Society for Hematopathology Newsletter, Fall 2004

Greetings! It has been a busy quarter for the Society for Hematopathology. We are very grateful to all those who have been working hard on assorted projects, many of which are mentioned below. I would also like to thank the moderators and speakers for the recent successful ASCP companion meeting: W. Finn, S. Kroft, J. Vardiman, M. Kinney and B. Kim.

In brief

  • Watch your mail in mid-December for your Pathology Patterns issue with the Proceedings of the SH/EAHP/St. Jude's Slide Workshop on Pediatric Hematopathology.
  • Please see the important attached letter and copy of proposed revisions to our constitution and bylaws. We will vote on them at our next business meeting in San Antonio on February 26, 2005. We are required to distribute them at least one month prior to the meeting, so here they are. Your Executive Committee and J. Chan, Chair of the Bylaws Committee, put a lot of effort into this.
  • Information about our 2005 workshop on T-cell malignancies and case submission forms are now available on the web (see below).
  • Other upcoming meetings are described below.
  • The SH Education Committee has been hard at work. A policy statement was sent to Dr. S. Nestler regarding pathology trainee performance of pediatric bone marrow procedures and they are working hard on a host of other fellowship training issues in preparation for the Hematopathology Fellowship Directors meeting in San Antonio at the USCAP meeting (see below).
  • Don't forget that for those trainees with accepted posters/presentations for the upcoming USCAP meeting that are not a part of the Stowell-Orbison competition, there are nomination forms for our pathologist-in-training award (see below for details). These must be submitted no later than January 26, 2005.
  • M. Borowitz has contributed an update on new developments in flow cytometry professional billing (see below).
  • Visit our updated website! Thanks, as always, to N. Levy for his Herculean efforts on our behalf.
  • Dues notices will be coming out shortly. Please return them promptly.
  • The Society is about to sign an agreement to continue having the USCAP manage our society. We remain very appreciative for all their help.

SH/EAHP 2005 Workshop MD Anderson Cancer Center, Houston, Texas, October 20-22, 2005 CALL FOR CASES

"Progress in T-cell Malignancies: Classification and Molecular Pathogenesis"
The meeting announcement and case submission guidelines are now available at the meeting website: http://www.mdanderson.org/hematopath. You can get to the website via the SH website as well. The online case submission form is now accessible from the website and the online registration form will be available after 1/31/2005. The deadline for case submission is January 31, 2005.

Educational issues & upcoming meeting:

Performing pediatric bone marrow examinations
On behalf of S. Perkins, Chair of the Education Committee and our whole Society, the following statement concerning the Society's strong feelings about pathology trainee performance of pediatric bone marrow procedures was sent to S. Nestler, Executive Director of the Residency Review Committee:

Policy Statement: Pathology Trainee Performance of Pediatric Bone Marrow Procedures
Based on the reports of several members of the Society of Hematopathology, there is growing concern about the perceived requirement or strong suggestion by the RRC that pathology and pathology hematology subspecialty trainees perform bone marrows on pediatric patients as part of their training. Pediatric bone marrows are commonly performed under total or conscious sedation, a clinical situation with attendant risks that could require the physician performing the procedure to be capable of medical resuscitation. Many pathology trainees do not have adequate training and/or experience to be placed in this situation, particularly with regards to pediatric patients. Furthermore, due to the highly emotional nature of such a procedure performed on a child, most pediatric hematologist/oncologists are not willing to accommodate a trainee that will not be a day-to-day or long-term part of the care team to perform such a procedure. In addition, most pediatric bone marrows are performed in a tertiary care setting, limiting adequate exposure and training for many pathology trainees. Based on the concerns about proper medical care and the wide experience that pediatric hematologist/oncologists are not willing to allow pathology trainees to perform bone marrows on their patients, it is the strong recommendation of the Hematopathology Society Education Committee that pathology trainees not be required or expected to perform bone marrow procedures on pediatric patients. It is appropriate that the pathology trainees, when possible, observe pediatric bone marrow procedures performed by pediatric hematologists/oncologists.

Fellowship Directors Meeting at the USCAP Meeting Sunday, February 27, 2005
For those of you who are Hematopathology Fellowship Directors, we will once again have a Sunday morning breakfast meeting at the USCAP in San Antonio. It is being planned by S. Perkins and members of her Education Committee. The RRC has identified Bruce Alexander to talk with us on Sunday morning and "our very own" Rob McKenna has also agreed to come as a representative from the American Board of Pathology. This should be a very interesting session and may help to clarify some of the apparent dichotomies that we face in trying to meet RRC requirements and prepare fellows for the hematology subspecialty boards.

As part of these efforts the committee has been conducting a survey regarding opinions regarding the length of the training and the requirement for performance of any type of bone marrow aspirates and biopsies.

