Excisions: Use 3 Steps to Ethically Add $37 to This Excision Claim   (July 2010)

Measurement, report, location ensures coding accuracy.
Patience is a virtue, particularly when it comes to coding lesion removal.
Waiting for the pathology report to come back is critical for choosing the correct benign or malignant excision set. Use these steps to prevent mislabeling a patient and assigning a lesser paying code.
Step 1: Encourage Your Dermatologists to Measure First
You should select the appropriate lesion excision size code based on the physician’s  report. “If the physician doesn’t measure the [...]

E/M: New or Established? Answer Wrong and It Could Cost You   (July 2010)

Remember, what used to be a consultation is now likely a 99201-99215 service.
Dr. Derm provides a new patient with a standard office-visit E/M. You use an established patient E/M to code the encounter.No big deal, right?
Wrong: Not only is the coding incorrect, but this mistake will cost your practice deserved reimbursement. Further, Medicare’s deletion of consultation codes means that coders will have to answer the new vs. established question more often than before. For Medicare [...]

Part B Payment: Part B Claims Remain in Holding Pattern Through June 17   (July 2010)

MACs won’t process June claims until June 18, in hopes that Congress acts by then.
The Senate’s delays could mean serious payment crunches for your dermatology practice. In June, the freeze that has been keeping the Medicare conversion factor at 2009 levels expired, meaning that Part B practices were due to face a 21 percent cut effective for dates of service June 1 and thereafter. Because Congress had not yet intervened to stop those cuts, CMS [...]

You Be the Coder: Laceration Repair With Dermabond   (July 2010)

Question: The dermatologist treats an established 18-year-old patient who has a long, but superficial, cut on his forehead just above the brow. Using Dermabond, the dermatologist closes the 10.2 cm cut. How should I code wound closures with Dermabond? Is this an E/M, or a laceration repair?Michigan Subscriber
Answer: For this patient, and most patients your dermatologist will treat, a laceration the dermatologist closes with Dermabond is a procedure. On the claim, report the following:12015 [...]

Reader questions: Check Payers for Removal of Benign Lesions   (July 2010)

Question: Recently, our practice has been getting more denials for the removal of benign skin lesions, and I’m not completely sure why. What guidelines should we follow?
Virginia Subscriber
Answer: Many insurance companies question the “medical necessity” of benign lesion removal. Many times, the request is for cosmetic reasons, so without documentation indicating the medical reason to remove a lesion, the insurance company denies the request. However, in many cases, the patient’s insurance policy does not cover [...]

Reader questions: Remember to Represent Pressure Ulcer’s Stage   (July 2010)

Question: An established elderly patient reports to the dermatologist for inspection of sores on her back. The dermatologist diagnoses a stage I pressure ulcer on her lower back. How should I report this diagnosis?
Indiana Subscriber
Answer: You should submit a pair of codes; one to represent the stage of the pressure ulcer, and another for the ulcer itself. On the claim, report the following:99213 (Office or other outpatient visit for the evaluation and management of an [...]

Reader questions: Collect Medicare Copay Up Front   (July 2010)

Question: We have many patients on Medicare in our practice. When a Medicare patient presents, can we collect the 20 percent coinsurance at the time of the visit, or do we need to wait until we receive payment from Medicare itself?
Louisiana Subscriber
Answer: If you are a participating Medicare practice, you should be able to collect the standard 20 percent copayment of the Medicare participating fee schedule upfront in most situations. You cannot charge in excess [...]

Reader questions: Report 11201 for 15+ Skin Tags   (July 2010)

Question: What should I report for freezing of skin tags? At first I considered the destruction code, but my desk reference says that is only cutting or electrodessication, and doesn’t list cryosurgery for skin tags.
Minnesota Subscriber
Answer: Report code 11200 (Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions) for the removal of up to 15 skin tags (fibrocutaneous tags). If the dermatologist removes more than 15 tags, report +11201 [...]

Reader questions: Code E/M With Wart Removal   (July 2010)

Question: A 12-year-old male presents to our dermatologist with complaint of a bump on his foot. The patient reports that he has had the lesion for six months. He has pain when walking and playing sports. The patient tells the dermatologist that the lesion feels better after the patient soaks in the bath tub. The dermatologist documents that the wart is 2 cm in diameter and depth, has no edema, and there is no redness [...]

Reader questions: Append 59 to Indicate 2 Surgical Sites   (July 2010)

Question: Our dermatologist excised two benign lesions – one on the shoulder and the other on the abdomen. He also removed an actinic keratosis from the patient’s face. CCI bundles 11400 and 17000 as mutually exclusive. Does this mean I can only report 11400 x 2 and not 17000?
Oregon Subscriber
Answer: You can report both in this case, since there were two separate surgical sites. Even though 11400 (Excision, benign lesion including margins, except skin tag [unless [...]