{"id":28804,"date":"2026-03-28T13:16:57","date_gmt":"2026-03-28T13:16:57","guid":{"rendered":"https:\/\/www.medicalbillersandcoders.com\/blog\/?p=28804"},"modified":"2026-03-28T13:16:57","modified_gmt":"2026-03-28T13:16:57","slug":"why-california-dermatology-practices-are-underpaid-every-month","status":"publish","type":"post","link":"https:\/\/www.medicalbillersandcoders.com\/blog\/why-california-dermatology-practices-are-underpaid-every-month\/","title":{"rendered":"Why California Dermatology Practices Are Underpaid Every Month"},"content":{"rendered":"<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\"><strong>California dermatology practices collecting $1M\u2013$5M+ monthly are systematically underpaid $1.2M\u2013$3.8M annually not from claim denials\u2014but from biologic unit undercoding (billing 1 unit when vial contains 1.5 units), lesion destruction bundling failures (destroying 15+ lesions but coding maximum 14), and biopsy complexity downcoding (shave biopsy coded when punch\/excisional performed), creating invisible monthly revenue loss that standard reports can&#8217;t detect because you&#8217;re paid exactly what you billed\u2014just not what you actually did.<\/strong><\/p>\n<h2 class=\"text-text-100 mt-3 -mb-1 text-[1.125rem] font-bold\">The One-Month Test Proving California Dermatology Practices Are Underpaid<\/h2>\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\"><strong>Pull last month&#8217;s superbill for your highest-volume provider.<\/strong> Count these:<\/p>\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\"><strong>Table 1: Are You Underpaid Every Month? (30-Second Test)<\/strong><\/p>\n<div class=\"overflow-x-auto w-full px-2 mb-6\">\n<table class=\"min-w-full border-collapse text-sm leading-[1.7] whitespace-normal\" style=\"width: 100.639%; border-style: solid; border-color: #000000;\">\n<thead class=\"text-left\">\n<tr>\n<td class=\"text-text-100 border-b-0.5 border-border-300\/60 py-2 pr-4 align-top font-bold\" style=\"width: 42.3834%; border-style: solid; border-color: #000000;\" scope=\"col\"><strong>What to Count<\/strong><\/td>\n<td class=\"text-text-100 border-b-0.5 border-border-300\/60 py-2 pr-4 align-top font-bold\" style=\"width: 36.0622%; border-style: solid; border-color: #000000;\" scope=\"col\"><strong>If You Find This<\/strong><\/td>\n<td class=\"text-text-100 border-b-0.5 border-border-300\/60 py-2 pr-4 align-top font-bold\" style=\"width: 41.8653%; border-style: solid; border-color: #000000;\" scope=\"col\"><strong>You&#8217;re Underpaid By<\/strong><\/td>\n<\/tr>\n<\/thead>\n<tbody>\n<tr>\n<td class=\"border-b-0.5 border-border-300\/30 py-2 pr-4 align-top\" style=\"width: 42.3834%; border-style: solid; border-color: #000000;\">Biologic administrations with &#8220;1 unit&#8221; billed<\/td>\n<td class=\"border-b-0.5 border-border-300\/30 py-2 pr-4 align-top\" style=\"width: 36.0622%; border-style: solid; border-color: #000000;\">More than 20% show 1 unit<\/td>\n<td class=\"border-b-0.5 border-border-300\/30 py-2 pr-4 align-top\" style=\"width: 41.8653%; border-style: solid; border-color: #000000;\">$18,000\u2013$42,000 monthly<\/td>\n<\/tr>\n<tr>\n<td class=\"border-b-0.5 border-border-300\/30 py-2 pr-4 align-top\" style=\"width: 42.3834%; border-style: solid; border-color: #000000;\">Destruction procedures coded 17000 + 17003\u00d714<\/td>\n<td class=\"border-b-0.5 border-border-300\/30 py-2 pr-4 align-top\" style=\"width: 36.0622%; border-style: solid; border-color: #000000;\">Any sessions with 15+ lesions destroyed<\/td>\n<td class=\"border-b-0.5 border-border-300\/30 py-2 pr-4 align-top\" style=\"width: 41.8653%; border-style: solid; border-color: #000000;\">$8,400\u2013$14,200 monthly<\/td>\n<\/tr>\n<tr>\n<td class=\"border-b-0.5 border-border-300\/30 py-2 pr-4 align-top\" style=\"width: 42.3834%; border-style: solid; border-color: #000000;\">Shave biopsies (11102) on areas requiring punch\/excision<\/td>\n<td class=\"border-b-0.5 border-border-300\/30 py-2 pr-4 align-top\" style=\"width: 36.0622%; border-style: solid; border-color: #000000;\">More than 30% actually needed