Generally surgical cases are reported out by the pathologist of record or after an intradepartmental review by another staff pathologist. Occasionally a much more aggressive review must be undertaken — this involves one of our pathologist s requesting a formal consultation from another pathologist, generally a nationally recognized expert in the field.

Some of the more common reasons for this additional review are:

• Rare lesions (don t see enough of them), also known as zebras; most standards suggest these cases should be reviewed by experts who see those types of cases more frequently.
• National Standards and Guidelines recommend a specific specialist to evaluate the lesion — this is most common in the field of dermatopathology: medical chronic dermatosis, i.e. skin rashes, adnexal tumors of the skin, melanomas, spitz nevi, dysplastic nevi, etc.
• Bone and Soft Tissue Tumors, which are rare tumors and need expert review by a bone or soft tissue pathologist.
• Unusual cancers, i.e. gynecological cancers in young patients, tumors of the genito- urinary tract because of a lack of reproducibility regarding certain types of tumors; such cases should be reviewed by an expert in the field.
• Less differentiated types of hematolymphoid tumors.
• Cases where the clinical physician or patient desires a second opinion for confirmation.

Consultation charges are applicable in these cases and since the need for the consultation will not be evident until the tissue is diagnosed — you should alert your patients to the possibility that the Consultant Pathologist will bill additional charges if one or more of the above conditions apply.

CPT CODING — charges typically includes 88305, LEVEL IV Surgical or above plus any Special Stains or Immunohistochemistry stains performed and billed by Doctors Laboratory (DLI) and 88321 Consultation fees and other diagnostic components billed by the Consulting Pathologist.

For more information about DLI, visit our website at http://www.doctorslabinc.com. We look forward to working with you and speaking to you about how we may serve your practice.

Jackson L. Gates, MD, FCAP