L4E rule 4 (2018)

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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.[1]

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


  • 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 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);[1] thus, the rule in the 2018 edition of L4E results in a different weighting where larger cases have significantly less value.
    • A 10 block benign hemithyroidectomy in 2014 was 3.33 L4Es; in the 2018 edition it is 2.5 L4Es.


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


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

See also


  1. 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.