated as such. This consultation is billable (CPT 85060). There is a
higher CPT code for more extensive consultation (80502) but I've never
talked to anyone who'd heard of it. The pathologist should review the
history to the extent necessary, and record this review in the note.
(The patient doesn't live whose relevant history I can't summarize in
one sprawling, badly written sentence.) The consult should include the
basic data from the blood count that comes with the smear, since this
information probably won't be simultaneously available to the
physician reading the consult.

The blood smear review should be focused in view of the information
available. The pathologist should recommend such basic tests
(reticulocyte count, vitamin B12, ferritin, direct antiglobulin test)
as haven't been done.

I prefer to type these consults myself, but most pathologists dictate
them. A template would be worthwhile.

The point here is - the pathologist is a consultant, not a technician,
and should not regard themself as a technician nor allow themself to
be treated as a technician.

These reviews can be the best bargain in laboratory medicine, given
that the pathologist would make better money flippin' burgers at
McDonald's. I get enough feedback about them to know they're

The opinions expressed are my own, and have not been vetted by anybody
with an MBA.

Bob Richmond
Samurai Pathologist
Knoxville TN

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