Innovative Pathology Services - Information for Patients

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Information for Patients

Pathology (from Greek pathos, feeling, pain, suffering; and logos, study of; see also -ology) is the study of the processes underlying disease and other forms of illness, harmful abnormality, or dysfunction. Within biology but also a branch of medicine, it means specifically the study and diagnosis of the structural and functional changes in cells, tissues and organs that underlie disease. Pathology as a field of knowledge hence forms the basis of the scientific reasoning behind the practice of medicine.

Because the public rarely meets pathologists, their work is not well understood. Pathology is a large and diverse field that allows a pathologist to participate in multiple areas of the field or focus their scope to a specific area. Essential to everyday surgeries, pathologists are responsible for processing and reporting on all specimens generated during a given surgery. Tissue samples are taken from the submitted specimens, stained, and processed for microscopic evaluation. Microscopic examination searches for disease of any type and this information is returned to the surgeon via a pathology report. Pathologists are also responsible for laboratory specimens. They, along with medical technologists, process specimens at medical laboratories for interpretations. In other words, patients should know that what their doctor calls a "laboratory result" is not a number generated by a black box. Instead, it is the interpretation of the value by a pathologist or a technologist. It is also important to understand that a different laboratory might produce a different value on the same specimen. Pathologists are also called upon to perform autopsies. Autopsies represent less than 10% of the workload of a typical modern pathologist. There exists a subspecialty in pathology that allows for the training of medical examiners who wish to pursue forensics.

Pathologists usually do not see patients, only specimens or autopsies. Thus, it is best considered a form of diagnostic medicine. In addition to the diagnosis of disease, including cancer, and the administration of medical laboratories, pathologists often participate in the teaching of medical students (Pathology is a core course in the medical curriculum). Pathologists express their opinion as a pathology report addressed to the doctor requesting it. Since pathologists most often communicate with other doctors, they are sometimes nicknamed "the doctor's doctor". Pathology is often considered the most scientific branch of medicine because of the available avenues of research involving human material. Finally, the circulation of laboratory data is a central issue in medical informatics and the current tendency towards electronic medical records.

*Excerpt from Pathology. (2006, July 5). In Wikipedia, The Free Encyclopedia. Retrieved July 5, 2006, from http://en.wikipedia.org/wiki/Pathology

Notice Of Privacy Practices

If you would like to print the privacy policy you can click here for a printable version.
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THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

