[Histonet] Slide labels or slide labeler

[Vickroy, James via Histonet]

We have used the older version Slidemate slide labelers from Thermofisher for 
the last three years.   I think putting the patient information directly on the 
slide is preferred however the wear and tear on slide printers means higher 
maintenance costs and more down time.  Thermofisher has a newer version of the 
Slidemate now that has been designed so that there is less wear and tear on the 
machines.   Currently when one of the old labelers breaks down we have to send 
the instrument out and the cost is generally 1000 - 1500 for repair each time.  
  It also seems that the older machines have to be sent in at least every other 
year.  Our older machines have been sent in almost yearly.

We are considering switching to a slide label making system by General Data.   
One of the downsides is that we have to apply the label to each slide so 
therefore we introduce another step where the slides could be mislabeled.   The 
upside is that equipment costs are much less.   A new thermal label printer 
runs around 700.00 where as the instrument that imprints the slide label on the 
slide runs between 12000 - 15000 per unit.  We need three units.
Thermo also offers a lease system.What I need to know is what has been the 
experience with the new Slidemate AS printers?   What kind of maintenance 
issues have you encountered? Finally please let me know your latest experiences 
with both slide label printers versus slide labeling printers?

Thanks for your input.

Jim


Jim Vickroy
Histology Manager
Springfield Clinic, Main Campus, East Building
1025 South 6th Street
Springfield, Illinois  62703
Office:  217-528-7541, Ext. 15121
Email:  jvick...@springfieldclinic.com



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[Histonet] CAP question ANP.12500

[Vickroy, James via Histonet]

Wondered if something has changed on the question pertaining to retention.   We 
only do biopsies and keep the containers they come in for two days.   We have 
done this forever.   Going through the new checklist I notice under wet tissue 
it has (stock bottle).   Before I interpret this incorrectly, a stock bottle to 
me meant left over fixed tissue not taken for sections.  Last week I got an 
email saying this other institution was keeping the empty containers for two 
weeks after final report.

Obviously, it is clear if we have left over tissue we hold it for the specified 
time period but does this also mean we should be holding the empty biopsy 
container for two weeks plus also?

I hope I am overthinking this since we don't have room for them.

Your thoughts?

Jim

Jim Vickroy
Histology Manager
Springfield Clinic, Main Campus, East Building
1025 South 6th Street
Springfield, Illinois  62703
Office:  217-528-7541, Ext. 15121
Email:  jvick...@springfieldclinic.com



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[Histonet] Formalin collection at grossing stations

[Vickroy, James via Histonet]

We have been told by our chemical waste company that we no longer can discard 
small biopsy containers with formalin in them.  In our workflow process we 
gross small specimens.  We generally use forceps to take the small biopsies 
from the container of formalin and reseal the container with the residual 
formalin.  The container is then discarded in a red bag and held for two days 
incase we have to go back for labeling questions.  Rarely do we have to go back 
to make sure a specimen was not left in a container. (example three fragments 
grossed and the clinician said there were four fragments).  Large amounts of 
formalin from our tissue processors is recycled so the only formalin that has 
been going in the biohazard waste has been what's in the prefilled containers.  
However, I know it adds up.   We have two options that seem to make the most 
sense.  We can collect and recycle the residual formalin from the containers or 
we can collect and neutralize the formalin.   Since we already recy
 cle it seems logical to recycle when we can however at some point we will have 
an abundance and will be forced to neutralize.

Here is my questions:

Do your grossing techs collect the formalin as they gross each specimen or do 
they leave the containers with the residual formalin in them for a period of 
time?  We will still keep the empty containers for two days whether we dump the 
formalin while we are grossing or have to go back to them two days later just 
in case there are labeling questions.

If they collect the formalin as they gross each specimen is there any special 
way they have come up with to keep the formalin fumes down besides removing a 
lid of a waste container each time they discard the formalin.   I realize that 
grossing is done under the hoods however, I'm not in favor of an open container 
of formalin in the grossing station.   It elevates exposure amounts and 
expensive filters become exhausted much faster.  One of my staff members 
immediately went into McGiver mode to come up with a method however I'm not 
sure we aren't overthinking this process.   Your thoughts?

Jim



Jim Vickroy
Histology Manager
Springfield Clinic, Main Campus, East Building
1025 South 6th Street
Springfield, Illinois  62703
Office:  217-528-7541, Ext. 15121
Email:  jvick...@springfieldclinic.com



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[Histonet] Balance calibration

[Vickroy, James via Histonet]

We use two very basic electronic balances in the histology lab at the clinic.   
There is very limited use of these instruments.   One is we weigh an amount of 
diastase when performing a PAS stain with diastase and we weigh the bladder and 
prostate TUR specimens.  Is it necessary to have some sort of calibration 
system or annual review for CAP?

While I was in the hospital we used balances for measuring IHC reagents and of 
course we needed very precise measurements however in the clinic we don't do 
any IHC stains and the special stains are limited to PAS and AFB stains.  We 
hired a third party company to calibrate all of the balances throughout the 
entire lab at the hospital.   The small lab at the clinic does not have any 
balances in usage besides the ones in Histology.

Any thoughts?


Jim Vickroy
Histology Manager
Springfield Clinic, Main Campus, East Building
1025 South 6th Street
Springfield, Illinois  62703
Office:  217-528-7541, Ext. 15121
Email:  jvick...@springfieldclinic.com



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[Histonet] Histology Manager - Technical Supervisor

[Vickroy, James via Histonet]

We are reviewing the requirements in a job description for Histology Manager of 
a multi-specialty clinic.  I am retiring next year and we are wanting to make 
sure that we have a good succession plan.   With the dwindling number of 
certified HT's and HTL's and lack of CAP requirements to perform histology 
functions we are wondering how to list requirements for this position.   I 
still believe a manager/supervisor should have a certification (HT or even HTL 
) along with some years of histotech experience.Can someone enlighten me if 
there are specific CAP requirements for a Histology supervisor and how are 
others handling these positions?

Jim

Jim Vickroy
Histology Manager
Springfield Clinic, Main Campus, East Building
1025 South 6th Street
Springfield, Illinois  62703
Office:  217-528-7541, Ext. 15121
Email:  jvick...@springfieldclinic.com



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[Histonet] Colloidal Iron and PAS with and without diastase

[Vickroy, James via Histonet]

I have probably asked this before but when performing the PAS stain with and 
without diastase I have been told you can charge two 88313's.   When performing 
the colloidal iron stain the place we send it to also charges us for two 
stains, one with omitting the colloidal iron solution.   I understand the 
principle in determining whether the Prussian blue staining is from  the acid 
mucopolysaccharides or hemosiderin.  How are others charging for this stain if 
they run two slides?And do you agree that the PAS with and without can be 
charged twice?

Jim


Jim Vickroy
Histology Manager
Springfield Clinic, Main Campus, East Building
1025 South 6th Street
Springfield, Illinois  62703
Office:  217-528-7541, Ext. 15121
Email:  jvick...@springfieldclinic.com



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[Histonet] Formaldehyde filters in Grosslab Senior

[Vickroy, James via Histonet]

It seems to me that we are replacing filters much too often on our Grosslab 
senior grossing station.  I do realize that there are so many variables but 
would be interested in:
By the way we only gross small biopsies, gyn, gi, derm)


a.How often others replace Grosslab filters?

b.  How others have maybe lengthened the time that the filters last?   (We 
do use formalin absorbing and neutralizing pads.)

Any other experiences or help would be appreciated.Also we do monitor the 
formalin levels with badges and our levels every six months are way below 
safety levels.   Badges are worn by the techs doing the gross.

Jim


Jim Vickroy
Histology Manager
Springfield Clinic, Main Campus, East Building
1025 South 6th Street
Springfield, Illinois  62703
Office:  217-528-7541, Ext. 15121
Email:  jvick...@springfieldclinic.com



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[Histonet] Logging expiration dates and receiving of chemicals

[Vickroy, James via Histonet]

One of my techs has asked about a practice that we have been doing for some 
time.   Occasionally we find that we are doing something just because it has 
been done in the past and as we all know sometimes we get bogged down with 
things that are just not necessary.
When we order chemicals such as alcohols, clarifier, bluing, hematoxylin, etc.  
 each chemical with their lot number and expiration date is listed in a log 
book.  Of course we also date the container when we receive each chemical and 
we also make sure that all of the chemicals are used within expiration dates.

