The Surgical Pathology Sendout protocol provides instructions for preparation of slides and/or blocks to be sent to an outside institution by a designated courier.
Note: Only Staff trained in the Anatomic Pathology send out area are to prepare surgical pathology slides and/or blocks for referral. If the request occurs during off-hours, the Pathologist on-call is contacted.
1. Obtain the relevant clinical information and supporting documents from the requesting source:
A. Requesting pathologist or physician (The order must be faxed if the requesting physician is not a Pathology Associates (PA) physician.)
B. Name, address and telephone number of the physician and institution where slides/blocks are to be sent
C. Patient name and case number(s)
D. The consent form “Authorization to Release of Health Information”, signed by the patient, is required if there is no physician order. The patient must sign before the material is sent. The patient can stop at a lab site, or the physician’s office can fax one to the appropriate lab site. A copy of the original Authorization to Release Health Information is scanned into the image gallery of CoPath and the original document is filed in a designated file in the pathology department.
Note: Materials may be sent in emergency or special situations without consent if approved by a pathologist. If the case is being sent by our Pathologist, or a FAXed or written order is received, no consent is needed.
2. Locate the slides/blocks and the corresponding pathology report. Place a marker in the slide drawer.
Note: Mayo requires that a patient report be sent. If the case is not yet signed out, print a copy of the preliminary report for submission with the materials.
3. Contact the pathologist of record to review the slides.
Note: If the pathologist of record is unavailable, another Pathologist should be contacted.
4. Pathologist will select slides/blocks to be sent. If all materials are not available, this will be noted in the log and the referral facility will be notified.
Note: The slide and/or block preparation for referral is carried out to completion at the time the request is made. PARTIAL COMPLETION IS NOT ACCEPTABLE since after-hours pickups would require untrained staff and personnel to complete the task.
5. The slides/blocks are placed into the appropriate transport containers. Complete the “Loan of Anatomic Materials” form. If a request is for patient treatment at another facility (i.e., appointment, second opinion) no orders need to be placed in either the HIS or CLICS; skip to step 11.
6. Record the following information under the Slide Send Out (SSO) tab in CoPath:
Enter the case # being sent out (if more than one case is being sent out, log in under the most recent and then click on the “Add a Specimen” tab to add other specimens.
A. Physician making the request.
B. Numbers of slides and/or blocks; record as much detail as possible
C. Other (letter, frozen tissue, etc.)
D. Destination physician and institution, appointment date, department, etc.
E. Date sent
F. Courier and airbill number
G. Date of slide/block return of 60 days. If a report only is to be returned (i.e., fresh tissue, Her2, cornea) mark out for 10 days to watch for a report.
H. Date Report return and Pathologist for review.
I. Insurance Information sent, Y (yes) or N (no).
7. Insurance information:
A. Print the insurance screen from CoPath or the hospital information system if the patient is a hospital patient.
B. If the patient’s insurance is BCBS and prefix is XQW a Rapid Referral form is required for sendouts to Mayo or University of Washington.
8. Handling of Copies of letters and/or air bills and insurance forms used:
A. Any letter generated by a Pathologist is scanned into the image gallery.
B. File the Air bill in the paperwork area
C. Copy all information sent and keep the copies in the paperwork file under “faxed orders”.
9. Test Ordering: All testing requested for sendout on a hospital case that is being sent within 30 days of the original collection date are entered in the HIS system at Mercy or Finley.
A. Hospital Cases:
a. Current Hospital Cases:
All current hospital cases with surgical consults referred to Mayo are ordered through the appropriate Hospital Information System (HIS). The referral is ordered in MayoLink using the appropriate hospital inpatient Mayo account number (MMC: C7000122 or Finley: C7003890). Refer to established HIS order entry procedures for MMC and Finley.
b. Hospital Cases >1 Month Old:
Any hospital cases that are more than a month old and have surgical consults referred to Mayo are ordered in MayoLink only using the appropriate Mayo global account (MMC OP/Global: C7027701 or Finley OP/Global: C7027702). Indicate the insurance information on the Mayo orders to have Mayo bill the patient/insurance. Place a copy of the Mayo order in the AP Paperwork folder.
c. Current Outpatient/Global Cases:
All outpatient global cases are ordered in MayoLink only using the appropriate Mayo global account (MMC OP/Global: C7027701 or Finley OP/Global: C7027702). Indicate the insurance information on the Mayo orders to have Mayo bill the patient/insurance. Place a copy of the Mayo order in the AP Paperwork folder.
B. Mayo Sendouts: Place the order in the HIS, which will send the order to CLICS, from CLICS the order will be processed and sent to MayoAccess under the correct Mayo hospital client code. The Mayo batch report is retained in the paperwork office at MMC-DBQ for report distribution follow-up.
a. Orders are placed in CLICS either automatically via interfaces or manually through the Order Registration screen.
b. Specimens are registered when they are received using the Specimen Registration screen in CLICS.