Our Notice.
Innovative Pathology Services, PLLC ("IPS") and its affiliated companies appreciate the opportunity to provide health care benefits to you and your family. In the course of providing the health benefit plans we administer or offer, IPS must collect, use and disclose nonpublic personal information. We consider this information private and confidential and consequently we have policies and procedures in place to protect the information against unlawful use and disclosure. In addition, we are required by law to:
- Generally keep confidential your nonpublic personal information while providing for the uses and disclosures described here which are necessary to administer your health care benefits; and
- Provide you with this Notice of our legal duties and privacy practices with respect to your nonpublic personal information. If you have questions about this Notice, please contact the Information Privacy Officer for IPS at 865.522.7591. The effective date of this Notice is April 9, 2003.
What is Nonpublic Personal Information?
Nonpublic personal information ("NPI") is information maintained by IPS that identifies an individual applying for treatment, the person's past, present or future physical or mental health or condition, the provision of health care to that person, or payment for the provision of health care to that person. NPI does not include publicly available information, or information that is available or reported in a summarized or aggregate fashion that does not identify any individual person. NPI includes information that federal regulations refer to as "protected health information" and certain state laws refer to as "nonpublic personal financial information" and "nonpublic personal health information."
What types of Nonpublic Personal Information do we collect and disclose?
In order to treat you and operate our laboratory, we collect the following types of information about you and your dependents: (a) Information we receive directly or indirectly from you, your employer or health benefits plan sponsor through enrollment forms, surveys or other forms, in writing, in person, by telephone, or electronically including email and our website (e.g., name, address, social security number, date of birth, marital status, dependent information, employment information, medical history); and (b) Information we collect from our affiliates, health care providers, and others regarding your health care services and your coverage (e.g., health care claims and encounters, medical history, eligibility information, payment information, and service request, appeal and grievance information). IPS discloses NPI to affiliates and third parties, as permitted by law. We do not disclose and do not intend to disclose NPI other than as authorized by the member (directly or through the policyholder, subscriber, or other personal representative) or as permitted by law including but not limited to processing and servicing transactions, including effecting, administering or enforcing an insurance transaction that an individual requests or authorizes, administering health care benefits including reporting, investigating or preventing fraud or material misrepresentation, underwriting, processing premium payments, claims processing, and utilization review, and to comply with other federal, state or local laws, rules and other applicable legal requirements.
How do we protect the confidentiality of your information?
Within IPS, we restrict the access to your NPI information to those employees who need it to provide products or services to you and your dependents. When storing NPI electronically or on paper, we maintain physical, electronic and procedural safeguards to protect against unauthorized access and use. For example, access to our facilities is limited to authorized personnel and we use various technologies to protect information we maintain electronically. We also have appointed a Privacy Officer, who has overall responsibility for developing privacy and security policies and procedures to safeguard NPI against uses and disclosures that are inconsistent with applicable law. Our Privacy Officer also is responsible for training and educating our personnel regarding our privacy and security policies and procedures, and for overseeing the implementation and enforcement of these policies and procedures.
What rights do I have as a patient?
Your medical information is the property of IPS. You have the following rights, however, regarding medical information we maintain about you:
- Right to Inspect and Copy.
  With certain exceptions, you have the right to inspect and/or receive a copy of your medical information. If you request a copy of the information, we may charge a fee for these services. We may deny your request to inspect and/or to receive a copy in certain limited circumstances.
- Right to Request an Amendment or Addendum.
  If you feel that medical information we have about you is incorrect or incomplete, you may ask us to amend the information or add an addendum. You have the right to request an amendment or addendum for as long as the information is kept by or for IPS. In addition, you must provide a reason that supports your request. We may deny your request for an amendment if it is not in writing or does not include a reason to support the request.
- Right to an Accounting of Disclosures.
  You have the right to request an "accounting of disclosures." This is a list of the disclosures we have made of medical information about you that were for purposes other than treatment, payment, health care operations and certain other purposes. Your request must state a time period that may not be longer than the six previous years and may not include dates before April 14, 2003. You are entitled to one accounting within any 12 month period at no cost. If you request a second accounting within that 12 month period, we may charge you for the cost of compiling the accounting. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.
- Right to Request Confidential Communications.
  You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.
- To request any of the following above, you must make your request in writing to Innovative Pathology Services, 501 20th Street Suite G3, Knoxville, TN 37916.
How do we inform our patients about this Notice or future updates?
We reserve the right to change the terms of this Notice and to make the provisions of the new Notice effective for all nonpublic personal information we maintain. Updates of this Notice are made available on our web site at www.gowithips.com or made be requested either in person or via mail.
How can you contact us if you feel that your information has been used inappropriately?
If you believe that your privacy rights have been violated, you may file a written complaint with Innovative Pathology Services, 501 20th Street Suite G3, Knoxville, TN, 37916 or through the Secretary of the United States Department of Health and Human Services. No retaliation will occur against you for filing a complaint.

1. For purposes of this notice, "Innovative Pathology Services, PLLC" refers to the Innovative Pathology Services, PLLC as parent company. These entities will abide by the privacy practices described in this Notice.

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Authorization to Use or Disclose Protected Health Information

To authorize Innovative Pathology Services to use or disclose protected health information please complete this form and forward it to the address indicated on the form.

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Authorization to Obtain Protected Health Information

To authorize Innovative Pathology Services to obtain protected health information from a third party please complete this form and forward it to the address indicated on the form.

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Insurance Information

Innovative Pathology Services is contracted with all managed care plans except the following:

Beechstreet Corporation
Cigna Health Care

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Billing Questions

Patients with questions about pathology services billed by Innovative Pathology Services should call our toll free number at: 1-877-268-0407

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Biopsies

What is a biopsy?

A biopsy is a procedure performed to remove tissue or cells from the body for examination under a microscope. Some biopsies can be performed in a physician's office, others need to be done in a hospital setting. In addition, some biopsies require use of an anesthetic to numb the area, while others do not require any sedation.

How is a biopsy performed?

A biopsy can be obtained in various ways, depending on the type of specimen needed. Flexible endoscopes (flexible fiberoptic tubes with a viewing lens and lights) allow a surgeon or other doctor to view the inside of the body through a small incision and take a tissue sample. Tissue samples are usually small and taken from tissue that appears changed in structure, such as a tumor.

