READER QUESTIONS: Look to Your Op Note When Reporting 99354   (May 2005)

Question: A patient comes for a routine skin exam. During the exam, the patient tells the dermatologist that a specific mole has been itching and bleeding. The dermatologist spends more time with the patient than a level-two E/M service typically takes (about 10 minutes). What should our claim look like?New Hampshire SubscriberAnswer: In this case, you should report a prolonged service code with the E/M code on this claim. The claim should read:  99212 [...]

READER QUESTIONS: 95044 Can Unite Modifier -25 to E/M Services   (May 2005)

Question: A new patient with a red, itchy rash on her arm comes to our practice. Our dermatologist makes an initial diagnosis of nonspecified contact dermatitis (692.9, Contact dermatitis, NOS). After thorough examination, the dermatologist applies the patch tests the same day and asks the patient to return in 48, 72, and 96 hours for readings. How should we code this?Michigan Subscriber Answer: You should report 95044 (Patch or application test[s] [specify number of tests]) [...]

READER QUESTIONS: 16000 May Include More Procedures Than You Think   (May 2005)

Question: Our dermatologist sees a patient with first- and second-degree burns on her hand. He cleans and dresses the burn but doesn\’t perform debridement. Should I bill 16000 and 16020?Rhode Island Subscriber Answer: No. You should only report 16020 (Dressings and/or debridement, initial or subsequent; without anesthesia, office or hospital, small). A burn usually involves more severe burning in the center - the second-degree burn - and radiates out with less severe burning on the [...]

You Be the Coder: Same Sites Call for Summed Lengths   (May 2005)

Question: A patient with a 1.5-cm laceration on his eyebrow presented to our dermatology practice. Our dermatologist performed an intermediate repair. The patient also had a 3.6-cm forehead laceration that required a simple repair. Should we add these two wound lengths together and then code the intermediate repair, or does each get its own code?New York SubscriberAnswer: In this instance, you should report code 12051 (Layer closure of wounds of face, ears, eyelids, nose, lips [...]

READER QUESTIONS: Do Excision Codes Override 17250? Read On   (May 2005)

Question: A patient presents for a follow-up of an ingrown toenail. The physician finds that the patient now has two ingrown toenails, one on each foot. The physician removed both from each toe and also did a silver nitrate cauterization.I believe that we should report the following codes, but my physician disagrees:     99212  11750  11750 with modifier -50  17250.Would you please tell us the correct coding solution for this scenario? [...]

READER QUESTIONS: Report Preventive and Problem-Related Services   (May 2005)

Question: A new patient presents for a physician/preventive exam. The patient also had three complex problems that the dermatologist spent 45 minutes examining and discussing. My dermatologist dictated two notes: one for the preventive exam and another for the office visit. He wants to bill for a new patient preventive visit and an established patient visit because he discovered the patient\’s three problems while performing the preventive exam. Can we do this?Massachusetts SubscriberAnswer: Proper coding [...]

NCCI 11.1 Update: Add a New Layer to Your Intermediate Repair Claims   (April 2005)

Deletions in the most recent round of edits may pleasantly surprise you When your dermatologist performs layer closures, you can report 12042 with either 12052 or 12053 and receive full pay for each procedure. Background: The National Correct Coding Initiative previously declared these codes as mutually exclusive and bundled 12042 (Layer closure of wounds of neck, hands, feet and/or external genitalia; 2.6 cm to 7.5 cm) with codes 12052 (Layer closure of wounds of face, ears, [...]

Billing Tip of the Month: Follow These 6 Steps to Stay On Top of Your Denials   (April 2005)

Face your fears and grab the denials bull by the horns If you establish a systematic protocol to track all your denials, you should be able to turn those rejections into revenue.Taking care of your billing procedures and the subsequent denials are the key to controlling your practice, says Carole Violette, CPC, CDC, clinical manager at Yakima Valley Dermatology/Derm Attractions in Yakima, Wash.Best practice: Many billing experts recommend that you focus your denial management process [...]

Correction   (April 2005)

The January 2005 Dermatology Coding Alert article \”Get Ready to Change Your Lesion Destruction Reporting\” stated that NCCI 11.0 edits included several mutually exclusive edits for codes 17000 (Destruction [e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement], all benign or premalignant lesions [e.g., actinic keratoses] other than skin tags or cutaneous vascular proliferative lesions; first lesion) and 17004 (Destruction [e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement], all benign or premalignant lesions [e.g., actinic keratoses] [...]

Longer Face-to-Face Time May Justify Higher Pay   (April 2005)

If you report add-on codes, make sure to report an E/M code and avoid denials Prolonged service codes (99354-99359) may hold the key to boosting your pay when your dermatologists spend more than the usual face-to-face time allotted for E/M services. Remember: Prolonged service codes are add-on codes, so you shouldn\’t ever report prolonged service codes alone, coding experts say.Here is a closer look at the prolonged service codes, when to use them, and what [...]