The Mother of all Surg Path Reports

[LADoc00]

I have spent a lifetime looking for the end of all of Surg Path report write ups and now found it: Consultant report from an unnamed California academic center.

Specimen: Spleen
Length of report: 5 single spaced pages
Number of Immunos reported on: 42
Number of special stains: 2
Number of molecular tests: 2
Comments subdivided in 17 sections

To call this baby epic is understatement. It is some poor fellow's OPUS.

Anyone seen one longer/more elaborate??

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[Absidia]

Wow...

What the heck did they end up calling it?

 

[Gut Shot]

Wow...

What the heck did they end up calling it?

Marked autolytic changes.

 

[yaah]

Atypical lymphoid infiltrate.

 

[listeriaismfb]

I saw a two page report on an abscess once.

 

[pathdawg]

Wow...

What the heck did they end up calling it?

Ruptured spleen with associated hemorrhage.

A report that ungodly long is the sure-fire mark of someone who doesn't know what they are doing. I don't care if they found a gnome in that spleen, that diagnosis shouldn't be more than a paragraph. If that.

 

[Pingu]

A report that ungodly long is the sure-fire mark of someone who doesn't know what they are doing. I don't care if they found a gnome in that spleen, that diagnosis shouldn't be more than a paragraph. If that.

I think gnomes qualify for a diagnosis only. Unless you were supposed to subclassify said gnome.

I am still dying to know what the diagnosis was...42 immunos is bananas.

 

[docbiohazard]

I find a gnome in a spleen, I'm autopsying the sucker.

I bet the final diagnosis was "No pathologic alteration identified. Recommend clinical correlation."

 

[yaah]

We had a two page consult earlier in the year, I thought that was excessively long. A lot of that was reiterating the extensive clinical history and radiologic findings the OSH pathologist gave us. It was some god awful tiny needle biopsy of a retroperitoneal mass with mostly histiocytes.

 

[deschutes]

CIMF and associated DDx in an autolytic spleen.

I saw a report today where the bottomline was literally the "bottomline" - all the way at the bottom of the last (4th) page. That's a lot of reading just to get to "AML"!

 

[pathstudent]

The most immunos I have ever seen on a case was 63 performed by an academic medical center, and the conclusion was poorly differentiated malignant neoplasm.

It was an outpatient biopsy so they must have been billing PC/TC for the immunos which means the immuno bill was 15k-20k. Nice.

 

[112641]

I forget.. what is the timeline exactly that certain groups/centers have established to force CPT codes for batches of immunostains due to abusive, excessive numbers of stains? I don't know that I could even list 63 immunostains off the top of my head. But even if I had been teaching shop for 60 years I could count on one hand how many years it would be allowed to bill 63 times if it became a common thing to do for 'poorly differentiated neoplasms'

 

[listeriaismfb]

The most immunos I have ever seen on a case was 63 performed by an academic medical center, and the conclusion was poorly differentiated malignant neoplasm.

It was an outpatient biopsy so they must have been billing PC/TC for the immunos which means the immuno bill was 15k-20k. Nice.

This sounds like urban legend. As I understand it there is a diminishing return on IHCs after ten.

They should have just done EM

 

[yaah]

I had heard the diminishing returns thing too - although I thought it was less than 10, maybe 6. But I don't really know the exact info.

 

[pathstudent]

I had heard the diminishing returns thing too - although I thought it was less than 10, maybe 6. But I don't really know the exact info.

What you bill and what you get paid aren't necessarily the same.

If they guy was uninsured he would get would charged the full bill. Of course no one would pay that, so I guess it would go to a collection agent. Or you could deal with him. Offer to waive it if he gives you his car or something. People and other docs probably have no idea that pathology bill can be much more than the surgery/procedure.

 

[listeriaismfb]

What you bill and what you get paid aren't necessarily the same.

If they guy was uninsured he would get would charged the full bill. Of course no one would pay that, so I guess it would go to a collection agent. Or you could deal with him. Offer to waive it if he gives you his car or something. People and other docs probably have no idea that pathology bill can be much more than the surgery/procedure.

Pathstudent, you are spot on. I just had the visual of seizing some dude's '96 Buick for non-payment .

Two points come to mind: ~ 5/6 people in the US still have some insurance, and insurance companies will dictate what they think is a reasonable amount of money to pay for the services rendered.

There must be an acutarial cap on the number of IHCs. I imagine that everything in excess of the cap is on the house. Or should I say, on Dr. House?