How to improve Dermatology Medical billing and coding?

Unlike other medical professionals, dermatologists provide several types of medical, surgical and cosmetic procedures and services. But dermatology medical billing and coding as well as getting reimbursed appropriately are a challenge. To the matter of fact, responding to the dermatologist compensation survey, dermatologists reported getting fair reimbursement and having so many rules and regulations as the most challenging part of their tasks.

About 46% of the dermatologists revealed that they spend 10-19 hours a week on paperwork and administrative tasks, compared to 38% of all    other physicians. Outsourcing dermatology medical billing and coding services is a practical solution to stay current on changing codes and billing rules, and ensure proper payment for services rendered.

In this article, we will learn the recent and upcoming billing, coding and documentation updates impacting dermatologists:

1. New time reporting option for evaluation and management (E/M) services:

• External factors for reporting E/M services came into effect beginning Jan. 1, 2019. In addition to using the current 1995 and 1997 documentation guidelines, office and outpatient E&M codes can be selected based on time or by using medical decision-making alone, regardless of the level of history or physical exam performed.
• Earlier, selection of a visit was based on their time and required documentation of the duration of face-to-face time with the patient. More than 50 percent of the visit had to be spent in counseling or coordination of care.
• The definition of time associated with E/M codes 99202-99215 has been changed from “typical face-to-face time” to “total time spent on the day of the encounter.”
• From 2021, healthcare professionals or dermatologists had no necessity to establish how much time was devoted to counseling and coordinating on the day of the encounter. Code selection would depend on the total length of the visit even if counseling did not dominate the service time.

2. Changes in modifier payment policy:

• The Centers for Medicare and Medicaid Services completely scrutinized the way healthcare professionals use modifier 25(significant, separately identifiable evaluation and management [E/M] service by the same physician on the same day of the procedure or other service) and modifier 59 (Distinct Procedural Service), and whether there are instances of overpayment.
• According to an article in Dermatology Times, approximately 60% of E/M services performed by dermatologists are submitted with modifier 25 attached, compared to about 25% “for the rest of medicine”. This means that any change in modifier 25 payment policy will affect dermatology more than other specialties.
• Dermatologists must also be knowledgeable about the specific requirements associated with the use of modifier 25 or risk recoupment resulting from post-payment audits. Modifier 59, which indicates a separately identifiable procedure done on the same encounter date on the same person, should not be appended to additional biopsy codes.

3. Medicare changing modifier rules to override claims edits:

• Ultimately, Medicare as well as other insurance companies that use the National Correct Coding Initiative (NCCI) edits to bundle services provided to the same patient on the same date have mandated that any modifier used to override an edit must be applied to the “column 2 code” in an edit pair. This means that the code would not be paid in the absence of a modifier.
• Medicare has allowed the following modifiers to be appended to either code in the procedure to procedure NCCI edits, when a modifier override is allowed:

1. 59 –“Distinct Procedural Service”
2. XE –“Separate encounter, A service that is distinct because it occurred during a separate encounter”
3. XS –“Separate Structure, A service that is distinct because it was performed on a separate organ/structure”
4. XP – “Separate Practitioner, A service that is distinct because it was performed by a different practitioner”
5. XU –“Unusual Non-Overlapping Service, The use of a service that is distinct because it does not overlap usual components of the main service”

• Modifier 25 remains to be an exception to this new rule and should still be appended to the “column 2 code” unless the payer instructs otherwise.

4. Changes in biopsy coding:

• Dermatologists perform skin biopsy on a daily basis. In 2019, dermatology had a set of six new biopsy codes CPT 11102-11107, that is, three types of primary biopsy codes and three kinds of secondary codes.

1. 11102 Tangential biopsy of skin, single lesion
2. + 11103 each separate or additional lesion
3. 11104 Punch biopsy of skin including simple closure, when performed single lesion
4. +11105 each separate or additional lesion
5. 11106 incisional biopsy of skin including simple closure, when performed single lesion
6. +11107 each separate or additional lesion

• Medical billing and coding practitioners must consider hierarchy when using these codes:

1. Only one primary code can be reported if several biopsies of different types are obtained from the same patient at the same visit.
2. Additional biopsies should be designated by their add-on codes.
3. Incisional is always primary to punch and tangential, and punch is always primary to tangential.

5. Coding for photo-dynamic therapy (PDT): 

• PDT codes have been changing to incorporate physician work time and become more complex.
• PDT CPT Codes 96567, 96573, and 96574 are used to report nonsurgical treatment of cutaneous lesions using PDT which means external application of light to destroy premalignant lesions of the skin and adjacent mucosa by activation of photosensitizing drug.
• These codes can only be used once per patient per day, and only one of the 3 codes can be used on a given anatomic area.

Category III Code Changes:

Medical billing and coding changes change frequently and hence it’s vital to stay updated to receive accurate reimbursements for the growth of business. As discussed, check for the best outsourcing medical billing and coding companies to submit your bills and stay tension free.

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