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Dermatology Coding Alert

Lesion Removal:
11443 or 11441? Measure Correctly and Add $54 to This Excision Claim
Timing is everything for coding accuracy.Waiting for the pathologist to measure an excised... Read more
CPT 2011 Update:
11042-11047 vs. 97597-97602: Focus on One Thing, Not Factors
Hint: Reserve debridement codes for deeper wound care.Confused about when to choose a debr... Read more
Diagnosis Coding:
6 Steps Pave the Way to Audit-Hardy Coding
Precise coding doesn't require an overly-detailed coding policy.An ICD-9 coding policy can... Read more
News You Can Use:
Congress Boosts Conversion Factor Through Dec. 31
Medicare Physician Fee Schedule rate won't be cut 23 percent.Although the government appea... Read more
Reader Questions:
Avoid Modifiers With +17003
Question: Our dermatologist removed three lesions from a patient's left arm. Should we cod... Read more
Reader Questions:
99441-99443: The Hard Truth about Phone Call Pay
Question: Another physician told my dermatologist that he's receiving payment from his con... Read more
Reader Questions:
Count Supply Cost in In-Office Procedure Pay
Question: My doctors want me to bill for supplies, such as surgical trays, that they use d... Read more
Reader Questions:
Stick With 11600 for Repeat Excision
Question: My dermatologist removed a malignant mole last week, which I reported with 11600... Read more
Reader Questions:
Look to Cause for Bruises
Question: What is the ICD-9 code for "easy bruising"?Answer: Easy bruising is not a diagno... Read more
Reader Questions:
Don't Bill Under Another Provider's ID
Question: A physician in my office wants to bill services under another physician's tax ID... Read more
Reader Questions:
Face Time Is Essential to Established Patient
Question: Our practice performed a test on a patient who was referred to us by another doc... Read more
You Be the Coder:
Multiple Skin Tags
Question: Patient has 30 skin tags. Should we report 11200 for the first 15 lesions and 11... Read more
Ulcer Treatments:
707.00-707.09 Basics: 4 Questions Guide Your Ulcer Reporting
Hint: Know depth and location.When your dermatologist performs a decubitus ulcer excision ... Read more
Modifier Basics:
Follow 3 Rules to Capture Separate E/M Pay
Avoid modifier 25 scrutiny with proper 'separately identifiable' documentation.Reporting a... Read more
25 or 57? Use This Handy Tool to Pick the Right Modifier -- Every Time
Your modifier 25 claims should meet all of the following criteria:The E/M occurs on the sa... Read more
OIG Update:
Practices Collected Over $8 Million for Services Rendered After Patients Died
OIG identified massive overpayments for services rendered after patients' dates of death.Y... Read more
Reader Questions:
11403 and 21930: Should You Measure Lesions the Same Way?
Question: If our dermatologist removes a sebaceous cyst from the back that measures 2.5 x ... Read more
Reader Questions:
CMS Spells Out MD's Role in E/M
Question: I've heard that for an E/M visit, the physician is responsible for certain parts... Read more
Reader Questions:
Biofreeze or Cryotherapy?
Question: A patient came to the office with a bump on her foot; the dermatologist diagnose... Read more
You Be the Coder:
Botox Injection During Global
Question: How should we code if a patient recently had surgery and a Botox injection is sc... Read more
Wound Repair:
14000 Update Helps You Achieve Proper Tissue Transfer Coding in Just 3 Steps
Tip: Don't count on separate lesion removal payment.When your dermatologist performs a wou... Read more
Billing 101:
5 Tips Speed Up New Patient Data Capture
A smart registration process can prevent claim-submission headaches.If you're trying to gr... Read more
E/M:
Scope Out Potential Level 4 and 5 E/Ms By Knowing Crucial HPI Facts
Watch out for CPT/Medicare differences when counting HPI elements.If you're not accurately... Read more
Reader Questions:
Look for Local Treatment to Up Sunburn Pay
Question: A mother brought her child to our office with swelling and minor blisters on the... Read more
Reader Questions:
Look Into Options for Handling Late or No Show Patients
Question: We have a few patients who routinely miss appointments or show up late. We'd lik... Read more
Reader Questions:
No CCI Bundle? Here's Where to Find Modifier Details
Question: Sometimes I cannot find my two-code pair in the CCI edits. How do I know which c... Read more
Reader Questions:
Apply 'Birthday Rule' to Double-Covered Patients
Question: If a married couple has a baby who becomes our patient, what insurance do we bil... Read more
You Be the Coder:
Wart Removal Without Cryo
Question: The dermatologist documented, "Dermatology treatment rendered in the form of deb... Read more
CCI 16.3Update:
Include Wound Repair in Free-Flap Grafts or Risk Denials