The question is whether it is really necessary to keep a log of information 
besides what is written on the container.  In addition we are a new lab and 
have started to do some special stains inhouse in the lab.  (PAS, PAS for 
fungus, AFB)   We started with purchasing kits and have now simply ordered the 
chemicals in bulk.   Do we need to test each lot of chemical that we use for 
the stains?  We run a control with every run and I don't feel it is necessary 
to test the chemicals additionally.   One of the companies we ordered the stain 
kit from sent us control test slides and my tech wondered if we should run one 
of the control test slides before we used the kit.  I know that in IHC staining 
there are rules for using, testing, comparing with previous lots,etc. for kits 
however since we are going to use bulk chemicals and we run a control each time 
I don't want to do extra unnecessary work.

It also seems to me that over the years the CAP questions governing routine 
special staining has been reduced more and more.At this point we don't run 
any IHC stains and therefore I am not worried about detections kits, new lots 
of antibodies, etc.   Just need to know what most do with special stain 
chemicals.

I would appreciate your thoughts before we continue our practice or scale down 
some of the documentation.

Jim


Jim Vickroy
Histology Manager
Springfield Clinic, Main Campus, East Building
1025 South 6th Street
Springfield, Illinois  62703
Office:  217-528-7541, Ext. 15121
Email:  jvick...@springfieldclinic.com



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[Histonet] Performing PAS with Diastase by Hand

[Vickroy, James via Histonet]

We are starting to perform a PAS with diastase for fungus to be used by our 
dermatopathologist.   At first we weren't sure he was going to need a method 
that used diastase but he now prefers it.  Problem is our PAS counter kit did 
not come with diastase.  Please don't tell me to use saliva although I'm old 
enough to know we did for years.  We did order some powered diastase that was 
quite expensive and of course the working solution had a very short shelf-life. 
  Can anybody recommend a product and vendor that is relatively inexpensive and 
economical to use?

Jim

Jim Vickroy
Histology Manager
Springfield Clinic, Main Campus, East Building
1025 South 6th Street
Springfield, Illinois  62703
Office:  217-528-7541, Ext. 15121
Email:  jvick...@springfieldclinic.com



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[Histonet] Handling Breast Lumpectomy Specimens with radioactive seed localization

[Vickroy, James via Histonet]

Our organization is looking into the workflow necessary to handle breast 
lumpectomies with radioactive seed localization. Right now we have more 
questions than answers.  I have looked at several articles and am aware of the 
drastic changes that will need to be in place to handle the radioactive seed.   
My experience in the past has been handling a wire-located lumpectomy proceeded 
usually by a sentinel node biopsy by frozen section.   From what I read the 
sentinel node biopsy procedure will probably not be changed, however I have 
several questions regarding handling the lumpectomy specimen and would 
appreciate any thoughts from someone already handling these specimens.  I know 
there are precautions on how to handle and remove the seed as well as 
procedures in case the seed is cut during the removal.  I am trying to figure 
out how the workflow will proceed.

Wire-located lumpectomy procedure:

Currently the sentinel nodes are sent to the lab from surgery and frozen 
sections are performed.  The pathologist then calls the surgeon and depending 
on whether the sentinel nodes were positive further nodal dissections may or 
may not be necessary.   The  wire-located lumpectomy specimen is usually sent 
over to pathology after the sentinel node biopsies.  The lumpectomy specimen 
has usually been x-rayed to show the location of the wire prior to being 
received by pathology.   Pathology then usually gets a copy of the x-ray along 
with the fresh lumpectomy specimen.   Next the pathologist or pathology 
assistant would place the specimen in formalin and let it fix for sometimes 
overnight.  The next day the fixed lumpectomy specimen was grossed and 
sectioned for histologic examination.  Special care is taken to take specific 
sections where the wire was implanted.

Radioactive seed lumpectomy procedure questions:


1.   Since the lumpectomy is obviously "hot" what precautions are taken to 
remove the seed and give it back to radiology?

2.   Does the pathologist  or pathology assistant remove the seed?

3.   After seed removal is the specimen handled similarly to a wire-located 
specimen.In other words is the specimen then fixed for a period of time 
before grossing?

4.   How is the location of the seed marked in the lumpectomy specimen when 
the seed is removed?  Do the pathologists use an ink to mark the location, do 
they then fix the tissue as before?

Finally another "WRENCH"  to this new procedure is that we usually send our 
larger tissue specimens to be grossed and processed at a hospital lab.  We are 
being asked to perform the frozen section onsite and then send the fixed tissue 
left over from the frozen sections with the lumpectomy specimen to the hospital 
lab. Obviously the radioactive seed has to be removed before transportation to 
the  hospital lab.

As you can see there are more questions than answers and I would appreciate 
hearing from someone  that is already handling the new radioactive seep 
lumpectomy specimens.

Jim

Jim Vickroy
Histology Manager
Springfield Clinic, Main Campus, East Building
1025 South 6th Street
Springfield, Illinois  62703
Office:  217-528-7541, Ext. 15121
Email:  jvick...@springfieldclinic.com



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[Histonet] Intraoperative tissue requisition or form

[Vickroy, James via Histonet]

We are a physician owned clinic and the number of frozen sections we do is 
small.   Occasionally we have a few skin biopsies that are done in the ASC 
surgery department.

I got a call from them today and they have a problem that they encounter every 
time they do a frozen section.  When the surgeon takes the biopsy a nurse has 
to hold the specimen in surgery until the tissue order (requisition) is put 
into the computer.   With staffing in ASC this may take fifteen minutes after 
the biopsy is removed and given to the nurse, especially if the surgeon is 
asking the nurse to do other things in the meantime.

Of course when the specimen then is received by Histology it may take another 
15-20 minutes before the surgeon gets a frozen section diagnosis.  This morning 
the surgeon said this needs to get fixed.   Of course it's easy for me to say 
to the ASC department that  someone needs to put in the information immediately 
and not take fifteen minutes.  I even asked why can't the order be put into the 
computer before the frozen is done.  My other response to ASC was that we can 
do the frozen section but we can't assign a number not print barcoded slides 
and blocks until the order has been entered into the computer.

I do recall that organizations with less robust IT systems than CoPath  
sometimes use a written Frozen section order form and report.   Can anyone 
share with me a form they use currently that I could modify for our purposes?
I know the basics but don't want to have to reinvent the wheel if someone 
already has a form that they use for this purpose.

Of course once the nurses have had time to put the order into the computer  
histology would have to enter the case into the pathology system, assigning a 
surgical number.   The pathologist would have to in turn take the diagnosis 
etc. off of the written sheet and enter the diagnosis and gross into the 
computer system.  The written form would in turn have to be kept for 
documentation which can include scanning into the electronic health record  and 
would include things like time surgeon is called, site, patient sticker with 
patient identifiers, clinical history, etc.

I realize that this might seem like a step backward however given staffing 
issues I understand where the ASC nurse manager is coming from and if it helps 
the patient and surgeon I think we can live with the inconvenience.

Your thoughts and examples of forms or frozen section requisitions?


Jim Vickroy
Histology Manager
Springfield Clinic, Main Campus, East Building
1025 South 6th Street
Springfield, Illinois  62703
Office:  217-528-7541, Ext. 15121
Email:  jvick...@springfieldclinic.com



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[Histonet] Mohs lab - CLIA or CAP inspections

[Vickroy, James via Histonet]

We have a Mohs lab that is in the process of moving and will end up with a new 
CLIA number.   The Mohs physician is more familiar with CLIA certification and 
would like for us to choose CLIA inspections instead of CAP inspections.  I am 
very familiar with CAP inspections although not very familiar with the Mohs lab 
inspections done in the past.   Can someone comment on the difference between 
CLIA and CAP inspections of a Mohs lab?   The medical director of the current 
Histology lab believes that having the new Mohs lab under CLIA instead of CAP 
will be more difficult than we have now.

Can anyone share any experiences or thoughts?