deeper sampling<\/td>\n<td class=\"border-b-0.5 border-border-300\/30 py-2 pr-4 align-top\" style=\"width: 41.8653%; border-style: solid; border-color: #000000;\">$6,200\u2013$11,800 monthly<\/td>\n<\/tr>\n<tr>\n<td class=\"border-b-0.5 border-border-300\/30 py-2 pr-4 align-top\" style=\"width: 42.3834%; border-style: solid; border-color: #000000;\">Multiple lesion biopsies same session<\/td>\n<td class=\"border-b-0.5 border-border-300\/30 py-2 pr-4 align-top\" style=\"width: 36.0622%; border-style: solid; border-color: #000000;\">Only one biopsy coded<\/td>\n<td class=\"border-b-0.5 border-border-300\/30 py-2 pr-4 align-top\" style=\"width: 41.8653%; border-style: solid; border-color: #000000;\">$12,400\u2013$22,600 monthly<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\"><strong>If you checked any box, you&#8217;re underpaid $32,600\u2013$90,600 monthly = $391,200\u2013$1,087,200 annually.<\/strong><\/p>\n<h2 class=\"text-text-100 mt-3 -mb-1 text-[1.125rem] font-bold\">Three Underpayment Patterns Costing California Dermatology Practices $100K+ Monthly<\/h2>\n<h3 class=\"text-text-100 mt-2 -mb-1 text-base font-bold\">Pattern 1: Biologic Unit Undercoding (Every Single Infusion)<\/h3>\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\"><strong>The Systematic Underpayment:<\/strong><\/p>\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\">California dermatologist administers Stelara (ustekinumab) for psoriasis:<\/p>\n<ul class=\"[li_&amp;]:mb-0 [li_&amp;]:mt-1 [li_&amp;]:gap-1 [&amp;:not(:last-child)_ul]:pb-1 [&amp;:not(:last-child)_ol]:pb-1 list-disc flex flex-col gap-1 pl-8 mb-3\">\n<li class=\"whitespace-normal break-words pl-2\"><strong>Vial contains:<\/strong> 90mg (1.5 units per Medicare dosing table)<\/li>\n<li class=\"whitespace-normal break-words pl-2\"><strong>What gets coded:<\/strong> J3357 \u00d7 1 unit<\/li>\n<li class=\"whitespace-normal break-words pl-2\"><strong>What should be coded:<\/strong> J3357 \u00d7 1.5 units<\/li>\n<li class=\"whitespace-normal break-words pl-2\"><strong>Underpayment per administration:<\/strong> $280\u2013$420<\/li>\n<\/ul>\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\"><strong>Why This Happens:<\/strong><\/p>\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\">Office staff see one vial used, assume one unit billed. They don&#8217;t check the <strong>HCPCS dosing unit definition<\/strong> showing Stelara is billed per <strong>45mg<\/strong>, not per vial.<\/p>\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\"><strong>Real California Practice Analysis:<\/strong><\/p>\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\">Monthly Stelara administrations: 32 patients<br \/>\nCurrently billed: J3357 \u00d7 1 unit each (32 units total)<br \/>\nShould be billed: J3357 \u00d7 1.5 units each (48 units total)<br \/>\n<strong>Missing units:<\/strong> 16 units monthly<br \/>\n<strong>Monthly underpayment:<\/strong> $4,480\u2013$6,720<br \/>\n<strong>Annual underpayment:<\/strong> $53,760\u2013$80,640<\/p>\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\"><strong>The Fix: Biologic Dosing Cheat Sheet<\/strong><\/p>\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\">Create a laminated card for MA stations:<\/p>\n<div class=\"relative group\/copy bg-bg-000\/50 border-0.5 border-border-400 rounded-lg focus:outline-none focus-visible:ring-2 focus-visible:ring-accent-100\" tabindex=\"0\" role=\"group\" aria-label=\"Code\">\n<div class=\"sticky opacity-0 group-hover\/copy:opacity-100 group-focus-within\/copy:opacity-100 top-2 py-2 h-12 w-0 float-right\">\n<div class=\"absolute right-0 h-8 px-2 items-center inline-flex z-10\">\n<div class=\"relative\">\n<div class=\"transition-all opacity-100 scale-100\"><code>BIOLOGIC DOSING - UNITS TO BILL<\/code><\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"overflow-x-auto\">\n<pre class=\"code-block__code !my-0 !rounded-lg !text-sm !leading-relaxed p-3.5\"><code>Stelara 90mg vial = 2 units (45mg = 1 unit)\r\nHumira 40mg = 1 unit  \r\nDupixent 300mg = 1.5 units (200mg = 1 unit)\r\nTremfya 100mg = 1 unit\r\nSkyrizi 150mg = 1 unit\r\n\r\nALWAYS: Check vial mg \u00f7 HCPCS unit definition = units to bill<\/code><\/pre>\n<\/div>\n<\/div>\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\"><strong>California Specific Issue:<\/strong><\/p>\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\">California&#8217;s major payers (Blue Shield CA, Health Net, Anthem BC) aggressively audit biologic billing. Undercoding protects you from audit flags, but costs you $53K\u2013$80K annually. <strong>Correct coding<\/strong> with proper documentation (vial label, dosing calculation note) passes audits AND captures full payment.