L4E rule 4 (2018)

This article covers L4E rule 4 for the 2018 L4E workload system. An overview of the L4E rules is found in the L4E rules of 2018.

The definitive reference for the rule is found on the CAP-ACP website.

You can test your knowledge in the L4E rule 4 quiz.

Overview

• This rule applies to most benign resections.
• It applies to some small biopsies that are submitted in several blocks, e.g. an endoscopically resected large tubular adenoma of the colon without high-grade dysplasia submitted in 3 blocks.
• The CAP-ACP workload committee references states this rule has not been modified (see Page 4). However, the General Guidelines for Coding (see Page 7) have changed for L2 (from 0.333 L4E to 0.25 L4E); thus, the rule on a practical level results a different weighting where larger cases have significantly less value.

Details

Specimen type(s)	Weight (L4E)	Details	Examples
Most non-malignant resections (see below)	1 L2/block, 0.25 L4E/block, minimum 1 L3 (0.5 L4E)	1 block = 0.5 L4E, 2 blocks = 0.5 L4E, 3 blocks = 0.75 L4E, 4 blocks = 1 L4E, 5 blocks = 1.25 L4E	benign hysterectomy in 12 blocks = 3 L4E, hemithyroid with nodular hyperplasia in 16 blocks = 4 L4E

Note:

• Rule 5 may apply to cases requiring a synoptic report as per the CAP.

Specimens this rule applies to

Benign disease in:

• Hysterectomy.
• Thyroidectomy.
• Simple Nephrectomy.
• Breast lumpectomy.
• Small bowel resection.
• Large bowel resection.
• Sleeve gastrectomy.
• Appendix.

Malignant disease - non-radical resections:

• Partial nephrectomy.
• Hemithyroidectomy with cancer.

See also

• L4E rules of 2014.