Jim Vickroy
Histology Manager
Springfield Clinic, Main Campus, East Building
1025 South 6th Street
Springfield, Illinois  62703
Office:  217-528-7541, Ext. 15121
Email:  jvick...@springfieldclinic.com



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[Histonet] Fading of H controls

[Vickroy, James via Histonet]

We are getting ready for our first CAP inspection in the new laboratory.I 
was checking over the H controls that we do daily and made a discovery.   
Several of the first slides we stained, over a year ago, are now washed out.  
The eosin staining is probably worse than the hematoxylin however both have 
faded.The H slides are in a file box that sits on the counter.   I next 
checked our surgical slide files and found that there were a very few slides 
from the same time period that have faded but most were still very good.

One of the weird things I have found in the controls is that some slides are as 
vibrant and brilliant as the day we stained them and some are almost completely 
faded with little color.   I am trouble shooting to figure out why the slides 
are fading.  I am trying to think of the variables  between the H control 
slides and the routine surgical slides.   The only thing that is different is 
that the routine surgical slides are filed in a rack and not exposed to the 
fluorescent light all day.  Is this possible?

Other thoughts:

If it is not the exposure to light than I am wondering if there is a problem 
with the staining protocol.   Another variable is that we use recycled clearing 
reagents.   On the stainer we use Fisher's Citrus Clearing agent and we 
recycle.  We process with Clearite III.  I know xylene is the best but do not 
want to use Xylene because of health issues.   I also wonder if there may still 
be some alcohol in the sections since some frozen sections fade when the 
clearing is not complete.  I do think the fading problem would be more evident 
in the routine filed slides if the problem was a staining protocol problem, but 
the recycled clearing agent is still on the table of suspects.
In the beginning we did not change the reagents as often as we do now but of 
course our volumes have increased also.

Please share with me your thoughts.

Jim Vickroy
Histology Manager
Springfield Clinic, Main Campus, East Building
1025 South 6th Street
Springfield, Illinois  62703
Office:  217-528-7541, Ext. 15121
Email:  jvick...@springfieldclinic.com



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[Histonet] Prefilled formalin containers

[Vickroy, James via Histonet]

This is one of the things that comes up every couple of years.   Leaky 
prefilled formalin containers.   I know we have all dealt with nurses or 
physicians that can't put the lid on correctly or put the label on the threads 
of the containers.  Some of the new designs have a "clicking lid" when they are 
supposed to be sealed.   My experience with the "clicking lids" are that some 
vendors have lids that the "clicker" breaks off as soon as you unscrew it so 
obviously it doesn't help when putting the lid back on.   Another vendor that 
has the "clicking lid" does not have the "clicker" break off when you unscrew 
and screw but the containers still leak.

It seems to me that someone could come up with accost-effective prefilled 
formalin container that does not leak (of course provided the lids was put on 
straight).   I would be interested in other's experiences with this elemental 
yet extremely annoying issue. It seems like if we can make new automated 
electronic instruments someone might be able to make affordable container that 
doesn't leak.

Jim

Jim Vickroy
Histology Manager
Springfield Clinic, Main Campus, East Building
1025 South 6th Street
Springfield, Illinois  62703
Office:  217-528-7541, Ext. 15121
Email:  jvick...@springfieldclinic.com



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[Histonet] HT Certification

[Vickroy, James via Histonet]

I just got through meeting with HR regarding a salary incentive for employees 
that successfully pass their HT certification.   All of us are aware that many 
histology labs have employees that are not certified.   We are a small clinic 
lab that was set up about a year and a half ago.  When we first set up the lab 
we were able to bring three qualified HT's from another lab locally.   The lab 
has continued to grow since then and now we have 4 other staff members that are 
performing HT tasks including microtomy, H staining, and  grossing (they all 
have BS degrees).  They were hired believing that once they were eligible to 
take the HT certification that they would take the test and if they passed they 
would get a 5% salary adjustment.  However the incentive or 5% increase was not 
written into the job description.

Currently the clinic purchases the study materials (self-instruction program) 
for the staff but we use very little work time for instructional purposes.  The 
staff are expected to study on their own, pay for the exam, and take the test.
If they do not pass the test in the period of one year after completing the  
on-the-job training then technically we could tell them they are no longer 
employed.  However where would that leave us given we couldn't find any 
additional certified HT's to hire in the first place.  We would have to start 
over again with another untrained BS graduate.

One of the question I was asked in the HR meeting was, "What duties can a 
certified HT do that a non-certified technician cannot?".Since all of our 
staff have BS degrees in biology and have all received gross training (90 days) 
I wasn't sure there was anything else that they couldn't do in the lab that 
only a certified HT could do.   I wish there were many duties.   I am afraid 
that if we don't have some certification requirements then in a few years we 
will have very few HT's except those wanting to be supervisory.We are CAP 
certified.Is anybody aware of certain HT duties that can and should only be 
done by a certified HT or HTL?  I know the high complexity requirement in 
grossing but this is based upon 90 days of training and a set number of science 
courses (biology and chemistry), and not certification.

I know that some institutions have handled the incentive to take the HT 
certification by hiring new staff as HT trainees  and then if they passed the 
HT certification they move into another job class which has a higher salary 
range.  This is an option that may be done in the future here but unfortunately 
that was not set up initially here at the clinic.   I also know of institutions 
that have discouraged BS degree staff from taking the HT certification exam  
thinking that if they become certified they will find a job elsewhere.

So I am trying to list the advantages of staff becoming certified.  The clinic 
in particular wants to know what they get for the 5% increase if someone passes 
the certification.   Any ideas how to respond?

Jim

Jim Vickroy
Histology Manager
Springfield Clinic, Main Campus, East Building
1025 South 6th Street
Springfield, Illinois  62703
Office:  217-528-7541, Ext. 15121
Email:  jvick...@springfieldclinic.com



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[Histonet] Formaldehyde annual education

[Vickroy, James via Histonet]

I seem to recall that we once had to document that we went over the hazards of 
formaldehyde to the staff annually.  Does anyone still do this?   I know the 
rules on monitoring but as I was going over a past procedure I saw that we used 
to reeducate the staff each year.

Jim

Jim Vickroy
Histology Manager
Springfield Clinic, Main Campus, East Building
1025 South 6th Street
Springfield, Illinois  62703
Office:  217-528-7541, Ext. 15121
Email:  jvick...@springfieldclinic.com



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[Histonet] Grossing of oriented skin biopsies and small lymph nodes

[Vickroy, James via Histonet]

Currently our non-pathologists do not gross oriented skin excisions or small 
lymph nodes.   I do understand that CAP requires a list of tissues that can be 
handled by non-pathologists but am wondering how others are handling these 
specimens.

I know there are labs, for example  some large dermatopathology labs that are 
having the oriented skin biopsies grossed by techs.   Of course a accepted 
protocol has to be listed for the dissection.

Let me know how your institution are handling these specimens.

Jim

Jim Vickroy
Histology Manager
Springfield Clinic, Main Campus, East Building
1025 South 6th Street
Springfield, Illinois  62703
Office:  217-528-7541, Ext. 15121
Email:  jvick...@springfieldclinic.com



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[Histonet] Grossing tech qualifications

[Vickroy, James via Histonet]

a.   We are experiencing trouble finding another tech that will meet CLIA 
high complexity testing standards as well as has histotechnician training.   
Also the qualifications for who can gross is a little vague so I wanted to see 
if anyone has any information that would help me.  A summary of the grossing 
qualifications are listed below.   In the past we have hired applicants with 
bachelor's degrees in biology and then trained them in histotechnology.   We 
also went through the 90 day inhouse training for grossing.   My questions have 
to do with a clarification regarding those with an associate's degree. I 
have an applicant that has an associate's degree in science with an emphasis on 
microbiology. My question has to do with the language  "An earned associate 
degree in a laboratory science or medical laboratory technology" .   How can I 
determine what that exactly means?   Would a person with an associate's degree 
in science with an emphasis in microbiology qualify?  I'm 
 not sure she has the sixty hours total.

