It’s not rocket science to know that dermatology is one of the most difficult and complex medical specialties when it comes to medical billing and coding. Elements like global procedure periods, bundled procedures, and particularly modifiers – all contribute to a multifaceted coding environment that leads to errors and one which eventually ends with claims being denied.
Possibly one of the least understood topics in dermatology coding is the use of modifiers, particularly after CMS issued the new alphabetical HCPCS modifiers back in 2015. This was to replace the overused 59 modifier. Like other dermatologists even you have struggled with the issue of medical documentation and use of modifiers with your E/M and dermatology procedure codes, this article might solve your queries.
Dermatology Coders must be familiar with benevolent and menacing masses along with 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. Along with this don’t forget understanding the difference between centimeters (cm) and millimeters (mm).
Specialty medical coders who work in a field that only occasionally uses concepts from this section, such as urology, gynecology, and family practice, may have more difficulty with this section of CPT.
Dermatologists, as you must be aware, are very adept at providing their coding team with the information they need to code correctly. But, this may not be the case for all other providers. Medical coders who need to code dermatology-related procedures need to understand what each skin condition really is.
Coders can also have a tough time, if the physician or provider does not provide a clear description of the treatment he or she performed. The physician may state that he/she is going to biopsy a lesion, when in reality all they do is perform a shave.
If your medical coding department is unclear regarding the medical documentation, question the physician and ask for clarification to be amended to the note. Once that is done, then 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, then 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:
- Scales (dead skin cells that form flakes)
- Scar/cicatrix (fibrous tissue that forms after a skin injury)
- Keloid scars (thick, rounded, or irregular clusters of scar tissue that grow at the site of a wound on the skin)
- Port-wine stain (congenital capillary malformation)
- Hemangioma (a vascular birthmark)
- Telangiectasia (small blood vessels that are located under the surface of the skin)
- Warts ( growths of skin or membrane that are not malignant)
- Hidradenitis (inflammation of the sweat glands)
- Atrophic (wrinkled skin)
- Blister (a fluid-filled bump)
- Crust/scab (formation of dried blood, pus, or other skin fluid over a break in the skin)
- Excoriation (a scratch)
- Hives/wheals (a pink or white swelling of the skin)
- Lichenification (skin that has become thickened, hardened, or leathery)
- Macule (a flat, discolored spot)
- Nodule/papule (solid raised bump[s])
- Raised bumps (bumps that stick out above the skin surface)
- Patch (a flat, discolored spot/area)
- Pustule/pimple (an inflamed, elevated lesion that appears to contain pus)
In conclusion…
Keep in mind that correctly applying procedure codes in the dermatology specialty requires a deep understanding of all the components and medical documentation requirements with regards to codes. It is only then that you can select the correct modifiers where applicable and avoid a claim denial.