L4E rule 6 (2018)

This article covers L4E rule 6 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.^[1]

Overview

This rule applies to any case with extra blocks and/or levels requested by the pathologist.

The CAP-ACP workload committee document states this rule has not been modified from the 2014 edition of L4E (see Page 4).^[1] However, the General Guidelines for Coding (see Page 7) have changed for L2 (from 0.333 L4E to 0.25 L4E) and L1 (from 0.15 to 0.125);^[1] thus, the rule in the 2018 edition of L4E results in a different weighting where larger cases have significantly less value.
- Cutting 6 deepers in 2014 was 0.3 L4E; in the 2018 edition it is 0.25 L4Es.
- Submitting 6 additional blocks in 2014 was 2 L4E; in the 2018 edition it is 1.5 L4E.

Specimen type(s)	Weight (L4E)	Details	Examples
All specimens with extra blocks requested by the pathologist	0.25 L4E/additional block	1 extra block (EB) = 0.25 L4E, 2 EB = 0.5 L4E, 3 EB = 0.75 L4E, 4 EB = 1 L4E	colorectal cancer in 32 blocks with 11 lymph nodes, 4 more blocks submitted = 8 L4E (rule 9) + 1 L4E (rule 6) + 3 L4E (rule 5)
All specimens with levels requested by the pathologist	0.125 L4E/3 levels (or 1 L1/3 levels)	1-3 levels = 0.125 L4E, 4-6 levels = 0.25 L4E, 7-9 levels = 0.375 L4E	normal colorectal mucosa submitted as polyp + 3 deepers cut = 0.5 + 0.125 L4E

Note:

The above is in relation to the routine of the laboratory. If a lab routinely cuts 1 one slide for a particular type of case and the pathologist orders 3 deepers this rule applies.

↑ ^1.0 ^1.1 ^1.2 Workload and Workforce Committee of the CAP-ACP. Workload Measurement Guidelines. Canadian Association of Pathologists (CAP-ACP). 2018. URL: https://www.cap-acp.org/cmsUploads/CAP/File/CAP-ACP_Workload_Model_2018_Final_2020180907(1).pdf. Accessed on: 19 May 2019.