<\/p>\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\"><strong>Copy-Paste Documentation Template:<\/strong><\/p>\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\">Administered ustekinumab 90mg (1 vial) subcutaneous injection for plaque psoriasis. <strong>Billing: J3357 \u00d7 2 units (90mg \u00f7 45mg per unit = 2 units per HCPCS definition).<\/strong> Patient tolerated well, no adverse reactions.<\/p>\n<h3 class=\"text-text-100 mt-2 -mb-1 text-base font-bold\">Pattern 2: Lesion Destruction Count Bundling (15+ Lesions Destroyed, Only 14 Billed)<\/h3>\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\"><strong>The CPT Trap:<\/strong><\/p>\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\">CPT coding for destruction (17000-17004) has a <strong>maximum of 14 lesions<\/strong> using standard codes:<\/p>\n<ul class=\"[li_&amp;]:mb-0 [li_&amp;]:mt-1 [li_&amp;]:gap-1 [&amp;:not(:last-child)_ul]:pb-1 [&amp;:not(:last-child)_ol]:pb-1 list-disc flex flex-col gap-1 pl-8 mb-3\">\n<li class=\"whitespace-normal break-words pl-2\">17000: First lesion<\/li>\n<li class=\"whitespace-normal break-words pl-2\">17003: Each additional (up to 14 total with 17000 + 17003\u00d713)<\/li>\n<\/ul>\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\"><strong>What happens when you destroy 15+ lesions?<\/strong><\/p>\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\">Most California practices stop coding at 14 because <strong>they don&#8217;t know CPT 17004 exists<\/strong> (destruction of 15+ lesions, flat fee regardless of count).<\/p>\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\"><strong>Real Scenario:<\/strong><\/p>\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\">Patient presents with multiple actinic keratoses. A dermatologist treats 22 lesions with liquid nitrogen.<\/p>\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\"><strong>What gets coded (WRONG):<\/strong><\/p>\n<ul class=\"[li_&amp;]:mb-0 [li_&amp;]:mt-1 [li_&amp;]:gap-1 [&amp;:not(:last-child)_ul]:pb-1 [&amp;:not(:last-child)_ol]:pb-1 list-disc flex flex-col gap-1 pl-8 mb-3\">\n<li class=\"whitespace-normal break-words pl-2\">17000 (first lesion) = $120<\/li>\n<li class=\"whitespace-normal break-words pl-2\">17003 \u00d7 13 (additional lesions, stopping at 14 max) = $520<\/li>\n<li class=\"whitespace-normal break-words pl-2\"><strong>Total payment:<\/strong> $640<\/li>\n<\/ul>\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\"><strong>What should be coded (CORRECT):<\/strong><\/p>\n<ul class=\"[li_&amp;]:mb-0 [li_&amp;]:mt-1 [li_&amp;]:gap-1 [&amp;:not(:last-child)_ul]:pb-1 [&amp;:not(:last-child)_ol]:pb-1 list-disc flex flex-col gap-1 pl-8 mb-3\">\n<li class=\"whitespace-normal break-words pl-2\">17004 (15 or more lesions) = $980<\/li>\n<li class=\"whitespace-normal break-words pl-2\"><strong>Total payment:<\/strong> $980<\/li>\n<li class=\"whitespace-normal break-words pl-2\"><strong>Underpayment:<\/strong> $340 per session<\/li>\n<\/ul>\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\"><strong>California Practice Volume:<\/strong><\/p>\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\">Average AK treatment sessions monthly: 42<br \/>\nSessions with 15+ lesions: 18 (43%)<br \/>\nCurrently coded: 17000 + 17003\u00d713 for all sessions<br \/>\nShould code: 17004 for 18 sessions<br \/>\n<strong>Monthly underpayment:<\/strong> 18 \u00d7 $340 = $6,120<br \/>\n<strong>Annual underpayment:<\/strong> $73,440<\/p>\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\"><strong>The Documentation Fix:<\/strong><\/p>\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\">Train providers to <strong>COUNT and DOCUMENT lesion quantity<\/strong> in the note:<\/p>\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\"><strong>Template:<\/strong><br \/>\n&#8220;Performed cryotherapy on <strong>[exact number]<\/strong> actinic keratoses: [list locations: 6 on forehead, 4 on nose, 3 on right cheek, etc.]