Elnora2009
New
Is anyone able to confirm if skin checks/exams are considered preventative? Can the Dermatologist bill an E&M for a preventative skin check? Thank you in advance.
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Wiki Skin Checks
- Thread starter Elnora2009
- Start date
nkrush12
Networker
Per the USPSTF , skin cancer screening is not preventive. Last recommendation was that the USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of visual skin examination by a clinician to screen for skin cancer in adults. It should be noted that this is currently under review but a final new statement has not been released. If you visit your specific insurance website and review member resources for preventive services, you will also find similar information.
Preventive EM codes are for age/gender comprehensive physical and exam. We typically use DX Z12.83 as the secondary or primary code depending on insurance. For instance, Delta employees under UHC are allowed one derm visit each year to be paid under their preventive benefits but we still use our OV em codes 99202 - 99215
Preventive EM codes are for age/gender comprehensive physical and exam. We typically use DX Z12.83 as the secondary or primary code depending on insurance. For instance, Delta employees under UHC are allowed one derm visit each year to be paid under their preventive benefits but we still use our OV em codes 99202 - 99215
KKWood
New
Most insurance payers only allow one preventative exam a year. Think Medicare's Wellness Visit or Blue Cross Blue Shields "Healthy You" ....a skin check does not cover all of the preventative services and measures and is therefore, not billed as a preventative visit. If a patient wants a skin check we normally bill Z12.83 if there is no HX of skin cancer and an OV E&M code.
sboras
New
I’m having a hard time with these as well because as far as I know there is no CPT code for preventative skin check, so preventative diagnosis would be the only way to identify it. Even with Z12.83 primary diagnosis it’s not being covered as preventative by the insurances.
thomas7331
Guest
You're correct that there's no code for this service, so technically it should be submitted with an unlisted code, e.g. 99499. But you might want to have a discussion with your providers. Often when patients see a dermatologist for a 'skin check', there's usually some concern that they have about a part of their skin - some kind of lesion or discoloration that they want to have looked at to make sure it's nothing serious. If that's the case, and it's documented appropriately, then it's not a preventive service and can be billed as a regular office visit.
If the patient truly has no concerns at all, then they shouldn't be taking up a specialist's time to get their skin checked - this can be done by their primary care physician as part of their comprehensive annual physical, and that provider can refer them to a dermatologist if something is identified that is of concern and needs further evaluation. Payers are right to deny these services - as mentioned in the post above, a skin cancer screening has not been shown by the USPSTF to be an effective use of healthcare resources.