When it comes to dermatology billing, coders at the medical billing facility need to familiarize themselves with skin conditions and treatments to use the accurate code for the same. This is because it is not unusual when coders interrelate dermatology billing and cosmetic billing.
Claims for dermatology billing are directed to insurance companies, while cosmetic claims are billed directly to the patients. Even before billing for dermatology, coders need to ensure that the treatment provided is medically necessary for the diagnosed disease or condition. Once the necessity of the treatment is justified, coders will then translate the services into industry-specific codes to bill the patient.
Medical billing poses a unique set of challenges for the profession of dermatology. These challenges demand careful attention and a high level of expertise. In today’s healthcare industry practices, dermatology firms who wish to be successful need to establish billing processes that are both precise and efficient. Today, we will discuss some common challenges with billing for dermatology services and offer some comprehensive guidelines for dermatology billers to minimize issues like claim delays and rejections. By implementing these strategies, dermatology firms will be able to improve the efficiency of their billing processes and experience greater financial success.
Understanding Dermatology Medical Billing Challenges
1. Complex Coding System
A wide number of specific codes need to be utilized regularly to provide accurate billing for dermatology procedures and treatments. The tenth version of the International Classification of Diseases (ICD-10) and Current Procedural Terminology (CPT) codes can be difficult to understand, which can increase the likelihood of making mistakes and cause payment to be held up. Dermatology practices need a complete understanding of these coding schemes to make the most reimbursements possible and avoid having claims denied.
2. Frequent Changes in Coding Guidelines
Due to the evolution in dermatology billing and treatment coding standards, medical coders must get along with ongoing education and training. Maintaining up-to-date knowledge of these developments in healthcare billing is required to guarantee accurate coding and the prevention of rejection of claims. Attending conferences and obtaining regular updates on coding standards are two ways in which staff can stay up to date and ensure compliance with regulations.
3. Insurance Coverage Complexities
Going through the insurance coverage complexities can be one of the major hassles in dermatology medical billing. This is because that insurance companies and paying clients have their own policies, documentation guidelines, and pre-authorization requirements for the claim submission and can be complex enough to deny claims if they are not properly met.
Dermatology practices and organizations need to have strong communication and positive bond with the insurance companies and compliance with the insurance companies’ specific requirements.
It is essential for dermatology practices to establish strong communication channels with insurance companies and stay up to date with their specific requirements.
4. Managing Prior Authorizations
Many times, treatments and procedures require authorization for insurance companies to be executed so that they can be billed properly. When patients need that treatment, they need to contact the organization to confirm the process. The process takes time and can become complex in no time. This is because dermatology and cosmetic billing needs special attention to prevent claims from denials, and that’s where they are required special permission. If the process of pre-authorization doesn’t process, it can significantly impact the provider’s revenue cycle. To mitigate the chances, clear communication, efficient documentation, and pre-authorization are required so the process can be streamlined.
5. Dealing with Claim Denials and Appeals
Since claim denials are common in medical billing, and so in dermatology, handling claims denials and management refers to a smooth and successful cash flow. For this, identification of errors, review of supported documentation, and management claim denials should be efficiently handled.
Implementing robust denial management strategies can help dermatology practices minimize revenue losses and improve their overall billing performance.
Common Dermatology-Related Medical Billing Codes
Here are some of the common dermatology CPT codes related to skin-related issues used in dermatology billing.
Lesion Removal CPT Codes
Premalignant, benign, and malignant fall under Lesions that can be removed by methods including cryosurgery, chemical or laser treatment, and electrosurgery.
When in one surgical process, multiple lesions are removed, multiple CPT codes are used to cover them. Some of them are;
- 17000: Premalignant lesions destruction; first lesion (e.g., actinic Keratoses)
- 17003: Premalignant lesions destruction; 2- 14 lesions (e.g., actinic Keratoses)
- 17110: Benign lesions destruction other than cutaneous vascular proliferative lesions (up to 14 lesions)
Dermatology CPT Codes for Excisions of Lesions
Excisions of lesions involve the removal of lesions and the tissues around the lesions.
