143 TELEMEDICINE JOURNAL AND e-HEALTH Volume 8, Number 2, 2002 © Mary Ann Liebert, Inc. Telemedicine Versus In-Person Dermatology Referrals: An Analysis of Case Complexity ELIZABETH KRUPINSKI, Ph.D., 1 GAIL BARKER, B.A., 1 GILMER RODRIGUEZ, M.D. 2 MICHAEL ENGSTROM, B.S., 1 NORMAN LEVINE, M.D., 1 ANA MARIA LOPEZ, M.D., 1 and RONALD S. WEINSTEIN, M.D. 1 ABSTRACT The goal of this study was to determine whether teledermatology referrals differ significantly from in-person referrals with respect to case complexity and diagnosis of cases referred. Tele- dermatology cases were compared to in-person cases seen by the same university dermatol- ogist who also reviews the teledermatology cases. These were also compared with in-person cases evaluated by a different dermatologist at local clinics using traditional referral patterns. Study parameters included Current Procedural Terminology (CPT) codes as a measure of case complexity, International Classification of Disease (ICD) codes as a measure of case types, and time from referral to actual consultation. The most common CPT codes used for teleder- matology were 99241 and 99242 with no significant differences in the frequency of assigned CPT codes for teledermatology versus in-person consultation. An analysis of the diagnostic codes revealed no significant differences between the types of cases referred to telemedicine and those referred for in-person consultation. Time between referral and actual encounter with the dermatologist was significantly shorter via telemedicine than either local or univer- sity clinic in-person visits. 1 Departments of Radiology, Pathology, Dermatology, and the Arizona Telemedicine Program, University of Ari- zona, Tucson, Arizona. 2 Southeast Arizona Medical Center, Douglas, Arizona. INTRODUCTION A NUMBER OF RECENT STUDIES has demon- strated that store-and-forward telederma- tology consultations were equivalent to in-per- son review of the same cases. 1–4 It has also been demonstrated that diagnostic performance with relatively low-resolution store-forward digital images (720 3 500 pixels) is equivalent to high-resolution images (1490 3 1000 pixels), making it possible to use a relatively modest camera configuration. 5 As a result of these fea- sibility studies, many programs, including our own, 6 are utilizing store-forward technologies for their teledermatology services. However, as noted in a recent review of teledermatology, there are still areas that need to be investigated to help ensure comparability of telemedicine services with in-person services. 7 One area that has not been investigated ex- tensively in teledermatology is case type and complexity to determine if there are major dif- ferences between cases being referred for a teledermatology consult and those seen via the traditional in-person clinical visits. If differ- ences were observed, follow-up studies would