If you're going to steal from the system

[BrainPathology]

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Members don't see this ad.

And force us into having one global reimbursement for immunohistochemistry no matter how many studies are needed, at least steal money with the correct or at least marginally defensible stains.

When you get a brain tumor and there isnt a known primary AND the presence of vascular hyperplasia, psuedopalisading necrosis, atypical astrocytes and abundant atypical mitoses don't cinch the diagnosis for you, order a GFAP and a Ki-67 and MAYBE an EMA because a 1st year might buy that it could be a malignant meningioma.

Don't order (all of these on the same case)
- High molecular weight cytokeratin
- Low molecular weight cytokeratin
- A double stain of high molecular weight cytokeratin and low molecular weight cytokeratin
- Cytokeratin 7
- Cytokeratin 20
- TTF-1
- Vimentin
- "pan melanoma" triple stain

This is absolutely uncalled for and it's only accurately described as insurance fraud or theft depending on who's paying. This does nothing at all for patient care and is the kind of attitude in all specialties that leads us to where we are now of impending strangulation by health care reform. If you see your collegues doing this CALL THEM OUT!

 

[Thrombus]

And force us into having one global reimbursement for immunohistochemistry no matter how many studies are needed, at least steal money with the correct or at least marginally defensible stains.

When you get a brain tumor and there isnt a known primary AND the presence of vascular hyperplasia, psuedopalisading necrosis, atypical astrocytes and abundant atypical mitoses don't cinch the diagnosis for you, order a GFAP and a Ki-67 and MAYBE an EMA because a 1st year might buy that it could be a malignant meningioma.

Don't order (all of these on the same case)
- High molecular weight cytokeratin
- Low molecular weight cytokeratin
- A double stain of high molecular weight cytokeratin and low molecular weight cytokeratin
- Cytokeratin 7
- Cytokeratin 20
- TTF-1
- Vimentin
- "pan melanoma" triple stain

This is absolutely uncalled for and it's only accurately described as insurance fraud or theft depending on who's paying. This does nothing at all for patient care and is the kind of attitude in all specialties that leads us to where we are now of impending strangulation by health care reform. If you see your collegues doing this CALL THEM OUT!

👍👍👍

These thieves are the same ones who screw over the rest of us by stealing our business.

 

[lipomas]

There is a major reference lab who does a "standard" panel of immunostains on all lung cancers. It's like 6 stains and in most cases they are not useful at all.

People who do lots of immunostains often couch it in "better patient care." When I was in residency we had a case of a recurrent sarcoma which was histologically identical to the prior resection (which had been worked up to determine histotype and sent out for consult because it was unusual). We signed it out as "recurrent leiomyosarcoma" and the attending and I both got an angry letter from the patient accusing us of trying to save money (or make money off of him) by not doing immunostains which would be appropriate to do. Because, obviously, you are doing a better job in pathology if you spend more money on a case unnecessarily. Everything possible should be done!

In that case we said it was identical to the previous tumor and there was no need for immunostains. He wrote back again, disagreed, and I think he ended up having it sent to a soft tissue expert as a consult. I don't know what happened after that.

Look at it from this perspective: It is a lot easier to justify DOING an immunostain than it is to NOT do an immunostain. It would be hard to get sued for doing an immunostain (unless you interpreted it wrong). Whereas you could get sued for not doing them. Such is life.

 

[danaphosaurus]

i feel it is stuff like this that also gives private practice a bad name-

 

[BrainPathology]

There is a major reference lab who does a "standard" panel of immunostains on all lung cancers. It's like 6 stains and in most cases they are not useful at all.

People who do lots of immunostains often couch it in "better patient care." When I was in residency we had a case of a recurrent sarcoma which was histologically identical to the prior resection (which had been worked up to determine histotype and sent out for consult because it was unusual). We signed it out as "recurrent leiomyosarcoma" and the attending and I both got an angry letter from the patient accusing us of trying to save money (or make money off of him) by not doing immunostains which would be appropriate to do. Because, obviously, you are doing a better job in pathology if you spend more money on a case unnecessarily. Everything possible should be done!

In that case we said it was identical to the previous tumor and there was no need for immunostains. He wrote back again, disagreed, and I think he ended up having it sent to a soft tissue expert as a consult. I don't know what happened after that.

Look at it from this perspective: It is a lot easier to justify DOING an immunostain than it is to NOT do an immunostain. It would be hard to get sued for doing an immunostain (unless you interpreted it wrong). Whereas you could get sued for not doing them. Such is life.

I definitely admire your restraint in the case. If a patient actually wrote to me demanding that I order stains I'd probably do that, (or depending on my mood tell him I'd be happy to run them if he wants to pay cash for them). I think we should all be happy to do all the immunostains a patient wants and will pay for in cash. I'll stain for GFAP in colon cancer if a patient wants it. I'll stain for CD45 in all my GBM's if a patient wants it. I'll stain for gold, diamonds or even fluffy noonan cells in whatever tumor a patient wants to throw his or her money away for. While I do it I'll tell them they are wasting their money.

---and will pay cash. And I'm happy to offer that option. As long as the public or insurance are paying for things then we need to have to authority to say no. I would suspect that patients demanding stains that are *****ic isn't the predominent driving force behind these practices though.

 

[BrainPathology]

i feel it is stuff like this that also gives private practice a bad name-

Yeah or at least large private labs. However, if you, say, build into your contract with the hospital 80% turnover in 24 hours from specimen receipt it might prevent you from ordering a bunch of nonsense that you have to deal with interpreting AND preforming. It MIGHT make you actually think a moment about what questions you really need to have answered and what exact stains would have a bearing on your diagnosis based on both positive and negative results.

 

[LADoc00]

Hold it..what is this you refer to??

And force us into having one global reimbursement for immunohistochemistry no matter how many studies are needed

WHO is doing this? This post makes no sense...Please someone clarify. CMS does NOT have one global IHC CPT code.

 

[BrainPathology]

Hold it..what is this you refer to??



WHO is doing this? This post makes no sense...Please someone clarify. CMS does NOT have one global IHC CPT code.

Which part? The original post or assuring a certain amount of cases signed out?

 

[LADoc00]

WHO is forcing us into a system of 1 global IHC fee??? Where, when, who.

What is your point dude?? I read the OP 3 times and dont understand what your getting at.

 

[BrainPathology]

WHO is forcing us into a system of 1 global IHC fee??? Where, when, who.

What is your point dude?? I read the OP 3 times and dont understand what your getting at.

I'm not sure I could add anything that would make it more clear.

 

[danaphosaurus]

2 words- flow cytometry-

also- I would like to add that fluffy noonan cells are often very difficult to diagnose and often require upwards of 30 IHCs

 

[BrainPathology]

2 words- flow cytometry-

Yeah they say history repeats itself.

But then again they've said that before.

 

[lipomas]

WHO is forcing us into a system of 1 global IHC fee??? Where, when, who.

What is your point dude?? I read the OP 3 times and dont understand what your getting at.

I thought his point was that if people keep ordering huge impox panels on cases that don't need them, authorities will threaten to move to a payment system that discourages ordering too many. I think they pretty much stop paying after what, 6 stains, now?