Dermatology Coding Alert

Question: A patient with a history of skin cancer presents for a total body skin check. The dermatologist noted no tumor, but one pre-cancer lesion. What code should I report for the visit and diagnosis?

Wyoming Subscriber

Answer: You should code the E/M as follows: 99212 (Office or other outpatient visit for the evaluation and management of an established patient ... Physicians typically spend 10 minutes face-to-face with the patient and/or family), appended with modifier 25 (Significant, separately identifiable evaluation and management service on the same day of a procedure or other service). In addition, use 702.0 (Actinic keratosis) as the primary diagnosis for the AK with the procedure code, and V10.83 (Personal history of other malignant neoplasm of skin) as a secondary diagnosis. 

Remember: Many insurance carriers do not like screening V codes, so you should use them as primary diagnoses when your dermatologist finds no other diagnosis. Also, make sure you indicate in your report that the patient has a history of BCC (basal cell carcinoma) or SCC (squamous cell carcinoma).