Diagnostic Consultation

Dr. Carolina Gutierrez offers comprehensive diagnostic consultation services to physicians and patients at the Baylor/Ben Taub Breast Care Center. Access to the same services for individuals outside the Baylor/Ben Taub system can be arranged by contacting us directly.

Breast pathology is an evolving science and art. We conform closely to the approach described in Diagnostic Histopathology of the Breast, ed. DL Page and TJ Anderson, First Edition, Churchill Livingston, 1987 – modified to accommodate our own thinking and experience. Our evaluation of breast cancer provides all the information currently considered to be essential for therapeutic decision making, including histological subtype, tumor size, histological grade, mitotic index, status of surgical margins, and status of axillary lymph nodes. We have developed a diagnostic template (see example) and use it in the majority of cases to promote concise standardized terminology and content.

Our pathologists need as much information as possible to provide an accurate and comprehensive diagnosis. To facilitate this, please send:

• Complete set of H&E-stained slides
• Representative paraffin block (or corresponding unstained slides) for immunohistochemical evaluation of prognostic/predictive factors (currently ER, PR, Ki67, and HER-2)
• Corresponding pathology reports
• Cover letter giving reason for consult and contact information of requesting physician or individual
• Completed billing form

Cases are routinely evaluated and reported within 48 hours of receiving them. We usually keep one or two representative slides in our files and return all remaining materials by mail to the originating hospital unless requested otherwise.

Physicians requesting consultation within the Baylor/Ben Taub system can send materials through the hospital courier service to the Department of Pathology at Ben Taub Hospital (please write "Attention Dr. Gutierrez" on the requisition slip), or hand deliver them to the Breast Center Pathology Laboratory (Alkek Building, Room 12.10).

Requests by physicians or individuals outside the Baylor/Ben Taub system should be mailed directly to the laboratory:

Breast Center Pathology Laboratory
Attention: Dr. Carolina Gutierrez
Alkek Building, Room N-1210.08
Baylor College of Medicine
One Baylor Plaza
Houston, TX 77030

The cost/billing structure of the Breast Center Pathology Laboratory is based on the Medicare/Medicaid RBRVS reimbursement scale and the AMA Current Procedure Terminology (CPT codes). We bill patients directly, and they are responsible for payment.

Procedure: Level IV – low complexity consultation (e.g. gross description, microscopic description, and diagnosis of core biopsy with report)
CPT: 88305
Fee: $216

Procedure: Level V – moderate complexity consultation (e.g. gross description, microscopic description, and diagnosis of excisional biopsy with report)
CPT: 88307
Fee: $347

Procedure: Level VI – high complexity consultation (e.g. gross description, microscopic description, and diagnosis of mastectomy and axillary dissection with report)
CPT: 88309
Fee: $483

Procedure: Consultation and report on referred slides prepared elsewhere
CPT: 88321
Fee: $197

Procedure: Consultation and report on referred material requiring preparation of additional slides (e.g. deeper levels)
CPT: 88323
Fee: $218

Procedure: Consultation and report on referred slides prepared elsewhere requiring comprehensive review of additional medical records
CPT: 88325
Fee: $307

Procedure: Evaluation and report of prognostic/predictive biomarkers (ER, PR, Ki67, and Her2) by immunohistochemistry.
CPT: 88342/assay
Fee: $208

Procedure: Evaluation of HER-2 by fluorescence in situ hybridization (FISH).
CPT: 88365, 88271x2, 88274x2
Fee: $654