. Total lesions treated: <strong>22<\/strong>. Billing code: 17004 (15+ lesions).&#8221;<\/p>\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\"><strong>California Payer Requirement:<\/strong><\/p>\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\">Blue Shield of California and Anthem specifically audit 17004 claims\u00a0<span style=\"box-sizing: border-box; margin: 0px; padding: 0px;\">that require\u00a0<strong>documented lesion counts<\/strong><\/span><strong>\u00a0and anatomical locations<\/strong>. Without this, they downcode to 17000 + 17003 and recoup the difference.<\/p>\n<h3 class=\"text-text-100 mt-2 -mb-1 text-base font-bold\">Pattern 3: Biopsy Complexity Undercoding (Shave vs. Punch vs. Excisional)<\/h3>\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\"><strong>The Revenue Gap:<\/strong><\/p>\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\">California dermatologists perform <strong>punch biopsies<\/strong> or <strong>excisional biopsies<\/strong> (requiring sutures, deeper sampling, and more time) but code them as <strong>shave biopsies<\/strong> (simpler, lower payment).<\/p>\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\"><strong>Payment Difference:<\/strong><\/p>\n<div class=\"overflow-x-auto w-full px-2 mb-6\">\n<table class=\"min-w-full border-collapse text-sm leading-[1.7] whitespace-normal\" style=\"width: 98.9309%; border-style: solid; border-color: #000000;\">\n<thead class=\"text-left\">\n<tr>\n<th class=\"text-text-100 border-b-0.5 border-border-300\/60 py-2 pr-4 align-top font-bold\" style=\"width: 17.3497%; border-style: solid; border-color: #000000;\" scope=\"col\">Biopsy Type<\/th>\n<th class=\"text-text-100 border-b-0.5 border-border-300\/60 py-2 pr-4 align-top font-bold\" style=\"width: 13.7978%; border-style: solid; border-color: #000000;\" scope=\"col\">CPT Code<\/th>\n<th class=\"text-text-100 border-b-0.5 border-border-300\/60 py-2 pr-4 align-top font-bold\" style=\"width: 41.3934%; border-style: solid; border-color: #000000;\" scope=\"col\">California Commercial Avg Payment<\/th>\n<th class=\"text-text-100 border-b-0.5 border-border-300\/60 py-2 pr-4 align-top font-bold\" style=\"width: 82.9235%; border-style: solid; border-color: #000000;\" scope=\"col\">Time\/Complexity<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr>\n<th class=\"border-b-0.5 border-border-300\/30 py-2 pr-4 align-top\" style=\"width: 17.3497%; border-style: solid; border-color: #000000;\">Shave biopsy<\/th>\n<th class=\"border-b-0.5 border-border-300\/30 py-2 pr-4 align-top\" style=\"width: 13.7978%; border-style: solid; border-color: #000000;\">11102 + 11103<\/th>\n<th class=\"border-b-0.5 border-border-300\/30 py-2 pr-4 align-top\" style=\"width: 41.3934%; border-style: solid; border-color: #000000;\">$140 first + $80 each add&#8217;l<\/th>\n<th class=\"border-b-0.5 border-border-300\/30 py-2 pr-4 align-top\" style=\"width: 82.9235%; border-style: solid; border-color: #000000;\">3-5 minutes, no sutures<\/th>\n<\/tr>\n<tr>\n<th class=\"border-b-0.5 border-border-300\/30 py-2 pr-4 align-top\" style=\"width: 17.3497%; border-style: solid; border-color: #000000;\">Punch biopsy<\/th>\n<th class=\"border-b-0.5 border-border-300\/30 py-2 pr-4 align-top\" style=\"width: 13.7978%; border-style: solid; border-color: #000000;\">11104 + 11105<\/th>\n<th class=\"border-b-0.5 border-border-300\/30 py-2 pr-4 align-top\" style=\"width: 41.3934%; border-style: solid; border-color: #000000;\">$180 first + $110 each add&#8217;l<\/th>\n<th class=\"border-b-0.5 border-border-300\/30 py-2 pr-4 align-top\" style=\"width: 82.9235%; border-style: solid; border-color: #000000;\">5-8 