L4E rule 1-3 (2014)
This article covers L4E rule 1, L4E rule 2, and L4E rule 3 for the 2014 L4E workload system.
It should be noted that the rules have changed in the 2018 edition of L4E; the 2018 version of these rules is found in L4E rule 1-3 (2018).
An overview of the 2014 L4E rules is found in the L4E rules of 2014.
Context
- This rule covers most biopsies/curettages.
- Special biopsies (e.g. medical liver, transplant biopsies) are coded differently, see L4E article.
Details
Specimen type(s) | Weight (L4E) | Details | Examples | Rule |
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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 "complex skin" includes inflammatory skin, malignancies except BCC and SCC, atypical melanocytic lesions, adnexal tumours, lymphoid infiltrates |
inflammatory skin biopsy 3 frags = 1 L4E, adnexal skin tumour 6 frags = 2 L4E | Rule 1 [1] |
Simple skin (non-complex skin) | 0.5 L4E/biopsy (1 L3/biopsy) | biopsies > 2 cm - use L4E rule 4; includes BCC, SCC, actinic keratosis, intradermal nevus | punch biopsy of BCC = 0.5 L4E, shave biopsy of seborrheic keratosis = 0.5 L4E | Rule 1 [1] |
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 [1] |
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 | 2 HP polyps in one block = 1 L4E, 1 tubular adenoma negative for HG dysplasia = 0.5 L4E | Rule 1 [1] |
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 12 prostate cores = 6 L4E |
Rule 2 [1] |
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 [1] |
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 [1] |
Tutorial
The following cases can be used to work through the above rules. If one clicks "Expand" on the right side one gets the answer with an explanation. It is presumed that no additional stains or levels are done.
1. Three cores of a neck lymph node. L4E?
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Answer: 1 L4E |
2. Six cores of a mediastinal mass. L4E?
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Answer: 2 L4E |
3. Two punch biopsies of BCC. L4E?
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Answer: 1 L4E |
4. Two punch biopsies (centre of lesion + edge of lesion) for an inflammatory skin lesion. L4E?
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Answer: 1 L4E |
5. Colonic tubular adenoma negative for HGD. L4E?
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Answer: 0.5 L4E |
6. Colonic tubular adenoma with HGD. L4E?
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Answer: 1 L4E |
7. Colonic tubular adenoma negative for HGD and hyperplastic polyp in same container. L4E?
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Answer: 1 L4E |
8. Random colonic biopsies 15 frags. L4E?
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Answer: 2.5 L4E |
9. Random colonic biopsies 20 frags. L4E?
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Answer: 3 L4E |
10. Prostate biopsy with 12 cores. L4E?
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Answer: 6 L4E |
11. Breast biopsy with 2 cores. L4E?
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Answer: 1 L4E |
12. Endometrial biopsy in 2 blocks. L4E?
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Answer: 1 L4E |
13. Benign TURP in 4 blocks. L4E?
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Answer: 2 L4E |
14. Benign TURP in 6 blocks. L4E?
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Answer: 2 L4E |
15. Endometrial biopsy in 5 blocks. L4E?
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Answer: 2 L4E |
16. Benign TURP in 8 blocks. L4E?
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Answer: 3 L4E |
Quiz
You can test your knowledge in the L4E rules 1-3 quiz.