Hey, Doc can I ask you about my biopsy? Pathologist to patient consultation with digital pathology

I am sure that every pathologist has during their career talked directly with a patient on that patient’s pathology report and slides. Most pathologists have found the experience rewarding.

I have had two kinds of patient consultations.  Occasionally, patients would call me up and we would discuss their pathology on the phone. However, a rare patient has made an appointment with me and come to the lab for a two-headed microscope consultation on their pathology.  I have found this experience to be very fulfilling, but it was inconvenient.

Dr. Lija Joseph, MD, laboratory medical director at Lowell General Hospital in Lowell, Mass, has created a pathologist to patient consultation service.  She schedules and meets one or two patients a week (2).  She has found the interaction to be very rewarding.  She provides a model for pathologists to consult with patients.  Dr. Joseph talked about her experience at the College of American Pathologists Annual meeting, CAP 18 in Chicago and this video can be seen at the CAP’s Facebook page.

However, it would be more convenient for the both the patient and the pathologist to have a telepathology consultation.  The patient could be at home connecting with their laptop and phone.  The pathologist could show digital whole slide images to the patient with the images stored in the cloud.  In contrast to using a double headed microscope, the pathologist doesn’t have to worry if the images are focus for the patient and doesn’t have to worry that patient will get motion sickness from moving a glass slide.  The pathologist can annotate the image in real time for the patient.  The pathologist can even take a screen shot and send it to the patient. 

Currently, Dr. Joseph provides her consultation with patients for free, as a community service.  However, pathologists could bill the patient for this service.  There are currently no pathology CPT codes for billing a patient’s insurance for providing a pathology consultation.  There are some new telemedicine Evaluation and Management CPT codes, but these codes would be difficult for a pathologist to use for billing.  However, at the time that an appointment with the pathologist is being scheduled, the patient can be informed of the cost of a pathologist’s consultation and that the patient’s insurance will not pay for the consultation. So digital telepathology consultations between a pathologist and a patient can occur. The patient can have their pathology questions answered and the pathologist can be compensated for their time.

Photo attribution and reference: 1) https://www.hhnmag.com/articles/8561-pathologist-brings-patients-into-the-lab-to-see-their-cancer-close-up

2) Amy Carpenter Aquino, “New pathology patient consult program takes off” captodayonline, July 17, 2017.