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,
Gregory N, Mulvaney M, Pattison T, Hill J, Carlson JA, Goncharuk V. Shrinkage of Skin Excision Specimens and Downcoding. Arch Dermatol. 2003;139(4):542–543. doi:10.1001/archderm.139.4.542
Artificial Intelligence Resource Center
Customize your JAMA Network experience by selecting one or more topics from the list below.