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Dermatologist today has to juggle between different tasks on the daily basis, so we have come forward in giving the dermatologist an understanding on a different guideline for channelized billing and documentation. The procedures are coded according to the Current Procedural Terminology (CPT) guideline, in the field dermatology procedure the codes are assigned globally based on the level of different complexity. With a global view it is defined as a length of time associated with the procedure and we get a part of the global surgical package.  The Centers for Medicare and Medicaid (CMS) has published a global surgical which includes:  intraoperative services, post-operative care, supplies, post-operative complications. 

CMS provides a list of CPT codes and their global periods. For any type of surgeries with 90 day periods with the actual number of days differing as the global period includes 92 days with day of before the surgery and the day of the surgery included. For many types of minor surgeries with 10-day global period, the actual number holds 11 days.

For many dermatologists the procedures usually take between zero or hold 10-day procedures. The global periods have been resisted by the federal government with legislation, this means the dermatology physician now has to bill for the post-operative follow-up differently in exchange for reducing the fee-schedule of the CPT code.

There are two modifiers you should be aware of as dermatology physicians with modifier 24 and modifier 79.  Modifier 24 is used for coding during Evaluation and Management (E/M) before the operation. Modifier 24 is used for the visit for the rash to indicate the new procedure and if the patient needs a skin biopsy then you need to use both 24 and 79 modifiers to indicate separate office visits. 

Usage of Modifier 59 is a relation with XE, XP, XS, and XU

The modifier 59 is most frequently used and misused is probably the reason new modifiers X is used with basically 59. The 59 modifier is used which allows the unbundling of codes in relation to distinct procedures that can be billed and the claim can pass Medicare edits.    

CMS has stated the policy that X-modifiers should never be used in the case of E/M codes. In addition to the modifiers, we use x-modifiers which is applied instead of using the 59 modifiers. Here is a quick summary when it comes to the usage of x-modifiers.

  1. XE—A distinct service in a separate encounter.
  2. XP—A distinct service performed by a separate provider.
  3. XS—A distinct service on a separate organ or structure.
  4. XU—A service that is distinct because it is unusual or doesn't typically overlap the main service.

With correctly applying modifiers in dermatology specialty require a deep understanding about the modifiers. With federal and global documentation differ we have to study out the different documentation and use of modifiers.   Medical Billers and Coders (MBC) with 16 years of experience in medical billing and coding for all types of dermatology procedures. We have increased the revenue of dermatology practices across the USA by 40 percent.  

Published By - Medical Billers and Coders
Published Date - Jun-06-2018 Back

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