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Prostate BX

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coomasie blue

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"It is estimated 1 million prostate biopsy procedures are performed each year in the United States. At roughly $70 per 88305 (the new Medicare reimbursement rate after the 52% TC reduction), that comes to about $840 million per year if every procedure generates twelve 88305s. That means if urologists would simply submit prostate biopsies so as to only generate six 88305s, we could save roughly $420 million a year without impacting patient care at all" Pathologyblawg
 

LADoc00

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"It is estimated 1 million prostate biopsy procedures are performed each year in the United States. At roughly $70 per 88305 (the new Medicare reimbursement rate after the 52% TC reduction), that comes to about $840 million per year if every procedure generates twelve 88305s. That means if urologists would simply submit prostate biopsies so as to only generate six 88305s, we could save roughly $420 million a year without impacting patient care at all" Pathologyblawg

You could carry this logic into lots of areas of healthcare, government spending etc.

there are good and valid reasons not to stuff multiple cores into 1 block including sectioning artifacts (ie not seeing 100% of each core) and mapping for treatment.

Regardless, it wont happen. They may try to bundle payments for prostate biopsies but so far that has been quite unsuccessful...

Im afraid my shields will be quite operational by the time your cost cutters arrive...
 

pathstudent

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You could carry this logic into lots of areas of healthcare, government spending etc.

there are good and valid reasons not to stuff multiple cores into 1 block including sectioning artifacts (ie not seeing 100% of each core) and mapping for treatment.

Regardless, it wont happen. They may try to bundle payments for prostate biopsies but so far that has been quite unsuccessful...

Im afraid my shields will be quite operational by the time your cost cutters arrive...

But you could put six cores from all 6 left sectors into a container and call it left prostate, and then do the same for right. Then you could pit one core in a casette and still have
12 individual cores to look at. And you reduced the cost to 1/6th and I dont believe you changed management. I've seen men go to prostatectomy with less than 5% in one core out of 12. What difference does it make if it is from the upper right mid base.
 

WEBB PINKERTON

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I really dont care if they submit them in 6 or 12 containers, but they need to decide what should be standard of care and go with it. The "white" paper leaves the door open for urologists to justify doing 88305x12.
 

icpshootyz

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Our urologists do 12-core prostate mapping with 2 cores per bottle, 6 88305s. Sure it's a loss of revenue for us, but it works out fine diagnostically. And I really don't see any valid reason for prostate "mapping". The only significant finding is bilateral disease. Left vs right would be fine.
 

Enkidu

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Our urologists do 12-core prostate mapping with 2 cores per bottle, 6 88305s. Sure it's a loss of revenue for us, but it works out fine diagnostically. And I really don't see any valid reason for prostate "mapping". The only significant finding is bilateral disease. Left vs right would be fine.

If left vs right is all that matters, why not submit 6 cores per bottle?
 

pathstudent

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Our urologists do 12-core prostate mapping with 2 cores per bottle, 6 88305s. Sure it's a loss of revenue for us, but it works out fine diagnostically. And I really don't see any valid reason for prostate "mapping". The only significant finding is bilateral disease. Left vs right would be fine.

Prostate pathology has to be one of the biggest games in pathology. It sounds great to make 1300-1800 (depending on the payer) global per prostate case, 88305x12, but basically you are totally gaming the system and not adding any real information over just doing 88305 x 2 and making only 210-300. And when you game the system long enough, CMS eventually figures it out and then reacts the other way (like cutting 88305s across the board 33%) ruining everything for everyone. Pigs get fat. Hogs get slaughtered.
 

path24

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If 88305s get cut, you can blame gi, uro...etc. But we provided the oversupply for them to cash in on their specimens. We still will be to blame. Why would uros, gis care if pathology gets thrown under the bus? Sad that other doctors have enough control over pathology to hurt our own field....oversupply.
 

icpshootyz

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If left vs right is all that matters, why not submit 6 cores per bottle?

We don't control how they submit the cores, and currently they do 2 per bottle. I'm saying diagnostically and medically it wouldn't matter if they switched to 6 per bottle. Yes, we would lose revenue, but patient care would not be impacted.
 

LADoc00

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But you could put six cores from all 6 left sectors into a container and call it left prostate, and then do the same for right. Then you could pit one core in a casette and still have
12 individual cores to look at. And you reduced the cost to 1/6th and I dont believe you changed management. I've seen men go to prostatectomy with less than 5% in one core out of 12. What difference does it make if it is from the upper right mid base.

You know what else.. A Gyn could see 5 patients at a time grouped by symptoms. You know, have them all sit around in 5 circled chairs and go back and forth talking about their uterine pain or whatever.

But you dont. You see things one at a time, carefully determine the extent of disease. Explain this to the patient etc.

When cores get in blocks they FRAGMENT. Put 6 cores in section and you could have 12+fragments easily. Now 6 of those fragments are positive, is that all 6 cores positive? Just 3? Just 2? What??

Dont mindlessly repeat what cost cutters blab about without listening to your own colleagues.
 
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Whether or not there is one core in each bottle, you better have one core in each block. Way easier to embed, section, level, etc and minimizes fragmentation. This all depends on the expertise of the histotech (pathologyblawg has written on this several times, and even had Epstein chime in). It's the same amount of processing and work for each core so I'd rather have an 88305 charge per core than 88305 per container because it's more reflective of the actual work done (as alluded by LADoc's post).
 

lipomas

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Two cores per block is fine too. You don't have to limit it to one. There have been studies on this. More than two it gets dicey.
 
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