L4E rule 1-3 (2014)
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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 L4E rule 1-3 quiz.
Context
- This rule deals with biopsies and curettages.
Details
| 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 "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] |