Also: Watch for new debridement and recipient site prep bundles.If you're in the habit of ... Read more
Diagnosis Coding:
Eliminate 'Uncertain Behavior' Confusion With Expert Tips on 238.2 Use
Hint: Wait for the path report to avoid payer scrutiny.If you always use diagnosis code 23... Read more
Documentation:
Watch Out: Nurse's History Note Might Be Audit Bait
The physician must indicate that he reviewed any nurse's notes.Warning: Don't let your nur... Read more
Get to Know Signature Requirements
On June 16, CMS updated its signature requirements, outlining the rules that you must foll... Read more
Reader Questions:
15788 Takes the Burn Out of Chemical Peel Pay
Question: Our dermatologist used glycolic acid to remove actinic keratoses from around a p... Read more
Reader Questions:
Use NOS Codes to Report Unknown Skin Rashes
Question: We recently treated a patient for a skin rash that seemed to be an allergic reac... Read more
Reader Questions:
Stop Omitting 25 Because of Same Dx
Question: I was recently told in a class that you do not need different diagnosis codes to... Read more
Reader Questions:
50 Percent Is the Modifier 22 Rule of Thumb
Question: If the physician states a large area was debrided and the debridement codes are ... Read more
Reader Questions:
Include Prescription Writing In E/M
Question: I heard that there's a code we can bill to indicate when our dermatologist write... Read more
You Be the Coder:
Live Tick Removal
Question: How should I submit the following claim: A patient with a tick embedded in his s... Read more
Patch Tests:
Include These Critical Elements in Your Next Dermatitis Exam
Don't bypass modifier 25 or else forfeit pay for patch tests.If you've missed out on patch... Read more
Checklist:
Separate Your Documentation To Ease Modifier 25 Claims
To append or not to append? Keep this checklist nearby to lead you to the answer.-- T... Read more
Consolidated Billing:
3 Simple Steps Put You on the Path to Capturing Payment for Your Nursing Facility Services
Determining whether a patient is in a Part A or Part B stay is your key to proper reimburs... Read more
Clip and Save:
Overcome Consolidated Billing Troubles With an SNF Contract
Best bet: Use one for every SNF your provider works with.To receive payment for the techni... Read more
Correction:
Correction:
An article in Dermatology Coding Alert Vol. 6, No. 6, "Code E/M With Wart Removal," incorr... Read more
Reader Questions:
Write Off Pay for Selective Debridement
Question: Can our in-office nursing staff report 97597-97598 for selective debridement? I'... Read more
Reader Questions:
Watch Closures With Fascia Excisions
Question: Our dermatologist re-excised a melanoma with an area that was 12 cm long and 3.5... Read more
Reader Questions:
Tackle Consultations on a Payer-By-Payer Basis
Question: I am still a little confused about the consultation codes 99241- 99245 and 99251... Read more
Reader Questions:
76880 Solves Your Ultrasound Conundrum
Question: Which code should I report when the dermatologist performs an ultrasound of a sk... Read more
Reader Questions:
Report Collagen Skin Tests With Q3031
Question: A patient came to us for her first collagen injections. The dermatologist perfor... Read more
You Be the Coder:
Acne Steroid Injections
Question: Our dermatologist injects an acne cyst with 0.05 cc of Kenalog. How should I cod... Read more
Skin Procedures:
Follow 3 Steps to Find the Right Code for These 3 Integumentary Procedures
Key: Let method drive your biopsy-versus-destruction coding.You can more easily determine ... Read more
Evaluation and Management:
Scope Out Potential Level 4 and 5 E/Ms By Knowing Crucial HPI Facts
Watch out for CPT/Medicare differences when counting HPI elements.If you're not accurately... Read more
Recovery Audit Contractors:
Stay on Top of RAC Requests to Meet All Deadlines
RACs ID insufficient documentation as weakness among practices.Recovery audit contractors ... Read more
News You Can Use:
Welcome a 2.2 Percent Medicare Pay Boost For the Rest of This Year -- Finally
But the news isn't all good -- first, you faced a week of lower payments, and second,... Read more
Reader Questions:
Depth and Location Matter Most for Lipomas
Question: Recently, our dermatologist excised 18 lipomas from a patient's right arm, and 1... Read more
Reader Questions:
Forget Bilateral Modifiers for Verrucae
Question: If a patient has bilateral verrucae (078.19) and the doctor treats two sites, on... Read more
Reader Questions:
You'll Get Mixed Signals on Complex Closure With Soft Tissue Tumor
Question: Based on the CPT description and notes, it appears that the new soft tissue tumo... Read more
You Be the Coder:
Carcinoma Excision With Tissue Transfer Closure
Question: My surgeon excised a carcinoma of the face. He closed the excision using adjacen... Read more
Excisions:
Use 3 Steps to Ethically Add $37 to This Excision Claim
