With the prevalence of electronic health records (EHR), adequate and proper documentation and coding has become an important aspect of modern medicine. Although documentation in the form of electronic records carry benefits such as ease of inter-physician communication and legibility (for some reason a doctor’s handwriting is always tough to decipher) it can also pose coding risks. Some EHR systems automatically calculate the procedure codes and level of service based on the documentation provided which may lead to incorrect or inadequate coding. It is worth remembering that irrespective of how the coding is generated (either by the EHR or billing professional), the responsibility ultimately lies with the physician.
Dermatology Coding Challenges
One of the more complex and intricate specialty in the coding and billing world is dermatology coding. Unique aspects such as sizing wounds and lesions and the vast number of terms that need to be memorized; makes dermatology coding extremely difficult and fraught with problems of inadequate or incorrect coding. In addition, dermatology coders must be able to identify repairs (simple, intermediate and complex) and understand terms associated with sizing (length, depth, width, and circumference). Add to this the requirement of being familiar with actions such as shaving, destruction, and performing biopsies.
An unclear description provided by the physician of the procedure performed will find even the best of coders struggling. If unsure, a coder must always ask the physician for clarification before coding the procedure. Using accurate and appropriate coding will expedite reimbursement. Incorrect or inadequate coding can lead to delayed payments, scrutiny or investigation for fraud. Using the correct codes can mean the difference between getting audited and getting paid.
Dermatology Coding Tips
The trick to dermatology billing and coding is to be accurate and avoid common mistakes such as those listed below:
- Understand the difference between a biopsy, a shave and an excision.
- Never overbill for excisions or under-bill for re-excisions.
- Do not upcode destruction of benign lesions
- Do not undercode destruction of malignancies
- Don’t submit claims for excisions until you’ve reviewed the pathology report
- Only base codes on what is known at that particular time
- Remember that billing insurance for cosmetic removal of lesions could be deemed fraudulent
- Know when to use modifiers.
Medical Coding Modifiers in Dermatology
Applied to either CPT (Current Procedural Terminology) codes or E/M (Evaluation/Management) codes, modifiers are codes that communicate specific information to the insurance carriers. While it is important to understand the role of modifiers in dermatology due to the variety of procedures, using modifiers is one of the least understood areas in dermatology coding. This has become even more confusing with the introduction of the new HCPCS modifiers in 2015 to replace modifier 59. Given below are some of the most commonly used modifiers in dermatology.
Modifier – 25
Modifier 25 is one of the most frequently used and poorly understood modifiers in dermatology. According to Current Procedural Terminology (CPT), one should use the modifier -25 to identify “significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service.” However, modifier 25 is often attached to any E/M code if a procedure is performed in the same visit. This can result in an audit as modifier 25 can only be applied to E/M codes. You have to separate a procedure from a visit to apply modifier 25 correctly.
Modifiers – 24 and 79
Modifier 24 indicates a separate E/M encounter during a postoperative period of a prior performed procedure where as modifier 79 indicate a separate and unrelated procedure during a post-operative global period.
Modifier – 59
A procedure or service was distinct or separate from other services performed on the same day is indicated with a 59 modifier. The overuse of modifier 59, lead to CMS developing four new modifiers in 2015 – the XS, XP, XU, and XE, and can be used in place of “59”.
How can MedConverge help?
Our certified and experienced coders and billers are proficient with ICD-10, ICD-9, CPT and HCPCS coding systems specific to dermatology and can help you through the dermatology coding and billing minefield. For more information on our dermatology billing services, contact us on: firstname.lastname@example.org
- Gary N. Fox, M. a.-P. (2013, January). 12 Errors to Avoid in Coding Skin Procedures. Retrieved November 09, 2018, from www.aafp.org: https://www.aafp.org/fpm/2013/0100/p11.html
- Lindsay Strowd, M. (2015, January 25). Billing, Coding and Documentation: A Primer on Dermatology Billing and Coding Guidelines . Retrieved November 09, 2018, from www.the-dermatologist.com: https://www.the-dermatologist.com/content/billing-coding-and-documentation-primer-dermatology-billing-and-coding-guidelines
- Lindsay Strowd, M. (2016, February 17). Understanding Coding Modifiers. Retrieved November 09, 2018, from www.the-dermatologist.com: https://www.the-dermatologist.com/content/understanding-coding-modifiers
- Lori-Lynne A. Webb, C. C.-P. (2014, January 08). Documentation challenges for skin and dermatology coding. Retrieved November 09, 2018, from www.hcpro.com: http://www.hcpro.com/HIM-299742-8160/Documentation-challenges-for-skin-and-dermatology-coding.html