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Heme signout

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Rhabdoid

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I'm just wondering.

Why is heme signout so descriptive? In other words, why can't it be a one-line diagnosis without comment as it is in surgpath? For example:

Lymph node, pelvic, left: Hodgkin lymphoma, classical type.

What's the benefit of describing the diagnosis in detail?
 

Enkidu

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I'm just wondering.

Why is heme signout so descriptive? In other words, why can't it be a one-line diagnosis without comment as it is in surgpath? For example:

Lymph node, pelvic, left: Hodgkin lymphoma, classical type.

What's the benefit of describing the diagnosis in detail?

So what does a heme signout look like?
 

yaah

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I'm just wondering.

Why is heme signout so descriptive? In other words, why can't it be a one-line diagnosis without comment as it is in surgpath? For example:

Lymph node, pelvic, left: Hodgkin lymphoma, classical type.

What's the benefit of describing the diagnosis in detail?

It often is. I think the tendency towards putting microscopic descriptions on many things is because immunostains are often performed, and because some heme specimens have necessary descriptors like the peripheral blood or marrow where clinicians want to know lots of details (marrow cellularity, RBC findings).
 

Rhabdoid

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So what does a heme signout look like?

Basically you render a diagnosis and make a note describing the histopathological picture of the tissue, any immunos you may have done, flow and cytogenetic results. The last line is usually a reaffirmation of the diagnosis based on all the gathered data.
 

Autopsy101

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Heme sign out for lymph nodes and bone marrows is so long due to billing. In order to bill for immunostaining and flow there must be a discription of the findings of each of the tests that you performed specifically and how you interpret it. Everything that is mentioned separately on a bone marrow report has a charge associated with it. Perismear, aspirate smear, clot section, and core biopsy each have a separate charge, so they must be described separately to bill a charge associated with interpreting each specimen.

Most clinicians I work with would prefer a shorter surgical pathology sign out for lymph nodes and rarely even read the long comments unless they are looking for the results of certain prognostic test or marker which is targeted by specific therapy. They usually read the bone marrow reports more closely because the comments and discriptions usually help them with their clinical diagnosis especially in the non-malignant cases.
 

gschl1234

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So what does a heme signout look like?

For a normal bone marrow:

1. BONE MARROW (BIOPSY, ASPIRATE): NORMOCELLULAR MARROW WITH TRILINEAGE HEMATOPOIESIS. SEE NOTE.

Note: The marrow is normocellular for age (50%) and displays trilineage hematopoiesis. The myeloid to erythroid ratio is appropriate (3:1). Megakaryocytes are normal in number and morphology. The accompanying aspirate correlates with the biopsy. Flow cytometry results reported in detail separately show no phenotypic abnormality.

It was explained to me the reason the notes are necessary is that these are medical biopsies (like kidney) in addition to biopsy for tumor.
 

2121115

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For a normal bone marrow:

1. BONE MARROW (BIOPSY, ASPIRATE): NORMOCELLULAR MARROW WITH TRILINEAGE HEMATOPOIESIS. SEE NOTE.

Note: The marrow is normocellular for age (50%) and displays trilineage hematopoiesis. The myeloid to erythroid ratio is appropriate (3:1). Megakaryocytes are normal in number and morphology. The accompanying aspirate correlates with the biopsy. Flow cytometry results reported in detail separately show no phenotypic abnormality.

It was explained to me the reason the notes are necessary is that these are medical biopsies (like kidney) in addition to biopsy for tumor.

Actually, if the marrow is truly normal the diagnosis line wouldn't warrant a note. They can refer to the description for that.
 

gschl1234

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Actually, if the marrow is truly normal the diagnosis line wouldn't warrant a note. They can refer to the description for that.

That's just the way we are taught to structure the diagnosis at our institution. We write a note with everything and do not have a special "description" section.
 

mikesheree

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I'm just wondering.

Why is heme signout so descriptive? In other words, why can't it be a one-line diagnosis without comment as it is in surgpath? For example:

Lymph node, pelvic, left: Hodgkin lymphoma, classical type.

What's the benefit of describing the diagnosis in detail?

not everyone does. i would not do a description on a hodgkins node. if i did immunos i would mention them to document the justification for the 88342's.
i do very few micro descriptions. they don't pay me or the transcriptionists for the extra (waste of) time to do it.
 
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