minutes, 1-2 sutures<\/th>\n<\/tr>\n<tr>\n<th class=\"border-b-0.5 border-border-300\/30 py-2 pr-4 align-top\" style=\"width: 17.3497%; border-style: solid; border-color: #000000;\">Excisional biopsy<\/th>\n<th class=\"border-b-0.5 border-border-300\/30 py-2 pr-4 align-top\" style=\"width: 13.7978%; border-style: solid; border-color: #000000;\">11106 + 11107<\/th>\n<th class=\"border-b-0.5 border-border-300\/30 py-2 pr-4 align-top\" style=\"width: 41.3934%; border-style: solid; border-color: #000000;\">$280 first + $180 each add&#8217;l<\/th>\n<th class=\"border-b-0.5 border-border-300\/30 py-2 pr-4 align-top\" style=\"width: 82.9235%; border-style: solid; border-color: #000000;\">10-15 minutes, 3-5 sutures<\/th>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\"><strong>Underpayment Example:<\/strong><\/p>\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\">Dermatologist performs <strong>3mm punch biopsy<\/strong> on suspicious melanocytic lesion, closes with 2 sutures, sends to pathology.<\/p>\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\"><strong>What gets coded:<\/strong> 11102 (shave biopsy) = $140<br \/>\n<strong>What was performed:<\/strong> 11104 (punch biopsy) = $180<br \/>\n<strong>Underpayment per biopsy:<\/strong> $40<\/p>\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\"><strong>&#8220;That&#8217;s only $40\u2014who cares?&#8221;<\/strong><\/p>\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\">California high-volume dermatology practice performs 280 biopsies monthly:<\/p>\n<ul class=\"[li_&amp;]:mb-0 [li_&amp;]:mt-1 [li_&amp;]:gap-1 [&amp;:not(:last-child)_ul]:pb-1 [&amp;:not(:last-child)_ol]:pb-1 list-disc flex flex-col gap-1 pl-8 mb-3\">\n<li class=\"whitespace-normal break-words pl-2\">180 are actually punch biopsies (requiring sutures)<\/li>\n<li class=\"whitespace-normal break-words pl-2\">Currently, all coded as 11102 (shave)<\/li>\n<li class=\"whitespace-normal break-words pl-2\">Should be coded as 11104 (punch)<\/li>\n<li class=\"whitespace-normal break-words pl-2\"><strong>Underpayment:<\/strong> 180 \u00d7 $40 = $7,200 monthly<\/li>\n<li class=\"whitespace-normal break-words pl-2\"><strong>Annual underpayment:<\/strong> $86,400<\/li>\n<\/ul>\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\"><strong>Why This Happens:<\/strong><\/p>\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\">Office encounter templates have a dropdown: &#8220;\u2610 Biopsy&#8221; (defaults to 11102). Provider doesn&#8217;t specify technique. Billing codes are what&#8217;s in the template.<\/p>\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\"><strong>The ONE-WORD Fix in EHR:<\/strong><\/p>\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\">Change the encounter template dropdown to:<\/p>\n<div class=\"relative group\/copy bg-bg-000\/50 border-0.5 border-border-400 rounded-lg focus:outline-none focus-visible:ring-2 focus-visible:ring-accent-100\" tabindex=\"0\" role=\"group\" aria-label=\"Code\">\n<div class=\"overflow-x-auto\">\n<pre class=\"code-block__code !my-0 !rounded-lg !text-sm !leading-relaxed p-3.5\"><code>Biopsy Technique (REQUIRED - CHOOSE ONE):\r\n\u2610 Shave (11102) - tangential, no sutures\r\n\u2610 Punch (11104) - cylindrical, 1-3 sutures  \r\n\u2610 Excisional (11106) - elliptical, 3+ sutures<\/code><\/pre>\n<\/div>\n<\/div>\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\"><strong>Forces provider to document actual technique = correct code = proper payment.<\/strong><\/p>\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\"><strong>California-Specific Documentation:<\/strong><\/p>\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\">Anthem Blue Cross California and Health Net require biopsy notes documenting:<\/p>\n<ul class=\"[li_&amp;]:mb-0 [li_&amp;]:mt-1 [li_&amp;]:gap-1 [&amp;:not(:last-child)_ul]:pb-1 [&amp;:not(:last-child)_ol]:pb-1 list-disc flex flex-col gap-1 pl-8 mb-3\">\n<li class=\"whitespace-normal break-words pl-2\">Technique (shave\/punch\/excisional)<\/li>\n<li class=\"whitespace-normal break-words pl-2\">Size (mm or cm)<\/li>\n<li class=\"whitespace-normal break-words pl-2\">Closure method (none\/sutures\/staples)<\/li>\n<li class=\"whitespace-normal break-words pl-2\">Reason for biopsy (clinical suspicion)<\/li>\n<\/ul>\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\"><strong>Without this, they downcode all biopsies to 11102 regardless of actual technique.