[Histonet] Advice needed on doing the technical component and professional component at two different sites

Linda lmdee1 at yahoo.com
Tue Jul 14 04:26:06 CDT 2015


Jim,
I know how you feel with confusing about not having a pathologist onsite.  I have lived your next adventure for over 5 years.  This is what I have done-
1.        Since the local pathologist group does not read these slides,  are our  grossing techs under the indirect supervision of the pathologists at the private company for these specimens? 
 No, you are not under indirect supervision. You are considered a reference lab.  Whom ever is your lab director is your supervising person.  But, if the director doesn't review any of same work batch, then you will need QC documentation from the private company.  And, your lab director will have to sign off after reviewing private lab documents.
2  How do you accession these specimens locally so tracking, slide preparation, and technical component billing can be done, without a local surgical report. 
 You are going to have to document all high complexity testing.  I have a tracking sheet that lists- accession #, patient's name, block#, general tissue type, grossing #, embed #, # of H&E's sent, specials sent, who checked in  received slides and (we receive back a slide level for our records) who sent back the slide.  I have a separate histology req, which is dictated straight into the patient's chart using dragon and a grossing template which lists our TC charges.  I have no LIS system.  The final report is interfaced using HL7 windows.
3.   If you have to do a local report, who signs the gross report that just has a gross and maybe a statement that the slides will be read at the private company?
I electronically sign my gross report. Yes, I do meet the CLIA and CAP requirements for doing high complexity testing.  My grossing template includes my CLIA and CAP number and a statement mentioning all technical component was performed at X company with address, phone, etc. 
4.      Are there other CAP considerations I am not thinking of?  
I do not know what policies and procedures you currently have in place, so this question is harder to answer.  BUT you do have to have documentation of all shipping and tracking numbers to show CAP inspectors and in case something goes awry in passage of slides.
A very important point to remember is BOTH sets of charges have to match or you will be red flagged by insurance companies.  If the reading pathologist doesn't use the special stain, you can not charge.
You have to have a copy of whom ever is reading your slides credentials and insurance, continuing ed,etc.
You have to have ready for inspectors- person doing grossing credentials and documentation.
CAP is very good with answering questions.  You do have to comb through all the CAP regulations to see what applies and what does not.
If you are not already CAP accredited, they have a team(which you pay) who can check to see if you are ready for accreditation. 
Good Luck,
Linda Dee, BGS, HT(ASCP)


       From: "Vickroy, James" <jvickroy at SpringfieldClinic.com>
 To: "histonet at lists.utsouthwestern.edu" <histonet at lists.utsouthwestern.edu> 
 Sent: Monday, July 13, 2015 4:27 PM
 Subject: [Histonet] Advice needed on doing the technical component and professional component at two different sites
   

Currently our dermatologists send their skin biopsies to a private lab.  Since we  now have our own Histology department we are proposing to do the technical component (grossing and preparation of slides) in house and sending the block and H&E slides to the same private company.  They call these type of clients " professional read only".  I understand the differences regarding billing since the CPT codes we are using have a professional component and a technical component.  My questions center around what other organizations do for accessioning and how they  meet CAP requirements for grossing, etc.

Normally we handle all of our other specimens in the normal way of accessioning, grossing (under the indirect supervision of a pathologist that comes to read the slides, processing, preparation of slides, and giving the slides to the pathologist who signs out the surgical report including the gross, and the rest of the surgical report.

The dermatology specimens would have to be handled differently. Our dermatologists want the slides read by the private company that only does dermatology specimens. (at least until we hire a dermatopathologist).  In the past the derm tissues were sent to the private company and they did all of the process including grossing.  Our organization has now decided that it is advantageous for us to do the technical portion in house and then send the slides to be read by the private company because of changes in billing.  The private company is perfectly willing to  help us make sure they get information they need  to diagnose the cases (they have even shown us how they like each type of skin biopsy sectioned and inked.  They will help us set up a system for them to get the slides and do the surgical reports.  Their report will have our gross description and surgical number, along with a statement that the gross and processing was done elsewhere.  They have done this with several other clients.  I have some unanswered questions since I have never done something like this.  Below is a list of my questions.  What I really need is someone to tell me how they are handling specimens that they prepare locally and then send the slides to a pathology group to read.


1.        Since the local pathologist group does not read these slides,  are our  grossing techs under the indirect supervision of the pathologists at the private company for these specimens?

2.      How do you accession these specimens locally so tracking, slide preparation, and technical component billing can be done, without a local surgical report.

3.      If you have to do a local report, who signs the gross report that just has a gross and maybe a statement that the slides will be read at the private company?

4.      Are there other CAP considerations I am not thinking of?

Am I making this too complicated?

Jim





Jim Vickroy
Histology Manager
Springfield Clinic, Main Campus, East Building
1025 South 6th Street
Springfield, Illinois  62703
Office:  217-528-7541, Ext. 15121
Email:  jvickroy at SpringfieldClinic.com<mailto:jvickroy at SpringfieldClinic.com>



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