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In 2017 and beyond, dermatologists need to keep track of ongoing and subtle medical code changes in order to avoid denials and a reduction in reimbursement. There are several complexities involved in using ICD-10 and CPT codes for this specialty, which is why opting for dermatology medical billing and coding services is a good idea.

A recent article in Dermatology Times carries the pertinent advice that a leading dermatologist offered on using ICD-10 codes:

  • Ensure specificity: Take cysts, a common condition. In ICD-10, cysts can be coded in many ways – epidermal cyst (L72.0), pilar cyst (L72.11), trichodermal cyst/trichilemmal (proliferating) cyst (L72.12), steatocystoma multiplex (L72.2), sebaceous cyst (solitary steatocyst) (L72.3) and other follicular cysts of the skin and subcutaneous tissue (L72.8). Similarly, eyelid cysts have a separate list of codes – cysts of right upper eyelid (H02.821), cysts of right lower eyelid (H02.822), cysts of left upper eyelid (H02.824) and cysts of left lower eyelid (H02.825).
  • Base codes on what is known at the time: Rather than the ultimate diagnosis, the physician should focus on what is known at the time. For instance, in the case of TB skin test, the expert recommends using the patient’s condition (e.g., psoriasis, L40.) and Z11.1: encounter for screening for respiratory TB (screening for TB: Mantoux, skin test).
  • Watch out for oddities: Use HCPCS code J7308, Aminolevulinic acid hcl for topical administration, 20%, single unit dosage form (354 mg) for Daylight photodynamic therapy – aminolevulinic acid is applied in office and the patient sits in shade for 2-3 hours. This service does not qualify for CPT 96567 (light exposure done in sunlight, outside the facility), but can be billed using the appropriate patient evaluation and monitoring CPT code (999201-99215).
  • Know the new CPT codes:
    • Reflectance Confocal Microscopy has new codes from CPT 96931-96936: RCM Codes 96931 (image acquisition, interpretation and report, first lesion), 96932 (image acquisition only, first lesion), and 96933 (interpretation and report only, first lesion), +96934 (image acquisition, interpretation and report, each additional lesion), +96935 (image acquisition only, each additional lesion), and +96936 (interpretation and report only, each additional lesion) Point to note: Technical is image acquisition, Professional is interpretation and report. Both components are included in 96931 and 96934. These codes apply to a free-standing device that produces stacked mosaic images but not for a hand-held confocal device.
    • New Category III CPT codes designated for emerging technology, services and procedures are temporary numerical codes ending with a T.
    • Use CPT 0394T for high dose rate electronic brachytherapy, skin surface application, per fraction, includes basic dosimetry when performed. Code 0182T for brachytherapy code has been removed.
    • Procedures with the MelaFind device can be reported using CPT 0400T (multi-spectral digital skin lesion analysis for detection of melanomas and high risk melanocytic atypia, one to five lesions). Use CPT 0401T for six or more lesions.

Using modifiers is one of the least understood areas in dermatology coding, more so after CMS introduced new HCPCS modifiers in 2015 to replace modifier 59, which is generally overused. For instance, there is some confusion on the use of modifier 25, a significant, separately identifiable evaluation and management (E/M) service by the same physician on the same day of the procedure or other service. “25” tells a payer that if the dermatologist performs an examination, diagnoses the condition, and performs a biopsy and a destructive procedure at the same visit, the dermatologist should get paid for both procedures.

Modifier 25 should only be used with E/M codes for established patients and for not new patients or with procedure codes. In addition, X- modifiers, basically as a subset of modifier 59, should never be used with E/M codes. If one of the X-modifiers applies, it should be used instead of the “59”.

Tracking and understanding these changes can be confusing for dermatologists. The AAPC-certified coders in reliable medical coding companies have a deep understanding of ICD-10 and CPT codes and keep an eye on changes that occur from time to time. They will carefully evaluate the documentation and pull out everything related to the procedure to apply the right codes and modifiers for dermatology services. Such support is crucial to prevent denials and audits and ensure maximum reimbursement.

Natalie Tornese

Holding a CPC certification from the American Academy of Professional Coders (AAPC), Natalie is a seasoned professional actively managing medical billing, medical coding, verification, and authorization services at OSI.

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