Qualifications of a technician for performing gross descriptions and 
preparation for tissue processing under the direct or indirect supervision of a 
pathologist include:

b.   An earned associate degree in a laboratory science or medical 
laboratory technology,
Obtained from an accredited institution, OR

c.   Education/training equivalent to the above that includes at least 60 
semester hours or equivalent from an accredited institution.  This education 
must include 24 semester hours of medical laboratory technology courses, or 24 
semester hours of science courses that includes 6 semester hours of chemistry, 
6 semester hours of biology, and 12 semester hours of chemistry, biology or 
medical laboratory technology in any combination. In addition, the individual 
must have laboratory training including either completion of a clinical 
laboratory training program approved or accredited by the ABHES, the CAHEA, or 
other organization approved by HHS (note that this training may be included in 
the 60 semester hours listed above), OR at least 3 months documented laboratory 
training in each specialty in which the individual performs high complexity 
testing.

I would appreciate any understanding that others might have.

Jim



Jim Vickroy
Histology Manager
Springfield Clinic, Main Campus, East Building
1025 South 6th Street
Springfield, Illinois  62703
Office:  217-528-7541, Ext. 15121
Email:  jvick...@springfieldclinic.com



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[Histonet] New Peloris

[Vickroy, James via Histonet]

Someone told me that you could not use eosin on the new Peloris II.   Many of 
us use eosin to color small biopsies during the process run.  We have it in one 
of the 95% ETOHs.  Can someone explain why this can't be used in the Peoris?

Jim

Jim Vickroy
Histology Manager
Springfield Clinic, Main Campus, East Building
1025 South 6th Street
Springfield, Illinois  62703
Office:  217-528-7541, Ext. 15121
Email:  jvick...@springfieldclinic.com



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[Histonet] Microscopic slides

[Vickroy, James via Histonet]

We are once again reviewing the microscopic slides we use.  We have found the 
sldies we have used on a regular basis take too long to dry properly which 
gives us some undesireable artifacts.  I have longed for a "one size fits all" 
microscopic slide.One of the slides I used in the past is not possible 
given that I have the Thermofisher Slidemates.   The slidemates require a very 
smooth labeled end.   Recently we tested several slides both hydrophobic and 
hydrophilic.  We really liked a hydrophilic slide by Leica but am told it 
doesn't work well for IHC's and special stains.   Our current slide is a 
"hydrophobic" slide which traps water easily underneath the section and 
therefore we having drying problems.  If we don't dry them for at least twenty 
minutes we get nuclear bubbling.  Leica has another slide we tried that is 
"hydrophobic" but with "hydrophilic" tendencies.  My staff thought tried that 
slide and found them to be very similar to the "hydrophobic" slide we already 
have.

We have tried the Stat-lab M2000 and they seem to  dry better but there often 
is a "trick" to getting the sections to stick to the slide without sliding off 
of the end.Of course we might just have to use two different slides, one 
for our routine H's and one for the IHC's and Special stains.   Anybody have 
any thoughts on this?

And is a "hydrophobic slide" that has "hydrophilic tendencies" really possible?

Jim Vickroy
Histology Manager
Springfield Clinic, Main Campus, East Building
1025 South 6th Street
Springfield, Illinois  62703
Office:  217-528-7541, Ext. 15121
Email:  jvick...@springfieldclinic.com



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Re: [Histonet] Nuclear Bubbling

[Vickroy, James via Histonet]

For the record please note that I have over thirty-six years experience working 
in a Histology lab.   I have been a supervisor or manager  of a hospital and 
clinic histology department for at least 25 years.

Jim Vickroy
Histology Manager
Springfield Clinic, Main Campus, East Building
1025 South 6th Street
Springfield, Illinois  62703
Office:  217-528-7541, Ext. 15121
Email:  jvick...@springfieldclinic.com<mailto:jvick...@springfieldclinic.com>


From: Jamal Rowaihi [mailto:j.rowa...@alborglaboratories.com]
Sent: Tuesday, February 16, 2016 1:56 PM
To: Manfre, Philip; Rene J Buesa; Vickroy, James
Cc: جمال الرويحي; histonet@lists.utsouthwestern.edu
Subject: Re: [Histonet] Nuclear Bubbling

Great, I agree



Regards

Jamal Rowaihi
Anatomic Pathology Supervisor
Al Borg Medical Laboratories
Sent from my cell phone
 Original message 
From: "Manfre, Philip via Histonet" 
<histonet@lists.utsouthwestern.edu<mailto:histonet@lists.utsouthwestern.edu>>
Date: 2/16/2016 10:44 PM (GMT+03:00)
To: Rene J Buesa <rjbu...@yahoo.com<mailto:rjbu...@yahoo.com>>, "Vickroy, 
James" <jvick...@springfieldclinic.com<mailto:jvick...@springfieldclinic.com>>
Cc: histonet@lists.utsouthwestern.edu<mailto:histonet@lists.utsouthwestern.edu>
Subject: Re: [Histonet] Nuclear Bubbling

Sort of a rude response to someone looking for help.

-Original Message-
From: Rene J Buesa via Histonet [mailto:histonet@lists.utsouthwestern.edu]
Sent: Tuesday, February 16, 2016 1:12 PM
To: Vickroy, James; 
histonet@lists.utsouthwestern.edu<mailto:histonet@lists.utsouthwestern.edu>
Subject: Re: [Histonet] Nuclear Bubbling

If I remember correctly, this issue has been discussed previously.The general 
consensus as to the cause of nuclear "bubbling" (in reality a lack of staining 
in the nuclear area) has been attributed to an incomplete section drying.After 
the section has be "fished" from the water bath, if the slide is not set to 
drain the underneath water before drying, the nuclear components are dissolved 
hence when the section is stained, there is nothing to stain → "nuclear 
bubbling".I think this has been previously stated so I really do not understand 
posting this same question again.I do not think that posting again the question 
a different answer is going to be received.rené

On Tuesday, February 16, 2016 12:32 PM, "Vickroy, James via Histonet" 
<histonet@lists.utsouthwestern.edu<mailto:histonet@lists.utsouthwestern.edu>> 
wrote:



Struggling to find an answer.  We do a lot of GI biopsies in our lab.  
Sometimes they look wonderful without any nuclear bubbling, other times the 
bubbling is pretty intense.  Since nuclear bubbling is often attributed to 
incomplete fixation we of course have investigated the fixation times.  I do 
not find that the problem is fixation.  In fact some of the biopsies end up 
fixing for 48 hrs before processing. (weekend).  There was a suggestion last 
week or so that there might be water trapped under the slides after cutting and 
before staining.  I really thought that this might be the issue however I'm not 
sure at this point.  Extra drying seems to help but sometimes slides side by 
side are so variable, one with bubbles and one without.  I also don't believe 
the problem is in the processing schedule since the problem has shown up on 
both a rapid and a normal schedule. (therefore longer dehydration, clearing, 
etc.)

I am wondering if anyone else has worked with this issue.  Here are my 
questions:


1.Could it be something that is happening with the tissue before it 
gets to the lab?  Usually a delay if fixation  causes other artifacts but not 
bubbling.  Could it be heat from the GI procedure?

2.  We do use blue sponges for our biopsies.  I know some say get rid of 
the sponges but has anyone seen this problem caused by usage of sponges?

3.  What about the heat stage in our Prisma stainer?


I am really getting frustrated.  Pathologists never complain however I would 
rather all of the tissue did not have the "nuclear bubbling".  Again we only do 
biopsies so I really don't think the standard old " not enough time in 
formalin" is the issue.  I have even wondered about variables such as we use 
recycled formalin, recycled Clearite III.

Any suggestions?

Jim



Jim Vickroy
Histology Manager
Springfield Clinic, Main Campus, East Building
1025 South 6th Street
Springfield, Illinois  62703
Office:  217-528-7541, Ext. 15121
Email:  
jvick...@springfieldclinic.com<mailto:jvick...@springfieldclinic.com<mailto:jvick...@springfieldclinic.com%3cmailto:jvick...@springfieldclinic.com>>



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[Histonet] Nuclear Bubbling

[Vickroy, James via Histonet]

Struggling to find an answer.  We do a lot of GI biopsies in our lab.   
Sometimes they look wonderful without any nuclear bubbling, other times the 
bubbling is pretty intense.  Since nuclear bubbling is often attributed to 
incomplete fixation we of course have investigated the fixation times.  I do 
not find that the problem is fixation.  In fact some of the biopsies end up 
fixing for 48 hrs before processing. (weekend).  There was a suggestion last 
week or so that there might be water trapped under the slides after cutting and 
before staining.   I really thought that this might be the issue however I'm 
not sure at this point.  Extra drying seems to help but sometimes slides side 
by side are so variable, one with bubbles and one without.   I also don't 
believe the problem is in the processing schedule since the problem has shown 
up on both a rapid and a normal schedule. (therefore longer dehydration, 
clearing, etc.)