Types of biopsies

Excisional or incisional biopsy - This type of biopsy is often used when a wider or deeper portion of the skin is needed. Using a scalpel (surgical knife), a full thickness of skin is removed for further examination, and the wound is sutured (with surgical thread). When the entire tumor is removed, it is called excisional biopsy technique. If only a portion of the tumor is removed, it is called incisional biopsy technique. Excisional biopsy is the method usually preferred when melanoma is suspected.
Fine needle aspiration (FNA) biopsy - This type of biopsy involves using a thin needle to remove very small pieces from a tumor. Local anesthetic is sometimes used to numb the area, but the test rarely causes much discomfort and leaves no scar. FNA is not used for diagnosis of a suspicious mole, but may be used to biopsy large lymph nodes near a melanoma, or other tumor, to see if the melanoma has metastasized (spread). A computed tomography scan (CT or CAT scan) -- an x-ray procedure that produces cross-sectional images of the body -- may be used to guide a needle into a tumor in an internal organ such as the lung or liver.
Punch biopsy - Punch biopsies involve taking a deeper sample of skin with a biopsy instrument that removes a short cylinder or "applecore" of tissue. After a local anesthetic, the instrument is rotated on the surface of the skin until it cuts through all the layers including the dermis, epidermis, and the most superficial parts of the subcutis (the fat).
Shave biopsy - This type of biopsy involves removing the top layers of by shaving it off. It is also performed with a local anesthetic.
Skin biopsy - Skin biopsies involve removing a sample of skin for examination under the microscope to determine if melanoma is present. The biopsy is performed under local anesthesia. The patient usually just feels a small needle stick and a little burning for about a minute, with a little pressure, but no pain.

(Source: Methodist Health Care System, Houston, Tx.)

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What is a Fine Needle Aspiration Biopsy?

What you need to know about the Fine Needle Aspiration Biopsy procedure

Fine needle aspiration biopsy (FNAB) is an established biopsy technique that may replace the need for or precede a more invasive biopsy of a palpable (can be felt) lump or mass. It is performed in an attempt to determine what is causing the mass and to decide whether it needs to be removed or evaluated in another way. FNAB is a minimally invasive, cost-effective technique with high diagnostic accuracy (in the range of 90 to 99%).1

How is the FNAB performed?

It is performed by a skilled cytopathologist using a tiny, ultra thin needle with a syringe to remove a small sample of tissue or cells from the suspected area for examination under the microscope. It is a quick reliable technique taking only 10 to 15 minutes and the results are usually ready within 24 to 48 hours. There may be minimal discomfort. This is often alleviated with the use of local anesthetic. In many cases, one biopsy is sufficient to obtain adequate cells for a diagnosis. In some instances, however, it may be necessary to repeat the procedure up to three or more times in order to obtain sufficient cells for diagnosis and/or special studies.

What are the possible complications?

The risks of FNAB are significantly less than the risk of undergoing surgery at most sites. The most common complication is minimal discomfort, followed by slight bleeding at the time of biopsy. Bleeding may occur under the skin following the biopsy and cause a bruise (hematoma). Direct pressure will minimize these risks. The risk of infection is reduced by cleansing the area thoroughly with alcohol prior to the FNAB. Any mild discomfort in the area that persists should disappear within a day or two and should respond to a mild non-aspirin pain medication. If discomfort continues you should contact your referring physician or local emergency room immediately.

How will I obtain the results of my biopsy?

The results will be reported to your referring physician, usually within 24 to 48 hours. If special studies need to be performed, the results may be delayed 2 to 3 days. The pathologist interpreting your slides will send a formal report to the doctor who requested the biopsy.

Instructions for Patients

Because of the obvious benefits of minimal invasion, diagnostic accuracy and cost-effectiveness, FNABs are procedures well tolerated and enthusiastically accepted by patients. FNABs are typically performed as outpatient procedures, completed without or with mild anesthesia within minutes. Pain, discomfort, and tissue scarring are minimal when compared to the alternative surgical biopsy. Patients can eat, take their prescribed medications and resume normal daily activities following an FNA appointment.

Knowing your medical history

Patients are encouraged to bring pertinent x-rays, records or reports regarding your medical condition or previous medical history. It is important for the cytopathologist to carefully acquaint him or herself with your problem. Where is the lump? How long has it been there? Are there any changes, or newer lesions appearing? Are you ill in other ways, (fever, weight loss) taking antibiotics, or have you ever had any type of cancer, even skin cancer? This information will help our pathologists provide your referring physician with a clinically relevant and accurate pathology report.

References 1. NCCLS. Fine Needle Aspiration Biopsy (FNAB) Techniques; Approved Guideline - Second Edition. NCCLS document GP20-A2 [ISBN 1-56238-000-0]. NCCLS, 940 West Valley Road, Suite 1400, Wayne, Pennsylvania 19087-1898 USA, 2002. What you need to know about the Fine Needle Aspiration Biopsy procedure

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What is cytopathology?

Cytopathology is the study of individual cells to detect abnormal cells. Used extensively to diagnose cancer, cytopathology is also used in screening for cervical cancer (Pap test) and in diagnosing infectious organisms.

The cells to be examined may be obtained through:

Scraping the tissue surface
Body fluids
Gine-needle aspirations (removing cells by drawing them through a fine needle)
Cytopathology is different from histology, which is the study of grouping of cells that form tissues.

(Source: Methodist Health Care System, Houston, Tx.)

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