Immediate on-site interpretation of fine-needle aspiration smears - A costand compensation analysis

BACKGROUND. A significant body of literature exists supporting the cost eff ectiveness of fine-needle aspiration (FNA) cytology in the work-up of patie nts with potential neoplastic disease. Several authorities have stated that immediate, onsite smear evaluation by cytopathologists optimizes diagnosti c accuracy and minimizes the technique's insufficiency rate. This favorable effect on FNA diagnostic accuracy is most pronounced for deep body sites, where FNA is guided by computed tomography (CT), ultrasound, bronchoscopy, or endoscopy. Little data exist regarding whether compensation from Medicar e is adequate to support the pathologist in this endeavor compared with oth er potentially more remunerative activities, including routine surgical pat hology sign-out, nongynecologic cytopathology sign-out, and frozen section consultation. METHODS. The authors studied a series of 142 fine-needle aspirates with imm ediate, on-site evaluations performed under a variety of clinical settings. These included bronchoscopic, endoscopic, ultrasound-guided, and CT-guided biopsies along with palpation-directed biopsies performed by either cytopa thologists or clinicians. For these aspirates, total pathologist attendance time was calculated and correlated with guidance technique, target organ, location where aspirate was performed, and nature of aspirator. Fifty froze n section evaluations were timed similarly. For comparison purposes, cytopa thologists' costs were calculated using the 80th percentile pay level of an associate professor with full-time clinical duties. Medicare rate schedule s were used to calculate compensation. Including salary and benefits, the p athologist cost was approximately $88.83 per hour. RESULTS. On average, an intraprocedural FNA evaluation for a CT-guided biop sy required 48.7 minutes, an ultrasound-guided biopsy required 44.4 minutes of pathologist time, an endoscopic procedure required 56.2 minutes, a bron choscopic procedure required 55.3 minutes, a clinic aspirate performed by a pathologist required 42.5 minutes, and a clinic FNA performed by a clinici an required 34.7 minutes. The average frozen section required 15.7 minutes of pathologist time for performance and interpretation. With the exception of FNA performed in clinic by the cytopathologist, time costs exceeded comp ensation by $40-50 per procedure. Clinic aspirates performed by a clinician and immediately evaluated by a pathologist resulted in a deficit of approx imately $18 over actual time cost. CONCLUSIONS. From the current data, it appears that intraprocedural consult ations by cytopathologists for CT-guided, ultrasound-guided, bronchoscopic, or endoscopic procedures are compensated insufficiently by current Medicar e compensation schedules using the CPT code 88172 for on-site evaluation. O nly when the cytopathologist personally performs the aspirate and immediate ly interprets it (CPT codes 88172 and 88170) does the Medicare payment adeq uately compensate for professional services. (C) 2001 American Cancer Socie ty.