Wiki "Consistent with"

[pducharme]

I am coming at this from the physician side of things but need some guidance about a path report that states biopsy results are 'consistent with' GVHD (graft vs host disease) for a patient who is post stem cell transplant for a blood cancer. There were clinical indications for GVHD and that is the reason the biopsy was done. My co-worker disagrees with using GVHD and wants to stick to the nonspecific 'rash'.

What is the verdict on the terminology 'consistent with'?

Thank you for your help!

 

[bbooks]

I found a previous discuss of this topic here: https://www.aapc.com/memberarea/forums/showthread.php?t=19465

Padget says (I must paraphrase because of copyright): We should never report on a "suspicious for" or "probable" diagnosis. However, a "consistent with" diagnosis can be used for a diagnosis code unless the pathologist states something to the contrary.

I would have to say that in my coding, sometimes I do use the "consistent with" diagnosis, and sometimes I do not, depending on the nuances of the report. If I come across an example today, I will post it.

 

[bbooks]

Here is a case in which I would code the "consistent with" diagnosis:

CLINICAL HISTORY:
Lump in/on the skin - left anterior lower leg

GROSS EXAMINATION:
The specimen consists of 3 portions of dense rubbery fibrofatty tissue, 1.0 x 0.4 x 0.4 cm to 2.3 x 1.7 x 1.0 cm. Sections, 2.

MICROSCOPIC EXAMINATION:
Sections reveal a poorly defined dermal nodule consisting of interlacing whorls of slender spindle shaped cells in a fibrovascular stroma. Widespread collections of foam cells are apparent. Peripheral entrapment of preformed dermal collagen is evident in areas. Margins are positive.

DIAGNOSIS:
Fibrohistiocytic proliferation, consistent with cellular dermatofibroma, skin of left anterior lower leg.

 

[bbooks]

Here is a case I am reluctant to use the "consistent with" diagnosis because of the comment in the microscopic (which I have a bold font).

CLINICAL HISTORY:
3 month history of ulceration under breast, seep fluid, no signs of infection - also has pink, thin plaques with fine scale on arms, trunk, positive mild pruritus - TAC helped but did not clear, no new meds, all started after husband died this summer, no blisters. Rash - ? related - R/O atopic derm vs drug reaction vs contact vs other. Erosions - R/O infection vs vasculopathy vs other

GROSS EXAMINATION:
A. right upper arm. The specimen consists of one 3 mm diameter x 2 mm skin punch biopsy. All submitted in one cassette.
B. right breast. The specimen consists of one 4 mm diameter x 5 mm skin punch biopsy. All submitted in one cassette.

MICROSCOPIC EXAMINATION:
A. Sections show homogeneity to superficial dermal collagen associated with ectatic blood vessels and angulated mononuclear inflammatory infiltrates. Occasional enlarged triangular fibroblasts are seen.

B. Dermal reactive and inflammatory changes are similar to the above. Additionally, an ulcer is characterized by a base of fibrin, inflammatory cells and necrotic debris.

Differential diagnostic possibilities include radiation change and lichen sclerosus. Clinical pathologic correlation is recommended.

DIAGNOSIS:
A. Homogenous dermal sclerosis, ectasia and mononuclear inflammation, consistent with lichen sclerosus, skin of right upper arm.

B. Homogenous dermal sclerosis, ectasia and mononuclear inflammation, consistent with lichen sclerosus, ulcerated, skin of right breast.