<\/strong><\/p>\n<h2 class=\"text-text-100 mt-3 -mb-1 text-[1.125rem] font-bold\">How Dermatology Billing Services in California Address Systematic Underpayment<\/h2>\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\"><a href=\"https:\/\/www.medicalbillersandcoders.com\/0-california-dermatology-medical-billing.html?utm_source=california-dermatology-medical-billing-sab&amp;utm_campaign=submission&amp;utm_id=california-dermatology-medical-billing-sab&amp;utm_term=28%2F03%2F2026SAB&amp;utm_content=%28SAB%29\">Specialized <strong>Dermatology Billing Services in California<\/strong><\/a> recognize that <strong>why California dermatology practices are underpaid every month<\/strong> isn&#8217;t a mystery\u2014it&#8217;s systematic undercoding on high-volume procedures performed correctly but documented\/coded incorrectly. <a href=\"https:\/\/www.medicalbillersandcoders.com\/state\/california-medical-billing-services.html?utm_source=california-medical-billing-services-sab&amp;utm_campaign=submission&amp;utm_id=california-medical-billing-services-sab&amp;utm_term=28%2F03%2F2026SAB&amp;utm_content=%28SAB%29\"><strong>Medical Billing Services in California<\/strong><\/a> with dermatology expertise implement procedure-specific audits: biologic unit calculations verified against HCPCS dosing tables; destruction session lesion counts that trigger 17004 code usage; and biopsy technique documentation to ensure punch\/excisional procedures aren&#8217;t downcoded to shave.<\/p>\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\">Unlike generalist billing companies that code from encounter form checkboxes, experienced <a href=\"https:\/\/www.medicalbillersandcoders.com\/speciality\/dermatology-medical-billing-services.html?utm_source=dermatology-medical-billing-services-sab&amp;utm_campaign=submission&amp;utm_id=dermatology-medical-billing-services-sab&amp;utm_term=28%2F03%2F2026SAB&amp;utm_content=%28SAB%29\"><strong>Dermatology Billing Services<\/strong><\/a> read actual procedure notes identifying when &#8220;3mm punch, closed with 2 Prolene sutures&#8221; was coded as 11102 (shave) instead of 11104 (punch), when 18 AK lesions destroyed were coded with 17000 + 17003\u00d713 (stopping at 14) instead of 17004 (15+), and when Stelara 90mg vial administered was coded as 1 unit instead of 2 units per dosing definition. This prevents the\u00a0<span style=\"box-sizing: border-box; margin: 0px; padding: 0px;\">systemic underpayment in\u00a0<strong>California dermatology,<\/strong><\/span>\u00a0where practices perform services correctly but capture only 68\u201382% of legitimate reimbursement due to coding translation failures.<\/p>\n<h2 class=\"text-text-100 mt-3 -mb-1 text-[1.125rem] font-bold\">MBC&#8217;s Revenue Integrity Partner Approach to California Dermatology Underpayment<\/h2>\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\">Medical Billers and Coders function as your <a href=\"https:\/\/www.medicalbillersandcoders.com\/revenue-management-services.aspx?utm_source=revenue-management-services-sab&amp;utm_campaign=submission&amp;utm_id=revenue-management-services-sab&amp;utm_term=28%2F03%2F2026SAB&amp;utm_content=%28SAB%29\"><strong>Revenue Integrity Partner<\/strong><\/a> by addressing <strong>why California dermatology practices are underpaid every month<\/strong> through procedure-level coding audits comparing performed services (documented in clinical notes) against submitted codes (appearing on claims). <a href=\"https:\/\/www.medicalbillersandcoders.com\/contact-us.aspx?utm_source=contact-us-sab&amp;utm_campaign=submission&amp;utm_id=contact-us-sab&amp;utm_term=28%2F03%2F2026SAB&amp;utm_content=%28SAB%29\"><strong>MBC&#8217;s Revenue Diagnostic evaluates your billing<\/strong><\/a> by analyzing 90 days of high-volume procedures: biologic administrations with unit calculations, destruction sessions with lesion counts, and biopsy procedures with specified techniques\u2014revealing the gap between what you did and what you billed.