Resect and Discard

[WEBB PINKERTON]

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Anyone see the surprise billing for colonoscopy article on medpage today? Resect and discard biopsy specimens is mentioned.

"In the short term, endoscopists should also consider using established cost-saving strategies, such as conscious sedation and the 'resect and discard' approach, to biopsy specimens," the authors wrote. "In the longer term, we must enhance ongoing reform efforts to remove consumer cost sharing for all clinically indicated care associated with colonoscopy."

 

[octopusprime]

I'm sure reforming consumer cost saving measures does not in any way involve gastros taking a cut on their procedure fees...

 

[Med Director New England]

Anyone see the surprise billing for colonoscopy article on medpage today? Resect and discard biopsy specimens is mentioned.

"In the short term, endoscopists should also consider using established cost-saving strategies, such as conscious sedation and the 'resect and discard' approach, to biopsy specimens," the authors wrote. "In the longer term, we must enhance ongoing reform efforts to remove consumer cost sharing for all clinically indicated care associated with colonoscopy."

what I am seeing with some of my GI friends is consolidating multiple small GI biopsies (esp lowers) into less jars. Ex two or more small polyps that are relatively close in the colon placed into one jar. They rightly point out if one is cancerous differentiating them isn’t critical b/c of proximity. Similar phenomena in cervical biopsies. I have spoken to some of my colleagues and they are getting pressure from patients to lower their out of pocket costs due to lab co-pays.

 

[deleted1074676]

1. GI docs must decide to "resect and discard" not pathologists.
2. In the age of defensive medicine, I cannot imagine a GI doc discarding a specimen.
3. Some pathologists like the easy specimens (tubular adenomas), so I think path would be against "resect and discard"
4. In regards to what New England said, this goes back to the whole debate about one biopsy per jar or multiple per jar. Path makes more money with one biopsy per jar, but I thought that it was insurance fraud to instruct the GI docs to do that. Am I wrong?

 

[Thr0mbus]

what I am seeing with some of my GI friends is consolidating multiple small GI biopsies (esp lowers) into less jars. Ex two or more small polyps that are relatively close in the colon placed into one jar. They rightly point out if one is cancerous differentiating them isn’t critical b/c of proximity. Similar phenomena in cervical biopsies. I have spoken to some of my colleagues and they are getting pressure from patients to lower their out of pocket costs due to lab co-pays.

I often get about 20 pieces of tissue supposedly representing 2-5 polyps. How the hell is one supposed to deal with this accurately. I guess it is why we have to move over from the science to the art of medicine from time to time!

 

[deleted314957]

Folks, the lawyers take care of all this stuff.

 

[WEBB PINKERTON]

I often get about 20 pieces of tissue supposedly representing 2-5 polyps. How the hell is one supposed to deal with this accurately. I guess it is why we have to move over from the science to the art of medicine from time to time!

Ok, how many people do we have on this site named Thrombus? You obviously aren't the real thrombus. I don't see anything about this is academia's fault.

 

[deleted314957]

I often get about 20 pieces of tissue supposedly representing 2-5 polyps. How the hell is one supposed to deal with this accurately. I guess it is why we have to move over from the science to the art of medicine from time to time!

They usually know which one they expect to look “bad”.
But all you can do is s/o as “ multiple fragments of colonic
mucosa, one of which contains invasive moderately differentiated colonic carcinoma.” Then give ‘em a call.
Just one more example of trying to make chicken soup from
chicken

 

[cmz]

I know a group of GI docs who do the exact opposite. Every patient gets "gastric mapping" (e.g. bx of antrum, body AND fundus with HP performed on all parts), two separate jars for duodenal bulb and 2nd portion (with CD3 performed on each separate bx to rule out celiac), and at least two separate jars for esophageal bx (upper and lower to rule out EoE). For the lower GI specimens, all polyps are separated, of course. Microscopic colitis cases are parsed out in distinct jars and mapped by quadrants (no right and left). These folks own their own TC lab, too.

A local lab tech's husband wanted me to review their GI pathology and I was astonished that this same lab not only performed and reported HP IHC on all three gastric bx, they also included two separate patient cases on the same slide (the slide had a total of 9 separate and distinct tissue fragments, all for HP IHC). An arbitrary line was drawn to separate each case in case you were confused. Unrelated to this, I saw another case involving a GIST. They did a total of 18 IHC to work it up, including neuroendocrine markers, ERG/CD31 to rule out a vascular tumor and HHV8 to rule out kaposi.

 

[Thr0mbus]

I know a group of GI docs who do the exact opposite. Every patient gets "gastric mapping" (e.g. bx of antrum, body AND fundus with HP performed on all parts), two separate jars for duodenal bulb and 2nd portion (with CD3 performed on each separate bx to rule out celiac), and at least two separate jars for esophageal bx (upper and lower to rule out EoE). For the lower GI specimens, all polyps are separated, of course. Microscopic colitis cases are parsed out in distinct jars and mapped by quadrants (no right and left). These folks own their own TC lab, too.

A local lab tech's husband wanted me to review their GI pathology and I was astonished that this same lab not only performed and reported HP IHC on all three gastric bx, they also included two separate patient cases on the same slide (the slide had a total of 9 separate and distinct tissue fragments, all for HP IHC). An arbitrary line was drawn to separate each case in case you were confused. Unrelated to this, I saw another case involving a GIST. They did a total of 18 IHC to work it up, including neuroendocrine markers, ERG/CD31 to rule out a vascular tumor and HHV8 to rule out kaposi.

TURN THOSE SOB’S IN!!

 

[Alteran]

Anyone see the surprise billing for colonoscopy article on medpage today? Resect and discard biopsy specimens is mentioned.

"In the short term, endoscopists should also consider using established cost-saving strategies, such as conscious sedation and the 'resect and discard' approach, to biopsy specimens," the authors wrote. "In the longer term, we must enhance ongoing reform efforts to remove consumer cost sharing for all clinically indicated care associated with colonoscopy."

I don't see that happening given that GI docs base patient management entirely on what the histologic findings are. Unless they're using the force or other metaphysical construct, I don't know how its possible to reliably and visually distinguish between an HP, SSA, TA, or a TA with a little surprise in it along with stalk margin status or other high-risk features. And forget about WNETs, hamartomatous polyps, and other more uncommon but significant pathologies.

 

[deleted314957]

I know a group of GI docs who do the exact opposite. Every patient gets "gastric mapping" (e.g. bx of antrum, body AND fundus with HP performed on all parts), two separate jars for duodenal bulb and 2nd portion (with CD3 performed on each separate bx to rule out celiac), and at least two separate jars for esophageal bx (upper and lower to rule out EoE). For the lower GI specimens, all polyps are separated, of course. Microscopic colitis cases are parsed out in distinct jars and mapped by quadrants (no right and left). These folks own their own TC lab, too.

A local lab tech's husband wanted me to review their GI pathology and I was astonished that this same lab not only performed and reported HP IHC on all three gastric bx, they also included two separate patient cases on the same slide (the slide had a total of 9 separate and distinct tissue fragments, all for HP IHC). An arbitrary line was drawn to separate each case in case you were confused. Unrelated to this, I saw another case involving a GIST. They did a total of 18 IHC to work it up, including neuroendocrine markers, ERG/CD31 to rule out a vascular tumor and HHV8 to rule out kaposi.

Oh my God! I hope they got a vimentin on that gist because it might have looked spindle celled !

 

[WEBB PINKERTON]

They need to do something if more and more people just take a dump in a box and sent it to Wisconsin. Gotta offset the loses.