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Dermatology Billing Compliance – Understanding the Basics

Dermatology as a healthcare specialty according to the latest census is ranked as the 10th most in-demand medical field, due to the aging US population. However, with such a demand comes increased salaries, which rose by 13% on average in 2017-18. This lucrative industry which now stands at $13 billion employs about 15,000 dermatologists in the country, with much of that cash coming from out-of-pocket cosmetic procedures like lip injections and laser hair removal.

While profitable, this specialty has faced its fair share of distress when it comes to reimbursement of claims. As recently as 2016, the CMS issued a number of reimbursement cuts to common dermatological procedures, like the complex closures on the face. But, the positive outcome is the many in the industry believe that the future of dermatology is steady and that further cuts are unlikely.

With these altering reimbursement rules, it is crucial for dermatologists to employ truthful dermatology billing and coding experts to get the money they deserve. Incorrect dermatology billing takes you’re your vital time and energy away from your main job, which is to take care of the patients. You might even find yourself spending more time handling the codes than attending the patients. Even then, you might be leaving money back due to claims denials or laagering AR days.

Dermatology coding basics you ought to get right!

No one disputes that the services a dermatologist provides do not benefit patients. However, there are some basic procedures and conditions detected by dermatologists that are not considered important medical services to preserve function or promote improved health.

  • Removal of skin tags (CPT 11200 and 11201) is usually considered a cosmetic procedure that is not covered by many commercial insurers or government health plans.Β 
  • Remember that a skin tag is a localized benign hyperplasia of the skin that presents petite threat to the overall health of the patient.Β 
  • A professional medical billing and coding experts like us can review the patient record to recognize when CPT codes 11000 and 11001 are more precise based on the acknowledged diagnosis and reason for the procedure.Β 
  • If a dermatologist submits specimens to a laboratory to rule out malignant dermal neoplasia, the diagnosis coding will reveal that the nature of the tags was in question at the time of removal, and that they were submitted to a pathologist for confirmation of the disease process involved.Β  The procedure performed was not a routine skin tag removal, but a biopsy.
  • Keep in mind that the language of CPT is very specific.Β  Codes exist for biopsies (11000 and 11001) and the method of obtaining the involved tissue does not affect the coding.Β 
  • CPT specifies that biopsies can be obtained through destruction, shaves, or excision.Β  CPT also states that the surgical removal of an overall lesion is included in the obtaining of biopsy tissue.

Dermatologists should not bill for an excision and a biopsy during the same encounter if the same lesion is involved.

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