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Cutting Manual




TO:                         All Residents, Fellows and AP Faculty Members


FROM:                   Joel K. Greenson, M.D.

                                Director, Surgical Pathology


RE:                          Non-pigmented skin excisions with frozen sections


DATE:                    August 22, 1997




Pursuant to our discussion at yesterday’s AP Faculty meeting, all non-pigmented skin excisions with frozen sections will now be designated IF cases and will be signed out by the Room I residents and faculty.  I believe this will not only cut down on duplication of effort, but also be an important aid in providing feedback to the fellows and staff performing the frozen sections.  If for some cruel and inhumane reason, frozen sections are done on pigmented lesions, those lesions should be deemed an ID case and forwarded to dermatopathology.






TO:                         Surgical Pathology, Hematopathology, and Neuropathology Faculty



FROM:                  Joel K. Greenson, M.D.

                                Director, Surgical Pathology


RE:                         CPT Fee Codes for 1998


DATE:                    January 8, 1998





It has come to our attention that there is a CPT fee code for the use of radiologic films in interpreting a pathologic specimen.  Hence, whenever we use a film for specimen orientation, localization, or interpretation, we should attach the CPT code 76098 to the other fee codes associated with the case.  This is particularly germain to breast biopsies in which the needle localization mammogram accompanies the specimen to pathology.  In addition, when touch preps are used with a frozen section to help with an intraoperative consultation, the CPT code of 88332 should be used.  If a touch prep is used without a frozen section for an intraoperative consultation the fee code is 88331.


CPT code for radiologic films as part of the specimen: 76098

CPT code for intraoperative touch prep alone:  88331

CPT code for intraoperative touch prep with frozen section: 88332




cc:           Dr. Joseph Fantone

                Mr. Eugene Napolitan

                Mr. David Golden











TO:                         House Officers

                                Cytopathology Faculty

                                Surgical Pathology Faculty

                                Dr. Joseph Fantone


FROM:   Joel K. Greenson, M.D.

                                Director, Surgical Pathology             


RE:                          Gyn biopsies


DATE:    May 8, 1997





In an attempt to facilitate easier QA/QC in gyn cytology, please set aside gyn biopsies in Room II that are discrepant with previous cytology specimens. 


Thank you for your attention to this matter.






TO:                         AP Faculty




FROM:   Joel K. Greenson, M.D.

                                Director, Surgical Pathology             


RE:                          Coding of histologically normal specimens


DATE:    April 9, 1998



It has been brought to my attention that since we have changed our tissue codes to better track our turn-around times, Code III is no longer being used.  The Operating Room Committee is desperately trying to keep track of all histologically normal organs that are removed during surgery.  Please use the tissue Code III for any Room I resection specimens that do not demonstrate any pathology (appendices, gall bladders, uteri, etc.).  The number of Code IIIs submitted by our department in recent months is so low that there is concern that the JCHO will find the statistics unbelievable.


Thank you for your attention to this matter.




cc:           Joseph C. Fantone, M.D.

                Ron Salisbury



TO:                   Residents, Fellows

                        Surgical Pathology Faculty

                        Joseph C. Fantone, M.D.


FROM:  Joel K. Greenson, M.D.

                        Director, Surgical Pathology


RE:                   Transplant biopsies


DATE:   October 12, 1998





While we normally have the luxury of having designated experts read the liver, lung, and heart transplant biopsies, there are occasional instances when all of the designated experts are out of town or unavailable.  In an effort to cross train all of the general surgical pathology faculty, I would like each expert to prepare a small tray of slides with accompanying text showing the various classic lesions of rejection as well as other lesions often encountered in transplant biopsies.  Currently there is a set of heart transplant biopsies and a set of liver transplant biopsies on the shelf in Room II which can be utilized when the designated experts are unavailable. 






TO:                 House Officers, Fellows

                        Tissue Procurement

                        Surgical Pathology Faculty

                        Dr. Joseph Fantone


FROM:           Joel K. Greenson, M.D.

                        Director,  Surgical Pathology


RE:                 Tissue procurement specimens


DATE:            May 7, 1997



I would like to remind everyone that any specimen received in pathology with a requisition must be accessioned as a specimen before being distributed to Tissue Procurement.  This does not apply to “disposable” specimens without requisitions that are brought to pathology for Tissue Procurement.


Thank you for your attention to this matter.





Date:               June 24, 1998


To:                   Pathology residents, Histopathology Laboratory Staff


From:              Riccardo Valdez, M.D.

                        Joel K. Greenson, M.D.

                        Kathy Smiezny


Subject:          Surgical Pathology Specimens


Beginning July 1, 1998, the following specimen types will be cut by a pathology resident in the designated grossing area(s) of the Histology Laboratory.




Breast biopsies

Small lumpectomies (including lymph node(s)/lymph node dissections if applicable)

All lymph node dissections not associated with a resection specimen

Reduction pneumoplasties

Reduction mammoplasties

Heart valves

Aortic plaques

Carotid plaques


Small segments of bowel

Colon for carcinoma

Prostate gland (tumor and non-tumor)

Testes (non-tumor only)

Uterus (non-tumor only)

Ovaries and fallopian tubes (non-tumor only)


Room II specimens not cut by Histotechnologist


Between the hours of 8:00am and 4:00pm, these specimens will be accessioned in Room I and subsequently be taken to the grossing area in the Histology Lab by the histotechnologist assigned to Room I; all cases will be brought up with an appropriate number of cassettes as per the surgical pathology cutting manual.  Specimens will be returned to Room I for storage after the gross examination/dissection is completed; this will also be performed by the Room I histotechnologist.




To:                   Residents


From:              Ann Lemieux


Subject:          Temporal Arteries


CC:                 Andrew Flint, Joel Greenson


Date:               May 21, 1998



Please be informed that we now submit temporal arteries whole.  The arteries are much easier to embed with they are processed whole and then serially sectioned just prior to embedding.


If you ever gross in a temporal artery (TABX) for routine processing and light microscopy, please submit it whole.  Thanks.



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