Pathologist-in-Training Award at Annual USCAP Meeting, 2005
The Hematopathology Pathologist-in-Training Award is given each year to a fellow, resident or medical student who presents an outstanding paper related to hematopathology at the annual USCAP meeting. Previous winners are not eligible. Papers are judged by a committee comprised of members of the SH Executive Committee and scored for scientific approach, significance and presentation. All nominees with posters must be at their posters during the official poster sessions so they can discuss their work with the judges in order to be eligible for the award. Each winner receives a $500.00 prize. To nominate a trainee, please visit the website, socforheme.org to check the eligibility requirements and complete the nomination form. Fax the form to the SH office at 706-733-8033 no later than January 26, 2005. Trainees with posters accepted for the Stowell-Orbison competition in the Hematopathology category are automatically nominated and need not submit an additional application.

Upcoming event
Society for Hematopathology Scientific Symposium, Sunday, February 27, 2005, San Antonio, Texas. Our moderators, Elaine Jaffe and John K.C. Chan, have organized the following program on extranodal lymphomas:

Part I

  • MALT lymphomas: genetic changes, their detection and significance - Andreas Chott, Vienna, Austria
  • Infective etiologies of MALT lymphomas: biological and clinical correlations - Peter Isaacson, London, U.K.
  • Problems in diagnosis of lymphoid lesions of the salivary gland and gastrointestinal tract - JKC Chan, Hong Kong
Part II
  • Lymphoid proliferations in the breast and gynecological tract - Nancy Lee Harris, Boston, MA
  • Mediastinal lymphomas: Practical and theoretical issues - Elaine S. Jaffe, Bethesda, MD
  • New WHO classification of cutaneous lymphomas - Steven H. Swerdlow, Pittsburgh, PA

Events being planned

SH/ASCP Companion Meeting Planning, 2005
Discussions with Dr. John Tomaszewski, Chair of the Annual Meeting/Weekends of Pathology Committee (ASCP), were held concerning the Society for Hematopathology ASCP Companion Meeting. The meeting used to be held on the Friday afternoon prior to the ASCP Meeting; however, it was moved to an evening with a contraction in the amount of time available. Dr. Tomaszewski said he would work on having the Companion Meeting moved back to the Friday afternoon next year in Seattle. He also indicated that he would attempt to advertise the Companion Meetings more through the ASCP.

W. Finn, F. Craig and B. Nelson, the newest member of this committee, are working on a plan for next year's meeting. We thank S. Kroft again for his years of service on the committee and for being the chair this past year.

EAHP meeting and EAHP/SH Slide workshop, October 6-13 2006, Vienna, Austria
Stay tuned for more information about this meeting and workshop that will cover the major topic of small B-cell lymphomas.

Financial page
Reimbursement News from M. Borowitz, Hematopathology Reimbursement Liason
We should all extend our thanks to M. Borowtiz for looking out for our interests and submitting the following detailed explanation of the new flow cytometry billing procedures:

Effective Jan 1, 2005, the 88180 CPT code for flow cytometry immunophenotyping of leukemia and lymphoma will be discontinued and replaced by 5 new codes. It is important to note that there will be no grace period, and no reimbursement will be given for tests billed as 88180 after that date. For the first time there will be separate technical and professional codes, as follows:

  • 88184 Flow cytometry, cell surface, cytoplasmic or nuclear marker, technical component only; first marker
  • 88185 Flow cytometry, cell surface, cytoplasmic or nuclear marker, technical component only; each additional marker
  • 88187 Flow cytometry, interpretation; 2 to 8 markers
  • 88188 Flow cytometry, interpretation; 9 to 15 markers
  • 88189 Flow cytometry, interpretation; 16 or more markers
The Center for Medicare and Medicaid Services (CMS) has implemented this change largely in response to a very rapid increase in units of service billed under 88180. Several points in particular are of note regarding the interpretation codes:
  1. There is now a cap on interpretation at 16 or more markers.
  2. It will not be possible to use these codes to bill interpretation fees on single markers. It is suspected that in the past many individuals were billing professional fee charges for CD4 counts or CD34 counts under 88180 and this is clearly not to be allowed in the future. Several new codes have been set up in the laboratory fee schedule (86xxx) to handle not only these tests but also total T, total B and total NK cells. These codes cannot have 88187/8/9 added on to them.
  3. The RVUs associated with these codes, and thus the actual reimbursement rates, have not yet been assigned as of this writing. These are expected toward the end of November
  4. While classic vignettes have been written to describe each of these codes as part of the process by which charges are set, there are as yet no hard and fast rules as to what specimens or diagnoses are to be considered candidates for each of the 3 codes. CMS's preference was originally for a single pro-fee interpretation code, but they could be convinced that there was incremental physician work involved in interpreting more extensive panels. It is, however, clearly CMS's expectation that flow cytometry professional charges will be distributed over the 3 CPT codes and not consist almost entirely of 88189; if this does not occur there is little doubt that the fee schedule will be revisited.
In July there was a public hearing held at CMS to discuss whether the interpretation codes for flow cytometry should be moved to the clinical laboratory fee schedule. Several societies spoke against this change and only one, the American Society of Microbiology, spoke in favor of it. CMS agreed with the majority and has decided to keep flow cytometry interpretation as a physician service.

Additional information can be found at the CMS website: http://www.cms.hhs.gov. A detailed accounting of CPT code changes, including restrictions on billing for the same marker by both immunoperoxidase and flow cytometry can be found at http://www.cms.hhs.gov/physicians/cciedits/chap10.pdf

Best wishes to all,
Steve