View source for L4E rule 1-3 (2014)

This article covers '''L4E rule 1''', '''L4E rule 2''', and '''L4E rule 3''' for the 2014 [[L4E]] [[workload]] system. An overview of the L4E rules is found in the [[L4E rules of 2014]]. 

You can test your knowledge in the ''[[Quiz:L4E rules 1-3 (2014)|L4E rules 1-3 quiz]]''.

==Context==
*This rule covers most biopsies/curettages.
*Special biopsies (e.g. medical liver, transplant biopsies) are coded differently, see ''[[L4E]]'' article.

==Details==
{| class="wikitable sortable"
! Specimen type(s) 
! Weight (L4E)
! Details
! Examples
! Rule
|-
| Complex skin biopsies and non-GI biopsies with countable fragments 
| 1 L4E / 5 tissue fragments (frags), all fractions are rounded down
| 1-5 frags = 1 L4E, 6-10 frags = 2 L4E, 11-15 frags = 3 L4E, 16-20 frags = 4 L4E<br>"complex skin" includes inflammatory skin, malignancies except [[basal cell carcinoma|BCC]] and [[skin squamous cell carcinoma|SCC]], atypical melanocytic lesions, adnexal tumours, lymphoid infiltrates
| inflammatory skin biopsy 3 frags = 1 L4E, adnexal skin tumour 6 frags = 2 L4E
| Rule 1 <ref name=capacp2014/> 
|-
| Simple skin (non-complex skin)
| 0.5 L4E/biopsy (1 L3/biopsy)
| biopsies > 2 cm - use [[L4E rule 4 (2014)|L4E rule 4]]; includes [[basal cell carcinoma|BCC]], SCC, actinic keratosis, intradermal nevus
| punch biopsy of BCC = 0.5 L4E, shave biopsy of [[seborrheic keratosis]] = 0.5 L4E
| Rule 1 <ref name=capacp2014/> 
|-
| Medical GI biopsies 
| 1 L3/3 tissue fragments (frags), all fractions are rounded down; 1 L3 = 0.5 L4E
| 1-3 frags = 0.5 L4E, 4-6 frags = 1 L4E, 7-9 frags = 1.5 L4E, 10-12 frags = 2 L4E, 13-15 frags = 2.5 L4E, 16-18 frags = 3 L4E, 19-21 frags = 3.5 L4E, 22-24 frags = 4 L4E 
| 6 frags colorectal biopsies = 1 L4E 
| Rule 1 <ref name=capacp2014/> 
|-
| Surgical GI biopsies (neoplastic/pre-neoplastic) 
| 1 L3/lesion (if submitted in one block) and low grade; lesion with high-grade dysplasia = 1 L4E
| lesions submitted in >1 block: use [[L4E rule 4 (2014)|L4E rule 4]]
| 2 HP polyps in one block = 1 L4E, 1 tubular adenoma negative for HG dysplasia = 0.5 L4E
| Rule 1 <ref name=capacp2014/> 
|-
| Breast core biopsies & prostate core biopsies
| 0.5 L4E/core (1 L3 per core)
| maximum of 20 cores; should use clinicians core count (if available), if clinicians' count not available use gross count
| 4 breast cores = 2 L4E<br>12 prostate cores = 6 L4E
| Rule 2 <ref name=capacp2014>Workload and Workforce Committee of the CAP-ACP. Workload Measurement Guidelines. Canadian Association of Pathologists (CAP-ACP). 2014. URL: [https://www.cap-acp.org/cmsUploads/CAP/File/CAP-ACP%202014%20Workload%20FINAL.pdf https://www.cap-acp.org/cmsUploads/CAP/File/CAP-ACP%202014%20Workload%20FINAL.pdf]. Accessed on: 17 October 2017.</ref> 
|-
| Core biopsies (not including prostate, breast) 
| 1 L4E / 5 cores, all fractions are rounded down
| 1-5 cores = 1 L4E, 6-10 cores = 2 L4E, 11-15 cores = 3 L4E, 16-20 cores = 4 L4E
| 3 cores of lymph node = 1 L4E, 6 cores of mediastinal mass = 2 L4E
| Rule 2 <ref name=capacp2014/>  
|-
| Fragmented tissue/ curettage
| 1 L4E / 3 blocks, all fractions are rounded down
| 1-3 blocks = 1 L4E, 4-6 blocks = 2 L4E, 7-9 blocks = 3 L4E, 10-12 blocks = 4 L4E, 13-15 blocks = 5 L4E, 16-18 blocks = 6 L4E, 19-21 blocks = 7 L4E
| endometrial biopsy in 2 blocks = 1 L4E, TURP in 7 blocks = 3 L4E, bladder biopsy in 12 blocks = 4 L4E
| Rule 3 <ref name=capacp2014/> 
|}

