Interpretation of dermatopathology specimens is within the standard of care of dermatology practice.
BACKGROUND
Laws have been passed in New York, California, New Jersey, Nevada, Louisiana, and Rhode Island and were recently tabled in South Carolina to prohibit providers from billing for pathology services provided by other physicians. The Ohio proposal included language stating that only board-certified pathologists be able to directly bill for anatomic pathology services. Dermatologists, however, have extensive training in dermatopathology and frequently bill anatomic pathology codes.


OBJECTIVE
To determine if interpretation of cutaneous pathology falls within the standard of care of dermatology practice.


METHODS
We used Medicare part A and B claims data from the Medicare Current Beneficiary Survey, 1992 to 2000. We identified surgical pathology claims by Current Procedural Terminology (CPT) code 88305 and those related to skin disease by the associated International Classification of Disease, 9th Revision (ICD-9), code. Weights were applied to obtain nationally representative estimates. The number of physicians in each specialty was obtained from American Medical Association estimates.


RESULTS
Pathologists, independent laboratories and group practices, and dermatologists submitted 59%, 26%, and 13% of total claims, respectively. For skin-related diagnoses, pathologists, dermatologists, and independent laboratories and group practices performed 34.5%, 31.2%, and 32.8% of cases, respectively. Assuming that independent laboratory and group practice claims were performed entirely by pathologists, dermatologists and pathologists submitted 1,047 and 1,154 cases/physician, respectively.


CONCLUSIONS
Dermatologists have extensive training in dermatopathology and interpret a large proportion of cutaneous specimens. Interpretation of anatomic pathology, in particular, skin and subcutaneous pathology specimens, falls within the scope of dermatology practice.
Hancox
John G
JG
Center for Dermatology Research, Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157-1071, USA.
Neville
Julie A
JA
Chen
John
J
Coldiron
Brett
B
Williford
Phillip M
PM
Feldman
Steven R
SR
D000328:Adult; D001706:Biopsy / Q000592:standards*; D002983:Clinical Competence; D003880:Dermatology / Q000592:standards*; D006801:Humans; D010819:Physician's Role; D012017:Referral and Consultation; D012867:Skin / Q000473:pathology*