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:
59 –“Distinct Procedural Service”
XE –“Separate encounter, A service that is distinct because it occurred during a separate encounter”
XS –“Separate Structure, A service that is distinct because it was performed on a separate
organ/structure”
XP – “Separate Practitioner, A service that is distinct because it was performed by a different
practitioner”
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.
11102 Tangential biopsy of skin, single lesion
+ 11103 each separate or additional lesion
11104 Punch biopsy of skin including simple closure, when performed single lesion
+11105 each separate or additional lesion
11106 incisional biopsy of skin including simple closure, when performed single lesion
+11107 each separate or additional lesion
Medical billing and coding practitioners must consider hierarchy when using these codes:
Only one primary code can be reported if several biopsies of different types are obtained from the
same patient at the same visit.
Additional biopsies should be designated by their add-on codes.
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:
0640T
Non-contact near-infrared spectroscopy studies of flap or wound (e.g., for measurement of
deoxyhemoglobin, oxyhemoglobin, and ratio of tissue oxygenation [StO2]); image acquisition,
interpretation and report, each flap or wound
0641T
Non-contact near-infrared spectroscopy studies of flap or wound (e.g., for measurement of
deoxyhemoglobin, oxyhemoglobin, and ratio of tissue oxygenation [StO2]); image acquisition only,
each flap or wound
0642T
Non-contact near-infrared spectroscopy studies of flap or wound (e.g., for measurement of
deoxyhemoglobin, oxyhemoglobin, and ratio of tissue oxygenation [StO2]); interpretation and report
only, each flap or wound
0643T
Transcatheter left ventricular restoration device implantation including right and left heart
catheterization and left ventriculography when performed, arterial approach
0644T
Transcatheter removal or debulking of intracardiac mass (e.g., vegetations, thrombus) via suction
(eg, vacuum, aspiration) device, percutaneous approach, with intraoperative reinfusion of aspirated
blood, including imaging guidance, when performed
0645T
Transcatheter implantation of coronary sinus reduction device including vascular access and closure,
right heart catheterization, venous angiography, coronary sinus angiography, imaging guidance, and
supervision and interpretation, when performed
0646T
Transcatheter tricuspid valve implantation/replacement (TTVI) with prosthetic valve, percutaneous
approach, including right heart catheterization, temporary pacemaker insertion, and selective right
ventricular or right atrial angiography, when performed
0647T
Insertion of gastrostomy tube, percutaneous, with magnetic gastropexy, under ultrasound guidance,
image documentation and report
0648T
Quantitative magnetic resonance for analysis of tissue composition (e.g., fat, iron, water content),
including multiparametric data acquisition, data preparation and transmission, interpretation and
report, obtained without diagnostic MRI examination of the same anatomy (e.g., organ, gland, tissue,
target structure) during the same session
0649T
Quantitative magnetic resonance for analysis of tissue composition (e.g., fat, iron, water content),
including multiparametric data acquisition, data preparation and transmission, interpretation and
report, obtained with diagnostic MRI examination of the same anatomy (e.g., organ, gland, tissue,
target structure) (List separately in addition to code for primary procedure)
0650T
Programming device evaluation (remote) of subcutaneous cardiac rhythm monitor system, with iterative
adjustment of the implantable device to test the function of the device and select optimal
permanently programmed values with analysis, review and report by a physician or other qualified
health care professional
0651T
Magnetically controlled capsule endoscopy, esophagus through stomach, including intraprocedural
positioning of capsule, with interpretation and report
0652T
Esophagogastroduodenoscopy, flexible, transnasal; diagnostic, including collection of specimen(s) by
brushing or washing, when performed (separate procedure)
0653T
Esophagogastroduodenoscopy, flexible, transnasal; with biopsy, single or multiple
0654T
Esophagogastroduodenoscopy, flexible, transnasal; with insertion of intraluminal tube or catheter
0655T
Transperineal focal laser ablation of malignant prostate tissue, including transrectal imaging
guidance, with MR-fused images or other enhanced ultrasound imaging
0656T
Vertebral body tethering, anterior; up to 7 vertebral segments
0657T
Vertebral body tethering, anterior; 8 or more vertebral segments
0658T
Electrical impedance spectroscopy of 1 or more skin lesions for automated melanoma risk score
0659T
Transcatheter intracoronary infusion of supersaturated oxygen in conjunction with percutaneous
coronary revascularization during acute myocardial infarction, including catheter placement, imaging
guidance (e.g., fluoroscopy), angiography, and radiologic supervision and interpretation
0660T
Implantation of anterior segment intraocular non-biodegradable drug-eluting system, internal
approach
0661T
Removal and re-implantation of anterior segment intraocular non-biodegradable drug-eluting implant
0662T
Scalp cooling, mechanical; initial measurement and calibration of cap
0663T
Scalp cooling, mechanical; placement of device, monitoring, and removal of device (List separately
in addition to code for primary procedure)
0664T
Donor hysterectomy (including cold preservation); open, from cadaver donor
0665T
Donor hysterectomy (including cold preservation); open, from living donor
0666T
Donor hysterectomy (including cold preservation); laparoscopic or robotic, from living donor
0667T
Donor hysterectomy (including cold preservation); recipient uterus allograft transplantation from
cadaver or living donor
0668T
Backbench standard preparation of cadaver or living donor uterine allograft prior to
transplantation, including dissection and removal of surrounding soft tissues and preparation of
uterine vein(s) and uterine artery(ies), as necessary
0669T
Backbench reconstruction of cadaver or living donor uterus allograft prior to transplantation;
venous anastomosis, each
0670T
Backbench reconstruction of cadaver or living donor uterus allograft prior to transplantation;
arterial anastomosis, each
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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