Introduction to Dermatology:
Dermatology is a branch of medicine that deals with skin diseases and related conditions. When we talk about dermatology, it deals with both surgical and conservative cosmetic approaches and procedures. Skin is the body’s largest organ and acts as the defensive wall against the outside world. This is why properly managing, monitoring, and preventing skin-related conditions is a necessity.
Using the right CPT code for dermatology service is crucial and one of the biggest challenges this field of medicine faces. Dermatology medical billing is a complex process involving all the paperwork and detailed documentation. It requires detailed reporting, the use of correct CPT codes, and the right coding modifiers. With a number of procedures come a vast range of unique codes for billing dermatology services.
Understanding the Coding Modifiers:
When we talk about medical billing and coding, the use of modifiers is a necessity. There are various modifiers in medical billing, commonly used modifiers include:
– Modifier 25: –
According to CMS, modifier 25 in medical billing is used for a “significant, separately identifiable E/M (evaluation and management) service” performed by the same healthcare physician on the same day.
– Modifier 59: –
According to CMS, modifier 59 in medical billing is used for a “separately identifiable, distinct non-E/M service.” Modifier 59 is used to unbundle the codes. Therefore, it is the most misused modifier of all. This is why the X-modifiers were introduced.
– The X-Modifiers: –
There are four types of X-Modifiers based on the distinct service provided:
o XE: –
The distinct service in another or separate encounter
o XU: –
A distinct service that doesn’t overlap with the main service provided by the physician.
o XP: –
If another healthcare physician provides the distinct service
o XS: –
If the distinct service is performed on a separate organ.
Medical Billing Codes for Dermatology Billing:
In dermatology medical billing, services can range from minor and simple cosmetic procedures to extensive and complicated surgical procedures and skin grafts. This makes dermatology medical coding even more challenging. Medical billers must have extensive knowledge and understanding of commonly used codes and modifiers related to dermatology to avoid claim denials. Following are the most common dermatology practices and their procedure (medical billing CPT) codes:
- Skin Biopsy: –
A skin biopsy is used to diagnose any skin-related condition. Following are the procedure codes for skin biopsy:
All of these mentioned codes are based on the type of lesion in tangential biopsy of the skin.
- Lesion Removal: –
Commonly used procedure codes for lesion removal include: –
- Mohs Micrographic Surgery:
Commonly used procedure codes for Mohs Micrographic surgery include:
- E/M (Evaluation and Management) Service:
Commonly used procedure codes for Evaluation and Management services provided by the dermatologist include:
Challenges Dermatology Billing Services:
With a vast range of procedures come a number of different codes and a set of errors along with them. Dermatology billing requires detailed and extensive documentation in order to optimize the administrative cost and time. It is a challenge to get reimbursed for the dermatology services rendered due to a number of rules. Following are some of the common challenges faced by dermatologists in medical billing:
a) Proper Documentation:
Proper and detailed documentation is required for preparing a medical claim in order to get reimbursement for the services rendered by the dermatologist. This documentation proves the services provided. Modifier 59 is the most commonly used modifier but is the least understood among the billers.
Using the wrong modifier can result in claim denials or rejections.
b) Coding System:
There are two most commonly used coding systems in medical coding. They include ICD Codes (ICD stands for The International Classification of Diseases) and CPT Codes (CPT stands for Current Procedural Terminology).
In dermatology, CPT codes are used to bill for in-patient and out-patient services. CPT codes are used to bill most the in-office dermatology services like skin biopsies, removal or destruction, and Mohs surgery. They also come with evaluation and management (E/M) codes.
Medical billers must have a vast understanding and knowledge of using both coding systems. Using the right codes is a challenge in dermatology coding and medical billing.
c) Billing Compliance:
As mentioned earlier, medical billers must have extensive knowledge about dermatology medical billing companies as it can lead to overuse or misuse of modifier 25 and modifier 59. One must be compliant and up-to-date regarding the use of modifiers in medical billing.
When we talk about dermatology, modifier 25 is used for billing almost 60% of the E/M services provided by the physician (dermatologist). Meaning if there is any change in modifier 25 guidelines, it will affect dermatology medical coding the most.
d) Patient information:
Old or incomplete patient insurance information is also one of the biggest challenges faced in this field. Getting in touch with the insurance provider to gather information can be very time-consuming, which is why it is better to get updated information before performing any procedure or rendering any service.
Tips for improving dermatology medical billing and coding services:
Addressing the above-mentioned challenges and managing the denials in the best way to improve your medical billing services. Any errors in medical billing result in claim denials or rejection, ultimately late payments, lower revenues, and reimbursement rates. Following are some tips to improve medical billing services for dermatology practice:
– Prepare and submit Clean Claims:
Maintain a clean claim rate of about 95%. It is simple, and a higher clean claim rate is equal to higher revenues and satisfied patients. If your clean claim rate is below 95%, it simply means your dermatology practice is missing out on revenues.
– Ensure complete and accurate information:
Errors are very common, and even minor ones can get the claim rejected or denied. This is why entering accurate and complete patient insurance information is essential. Double-check all the information before submitting the medical claim to avoid denials.
