Dermatology Medical Billing and Coding Program Guide

An examination, biopsy and excision of lesion in one visit is possible in under 15 minutes in dermatology. Codes are assigned to each of the three different procedures, and a payer needs to make sure they work properly together. A properly designed medical billing and coding program ensures that this claim stays true from consultation until payment is received. Exact Core Group provides this solution for dermatology practices.

Dermatology is both cosmetic care and medical care, and in addition there are always several different services performed during one visit. This particular combination is what makes it a particularly mistake-prone specialty to work with in terms of billing.

Acne, psoriasis treatment, a suspicious mole – this is medical.The removal of lesions for purely cosmetic purposes or injection for purely cosmetic reasons are usually not reimbursed by insurance and paid out-of-pocket by the patient. Claiming cosmetic treatments as medical can cause denials and non-compliance, and therefore, the supporting documentation must be able to prove medical necessity.

If there is a significant, separately identifiable E/M service done on the same day as the procedure, then you must apply modifier 25 with the E/M service code. Insurance companies will definitely look into this modifier very carefully. If the report does not have proof that the examination was not just pre-procedure, then it will not be reimbursed.

Dermatology coding consists of counting the number of lesions, the size of each, their location, and procedure employed.

Biopsy codes (11102 – 11107): Codes for biopsy are determined by the type of biopsy procedure, whether tangential, punch, or incisional.

Destruction procedures: premalignant lesions, for instance actinic keratosis, are classified using the codes 17000, 17003, and 17004 based on the number of lesions that have been destroyed, whereas benign lesions require codes 17110 and 17111.

Excision procedures: codes for both benign and malignant excisions are determined by lesion size and anatomic location of the excision site; determination of the size is required prior to the wound closure.

Mohs surgery: codes from 17311 to 17315 are assigned if the same physician acts as a surgeon and a pathologist.

Absence of any measurements or counts of the lesions can lower payments.

A checklist needs to be created that is to be followed by both the providers and the coders. It will contain details like location, size, number of lesions, type of procedure performed, and pathology.

An effective medical billing system would consist of eligibility verification, prior authorization whenever required, claim submission and proper management of the denied claims. Any weakness in each of these processes will be reflected in the form of revenue loss for the practice.

Revenue cycle management involves linking all these processes by properly managing claims from scheduling through to payment. Trend analysis and days of receivables is what makes it work.

One option for a practice could be to create an internal process for its staff members and even train them in special courses. It will certainly help in gaining knowledge, but codes and payor requirements keep changing along with consuming valuable time.

Insurance companies require evidence that the exam was conducted separately from the procedure, otherwise the E/M is included in the procedure charge.

Usually not. If the procedure was done solely for cosmetic reasons, then the procedure is paid for by the patient, but in case of medical necessity, it may be reimbursed.

The CPT codes are revised every year; hence, the coding guides must be checked every year.

Yes, both individual dermatologists and multiple provider clinics are our clients.

If you experience denials or reductions in your biopsies, destruction codes, or same-day visits, there is a reason behind it. Call Exact Core Group to have a billing review performed and we’ll pinpoint the lost revenue for you.