# Preventative derm visit



## smartcoder

Can we submit 99381-99397 for a dermatology preventative visit?


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## mkmgt001

It is my understanding that it would NOT be appropriate for a dermatologist to report a code from the Preventive Medicine range (CPT 99381-99397) because a dermatologist is a specialist.  If a patient comes in for a "routine" skin check, this should be coded with a problem-oriented E/M code (99201-99215).


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## tefranklin57

Preventive Medicine services include risk factor reduction guidance or counseling, such services may include screenings, well visits, or routine yearly examinations.  As long as a comprehensive skin examination is performed and reason for appointment is full body skin exam, I don't see why you can't use E/M 99381-99297 codes.


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## tefranklin57

I am changing my first post, since the majority of patients seeking a full body skin examination, already notice a lesion/mole they want looked at, this visit would be coded using E/M 99201-99215, because they are presenting with a specific problem/condition.


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## mkmgt001

Very good point.


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## mitchellde

If it truely is for preventive purposes, then I would assume it is a screening encounter which for derm a screeing would be a hands on exam so yes regular office levels.  If you use the preventive and the patient has a benefit of one preventive per year then they will be unable to have their comprehensive preventive visit covered.


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## mkmgt001

Another very good point!!


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## SylviaW

Dermatological visits are not preventive visits.  I would suggest for you to inform patient to contact insurance of what does this insurance refers to exaclty as "Comprehensive preventive visit."   
Most insurances cover 100% each year or two for "comprehensive preventive visit/care," but NOT in dermatology department. 

Derm MD performs FULL body exam, but it's not preventive.  There are different rules and regulations on preventive visits in certain settings.  Internal Medicine vs. Dermatology, two different thing.  

Most likely if this patient is NEW patient to your Derm MD then yes it be appropriate to use CPT 9920x.   
Or, if patient is EXISTING/returing to Derm patient within past 3 years then you can bill CPT 9921x if E/M performed.

Hope this helps.  I work in Derm clinic.   

Thank you, SW


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## dbryant

*Dermatology Preventive Billing*

I am a Dermatology billing operations manager (M.A.,CPC,CPC-H) and I agree with 
SYlWil0109.  Derm does not bill preventive medicine visit codes. Maybe a yearly full body skin exam. The code choices you want to biil 99381 - 99387 or 99391 - 99397 would be inappropriate for dermatology. I would suggest in the range 99201 - 99215 as well. 

Hope this helps!  

Thx 

DB


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## LTPerez

*full body skin exam*

Is a documented FBSE automatically coded as a 99214?


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## mitchellde

NO... Any visit to be coded at a certain level must meet the documentation requirements for that level. There is no automatic level choice.


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## JesseL

Do we use the V code screening for skin cancer and then v code for family history of melanoma?  I have a patient like this atm and not sure do I bill an E/M with the v screening and history code or do I code the diagnosed findings.


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## mitchellde

JesseL said:


> Do we use the V code screening for skin cancer and then v code for family history of melanoma?  I have a patient like this atm and not sure do I bill an E/M with the v screening and history code or do I code the diagnosed findings.



If the purpose of the encounter is screening of an a symptomatic patient then the screening V code is first listed followed by any relevant risk factors such as family hx then if there are and findings they would coded last.


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## JesseL

The patient didnt come with any symtoms.  She just wanted an annual skin exam because of family history of skin cancer.  Does that mean no v codes? Just code findings?


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## mitchellde

It reads like screening, so code screening for skin first (V code) followed by family history(V code) followed by findings.


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## JesseL

mitchellde said:


> It reads like screening, so code screening for skin first (V code) followed by family history(V code) followed by findings.



Do I bill the E/M with modifier 33 even though skin cancer screening is not grade A or B under USBSTF?
http://www.uspreventiveservicestaskforce.org/uspstf/uspsabrecs.htm


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## JesseL

I also found an article from aad that we can bill for preventive in derm... http://www.aad.org/file library/unassigned/dcc_summer_11_final.pdf

I think some carriers do see skin cancer screening as preventive... Just most dont?


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## CatchTheWind

It seems from what I read in the AAD article that if the patient uses his annual preventive screening exam with us, then he cannot have one with his general practitioner.  ("Usually an insurance carrier will only pay one preventive medicine service per year. If the patient requests these preventive visit codes to be used, have the patient sign a financial liability waiver.")  So it's hard to imagine how an ethical dermatologist could justify "using up" his patient's one and only comprehensive screening visit of the year on a single-system exam.  

My take on the issue of patients coming in for skin screening visits is as follows:
1) If the patient has a history of skin cancer, then this is a billable office visit (992xx) with V10.82 or V10.83 as the first diagnosis.  
2) If they have no skin cancer history, and there are some positive findings on exam which are managed non-surgically (ie: reassurance, counseling, prescription, etc.) then this is a billable office visit (992xx) and those positive findings are the diagnosis.
3) If they have no skin cancer history and entirely negative findings on the exam (or the only positive findings are treated with biopsy or other surgery at the time of visit), then there is nothing billable (unless you use the annual preventive visit which, as discussed above, I don’t think any of us would do).  I would code it as a regular office visit (992xx) with V82.0 as the diagnosis and either write it off as a courtesy or collect payment up front from the patient as a non-covered service.  (Note that Medicare allows you to collect non-covered services from the patient , and explicitly lists V82.0 as one of these services.  See “ Medicare National Coverage Determinations (NCD) Coding Policy Manual and Change Report January 2013” page 5.)


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## sarahandross@rocketmail.com

As a derm coder a lot of insurance companies here in Michigan are covering services in full when a V code is billed in conjunction with an office visit. Such as a V71.1, V108.2, V108.3 etc. Most insurance companies have a list of preventative diagnosis codes and will cover the visits in full when these diagnoses are used =) This is of course by policy but we too were told by many insurance reps for our drs that a preventative visit is not billable for a derm. Just my 2 cents.


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