Measurement, report, location ensures coding accuracy.Patience is a virtue, particularly w... Read more
E/M:
New or Established? Answer Wrong and It Could Cost You
Remember, what used to be a consultation is now likely a 99201-99215 service.Dr. Derm prov... Read more
Part B Payment:
Part B Claims Remain in Holding Pattern Through June 17
MACs won't process June claims until June 18, in hopes that Congress acts by then.The Sena... Read more
Reader questions:
Check Payers for Removal of Benign Lesions
Question: Recently, our practice has been getting more denials for the removal of benign s... Read more
Reader questions:
Remember to Represent Pressure Ulcer's Stage
Question: An established elderly patient reports to the dermatologist for inspection of so... Read more
Reader questions:
Collect Medicare Copay Up Front
Question: We have many patients on Medicare in our practice. When a Medicare patient prese... Read more
Reader questions:
Report 11201 for 15+ Skin Tags
Question: What should I report for freezing of skin tags? At first I considered the destru... Read more
Reader questions:
Code E/M With Wart Removal
Question: A 12-year-old male presents to our dermatologist with complaint of a bump o... Read more
Reader questions:
Append 59 to Indicate 2 Surgical Sites
Question: Our dermatologist excised two benign lesions -- one on the shoulder and the... Read more
You Be the Coder:
Laceration Repair With Dermabond
Question: The dermatologist treats an established 18-year-old patient who has a long, but ... Read more
Wound Repair:
3 Tips Help You Recover Your Full Debridement Pay
Maximize 11040-11044 pay with modifier 51.In most cases, your practice won't report debrid... Read more
E/M:
How Much ROS Documentation Is Enough?
Keep sufficient paperwork on hand to back up EHR.Transitioning to the world of electronic ... Read more
Definition:
Brush Up on What Constitutes ROS
Document systems like CMS counts them.CMS has specific guidelines regarding how physicians... Read more
Compliance; Curb Upcoding Mistakes Before You Run Afoul of the OIG
Practice size does not matter when dealing with compliance -- even solo practitioners... Read more
Reader Question:
Make 948 Your Burn Coding Constant
Question: Our general surgeon treats burn victims, and I'm wondering about diagnosis codin... Read more
Reader Question:
Ensure Your EHR Passes PQRI Muster
Question: We have been participating in the physician quality reporting initiative (PQRI),... Read more
Reader Question:
Modifier 59 Doesn't Override Payment Reduction
Question: When I remove one lesion and biopsy another with an uncertain nature, Medicare p... Read more
You Be the Coder; Harvesting of Keratinocytes
Question: How should I code for harvesting of keratinocytes for skin grafts?Texas Subscrib... Read more
FAQ:
4 Answers Clear Up Your Scar Revision and Related Excision Dilemmas
Use modifier 59 for 2-site procedures. Before you try to recoup any scar revision pay, ... Read more
Consult Update:
Work Around Consult Codes When Medicare Is Secondary Payer
Only shrewd payment calculation can salvage lost pay for dermatology consultations. As if... Read more
Reader Questions:
Distinguish Between 15825 or 15828 for Rhytidectomy
Question: The dermatologist in our practice removed excess skin from a patient's neck. I... Read more
Reader Questions:
Diagnosis Doesn't Change Re-Excision
Question: How should we code the re-excision of a benign (as opposed to malignant) lesion... Read more
Reader Questions:
Learn New Use for KX Modifier
Question: I've heard that Medicare has a new way to override genderspecific edits, when a... Read more
Reader Questions:
Condition Doesn't Change Patient Status
Question: Our office saw a patient six months ago for dermatitis, and sent the patient ba... Read more
Reader Questions:
Discover Payer Supply Rules
Question: Can I use 99070 to report the use of supplies at our dermatology office? Iowa ... Read more
Reader Questions:
Infected Ingrown Nails May Be Payable
Question: A Medicare patient presented with a painful ingrown toenail, and our dermatolog... Read more
Reader Questions:
ROS Determines 'Type' and 'Extent' of Exams
Question: When a dermatologist lists an organ system and documents past medical/surgical ... Read more
Reader Questions:
Sequence Procedures According to Complexity
Question: How should I code the following: the physician performed a wide excision of rec... Read more
Reader Questions:
Solve Flaps and Grafts Together
Question: The dermatologist excised a basal cell carcinoma from the patient's right ear. ... Read more
You Be the Coder:
Myobloc Isn't Botox, but Coding Is Similar
Question: How should I report Myobloc injections? Is Myobloc just another name for Botox?... Read more
CCI 16.1 Update:
Reporting Wound Repair and Blepharoplasty Separately? Read This First