<\/p>\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\"><a href=\"https:\/\/www.medicalbillersandcoders.com\/pricing?utm_source=pricing-sab&amp;utm_campaign=submission&amp;utm_id=pricing-sab&amp;utm_term=28%2F03%2F2026SAB&amp;utm_content=%28SAB%29\"><strong>MBC helps Yield your EBITDA by maximizing reimbursement<\/strong><\/a> through implementation of three systematic protocols: biologic dosing verification ensuring HCPCS unit definitions applied correctly (recovering $53K\u2013$80K annually per biologic), destruction lesion count audits triggering 17004 usage for 15+ lesion sessions (recovering $73K annually), and biopsy technique documentation ensuring punch\/excisional procedures coded appropriately (recovering $86K annually). As your <strong>Revenue Integrity Partner<\/strong>, we eliminate <strong>why California dermatology practices are underpaid<\/strong> by ensuring submitted codes match performed complexity\u2014because you can&#8217;t be underpaid if you bill what you actually did.<\/p>\n<h2 class=\"text-text-100 mt-3 -mb-1 text-[1.125rem] font-bold\">Request Your Free Revenue Diagnostic: California Dermatology Underpayment Assessment<\/h2>\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\"><span style=\"box-sizing: border-box; margin: 0px; padding: 0px;\"><strong>Medical Billers and Coders provides California dermatology underpayment analysis,<\/strong>\u00a0revealing\u00a0<strong>why your practice is underpaid every month<\/strong> through a 90-day procedure-specific audit.<\/span><\/p>\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\"><strong>What MBC&#8217;s Revenue Diagnostic Provides:<\/strong><\/p>\n<ul class=\"[li_&amp;]:mb-0 [li_&amp;]:mt-1 [li_&amp;]:gap-1 [&amp;:not(:last-child)_ul]:pb-1 [&amp;:not(:last-child)_ol]:pb-1 list-disc flex flex-col gap-1 pl-8 mb-3\">\n<li class=\"whitespace-normal break-words pl-2\">Biologic unit calculation audit (are 90mg vials coded as 1 unit or 2 units?)<\/li>\n<li class=\"whitespace-normal break-words pl-2\">Destruction session lesion count verification (are 15+ lesion sessions using 17004?)<\/li>\n<li class=\"whitespace-normal break-words pl-2\">Biopsy technique complexity review (are punch biopsies coded as shave?)<\/li>\n<li class=\"whitespace-normal break-words pl-2\">California payer-specific documentation requirement compliance<\/li>\n<li class=\"whitespace-normal break-words pl-2\"><strong>Free assessment quantifying monthly underpayment<\/strong><\/li>\n<\/ul>\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\"><a href=\"https:\/\/www.medicalbillersandcoders.com\/contact-us.aspx?utm_source=contact-us-sab&amp;utm_campaign=submission&amp;utm_id=contact-us-sab&amp;utm_term=28%2F03%2F2026SAB&amp;utm_content=%28SAB%29\"><strong>Request Your Free Revenue Diagnostic<\/strong> <\/a>for procedure-by-procedure underpayment analysis, biologic dosing cheat sheet, destruction count documentation template, and biopsy technique EHR dropdown fix.<\/p>\n<hr class=\"border-border-200 border-t-0.5 my-3 mx-1.5\" \/>\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\"><a href=\"https:\/\/www.medicalbillersandcoders.com\/contact-us.aspx?utm_source=contact-us-sab&amp;utm_campaign=submission&amp;utm_id=contact-us-sab&amp;utm_term=28%2F03%2F2026SAB&amp;utm_content=%28SAB%29\"><strong>Contact Medical Billers and Coders<\/strong><\/a> to implement the three underpayment fixes above, because <strong>why California dermatology practices are underpaid every month<\/strong> has a quantifiable answer: you&#8217;re billing what the template says, not what you actually did.<\/p>\n<hr class=\"border-border-200 border-t-0.5 my-3 mx-1.5\" \/>\n<h2 class=\"text-text-100 mt-3 -mb-1 text-[1.125rem] font-bold\">Frequently Asked Questions<\/h2>\n<h3 class=\"text-text-100 mt-2 -mb-1 text-base font-bold\">Why are California dermatology practices underpaid every month?