Note: The “status” is set to “In Lab”.
c. Choose Worklist under the Reports menu and the appropriate reference lab, e.g. Mayo Medical Labs, under the Work Area drop-down list. Refer to the Worklist procedure for more detail on the functionality of this screen.
d. Click the checkbox along side each test to be grouped in the batch. Those tests having an “X” in the respective check boxes will be included in the batch.
Note: Mayo requests that separate batches are created according to how the specimens are packaged; i.e. frozen, ambient, refrigerated, etc.
e. When the batch selection is completed, click the Send/Print button, this will trigger a worklist to print, move the test(s) status to “On Worklist” and transmit the batch to the reference lab interface.
f. Log on to MayoAccess to complete the tests and release the batch.
Note: Green indicates no additional data entry is needed and the test is ready to be accepted; Yellow indicates there are required fields that must be completed before the test can be sent.
g. Print the Mayo batch report and include it in the package with the specimen(s) to be sent.
Note: The Mayo batch report is to be used as the inventory list of a given package, UCL Worklist can be substituted in a downtime situation.
h. When Mayo releases the test, the results flow back to CLICS, which then routes them via interface to the appropriate system or prints a report for non-interfaced clients.
Note: Mayo will use the specimen labels generated by CLICS as their identifier, do not re-label specimens with Mayo labels.
C. Clarient: Place the order in the HIS, which will send the order to CLICS. Process the specimen manually for the appropriate reference laboratory.
Note: Clarient will bill patient insurances; therefore no charges are entered at the time of order. Enter a Lab Comment indicating the insurance information submitted to Clarient for billing. When results are returned, indicate this information in the CLICS order and send the report to the hospital Medical Records Dept.
D. All testing ordered on an outpatient case or a hospital case more than 30 days after the original collection date are to be ordered by Pathology Associates.
a. Mayo Sendouts:
1. Place these orders directly into MayoAccess since there is no UCL billing incurred.
2. Mayo will bill to all insurances other than HMO; however if the patient has Medicare with HMO, Mayo can bill to Medicare primary and HMO secondary.
b. Sendouts to Other Facilites (i.e. Clarient): Submit the insurance information with the specimen, the reference laboratory will bill the patient insurance.
A. To UIDL: Central Delivery Service (CDS) of Iowa courier is used Monday through Friday; pick up by 2:00 p.m. If a stat UIDL/UIHC send out is received after 2 p.m. are sent via Federal Express using the Fed Ex – preprinted air bills that bill to UIHC. Use the UIDL Anatomic Pathology Consult Requisition if appropriate.
B. To Mayo: Courier of choice is POE enterprises; they pickup daily in the afternoon at each of the UCL sites. The referral should be prepared for pickup by 3:30 PM. Phone: 1-888-305-8667. (The Mayo courier can only be used for Surg/Path Consults requested by PA physicians or other testing ordered, otherwise use FedEx.)
C. To Clarient: NGL has a daily pickup scheduled; if the daily pickup is missed or additional sendouts are needed, call Clarient and they will arrange the pick up of the specimen. Notify the lab staff at the front desk of the late pick up and location of the specimen.
D. All Other Referrals: UCL has an account set up with Fed Ex (800) 238-5355. Complete a blank air bill and package appropriately.
E. Corneas: Refer to the “Cornea/Eye” procedure.
F. Patient Hand-Carried: Refer to the “Surgical Pathology Consult, Patient Delivery” procedure.
13. Package should include:
A. Slides/Blocks or other material requested in appropriate medium.
B. Copy of the Pathology report (preliminary or final); see II.2.Note.
C. Insurance information
D. UCL site return address label
E. “Loan of Anatomic Pathology Materials” form.
F. Stamp of physician name, NPI # and ICD9 code.
G. The package must include all items listed for the following providers:
a. Clarient: The correct Clarient requisition for the test ordered and matching box.
b. Cornea/Eye: Refer to the “Cornea/Eye” procedure. The University of Washington kit in the paperwork office contains all applicable information to be sent.
c. Muscle: Muscle biopsies are performed Monday through Wednesday only. Order 10 lbs of dry ice through a courier and have delivered 1-1½ hours before the procedure is scheduled to begin. Muscle biopsies are sent to the laboratory fresh on saline-soaked gauze without clamps. Assign a surgical number. The available kit contains all paperwork to be completed and sent with the specimen. Refer to the Muscle Histochemistry Patient Information Sheet and Muscle Biopsy Specimen Preparation Sheet for further instructions.
d. Immuno to UIDL: Complete the UIDL Anatomic Pathology Consult Requisition.
e. HCT Dermatopathology Services, Baltimore, MD (form)
f. Dr. Argenyi/University of Washington Dermatopathology (U of Washington Pathology Service Request form)
g. Sural Nerve Biopsy: Refer to the “Sural Nerve” procedure.
i. March 2005 N. Schmitt, D. Willis
ii. May 2007 M. English (Revised: IV., V.)
iii. August 2008 M. English (Revised: miscellaneous cytopathology test addition for Mayo interface)
iv. May 2010 A. Kass, L. Theisen, B. Wederquest (Revised: entire procedure)
Interim Review: March 2012 K. Kalish (Revised: II.13.G.c.)