– Use the right modifiers and CPT codes:
As mentioned earlier, modifiers can be misused, resulting in denials. This is why use the right modifiers and CPT codes in your dermatology medical billing.
– Keep up with the changes in modifier and coding guidelines:
Modifier and CPT Coding guidelines are constantly going through changes and amendments, so medical billers must be up to date regarding any and all changes to avoid any errors in medical coding. If your practice is not up to date regarding the changes, you will encounter many challenges and issues with insurance payers.
– Outsource your medical billing and coding services:
There are various challenges and errors associated with in-house medical coding and billing practices, so outsourcing medical billing services is the most efficient way to increase revenues, reduce errors, and improve reimbursement rates. Outsourcing your medical billing to professionals can result in the following advantages:
– Lesser errors:
Due to advanced billing software and an expert team of medical billers solely working to reduce the errors and improve clean claim rates. The medical billing company is up to date regarding all the changes in guidelines and codes to avoid errors.
– Lower cost:
With outsourcing your medical billing services to a company like UControl Billing you wouldn’t have to purchase billing software or hire an in-house medical billing team of specialists. This ultimately reduces your administrative, benefits, and expenses related to computer equipment and billing software.
– Higher Reimbursement Rate and Revenue:
The team of expert medical billers and coders working solely to reduce errors results in lower claim denials, faster payments, and increased revenues.
Streamline your medical billing with UControl Billing:
UControl billing is a medical billing outsourced services company with a team of certified medical billers and coders. We have globally renowned credentials committed to providing the best medical billing services and solutions for your medical practice.
Outsourcing your dermatology medical billing services to a third-party medical billing company like UControl Billing has a number of benefits. When outsourcing, make sure you are choosing the right fit for your dermatology practice.
A third-party medical billing company is already in the industry, updated using advanced billing software. They are typically more consistent and know how to get the work done.
Why UControl Billing?
At UControl Billing, with our timely follow-ups and 24-hour billing, we consider ourselves as a “Remote Business Office”. So, you don’t have to worry, we are right there with you.
But why outsource to UControl billing?
UControl Billing has built a reputation of being a better partner. We work so you can focus on your patient care. Our team of expert medical billers and coders helps in making your medical practice profitable and successful.
Benefits of outsourcing billing services to UControl billing:
Outsourcing your medical billing services, you get the following benefits:
– HIPAA Compliance
– Higher reimbursement rate
– Improved Revenue Cycle
– Easy implementation of RCM
– Timely follow-ups
– Billing in 24-hours
– Significant reduction if AR (Account Receivables)
– Affordable Pricing
– You can choose to work with the EHR/EMR of your choice and our team of medical billers can work with any of them.
Our Plan and Pricing:
You don’t have to worry about fixed pricing anymore. At UControl Billing we offer to maximize reimbursements with certified medical billers and affordable pricing. With UControl Billing your billing costs are based on your monthly receipts. Not only this, but if your productions dip, so do your billing costs – we only get paid when you get paid.
We offer two pricing plans:
- Medical Billing Only
- Complete Revenue Cycle Management (RCM)
Our Medical Billing Services:
Medical billing and coding can be tricky and is yet the essential part for any healthcare service provider. This process helps in compensating the healthcare providers for the services they rendered. Medical billing services with UControl billing include: –
– Eligibility Verification
– Customized Financial Reports (Monthly)
– Claim Tracking
– Claim Denial Management
– Reduced rejections and denials
– HIPAA Compliant
– Insurance claim timely follow-ups
We give you the opportunity and complete freedom to work and run your practice in your way.
Following are the services offered by UControl Billing:
– Medical Billing services
– Medical coding Services
– Revenue Cycle Management (RCM)
– Front Office Management
– Telemedicine Billing Services
– Medical Transcription Services
– Medical Credentialing Services
– Value-Added Services like
- MIPS MARCA & Eligibility
- Medical Billing Reports
Frequently Asked Questions (FAQs)
What is the CPT code for a dermatology office visit?
Every procedure and service rendered by a healthcare physician or dermatologist has a corresponding code for medical billing. The CPT codes for a dermatology office for a new patient are; 99201 to 99205 and CPT codes for return patient visits are 99211 to 99215.
What is the CPT code for dermatology?
Dermatology is a field of medicine dealing with the largest human organ, i.e., skin. With this comes a number of procedures and their corresponding codes. The CPT codes for dermatology skin biopsies are 11102 to 11107. The Dermatology medical billing and coding guidelines change every year. These codes are under the Dermatology 2019 coding guidelines.
What is Physician billing in medical billing?
Physician medical billing particularly deals with any professional or healthcare procedures and services provided by the physician. There are a number of different physicians who can charge for the professional services they render. But medical billing does differ among the type of physicians like: –
– ER (Emergency room) Physician
– Radiographer or pathologist
– Surgeon or Anesthesiologist
– Primary or special care physician
Physician medical billing ensures that the physician is being reimbursed for the professional services provided by them.
A couple of years ago, I executed the effective plan of creating a Medical billing and Coding company named U Control Billing. The company aims to bring revolutionary advancements to foster medical billing and coding revenues. As an official member of HIA-LI and MGMA, I feel honored in providing networking opportunities, problem-solving, and improving the revenue management cycle.