Documentation Challenges for Dermatology Billing and Coding

Documentation Challenges for Dermatology Billing and Coding

It’s not rocket science to know that dermatology billing and coding is one of the most challenging and complex medical specialties in medical billing and coding. Elements like global procedure periods, bundled procedures, and modifiers contribute to a multifaceted coding environment that leads to errors and eventually results in denied claims.

One of the least understood topics in dermatology coding services is the use of modifiers, notably after CMS issued the new alphabetical HCPCS modifiers in 2015. This was to replace the overused 59 modifier. Like other dermatologists, this article might solve your queries even if you have struggled with the issue of medical documentation and the use of modifiers with your E/M and dermatology procedure codes.

Dermatology Coders must be familiar with benevolent and menacing masses and their actions, which are shaving, destruction, and performing biopsies. In addition, they must identify simple, intermediate, and complex repairs and deal with sizing terms such as length, depth, width, and circumference. Don’t forget to understand the difference between centimeters (cm) and millimeters (mm).

Specialty medical coders who work in fields that only occasionally use concepts from this section, such as urology, gynecology, and family practice, may have more difficulty with this section of CPT.

As you must know, dermatologists are adept at providing their coding team with the information they need to code correctly. However, this may not be the case for all other providers. Medical coders who code dermatology-related procedures must understand each skin condition.

Coders can also have trouble if the physician or provider does not clearly describe the treatment he or she performed. For example, the physician may state that he/she will biopsy a lesion when, in reality, all he/she does is shave.

If your medical coding department is unclear about the medical documentation, question the physician and ask for clarification to be added to the note. Once that is done, code it and bill your claim to the insurance provider.

This medical documentation is vital to ensure accurate reimbursement for the procedures performed. The relative value units (RVU) for code 11100 (biopsy of skin, subcutaneous tissue, and/or mucous membrane; single lesion) may be different than the RVU attached to 11300 (Shaving of the epidermal or dermal lesion, single lesion; diameter .5 cm or less).

Medical billing and coding with the most precise and appropriate procedure codes can accelerate reimbursement and revenue cycle. If the payer denies reimbursement, your medical documentation will support everything you coded and billed.

Below are some vital dermatology medical documentation terms that you, as a coder, should keep an eye on:

1. Scales (dead skin cells that form flakes)
2. Scar/cicatrix (fibrous tissue that forms after a skin injury)
3. Keloid scars (thick, rounded, or irregular clusters of scar tissue that grow at the site of a wound on the skin)
4. Port-wine stain (congenital capillary malformation)
5. Hemangioma (a vascular birthmark)
6. Telangiectasia (tiny blood vessels that are located under the surface of the skin)
7. Warts ( growths of skin or membrane that are not malignant)
8. Hidradenitis (inflammation of the sweat glands)
9. Atrophic (wrinkled skin)
10. Blister (a fluid-filled bump)
11. Crust/scab (formation of dried blood, pus, or other skin fluid over a break in the skin)
12. Excoriation (a scratch)
13. Hives/wheals (a pink or white swelling of the skin)
14. Lichenification (skin that has become thickened, hardened, or leathery)
15. Macule (a flat, discolored spot)
16. Nodule/papule (solid raised bump[s])
17. Raised bumps (bumps that stick out above the skin surface)
18. Patch (a flat, discolored spot/area)
19. Pustule/pimple (an inflamed, elevated lesion that appears to contain pus)

In conclusion…

Remember that correctly applying procedure codes in the dermatology specialty requires a deep understanding of all the components and medical documentation requirements. Only then can you select the correct modifiers where applicable and avoid a claim denial.

FAQs:

• What are common documentation errors in dermatology billing and coding?

Common mistakes include incomplete patient information, incorrect coding, and missing documentation for procedures performed.

• How can incomplete documentation affect billing in dermatology?

Incomplete documentation can lead to claim denials or delays, resulting in lost revenue and increased administrative work to resolve issues.

• What are the critical elements needed for accurate dermatology documentation?

Accurate documentation should include detailed patient history, clear descriptions of procedures, and correct use of CPT and ICD-10 codes.

• How do software changes impact Dermatology Billing and Coding documentation?

Software updates can introduce new coding standards or features that require staff training to ensure accurate and compliant documentation.

• How can medical billers and coders help with dermatology billing documentation challenges?

Medical billers and coders help by ensuring accurate documentation, reducing errors, and handling complex coding issues, ultimately improving revenue cycle management.