I am wondering if anyone else has worked with this issue.  Here are my 
questions:


1.Could it be something that is happening with the tissue before it 
gets to the lab?  Usually a delay if fixation  causes other artifacts but not 
bubbling.  Could it be heat from the GI procedure?

2.   We do use blue sponges for our biopsies.  I know some say get rid of 
the sponges but has anyone seen this problem caused by usage of sponges?

3.   What about the heat stage in our Prisma stainer?


I am really getting frustrated.  Pathologists never complain however I would 
rather all of the tissue did not have the "nuclear bubbling".   Again we only 
do biopsies so I really don't think the standard old " not enough time in 
formalin" is the issue.  I have even wondered about variables such as we use 
recycled formalin, recycled Clearite III.

Any suggestions?

Jim



Jim Vickroy
Histology Manager
Springfield Clinic, Main Campus, East Building
1025 South 6th Street
Springfield, Illinois  62703
Office:  217-528-7541, Ext. 15121
Email:  jvick...@springfieldclinic.com



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[Histonet] Tissue cassette baskets for VIP 6

[Vickroy, James via Histonet]

Anybody have an idea where we can get a used cassette basket that will fit in 
the VIP 6?  The cost of a new one is pretty high?

Jim

Jim Vickroy
Histology Manager
Springfield Clinic, Main Campus, East Building
1025 South 6th Street
Springfield, Illinois  62703
Office:  217-528-7541, Ext. 15121
Email:  jvick...@springfieldclinic.com



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[Histonet] Nuclear bubbling

[Vickroy, James via Histonet]

Traditionally we regard nuclear bubbling as incomplete fixation however I'm not 
so sure that nuclear bubbling can't be caused by additional processing 
problems.  This morning I have some GI biopsies that fixed for nearly 18 hrs 
that have a large amount of nuclear bubbling.   We run the biopsies on a "short 
run".   I am wondering if possibly we are not getting rid of all of the water 
and therefore our dehydration steps are not long enough?

Anybody have an idea besides incomplete fixation?

Jim

Jim Vickroy
Histology Manager
Springfield Clinic, Main Campus, East Building
1025 South 6th Street
Springfield, Illinois  62703
Office:  217-528-7541, Ext. 15121
Email:  jvick...@springfieldclinic.com



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[Histonet] Rapid tissue Programs

[Vickroy, James via Histonet]

Our latest CAP survey was returned today and although there are no major issues 
one possible improvement area is evident.   On all of the biopsies the area of 
"fixation/processing" was not rated as excellent.  The suggested possible 
reasons were:   fixation incomplete, nuclear bubbling artifact, tissue poorly 
processed.   The survey also said that many of the samples sent in throughout 
the country had similar  issues in the fixation/processing area most likely 
because of the rapid turnaround times and shortened processing times.   I am 
trying to be proactive here and see if we can adjust some times to improve the 
processing quality even though we have not had any complaints from the 
pathologists.   Of course we all know that other artifacts caused prior to the 
specimen arriving in the lab can also have an effect on the quality of the H 
slides.   Our fixation times should not be a factor so I have to conclude that 
maybe the rest of our processing times need to be adjusted.   Another
  factor that we have is that we use blue sponges for almost all of our 
tissues.  Our largest number of specimens are GI biopsies.If possible can 
anyone share with me their rapid processing schedules or simply the approximate 
times they have for each dehydration or clearing step. We do run a larger 
overnight tissue run on any biopsy or tissue that we feel is too large for the 
"rapid run".I am hesitant to run the biopsies routinely on the longer 
programs becase of over dehydration, etc. even though we do use an alcohol 
blend.

Any suggestions or similar experiences please share.Again our pathologists 
say everything looks great so I don't want to change much.

Jim

Jim Vickroy
Histology Manager
Springfield Clinic, Main Campus, East Building
1025 South 6th Street
Springfield, Illinois  62703
Office:  217-528-7541, Ext. 15121
Email:  jvick...@springfieldclinic.com



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[Histonet] On-the-job-training of histotechnicians

[Vickroy, James via Histonet]

Currently we are training new staff members that each have a Bachelor of 
Science in Biology.  According to the ASCP they can enroll to take the HT 
certification examination after a one-year period of on-the-job training.  Like 
in the past we have purchased Freida Carson's text, Histotechnology:  A 
Self-Instructional Text, and the workbook.  We are also using Carson's BOC 
Study Guide - Histotechnology Certification Examinations, and the ASCP 
Histotech flash cards.  I know that staff can successfully study this material 
on their own and can pass the HT certification because three of my past staff 
have already done this.  However I am looking for additional help, plans, a 
syllabus, curriculum guide, etc. to help facilitate the training of these new 
staff members.   They have quickly caught on to the practical skills of 
microtomy, embedding, and grossing however I am worried that we are not helping 
them to get the academic information that they need for certification.

As I previously said I know that  a person can get the certification by 
studying on their own but I also know that we are giving these people less time 
and instruction in the workplace.  They are busy helping with the daily 
workload and therefore any studying of the academic material is having to be 
done on their own time.   Any suggestions how to help these people without 
paying or having them enroll in an online Histotechnology program?

Jim Vickroy BS, HT(ASCP)


Jim Vickroy
Histology Manager
Springfield Clinic, Main Campus, East Building
1025 South 6th Street
Springfield, Illinois  62703
Office:  217-528-7541, Ext. 15121
Email:  jvick...@springfieldclinic.com



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[Histonet] Small grossing station

[Vickroy, James via Histonet]

We have outgrown our two small specimen grossing stations and our looking into 
finding a small system for a counter that will have a formaldehyde filter.  
Trying to make sure it is safe but not wanting to spend a lot of money.
Station will be for small gi biopsies.  Just need something to keep the 
formalin fumes within safe limits.

Any suggestions?

Jim Vickroy
Histology Manager
Springfield Clinic, Main Campus, East Building
1025 South 6th Street
Springfield, Illinois  62703
Office:  217-528-7541, Ext. 15121
Email:  jvick...@springfieldclinic.com



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[Histonet] Average number of slides reviewed by a surgical pathologist

[Vickroy, James via Histonet]

I realize this is a question that may be impossible to answer given all of the 
variables in pathology labs, specimens, physicians, etc.  However here goes:  
For those that work in a lab that primarily does biopsies ( mainly gi biopsies) 
what is the average number of slides that a pathologist reads each day.I 
have looked online for parameters recommended however I haven't had a whole lot 
of luck.  There are plenty of figures on numbers of blocks and slides for 
histotechs but just wondered if anyone was using any either national benchmarks 
or local practices.

Jim

Jim Vickroy
Histology Manager
Springfield Clinic, Main Campus, East Building
1025 South 6th Street
Springfield, Illinois  62703
Office:  217-528-7541, Ext. 15121
Email:  jvick...@springfieldclinic.commailto:jvick...@springfieldclinic.com



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[Histonet] Advice needed on doing the technical component and professional component at two different sites

[Vickroy, James]

Currently our dermatologists send their skin biopsies to a private lab.   Since 
we  now have our own Histology department we are proposing to do the technical 
component (grossing and preparation of slides) in house and sending the block 
and HE slides to the same private company.  They call these type of clients  
professional read only.   I understand the differences regarding billing since 
the CPT codes we are using have a professional component and a technical 
component.   My questions center around what other organizations do for 
accessioning and how they  meet CAP requirements for grossing, etc.

Normally we handle all of our other specimens in the normal way of 
accessioning, grossing (under the indirect supervision of a pathologist that 
comes to read the slides, processing, preparation of slides, and giving the 
slides to the pathologist who signs out the surgical report including the 
gross, and the rest of the surgical report.

