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Dermatologic surgeons performed majority of skin reconstructions among Medicare patients

Dermatologic surgeons performed more skin reconstructions among the Medicare population than any other single specialist, according to study results.

Researchers determined the proportion of layered closures, grafts and flaps by specialty by assessing the Medicare Physician Supplier Procedure Master File from 2004 to 2009. Claims by dermatologic surgeons (DS) in 2009 accounted for 60.8% of immediate closures, 75.1% of complex repairs, 55.5% of local tissue rearrangements and 57.5% of full-thickness skin grafts in the Medicare population.

The majority of skin reconstructions were billed by DS, except for simple repairs, split-thickness skin grafts and interpolation flaps. Compared with other fields, including plastic surgery and otolaryngology, claims by DS represented “far more reconstruction of the aesthetically important regions of the head and neck — including eyes, ears, nose and lips,” according to the researchers.

Relative to other specialists during the study, DS increased in reconstruction percentages in nearly every category.

The analysis addressed claim volumes only. “Cosmetic outcomes or appropriateness of closure selection or coding cannot be addressed,” the researchers reported.

“From 2004 through 2009, DS dominated nearly every type, site and size of cutaneous reconstruction in Medicare patients,” the researchers concluded. “DS play a primary role in routine and advanced cutaneous reconstructive surgery, especially of aesthetically important regions.

“This extensive reconstructive experience should be better recognized by the public and the referring physicians as such knowledge may impact patient decision-making when electing for skin surgery and confidence in his or her chosen specialist.”