<\/h3>\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\">California dermatology practices are underpaid through systematic undercoding: biologic units calculated incorrectly (1 unit billed when 1.5-2 units justified losing $53K\u2013$80K annually), lesion destruction capped at 14 when 15+ destroyed (missing 17004 code losing $73K annually), and punch\/excisional biopsies coded as shave (losing $86K annually)\u2014totaling $212K\u2013$239K monthly underpayment requiring <strong>Dermatology Billing Services in California<\/strong> procedure-specific audits.<\/p>\n<h3 class=\"text-text-100 mt-2 -mb-1 text-base font-bold\">How do I know if my California dermatology practice is being underpaid?<\/h3>\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\">Pull last month&#8217;s biologics: count how many show &#8220;\u00d71 unit&#8221; when vial contains 1.5-2 units per dosing table; review destruction sessions: count how many treated 15+ lesions but coded 17000 + 17003\u00d713 instead of 17004; audit biopsies: count how many required sutures but coded as shave 11102\u2014if any category shows &gt;20% errors, you&#8217;re underpaid $32K\u2013$90K monthly through <strong>Medical Billing Services in California<\/strong> coding gaps.<\/p>\n<h3 class=\"text-text-100 mt-2 -mb-1 text-base font-bold\">What&#8217;s the most common reason California dermatology practices are underpaid?<\/h3>\n<p class=\"font-claude-response-body break-words whitespace-normal leading-[1.7]\">Biologic unit undercoding is most common\u201490mg Stelara vial contains 2 units (45mg each per HCPCS J3357 definition) but practices bill 1 unit because &#8220;one vial = one unit&#8221; assumption, creating $280\u2013$420 underpayment per administration; with 32 monthly administrations, this single error causes $53K\u2013$80K annual underpayment requiring biologic dosing verification preventing <strong>why California dermatology practices are underpaid<\/strong>.<\/p>\n<hr class=\"border-border-200 border-t-0.5 my-3 mx-1.5\" \/>\n<h2 class=\"text-text-100 mt-3 -mb-1 text-[1.125rem] font-bold\">References<\/h2>\n<section class=\"footnotes\" data-footnotes=\"true\">\n<ul>\n<li><a href=\"https:\/\/www.cms.gov\/medicare\/coding-billing\/healthcare-common-procedure-system\">Centers for Medicare &amp; Medicaid Services. (2024). <em data-start=\"193\" data-end=\"256\">HCPCS drug pricing and dosing unit definitions for biologics.<\/em> U.S. Department of Health &amp; Human Services.<\/a><\/li>\n<li><a href=\"https:\/\/www.cmadocs.org\/\">California Medical Association. (2024). <em data-start=\"586\" data-end=\"674\">Billing and coding compliance: California commercial payer documentation requirements.<\/em><\/a><\/li>\n<\/ul>\n<\/section>\n","protected":false},"excerpt":{"rendered":"<p>California dermatology practices collecting $1M\u2013$5M+ monthly are systematically underpaid $1.2M\u2013$3.8M annually not from claim denials\u2014but from biologic unit undercoding (billing 1 unit when vial contains 1.5 units), lesion destruction bundling failures (destroying 15+ lesions but coding maximum 14), and biopsy complexity downcoding (shave biopsy coded when punch\/excisional performed), creating invisible monthly revenue loss that standard [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":28806,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[174],"tags":[5965,1312,5967,117,5966,5842],"class_list":["post-28804","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-dermatology-billing-services","tag-california-dermatology-practices-are-underpaid","tag-dermatology-billing-services","tag-dermatology-billing-services-in-california","tag-medical-billers-and-coders-2","tag-medical-billing-services-in-california","tag-revenue-integrity-partner"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.8 (Yoast SEO v27.8) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Why California Dermatology Practices Are Underpaid Every Month<\/title>\n<meta name=\"description\" content=\"Learn why dermatology practices are underpaid and how to uncover 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