Take a second look at your eyelid surgery claims, thanks to the latest edits.Among the tho... Read more
ICD-10:
CMS, AHIMA Reps Aim to Bust ICD-10 Myths With Expert Answers
Hint: You will be able to find hard copy ICD-10 books, CMS confirms.The ICD-10 implementat... Read more
Max Out Burn Claims When You Find 16000, Separate E/M Evidence
Net 16000 pay when 'treatment' occurs.A sunburn can qualify as a burn and result in added ... Read more
Reader Question:
Shelve Excision Codes When It's Just a Shave
Question:A patient with superficial lesions on his right hand reports to the dermatologist... Read more
Reader Question:
Don't Overstate Debridement
Question: When the surgeon performs a wound VAC or cleans a wound by scraping with a sharp... Read more
Reader Question:
Simplify Complex Penile Lesion Destruction
Question: How should I code for laser destruction of penile lesions with CO2 laser when th... Read more
Reader Question:
Extensive Cleaning May Mean a Higher-Level Code
Question:A patient presents with a 1.5-cm laceration of the eyebrow, and the dermatologist... Read more
Reader Question:
Unna Boot Application Includes E/M
Question: Our dermatologist recently applied an Unna boot for a patient with decubitus ulc... Read more
Reader Question:
Clarify 'Other' Code for Merkel Cell
Question: When the dermatologist excises a skin lesion and the pathology report returns as... Read more
You Be the Coder:
HCPCS Code for AVA Cream
Question: When the dermatologist performs photodynamic therapy, can I code separately for ... Read more
Stay Out of These Common Biopsy Coding Pitfalls and Boost Claims Accuracy
Go beyond 11000 to 'site' specific codes, which can net $25 or more. If you automatically... Read more
Unlock Secrets to Deciphering Between 10120 and 10121
4 questions make the difference when it comes to foreign-body removal cases. If you're un... Read more
Marginal Removal Smarts Might Mean Missed Money
Guess what you need to add to total removal area before coding? Lesion excision codes ... Read more
News You Can Use:
CMS to Issue More Guidance on Consult Replacement Codes
Best bet: Follow local guidance until more detailed info comes from Medicare. If you've b... Read more
READER QUESTIONS :
Check Anatomy for Clark's Nevus Diagnosis
Question: The dermatologist's notes state that he removed a "Clark's nevus." What exactly... Read more
READER QUESTIONS :
Code Office Visits, Warts and All
Question: Most of the patients who are having warts removed need to come in several times... Read more
READER QUESTIONS :
Use Neoplasm Dx for Smooth Dermabrasion
Question: How should I code for CO2 laser dermabrasion to treat a basal cell carcinoma? P... Read more
READER QUESTIONS :
3 or 4 HPI Elements Play Big Role in E/M Level
Question: How does a brief history of present illness (HPI) differ from an extended HPI? ... Read more
You Be the Coder :
Does Patch Test Include E/M?
Question: A new patient came to our practice with a red, itchy rash on her arm. Our derma... Read more
CCI 16.0:
Make Adhering to These Tissue Transfer Code Edits Your New Year's Resolution
Check out this matter-of-fact 14301/J2001 edit. Are you using CPT 2010's new skin repair ... Read more
4 Clues Lift the Pressure From Coding Milia Treatments
For benign lesions, numbers -- not size -- matters. Having a hard time reportin... Read more
Answer 3 Questions to Optimize Your Nurse Code Reporting
Be on the safe side by sticking to 99211's coding requirements. If used properly, 99211 (... Read more
Support Your 99211 Use With These Examples
Don't miss out on legitimate opportunities to report 99211. If you do, you could be costin... Read more
READER QUESTIONS:
Confused About Moderate Sedation Codes? Ask This Question!
Question: The dermatologists in my practice sometimes have to perform procedures on a pat... Read more
READER QUESTIONS:
Avoid V Codes When Coding Primary Diagnosis
Question: A patient with a history of skin cancer presents for a total body skin check. T... Read more
READER QUESTIONS:
Documentation Plays Essential Role in I&D Coding
Question: A patient presents to the office with cysts all over her body. The dermatologis... Read more
READER QUESTIONS:
Your Allergy Test Codes Depend on Solution Types Applied
Question: A physician tests a patient, who complains of skin rashes, for reactions to dog... Read more
READER QUESTIONS:
Detail the Number of Excisions to Avoid Missing Out
Question: A dermatologist excised several lipomas on a patient's single forearm in a sing... Read more
READER QUESTIONS:
Let Your Hair Down on Special Dermatological Procedures
Question: What CPT codes apply for PUVA treatment and narrow band treatment? Maine Subscr... Read more
You Be the Coder:
Go For Shave Removal Code If Lesion Is 'Skin Deep'
Question: A patient comes to the office with a 1.1 cm raised brown nevus on the middle, u... Read more
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