Department of Pathology and Laboratory Medicine, The University of North Carolina School of Medicine, Chapel Hill, NC.
Am J Surg Pathol. 2019 Nov;43(11):1510-1517. doi: 10.1097/PAS.0000000000001337.
Many physicians share the perception that the work required to evaluate breast pathology specimens is undervalued by Current Procedural Terminology (CPT) codes. To examine this issue, we compared slide volumes from an equal number of breast and nonbreast specimens assigned 88305, 88307, or 88309 CPT codes during four 2.5-week periods over 1 year. For each specimen, a number of initial hematoxylin and eosin-stained sections (H&Es), preordered additional H&E sections (levels), H&E sections ordered after initial slide review (recuts), and specimen type were recorded. Slides associated with ancillary stains were not considered. In total, 911 breast and 911 nonbreast specimens, each assigned 88305 (n=580), 88307 (n=320), and 88309 (n=11) CPT codes, were compared. Breast 88305 specimens were mainly core biopsies and margins and generated 2.3 and 6.4 times the H&Es and recuts, respectively, than did nonbreast specimens (P<0.01). Breast 88307 specimens were mainly lymph nodes and lumpectomies and generated 1.8 times the total slides than did nonbreast specimens (P<0.01). Eleven modified radical mastectomies (88309) generated 2.1 times the total slides than nonbreast 88309 specimens (P<0.01). In total (n=911 in each cohort), breast specimens generated 1.9, 4.0, and 1.7 times the H&Es, recuts, and total slides (P<0.01) than did nonbreast specimens. At our academic institution, the slide volume for breast specimens is nearly twice that of similarly coded nonbreast specimens. These results have significant implications for workload management and assessing pathologist productivity, particularly in subspecialty practices.
许多医生认为，当前的程序术语 (CPT) 代码对评估乳腺病理标本所需的工作重视不足。为了研究这个问题，我们比较了一年中四个为期 2.5 周的时间段内，分配了 88305、88307 或 88309 CPT 代码的等量乳腺和非乳腺标本的切片数量。对于每个标本，记录了初始苏木精和伊红染色切片 (H&E) 的数量、预订购的额外 H&E 切片 (切片水平)、初始切片审查后订购的 H&E 切片 (重切) 以及标本类型。未考虑与辅助染色相关的切片。总共比较了 911 例乳腺和 911 例非乳腺标本，每个标本分别分配了 88305 (n=580)、88307 (n=320) 和 88309 (n=11) CPT 代码。乳腺 88305 标本主要为核心活检和边缘，生成的 H&E 和重切分别是非乳腺标本的 2.3 倍和 6.4 倍 (P<0.01)。乳腺 88307 标本主要为淋巴结和保乳手术，生成的总切片数是非乳腺标本的 1.8 倍 (P<0.01)。11 例改良根治性乳房切除术 (88309) 生成的总切片数是非乳腺 88309 标本的 2.1 倍 (P<0.01)。在总共 911 例每个队列的标本中，乳腺标本生成的 H&E、重切和总切片数是非乳腺标本的 1.9 倍、4.0 倍和 1.7 倍 (P<0.01)。在我们的学术机构中，乳腺标本的切片量几乎是非乳腺标本的两倍。这些结果对工作量管理和评估病理学家的生产力具有重要意义，特别是在亚专科实践中。
