PROCEDURES FOR SKIN DISEASES PERFORMED BY PHYSICIANS IN 1993 AND 1994- ANALYSIS OF DATA FROM THE NATIONAL AMBULATORY MEDICAL-CARE SURVEY

Background: The provision of ambulatory dermatologic procedural care i s not well characterized. Objective: Our purpose was to determine the frequency that different cutaneous procedures are performed by differe nt physician specialties and the diagnoses corresponding to these proc edures. Methods: Outpatient dermatologic procedures recorded in the 19 93 and 1994 National Ambulatory Medical Care Survey were analyzed. To define dermatologic procedures and diagnoses, the International Classi fication of Diseases diagnosis and procedure codes were identified tha t related to the skin and subcutaneous tissues. Sampling weights were applied to achieve the nationally representative estimates. Results: D uring 1993 and 1994, an estimated 37 million dermatologic procedures w ere performed. Most were performed by dermatologists (69%) and by fami ly and general practice physicians (15%). A single procedure, ''Other local excision or destruction of lesion or tissue of skin and subcutan eous tissue,'' constituted 65% of all of the dermatologic procedures. UV light treatments, ambulatory microscopic examination of skin specim ens, and acne surgical procedures were performed almost exclusively by dermatologists. Most skin biopsies (82%) and excision/destruction pro cedures (71%) were performed by dermatologists. Actinic keratoses and viral warts accounted for 25% of all cutaneous dermatologic diagnoses treated. Conclusion: Dermatologists have far more experience performin g skin biopsies and excision/destruction procedures than other physici ans. Cost containment efforts that deny coverage for treatment of acti nic keratoses and viral warts would affect a significant portion of cu taneous procedures.