==Tutorial==
The following cases can be used to work through the above rules.
==Tutorial==
The following cases can be used to work through the above rules.
{{hide3|1. Three cores of a neck lymph node. L4E?|Answer: 1 L4E<br>Why? Rule 1: 1-5 frags ~ 1 L4E; see ''complex skin biopsies and non-GI biopsies with countable fragments'' }}

{{hide3|2. Six cores of a mediastinal mass. L4E?|Answer: 2 L4E<br>Why? Rule 1: 6-10 frags ~ 2 L4E; see ''complex skin biopsies and non-GI biopsies with countable fragments''}}

{{hide3|3. Two punch biopsies of BCC. L4E?|Answer: 1 L4E<br>Why? Rule 1: each (simple skin) biopsy is 1 L3}}

{{hide3|4. Two punch biopsies (centre of lesion + edge of lesion) for an inflammatory skin lesion. L4E?|Answer: 1 L4E<br>Why? Rule 1: complex skin biopsies for same purpose}}

{{hide3|5. Colonic tubular adenoma negative for HGD. L4E?|Answer: 0.5 L4E<br>Why? Rule 1: 1 L3/lesion; see ''surgical GI biopsies (neoplastic/pre-neoplastic)''}}

{{hide3|6. Colonic tubular adenoma with HGD. L4E?|Answer: 1 L4E<br>Why? Rule 1: HGD makes it worth more; see ''surgical GI biopsies (neoplastic/pre-neoplastic)''}}

{{hide3|7. Colonic tubular adenoma negative for HGD and hyperplastic polyp in same container. L4E?|Answer: 1 L4E<br>Why? Rule 1: 1 L3 for TA, 1 L3 for HP - together ~ 1 L4E}}

{{hide3|8. Random colonic biopsies 15 frags. L4E?|Answer: 2.5 L4E<br>Why? Rule 1: 15 frags x L3/3 frags ~ 5 L3, 5 L3 ~ 2.5 L4E}}

{{hide3|9. Random colonic biopsies 20 frags. L4E?|Answer: 3 L4E<br>Why? Rule 1: 20 frags x L3/3 frags ~ 6.66 L3 -> truncated to 6 L3, 6 L3 ~ 3 L4E}}

{{hide3|10. Prostate biopsy with 12 cores. L4E?|Answer: 6 L4E<br>Why? Rule 2: 12 cores x 1 L3/core ~ 12 L3; 12 L3 ~ 6 L4E}}

{{hide3|11. Breast biopsy with 2 cores. L4E?|Answer: 1 L4E<br>Why? Rule 2: 2 cores x 1 L3/core ~ 2 L3; 2 L3 ~ 1 L4E}}

{{hide3|12. Endometrial biopsy in 2 blocks. L4E?|Answer: 1 L4E<br>Why? Rule 3: 1-3 blocks ~ 1 L4E}}

{{hide3|13. Benign TURP in 4 blocks. L4E?|Answer: 2 L4E<br>Why? Rule 3: 4-6 blocks ~ 2 L4E}}

{{hide3|14. Benign TURP in 6 blocks. L4E?|Answer: 2 L4E<br>Why? Rule 3: 4-6 blocks ~ 2 L4E}}

{{hide3|15. Endometrial biopsy in 5 blocks. L4E?|Answer: 2 L4E<br>Why? Rule 3: 4-6 blocks ~ 2 L4E}}

{{hide3|16. Benign TURP in 8 blocks. L4E?|Answer: 3 L4E<br>Why? Rule 3: 7-9 blocks ~ 3 L4E}}

==See also==
*[[L4E rules of 2014]].

==References==
{{Reflist|1}}

[[Category:Workload]]