The dermatology specimens would have to be handled differently. Our 
dermatologists want the slides read by the private company that only does 
dermatology specimens. (at least until we hire a dermatopathologist).  In the 
past the derm tissues were sent to the private company and they did all of the 
process including grossing.  Our organization has now decided that it is 
advantageous for us to do the technical portion in house and then send the 
slides to be read by the private company because of changes in billing.  The 
private company is perfectly willing to  help us make sure they get information 
they need  to diagnose the cases (they have even shown us how they like each 
type of skin biopsy sectioned and inked.  They will help us set up a system for 
them to get the slides and do the surgical reports.  Their report will have our 
gross description and surgical number, along with a statement that the gross 
and processing was done elsewhere.  They have done this with several other clien
 ts.  I have some unanswered questions since I have never done something like 
this.  Below is a list of my questions.  What I really need is someone to tell 
me how they are handling specimens that they prepare locally and then send the 
slides to a pathology group to read.


1.Since the local pathologist group does not read these slides,  are 
our  grossing techs under the indirect supervision of the pathologists at the 
private company for these specimens?

2.   How do you accession these specimens locally so tracking, slide 
preparation, and technical component billing can be done, without a local 
surgical report.

3.   If you have to do a local report, who signs the gross report that just 
has a gross and maybe a statement that the slides will be read at the private 
company?

4.   Are there other CAP considerations I am not thinking of?

Am I making this too complicated?

Jim





Jim Vickroy
Histology Manager
Springfield Clinic, Main Campus, East Building
1025 South 6th Street
Springfield, Illinois  62703
Office:  217-528-7541, Ext. 15121
Email:  jvick...@springfieldclinic.commailto:jvick...@springfieldclinic.com



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[Histonet] Billing

[Vickroy, James]

Just need a reminder:

If a pathologist orders the same  several IHC stains on two blocks from the 
same specimen am I correct to think that we can only charge the stains on one 
of the blocks? 88342 and the remainder 88341's

Jim

Jim Vickroy
Histology Manager
Springfield Clinic, Main Campus, East Building
1025 South 6th Street
Springfield, Illinois  62703
Office:  217-528-7541, Ext. 15121
Email:  jvick...@springfieldclinic.commailto:jvick...@springfieldclinic.com



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[Histonet] Antimarkup in Illinois

[Vickroy, James]

We have a new histology lab and we contract a pathology group to come to our 
facility and read slides.  If they order a Special stain or IHC stain we send 
the slides to a hospital histology department to perform the stains.   
According to the new markup law we have to pass on and not markup the technical 
component of the stain, however since our contracted pathologist reads it here 
can we charge a usual and customary fee for reading the stain (professional 
component) which is higher than the negotiated fee that we pay the pathologist 
group for interpretation.   Again the slides are read at our facility.

Jim

Jim Vickroy
Histology Manager
Springfield Clinic, Main Campus, East Building
1025 South 6th Street
Springfield, Illinois  62703
Office:  217-528-7541, Ext. 15121
Email:  jvick...@springfieldclinic.commailto:jvick...@springfieldclinic.com



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[Histonet] Billing question

[Vickroy, James]

If I have two sections on an A specimen A1 and A2 and both had a GMS stain, 
do I charge 1 - 88312 or  2 - 88312?

Jim

Jim Vickroy
Histology Manager
Springfield Clinic, Main Campus, East Building
1025 South 6th Street
Springfield, Illinois  62703
Office:  217-528-7541, Ext. 15121
Email:  jvick...@springfieldclinic.commailto:jvick...@springfieldclinic.com



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[Histonet] Combination bracket for Gross lab senior

[Vickroy, James]

Does anybody have an idea how to attach the combination bracket with a shelf 
for the Printmate from Thermo Fisher.  No instructions and trying to 
conceptualize how this thing goes together.   Worse than putting together a 
swing set or new kid's bicycle.  Diagram or picture with one attached would be 
helpful.  Manufacturer trying to find some instructions also.

Jim

Jim Vickroy
Histology Manager
Springfield Clinic, Main Campus, East Building
1025 South 6th Street
Springfield, Illinois  62703
Office:  217-528-7541, Ext. 15121
Email:  jvick...@springfieldclinic.commailto:jvick...@springfieldclinic.com



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[Histonet] Recycling of alcohol

[Vickroy, James]

In the past I have plenty of years of experience recycling formalin and 
clearing agents, however I don't have much experience with recycling reagent 
grade alcohols.  If we recycle waste alcohol that is 95% - 100 %, I am told 
that our recycled product will be 99% or above.   With that said how are others 
using this alcohol?   Are they using it as 100% on the tissue processors?   Are 
they using it in the strainers for 100%?  Are others using it as 95% instead of 
100%.   Obvioulsy I am concerned that my last alcohol station on the VIP is as 
close to 100% as possible and the same is true for the automated stainer.

Obviously we can use the recycled alcohol for cleaning reagents on the tissue 
processors.   Please share with me if you are recycling alcohol to what extent 
are you using the recycled product.

Jim

Jim Vickroy
Histology Manager
Springfield Clinic, Main Campus, East Building
1025 South 6th Street
Springfield, Illinois  62703
Office:  217-528-7541, Ext. 15121
Email:  jvick...@springfieldclinic.commailto:jvick...@springfieldclinic.com



This electronic message contains information from Springfield Clinic, LLP that 
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[Histonet] H. Pylori Testing

[Vickroy, James]

We are a small lab processing mostly GI specimens.  Currently we are sending 
our H. Pylori testing to a local hospital for staining however I can predict 
that this year we may have around 1000 H. Pylori stains done.  I am looking for 
a small platform or manual test kit to perform the H. Pylori's inhouse.   Can 
someone please give me their thoughts, suggestions, or similar experiences  how 
they have or would approach this endeavor?

Jim Vickroy
Histology Manager
Springfield Clinic, Main Campus, East Building
1025 South 6th Street
Springfield, Illinois  62703
Office:  217-528-7541, Ext. 15121
Email:  jvick...@springfieldclinic.commailto:jvick...@springfieldclinic.com



This electronic message contains information from Springfield Clinic, LLP that 
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[Histonet] Question on IHC billing

[Vickroy, James]

Let me see if I have this straight:If a pathologist orders an Hpylori stain 
on 2 blocks from the same specimen C1 and C2 we can only bill one 88342.

If this correct.Obviously if he ordered addition different IHC stains we 
could change additional 88341's.

Jim Vickroy
Histology Manager
Springfield Clinic, Main Campus, East Building
1025 South 6th Street
Springfield, Illinois  62703
Office:  217-528-7541, Ext. 15121
Email:  jvick...@springfieldclinic.commailto:jvick...@springfieldclinic.com



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taken on the contents of this information is strictly prohibited. If you have 
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[Histonet] Formaldehyde filters on Grossing station

[Vickroy, James]

Does anybody remember how to test whether a formaldehyde filter for a grossing 
station is exhausted?  If I remember right there is some sort of test where you 
remove a couple of granules and cut the granules in half.  The color of the cut 
service is used somehow.

Also I know that changing formaldehyde filters on ductless workstations needs 
to be done regularly.  Can anyone share how often they change the formaldehyde 
filters for a gross lab senior or a small station such as a HYperclean?

Jim

Jim Vickroy
Histology Manager
Springfield Clinic, Main Campus, East Building
1025 South 6th Street
Springfield, Illinois  62703
Office:  217-528-7541, Ext. 15121
Email:  jvick...@springfieldclinic.commailto:jvick...@springfieldclinic.com



This electronic message contains information from Springfield Clinic, LLP that 
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[Histonet] Xylene spills

[Vickroy, James]

We are setting up a histology lab in a clinic.   We use very little xylene and 
only in the automated coverslipper.   I am writing up a procedure to handle a 
xylene spill.   When I was at the hospital I segregated small and large spills 
with separate procedures, both however involved the use of a PAPR.  I am 
looking for an economical way to clean up a potential xylene spill and am 
wondering if I need to have the clinic purchase a PAPR to clean up the 
potential spill.   I think that I have to do some sort of fit testing however 
if I use a PAPR.   Can anyone suggest their procedure on how to handle xylene 
spills in an economical manner?Again we use very little xylene in the lab 
but our supply comes in one gallon plastic containers.

