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A ReqPacket comes in with a surgical pathology report only, but we get a copy of the "normal" version from the pathology lab with tissue. Which should be included in the FinalReq at reporting?
BOTH! Surgical path reports could offer different information than the report from the pathology lab directly and need to be kept. Only true duplicates should be discarded
What is the minimum number of slides needed to run the Tissue Cypher assay?
4 uns slides
If the NPI is listed on the req but is incorrect, what do you do?
Cross it out with one line, add correct NPI # and annotate with "per NPI registry".
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Metaplasia
When can we test MOHS samples? How do we handle an order received that indicates the MOHS to be tested?
NO, unless it is under extenuating circumstances.
For DecisionDX-SCC test orders please always defer to the primary biopsy for testing. Reason being is that this test was originally validated on primary tissue.
-Please request the primary pathology report and hand off to PRS
Can a COA stamp with your initials and date be used in place of the signature date?
NO! The signature date should be written independently from the COA stamp date/initial.
A patient is considered to have long segment Barrett’s if the segment is how long? Short segment?
Long segment BE =≥3cm in total length
Short segment BE = <3cm in total length
How many documents are needed to confirm the middle initial on the req?
Only 1 other document
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Goblet Cells
What does MGF mean? How do we handle MGF's?
Multiple Gene Failure- the genes from the specimen tested failed to amplify in the lab and we are unable to obtain a result.
How to handle: 1st time- Issue MGF report, make notes, notify PRS/send OR form. If received marked "yes" new order placed and re-run on same sample a 2nd time.
2nd time- report out as MGF, no further action required
Define dysplasia. Name the three ICD-10 codes for TC and what each of them mean. (code # & definition)
A precancerous condition in which cells which are very similar to cancer cells grow in an organ but have not yet acquired the ability to invade into tissue or metastasize.
K22.70 Barrett's esophagus without dysplasia
K22.710 Barrett's esophagus with low grade dysplasia
K22.719 Barrett's esophagus with dysplasia, unspecified
What is a WATS procedure, and can we accept a WATS report independently?
Wide Area Transepithelial Sample-a endoscopic technique that uses a brush to collect larger tissue samples from the esophagus.
We do not accept WATS reports and need a pathology report from the standard biopsy.
What is required for reimbursement to write in Section VIII of the req that must be added if missing?
Date of Collection
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Squamocolumnar
What is a QC fail report and how do we process it?
-Tumor content is <40%
Processing:
1) Verify it is a true QC fail & review material
2) Check ReqPacket & pathology report gross description for alternate material or alternate path reports. If alternate material available, enter new test order and request all remaining blocks for that site. Indicate "QC Resubmission" in Exemplar and on Req packet.
3)Notate in test order and on req appropriate action & achieve box # (slides)
4)Hang block for send backs
Define what a Prague score is? Identify and explain each part of the score
-a tool used to measure the severity of Barrett's Esophagus using endoscopic findings
C= the length from the top of the gastric folds to the top of the circumferential extent of the BE segment
M= the maximum length from the top of the gastric folds to the top of the tongues if the BE segment
Explain what a Seattle Protocol procedure is
Random 4-quadrant biopsies every 1cm versus 2cm in patients with and without prior history of dysplasia.
Only samples <5% of BE mucosa. Risk of sampling error. Very time consuming
Is the treating provider's name, organization name required to be listed on the req for a COA order if the pathologist is listed in Section I?
YES! The treating provider's name & organization name must be listed in Section V of the requisition.
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Prague Score
Identify the trigger words found on the pathology report that could potentially make an SCC order ineligible for testing/should be sent to PRS?
Metastatic/Metastasis
Recurrent/Recurrence
Scar
Mucosal
Frozen Tissue
Basaloid Features
Basal Cell Carcinoma (BCC)
No connection to the overlying epidermis
SCC In-Situ
Mass/Soft Tissue
Explain the SOP for a report correction as a result of a Castle error from start to finish.
Refer to Confluence job aid
Define Barrett's Esophagus. What is it also called and what is it a result of?
-A condition in which the esophageal lining changes; normal squamous epithelium changes to a type of tissue normally found in the intestine. (Intestinal metaplasia.)
-It is believed this change is the result of chronic regurgitation (reflux) of the stomach contents up into the esophagus. The contents of the stomach contain digestive acid and other chemicals which damage the normal lining of the esophagus. In the healing process, the wrong type of cells grows to repair the damaged areas
Identify if we add the following to the test order and how many/what documents we need to verify:
Suffixes (Jr, Sr, III etc)
Nicknames (William versus Bill)
Middle Name
Suffixes: add if listed on ANY document
Nicknames: if written on the Req, proceed with legal name first, nickname in parentheses.
Ex.) William (Bill)
Middle Name: If written on the Req & confirmed with ONE other document, add to test order. If you can't confirm, cross out on req and annotate as "cannot confirm". initial & date.
**Patients with previous test order with middle initial, update req to match Exemplar**
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Esophageal Adenocarcinoma
You receive the first site of a multiple SCC order at reporting that resulted in a class 1. there are 2 other sites that are eligible. Explain the step-by-step process on how to proceed.
Refer to Confluence job aid