Wiki Cosmetic Skin Tag

[L.sanford14]

Hello all,

I work at a dermatology practice outside of Chicago. We were talking about skin tag procedures and policies regarding them. If a patient comes in for skin tags, and it is deemed a cosmetic procedure can the provider evaluating the skin tags originally bill an office visit? If the provider removes the skin tags cosmetically and charges a cosmetic fee for the removal, can she/he then bill the office visit for the evaluation of the skin tags on top of the cosmetic removal? We have been going back and forth about which is the appropriate and best way to bill this and just wanted to get other opinions on the topic.

It would seem that if we billed the skin tags only as medically necessary, we wouldn't be able to bill an office visit charge since the removal was all that was performed. However, is it separated enough that removing the skin tags cosmetically is separately identifiable as a procedure as is the evaluation of the skin tags? Any advice/thoughts would be greatly appreciated!

 

[CatchTheWind]

I would not bill the office visit for two reasons:

1) The work involved in cosmetically treating a skin tag should is the same as the work involved in treating a medically necessary removal. Since the evaluation is included in the work of a medically necessary removal, it should be included in the work for a cosmetic removal.

2) Regardless of whether or not the skin tag was treated - even if it was only evaluated - there would be justification for billing an office visit ONLY if the provider had to evaluate whether or not there is a medical problem. So if the patient complains of a "lesion" or "spot" and the provider has to diagnose it as a skin tag (versus perhaps something malignant, contagious, painful, etc.) that would be a medically necessary visit. But if the provider KNOWS that the patient has a skin tag and the patient comes in just to discuss how it can be treated, I would consider this a "cosmetic consult," which would not be billable to insurance.

 

[douglaCD]

Hello all,

I work at a dermatology practice outside of Chicago. We were talking about skin tag procedures and policies regarding them. If a patient comes in for skin tags, and it is deemed a cosmetic procedure can the provider evaluating the skin tags originally bill an office visit? If the provider removes the skin tags cosmetically and charges a cosmetic fee for the removal, can she/he then bill the office visit for the evaluation of the skin tags on top of the cosmetic removal? We have been going back and forth about which is the appropriate and best way to bill this and just wanted to get other opinions on the topic.

It would seem that if we billed the skin tags only as medically necessary, we wouldn't be able to bill an office visit charge since the removal was all that was performed. However, is it separated enough that removing the skin tags cosmetically is separately identifiable as a procedure as is the evaluation of the skin tags? Any advice/thoughts would be greatly appreciated!

Morning!

This is a difficult question to assist with because I feel that this is very subjective. I think initially it is okay to bill an E/M for the consult. However, if the provider acknowledges and more importantly, if the provider documents the b9 nature of a lesion prior to a patient returning for excision/destruction then, we [you] shouldn't be billing another E/M code. Especial if after the patient has returned and the dx has not changed.

My opinion

Christina D