Jim

Jim Vickroy
Histology Manager
Springfield Clinic, Main Campus, East Building
1025 South 6th Street
Springfield, Illinois  62703
Office:  217-528-7541, Ext. 15121
Email:  jvick...@springfieldclinic.commailto:jvick...@springfieldclinic.com



This electronic message contains information from Springfield Clinic, LLP that 
may be confidential, privileged, and/or sensitive. This information is intended 
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[Histonet] G0461 code for prostate biopsies

[Vickroy, James]

I am told that in 2015 there are no longer G codes for medicare patient billing 
of IHC stains.  That is great.  However the gentleman I talked to also said 
that now for medicare patients there is only one G code for prostate biopsies.  
G0461 to be used no matter how many of the biopsies procured.   I tried to 
google this to make sure he was correct.   What I found was that non medicare 
prostate biopsies continue to be billed 88305 but an 88305 is not to be used 
for a medicare patient with a prostate biopsy.   Is this everyone else's 
understanding?

Jim

Jim Vickroy
Histology Manager
Springfield Clinic, Main Campus, East Building
1025 South 6th Street
Springfield, Illinois  62703
Office:  217-528-7541, Ext. 15121
Email:  jvick...@springfieldclinic.commailto:jvick...@springfieldclinic.com



This electronic message contains information from Springfield Clinic, LLP that 
may be confidential, privileged, and/or sensitive. This information is intended 
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intended recipient, be aware that disclosure, copying, distribution, or action 
taken on the contents of this information is strictly prohibited. If you have 
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[Histonet] RE: G0461 code for prostate biopsies

[Vickroy, James]

Apparently the code is G0416 not G0461.  Sorry

Jim Vickroy
Histology Manager
Springfield Clinic, Main Campus, East Building
1025 South 6th Street
Springfield, Illinois  62703
Office:  217-528-7541, Ext. 15121
Email:  jvick...@springfieldclinic.commailto:jvick...@springfieldclinic.com


From: Vickroy, James
Sent: Thursday, March 19, 2015 3:14 PM
To: histonet@lists.utsouthwestern.edu
Subject: G0461 code for prostate biopsies


I am told that in 2015 there are no longer G codes for medicare patient billing 
of IHC stains.  That is great.  However the gentleman I talked to also said 
that now for medicare patients there is only one G code for prostate biopsies.  
G0461 to be used no matter how many of the biopsies procured.   I tried to 
google this to make sure he was correct.   What I found was that non medicare 
prostate biopsies continue to be billed 88305 but an 88305 is not to be used 
for a medicare patient with a prostate biopsy.   Is this everyone else's 
understanding?

Jim

Jim Vickroy
Histology Manager
Springfield Clinic, Main Campus, East Building
1025 South 6th Street
Springfield, Illinois  62703
Office:  217-528-7541, Ext. 15121
Email:  jvick...@springfieldclinic.commailto:jvick...@springfieldclinic.com



This electronic message contains information from Springfield Clinic, LLP that 
may be confidential, privileged, and/or sensitive. This information is intended 
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[Histonet] Slide and Block Combination Transport or Mailer

[Vickroy, James]

I have seen somewhere a combination transport or mailer for both a paraffin 
block and slides.   We are going to have our special stains and IHC stains done 
across town and we use a courier to take the paraffin block to the lab that 
will do the procedure and then they send back the block and the slide(s).   Any 
ideas which vendor carries something like this?   I want to have something in 
which the block and returned slides will be in the same container.   Experience 
tells me things find a way to get separated and lost.

Thanks

Jim

Jim Vickroy
Histology Manager
Springfield Clinic, Main Campus, East Building
1025 South 6th Street
Springfield, Illinois  62703
Office:  217-528-7541, Ext. 15121
Email:  jvick...@springfieldclinic.commailto:jvick...@springfieldclinic.com


This electronic message contains information from Springfield Clinic, LLP that 
may be confidential, privileged, and/or sensitive. This information is intended 
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taken on the contents of this information is strictly prohibited. If you have 
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[Histonet] New lab setup

[Vickroy, James]

I am working on setting up  an adequate validation study for tissue processing 
at a new lab.  I want it to be adequate but also not too labor intensive or 
costly.  I have been in Histotechnology for over 36 years and have done this 
before in the lab I can from.   Unfortunately sometimes I make things more 
complicated than others.  I realize the standards for testing new protocols and 
antibodies are defined in the CAP checklist but routine tissue processing  just 
says to document the procedure and to run parallel samples as a blind study.

We are going to run only GI biopsies at first and I had planned on running 
parallel samples with the department from my  previous employer.   I also 
thought that down the road we may have more than a rapid biopsy program so I 
should do a few larger samples at a regular processing schedule to validate 
both schedules (rapid and normal).  I also thought that I should pick out a 
couple of blocks for  representative special stains and IHC stains tha we would 
compare even though the new lab will send everything to the old lab for special 
stains and IHC stains.

We have two processors and know I will also have to run a small validation of 
each new processor.  I figured as I was validating the tissue processing 
programs I would also be validating the first tissue processor.

Both of our two processors will be VIP6(s) and the machines from my former 
employer were also VIP6(s) which were of course validated.

Can anyone share how many samples are adequate for tissue processing program 
validation and new processor validation? In other words what have you done and 
what was accepted by CAP since the wording of the question does not state any 
particulars?   Also can you tell me if you think the special stains and IHC 
stains comparison is necessary, given that all of the stains will be done at 
the old lab and the only difference will be where the tissues were processed.

My original design of the study had 25 parallel samples but I am wondering if 
that is overkill.

Thanks

Jim Vickroy

Jim Vickroy
Histology Manager
Springfield Clinic, Main Campus, East Building
1025 South 6th Street
Springfield, Illinois  62703
Office:  217-528-7541, Ext. 15121
Email:  jvick...@springfieldclinic.commailto:jvick...@springfieldclinic.com


This electronic message contains information from Springfield Clinic, LLP that 
may be confidential, privileged, and/or sensitive. This information is intended 
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[Histonet] Looking for the ideal temperature ranges and humidity levels - histology lab

[Vickroy, James]

We have always measured the temperature and humidity of the histology lab.   
Someone today asked what the normal ranges for a histology lab were?   Any 
ideas?

Jim Vickroy
Histology Manager
Springfield Clinic, Main Campus, East Building
1025 South 6th Street
Springfield, Illinois  62703
Office:  217-528-7541, Ext. 15121
Email:  jvick...@springfieldclinic.commailto:jvick...@springfieldclinic.com


This electronic message contains information from Springfield Clinic, LLP that 
may be confidential, privileged, and/or sensitive. This information is intended 
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taken on the contents of this information is strictly prohibited. If you have 
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[Histonet] Decon HydeAway

[Vickroy, James]

Anybody using Decon HydeAway for neutralization of 10% NBF.  If so what are 
your experiences and do you dispose of the product (gel) into your solid 
biological  waste for disposal?

In the past I have used Formalex or Formalex Green.  This material looks 
cheaper but cheaper is not always better of course.

Jim

Jim Vickroy
Histology Manager
Springfield Clinic, Main Campus, East Building
1025 South 6th Street
Springfield, Illinois  62703
Office:  217-528-7541, Ext. 15121
Email:  jvick...@springfieldclinic.commailto:jvick...@springfieldclinic.com


This electronic message contains information from Springfield Clinic, LLP that 
may be confidential, privileged, and/or sensitive. This information is intended 
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taken on the contents of this information is strictly prohibited. If you have 
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[Histonet] Recycling alcohol

[Vickroy, James]

We are planning to recycle alcohol in the new lab I am working with.   
Previously I always used an alcohol blend such as the Flex products.  However 
at this new lab we are going to only process biopsies so I believe I can get by 
using ethanol and not a blend.   We will be getting our alcohol from 
Thermofisher.  Can anyone tell me which alcohols they are using for 
dehydration?  Reagent alcohol or ethyl alcohol.  Obviously we will make our own 
concentrations from a 100%.

Jim

Jim Vickroy
Histology Manager
Springfield Clinic, Main Campus, East Building
1025 South 6th Street
Springfield, Illinois  62703
Office:  217-528-7541, Ext. 15121
Email:  jvick...@springfieldclinic.commailto:jvick...@springfieldclinic.com


This electronic message contains information from Springfield Clinic, LLP that 
may be confidential, privileged, and/or sensitive. This information is intended 
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taken on the contents of this information is strictly prohibited. If you have 
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[Histonet] Cassette lableler and slide labeler

[Vickroy, James]

I didn't plan on this however wondered if anyone  had a General Data system for 
making cassettes but a different setup for making slides, such as a Thermo 
Slidemate.