- 11403: Excision, benign lesion including margins; legs, arms, or trunk
- 11603: Excision, malignant lesion, including margins; legs, arms, or trunks
CPT Codes for Mohs Micrographic Surgery Dermatology
This micrographic dermatology surgery involves skin cancer removal. This surgery is often executed in multiple steps involving tissue removal and pathologic information.
- 17311: Mohs micrographic head technique; first stage hands, neck, feet
- 17312: Mohs micrographic head technique; each additional stage hands, neck, feet
- 17313: Mohs micrographic head technique on hands, neck, and trunk
- 17314: Mohs micrographic head technique; for every multiple stage; hands, neck, and leg.
Pathology CPT Codes
These procedures revolve around the study of tissues and skin at the cellular level.
- 88304: Level III – surgical pathology, gross & microscopic exam
- 88305: Level IV – surgical pathology, gross & microscopic exam
- 88312: Special stain, including interpretation and report
- 88341: Immunohistochemistry or immunocytochemistry
Phototherapy and Laser Therapy CPT Codes
- 96920 and 96921: Laser treatment for inflammatory skin disease
- 96900: Actinotherapy (UV light)
- 96910: Photochemotherapy; tar and ultraviolet B or petrolatum and ultraviolet B
- 96567: Photodynamic therapy by external application of light to destroy premalignant and/or malignant lesions
- J7308: Aminolevulinic acid HCL for topical administration
Tips to Overcome Dermatology Medical Billing Challenges
1. Invest in Training and Education
Continuous training and education for billing staff are essential to ensure they have the knowledge and skills to navigate the complexities of dermatology medical billing. Regular workshops, seminars, and online courses can help staff stay updated with the latest coding guidelines and insurance requirements. This investment will enhance their efficiency and accuracy in coding and billing procedures.
2. Utilize Technology Solutions
Leveraging technology can significantly streamline the medical billing process for dermatology practices. Implementing electronic health record (EHR) systems with integrated billing modules can automate coding, claim submission, and tracking. Advanced billing software can also assist in verifying insurance coverage, managing prior authorizations, and identifying potential coding errors, reducing the risk of claim denials.
3. Establish Effective Communication Channels
In order to ensure effective billing procedures, solid lines of communication must be established with insurance companies. Be in contact with insurance agents on a regular basis to learn about paperwork requirements, get questions answered about coverage, and swiftly address any claims-related issues. Claims denials and other billing problems could be avoided with more transparent communication.
4. Conduct Internal Audits
Internal audits of the coding and billing procedures on a regular basis can assist in analyzing areas for improvement and guarantee compliance. Hire outside auditors or assign a specialized team to examine the correctness of the coding, claims, and adherence to insurance regulations. Dermatology practices can streamline their revenue cycle and lower the chance of claim denials by proactively correcting any flaws or anomalies.
5. Outsource Medical Billing Services
In some cases, outsourcing medical billing services to specialized billing companies can be a viable option for dermatology practices. Professional billing services have dermatology coding and billing expertise, ensuring accurate claim submissions and prompt reimbursements. Outsourcing allows practices to focus on patient care while benefiting from the specialized knowledge and streamlined processes offered by billing experts.
Dermatology practices may benefit from delegating their medical billing services to specialized billing companies in certain instances. Professional billing services possess dermatology coding and invoicing expertise, ensuring accurate claim submissions and prompt reimbursements. Billing experts offer specialized knowledge and streamlined processes that enable practices to focus on patient care while benefiting from the specialized knowledge and streamlined processes offered by outsourcing.
Dermatology medical billing comes with its own set of challenges, but with the right strategies and proactive measures, these challenges can be overcome. By staying up to date with coding guidelines, leveraging technology solutions, and maintaining effective communication with insurance providers, dermatology practices can optimize their billing processes and improve financial outcomes. Implementing the tips provided in this article will help dermatology practices navigate the complex world of medical billing successfully.