[IGeL in dermatopathology-structural limitations and legal risks]

Individual health services (IGeL) require direct physician-patient interaction, including personal information, informed consent, and transparent cost clarification. These structural prerequisites are typically not met in dermatopathology, where indication and patient counselling are performed by the referring physician, while diagnostic responsibility and billing consequences rest with the dermatopathologist. This constellation results in unclear responsibilities and relevant legal and organizational risks. This article analyzes the structural limitations of the IGeL framework in dermatopathology and discusses typical conflict scenarios from both a legal and diagnostic perspective. Key aspects include billing risks, liability issues, challenges related to stepwise diagnostics, and the distinction between IGeL services, self-pay services, and regular private insurance billing. In addition, defensive medical practices and communication deficits are addressed as factors that may affect diagnostic quality and legal certainty. Dermatopathology is used as an exemplary field, as the underlying mechanisms and conflicts are transferable to other clinically active specialties, particularly clinical dermatology. The aim of this article is to highlight structural problem areas and to stimulate a fact-based professional discussion on responsibility, billing pathways, and medical necessity.