Faculty Bibliography

Sarcoidosis is a multisystem disorder characterised by granulomatous inflammation affecting various organs. The skin is commonly involved and can serve as an initial indicator of disease. While the precise aetiology of sarcoidosis remains elusive, evidence suggests involvement of T-helper type (TH)-1 and TH-17 pathways. Psoriasis shares common inflammatory pathways with sarcoidosis, prompting the repurposing of biologic therapies approved for psoriasis for off-label treatment of cutaneous sarcoidosis. However, this approach has raised concerns due to the development of granulomatous eruptions in some patients. We present a case of a patient with psoriasis who was diagnosed with systemic sarcoidosis while on ustekinumab. We review previous cases of ustekinumab-associated sarcoidosis and discuss the challenges associated with utilising biologic agents originally intended for psoriasis treatment for sarcoidosis.

Correct coding is an important component of effective dermatology practice management. Over the past several years there have been updates to many commonly used codes within dermatology. This review highlights many of these updates, such as: the skin biopsy codes have been subdivided to reflect the different biopsy techniques. The definition of complex linear repairs has been updated and clarified. Outpatient and inpatient evaluation and management visits have new coding guidelines to determine level of care. Dermatopathology consultation codes have been updated and category III codes related to digital pathology have been created. Understanding the details and nuances of each of these categories of codes is vital to ensuring appropriate coding is performed.

The 2023 ruling by the Supreme Court of the United States (SCOTUS) on the use of race-based criteria in college admissions may have implications for the selection of individuals into the dermatology workforce. This article highlights the impact of these decisions at the undergraduate, medical school, and graduate medical education levels, as well as within the field of dermatology.

On January 1, 2024, the new add-on complexity code for evaluation and management (E/M) services, G2211, went into effect. Understanding appropriate use of this code and how it can and cannot be utilized is of importance for all physicians. This article discusses the nuances of this code and gives examples of how to effectively incorporate it into practice.

Dermatology referral utilization is increasing, with 15% of dermatology-related visits by primary care resulting in a dermatology referral. Given this, both strengthening an expanding a referral is a key component of a successful dermatology practice. In particular, effective communication is essential for efficient patient-oriented coordinated care. Written and/or verbal communication can help build a strong communication network and, in some instances, can be applied toward Merit-based Incentive Payment System (MIPS) reporting and billing for coding families that incorporate the coordination of care. Reaching out directly to referring clinics has also been shown to increase the quantity of referrals. This can include providing clinics with patient handouts on your clinic, education on what information is prioritized within the referral, and educating staff on how to complete their referrals effectively and efficiently. Social media can play an important role in referrals, especially for patients looking for cosmetic care. There are many different platforms, and these can serve as a marketing tool for physicians looking to bring in new patients.

Purpose of Review: Patch testing is critical to diagnosing allergic contact dermatitis; however, there are barriers that can prevent prompt comprehensive access, including those affecting reimbursement, insurer challenges, and workforce shortages. Recent Findings: Multiple reimbursement models exist within various practice types for patch testing. Insurer limits remain a barrier to comprehensive patch testing in many situations; however, advocacy in this area has led to some improvements. Workforce shortages, within medicine overall, as well as in dermatology and contact dermatitis specialists continue to be a concern. Overall, there are multiple ways to engage in advocacy at the local, state, and national levels to help improve patient access to comprehensive patch testing. Summary: Patch testing is a vital component of appropriate care for allergic contact dermatitis patients. Challenges to ensuring access to patch testing include reimbursement and physician workforce shortages. Advocacy is crucial to addressing these areas, and physician involvement in advocacy efforts is necessary to ensure high-level patient care.