April 2003

Shrinkage of Skin Excision Specimens and Downcoding

Author Affiliations

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Copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2003

Arch Dermatol. 2003;139(4):542-543. doi:10.1001/archderm.139.4.542

Underpayments to providers by payers are a significant cause of lost revenue for medical practices.1 Resolution of problems such as inappropriate "downcoding" requires proper documentation to support the higher payment level. Recently, downcoding of claims for excision of skin lesions has occurred in our region due to discrepancies between surgical and pathology reported specimen sizes. Efforts to redress these underpayments have proven ineffectual despite explicitly stated guidelines published by the American Medical Association regarding skin lesion measurements2 and studies demonstrating shrinkage in nonskin tissues.3,4 According to the CPT Assistant,