I suspect there are issues with the LIS system, barcoding, etc.Am I wrong?

Jim

Jim Vickroy
Histology Manager
Springfield Clinic, Main Campus, East Building
1025 South 6th Street
Springfield, Illinois  62703
Office:  217-528-7541, Ext. 15121
Email:  jvick...@springfieldclinic.commailto:jvick...@springfieldclinic.com


This electronic message contains information from Springfield Clinic, LLP that 
may be confidential, privileged, and/or sensitive. This information is intended 
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intended recipient, be aware that disclosure, copying, distribution, or action 
taken on the contents of this information is strictly prohibited. If you have 
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[Histonet] Cassette printer and slide or lable printers

[Vickroy, James]

Comparing different products.  Currently we have Cyberpath as our anatomic 
pathology system.  I am trying to purchase a cassette printer and slide 
printers and am trying to figure out the added expenses for connecting these 
instruments to the CyberPath system.  I have an email out to CyperPath but also 
wondered if anyone can share their experiences when they connected their 
cassette printers and slide or label printers with me.  I suspect I have to 
have an interface from Cyberpath to the printers but will I need to purchase 
anything on the cassette or slide printer side.  This is definitely not my 
strong suit and any advice would be greatly appreciated.

Jim

Jim Vickroy
Histology Manager
Springfield Clinic, Main Campus, East Building
1025 South 6th Street
Springfield, Illinois  62703
Office:  217-528-7541, Ext. 15121
Email:  jvick...@springfieldclinic.commailto:jvick...@springfieldclinic.com


This electronic message contains information from Springfield Clinic, LLP that 
may be confidential, privileged, and/or sensitive. This information is intended 
for the use of the individual(s) or entity(ies) named above. If you are not the 
intended recipient, be aware that disclosure, copying, distribution, or action 
taken on the contents of this information is strictly prohibited. If you have 
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[Histonet] Primera cassette and slide labelers

[Vickroy, James]

Sakura now carries the Primera made cassette and slide labelers.  (Tissue Tek). 
  Does anybody have any experience with these instruments?

Jim

Jim Vickroy
Histology Manager
Springfield Clinic, Main Campus, East Building
1025 South 6th Street
Springfield, Illinois  62703
Office:  217-528-7541, Ext. 15121
Email:  jvick...@springfieldclinic.commailto:jvick...@springfieldclinic.com


This electronic message contains information from Springfield Clinic, LLP that 
may be confidential, privileged, and/or sensitive. This information is intended 
for the use of the individual(s) or entity(ies) named above. If you are not the 
intended recipient, be aware that disclosure, copying, distribution, or action 
taken on the contents of this information is strictly prohibited. If you have 
received this electronic message in error, please notify the sender 
immediately, by electronic mail, so that arrangements may be made for the 
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[Histonet] Slide and cassette labelers

[Vickroy, James]

Has anyone used the Tissue Tex SmartWrite Slide Printer and Cassette Printer? 
  These both use Thermal transfer.

I am also considering ThermoScientific, Leica, and General Data.

Any advice would be welcome.

Thanks

Jim



Jim Vickroy
Histology Manager
Springfield Clinic, Main Campus, East Building
1025 South 6th Street
Springfield, Illinois  62703
Office:  217-528-7541, Ext. 15121
Email:  jvick...@springfieldclinic.commailto:jvick...@springfieldclinic.com


This electronic message contains information from Springfield Clinic, LLP that 
may be confidential, privileged, and/or sensitive. This information is intended 
for the use of the individual(s) or entity(ies) named above. If you are not the 
intended recipient, be aware that disclosure, copying, distribution, or action 
taken on the contents of this information is strictly prohibited. If you have 
received this electronic message in error, please notify the sender 
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[Histonet] Usage of Thermo Cassette and Slde Printer

[Vickroy, James]

Could anyone comment on the Thermo Printmate and Slide Mate?   I am considering 
going to it for labeling of cassettes and slides.

Thanks

Jim Vickroy
Histology Manager
Springfield Clinic, Main Campus, East Building
1025 South 6th Street
Springfield, Illinois  62703
Office:  217-528-7541, Ext. 15121
Email:  jvick...@springfieldclinic.commailto:jvick...@springfieldclinic.com


This electronic message contains information from Springfield Clinic, LLP that 
may be confidential, privileged, and/or sensitive. This information is intended 
for the use of the individual(s) or entity(ies) named above. If you are not the 
intended recipient, be aware that disclosure, copying, distribution, or action 
taken on the contents of this information is strictly prohibited. If you have 
received this electronic message in error, please notify the sender 
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[Histonet] ASP300S or VIP 6

[Vickroy, James]

Buying two automated tissue processors for new lab.   I have always used the 
VIP tissue processors, can anyone comment on a side by side comparison between 
the Leica and the VIP 6?

thanks

Jim Vickroy
Histology Manager
Springfield Clinic, Main Campus, East Building
1025 South 6th Street
Springfield, Illinois  62703
Office:  217-528-7541, Ext. 15121
Email:  jvick...@springfieldclinic.commailto:jvick...@springfieldclinic.com


This electronic message contains information from Springfield Clinic, LLP that 
may be confidential, privileged, and/or sensitive. This information is intended 
for the use of the individual(s) or entity(ies) named above. If you are not the 
intended recipient, be aware that disclosure, copying, distribution, or action 
taken on the contents of this information is strictly prohibited. If you have 
received this electronic message in error, please notify the sender 
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[Histonet] Cyberlab pathology manual and Dragon

[Vickroy, James]

I have recently moved to a new organization and am setting up a new surgical 
pathology lab. The lab LIS system is Cyberlab and I am told that they have a AP 
module.   In the past I have worked with Cerner Classic and CoPath Plus at a 
hospital but this lab will be a much smaller set-up.  Obviously the 
organization would like us to use the AP module since the interfacing issues 
would be markedly reduced.  I am set for a demonstration of the pathology 
module later this week but wondered if anyone could share their experiences 
with Cyperlab and specifically their pathology module.  We will mainly be  
handling GI biopsies and skin biopsies.  The clinic also has Dragon being used 
in other areas.  One of my big questions is whether we will be able to use 
voice recognition in grossing and for result reporting by the pathologist.  If 
you can share any information I would be very appreciative.

Thanks

Jim

Jim Vickroy
Histology Manager
Springfield Clinic, Main Campus, East Building
1025 South 6th Street
Springfield, Illinois  62703
Office:  217-528-7541, Ext. 15121
Email:  jvick...@springfieldclinic.commailto:jvick...@springfieldclinic.com


This electronic message contains information from Springfield Clinic, LLP that 
may be confidential, privileged, and/or sensitive. This information is intended 
for the use of the individual(s) or entity(ies) named above. If you are not the 
intended recipient, be aware that disclosure, copying, distribution, or action 
taken on the contents of this information is strictly prohibited. If you have 
received this electronic message in error, please notify the sender 
immediately, by electronic mail, so that arrangements may be made for the 
retrieval of this electronic message. Thank you.
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[Histonet] VIP 6 processing baskets

[Vickroy, James]

Does anyone know if the VIP 6 cassette baskets fit other vendor embedding 
centers?  Spec sheets have a lot of measurements but practical experience is 
the best guide.

We are considering a Thermofisher embedding center or a Leica Embedding Center 
but most likely we will process with a VIP 6 so I want to make sure the baskets 
will fit.  I know that VIP has two sizes of baskets and I am most concerned 
about the 150 cassette basket.

Thanks

Jim Vickroy
Histology Manager
Springfield Clinic, Main Campus, East Building
1025 South 6th Street
Springfield, Illinois  62703
Office:  217-528-7541, Ext. 15121
Email:  jvick...@springfieldclinic.commailto:jvick...@springfieldclinic.com


This electronic message contains information from Springfield Clinic, LLP that 
may be confidential, privileged, and/or sensitive. This information is intended 
for the use of the individual(s) or entity(ies) named above. If you are not the 
intended recipient, be aware that disclosure, copying, distribution, or action 
taken on the contents of this information is strictly prohibited. If you have 
received this electronic message in error, please notify the sender 
immediately, by electronic mail, so that arrangements may be made for the 
retrieval of this electronic message. Thank you.
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