Like any medical billing procedure, dermatology medical billing requires highly educated professionals to ensure timely and accurate claim reimbursement. As the medical industry in the United States is evolving rapidly over the past few years practitioners – especially dermatologists are actively participating in getting familiar with the tailored needs of dermatology medical billing.
Dermatology medical billing has become a challenging task due to a range of dermatology CPT codes, required documents and extensive paperwork, therefore, it is suggested to keep optimizing administrative efforts at your practice to ensure reducing claim denials and time consumption.
Today we will discuss the insights into dermatology medical billing that help streamline the billing process at ease.
4 Challenges in Dermatology Medical Billing
Medical documentation or any record is essential in dermatology medical billing that identifies why a patient was provided with the services, what services were provided, and the evidence that services had been provided mentioning the proof of improvements. These documents work as legal documents enabling a provider to get reimbursed promptly.
Plus, modifiers are also excessively used in the documentation without knowing their proper use of them. Many times, coders struggle with the correct application of modifiers in dermatology and E/M procedure codes.
2. Coding Systems
Billing codes serve as a critical element in the reimbursement process that shows the services a physician has performed after a patient’s visit. The insurance companies confirm the services and reimburse providers on the basis of these codes and coding systems. Physicians commonly use two types of codes: Current Procedural Terminology (CPT) and International Classification of Diseases (ICD).
ICD-10 codes are standard transaction codes used to analyze and diagnose diseases under the Health Insurance Portability and Accountability Act – HIPPA. The act is generally designed to trace disease statistics, healthcare burdens, mortality statistics, quality outcomes, and billing. These ICD-10 codes are detailed alpha-numeric codes and typically range from 3 to 7 numbers which begin with an alpha character.
Regardless of whether an in-patient or out-patient, when a patient visits a physician for diagnosis, these codes represent the whole process from the first visit to the whole treatment procedure. Dermatology medical billing uses a range of these CPT codes for in-patient procedures such as excisions, biopsies, destructions, and Mohs surgery. Plus, within the Evaluation and Management of E/M codes and the CPT coding system, the billing needs appropriate and accurate codes to describe the services rendered.
3. Compliance required for Dermatology Medical Billing
As mentioned earlier, there are modifiers that are commonly overused, two of them are 25 and 59. However, modifier 25 is referred to as “significant, separately identifiable evaluation and management (E/M) service by the same physician on the same day of the procedure or other service.”
Whereas the modifier 59 is elaborated as the Distinct Procedural Service. Also, when the 59 modifier is used for certain circumstances, it should indicate that the services provided or procedure offered were independently performed without associating any E/M code or service to it performed on that day.
Centres for Medicare and Medicaid Services and many other third-party and private insurance payers strongly analyze bills and claims when these modifiers are used to confirm whether they are used for overpayments. An article published in Dermatology Times says that nearly 60% of the services of E/M performed by dermatologists were claimed with modifier 25 attached compared to other services which were 25%. This translates to the fact that any changes in the modifier policies will affect dermatology more as opposed to any other service.
4. Inaccurate Patient information
Another challenge that dermatologists face is collecting and updating the updated information of either patients or their insurance providers. However, billers and coders at a dermatology practice remain in touch with patients’ insurance providers. Taking time to confirm the information from insurance providers and patients before billing would be a lifesaver.
Dermatology CPT Codes
Here are some commonly used Current Procedural Terminology (CPT) codes in dermatology:
- Skin biopsy:
- 11100 – Biopsy of a single lesion (e.g., punch, incisional, or excisional biopsy)
- 11101 – Each additional lesion (List separately in addition to code for primary procedure)
- Skin tag removal:
- 11200 – Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions
- 11201 – Each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure)
- 17000 – Destruction (e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), all benign or premalignant lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions
- 17003 – Each additional lesion (List separately in addition to code for primary procedure)
- 96910 – Photochemotherapy; psoralens and ultraviolet A (PUVA)
- 96912 – Photochemotherapy; ultraviolet B (UVB), either alone or with topical psoralen
Note: These codes are subject to change, and it is recommended to consult the most recent CPT code book or online resources for up-to-date information. Also, keep in mind that the appropriate CPT code may vary depending on the specific procedure and circumstances.
4 Tips to efficiently manage Dermatology Medical Billing
1. Collecting co-pays timely
As a licensed practitioner, you must have a mechanism to measure the co-pays that the patient owes you at the beginning of your practice. In addition, it is essential that you establish a policy of receiving copays in advance. Have your staff trained to handle patients who refuse to pay upfront or refuse regularly.
2. Timely claim submission
Receiving full reimbursement would be challenging for providers, however, when claims are submitted timely, there’s a chance of receiving full reimbursement if the claims are submitted accurately. Educate your staff about submitting claims on a daily basis to maintain the denied and clean claims ratio timely.
3. Verifying and updating patient information
Patients are reluctant to hand over their insurance cards and information whenever they visit. But it is your front office’s responsibility to collect their insurance cards and ask for their information whenever they visit your practice to confirm the existing information or update them with the current. Double-check if they have changed their insurance payer. You also need to confirm if their plan covers the services they are prescribed and if not, make them sign the form where it mentions that the services will be out-of-pocket.
4. Follow-ups and tracking of unpaid claims
Evaluating your revenue cycle management will inform you about your paid, unpaid, and non-submitted claims. If claim submission has passed sixty days, you must take a follow-up before resubmitting them. Sometimes, it just needs a phone call from your front desk to either the insurance payer or the patient to confirm the claim.
With the above discussion of challenges and tips for managing your dermatology medical billing, you must have gotten an idea about why it is important to bill with accurate information and things that you need to consider while submitting claims to insurance payers. Follow them and streamline your dermatology medical billing practice claim submission process so your service claims can be timely reimbursed and facilitate your RCM to run smoothly.