Reader Question: 17110 Is Better Choice for Common Wart Removal   (August 2011)

Question: The physician used a laser to remove five lesions of verruca vulgaris on a patient. All lesions were buccal sulcus or membrane. Should I use 17110? Or is 40810 x 5 a better option?
California Subscriber
Answer: Stick with 17110 (Destruction [e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement], of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions) since the diagnosis is common warts (verruca vulgaris) or 078.10 (Viral [...]

Reader Question: Multiple 69100s Cover Multiple Punch Biopsies   (August 2011)

Question: Can we code multiple punch biopsies on a single claim? Our dermatologist sent 11 punch biopsies of the patient’s right ear to pathology for testing.
New Hampshire Subscriber
Answer: Yes, you can code multiple punch biopsies on the same claim; just list each on a separate line to clarify the procedure for your carrier. Report 69100 (Biopsy external ear) for the first punch and append modifier 59 (Distinct procedural service) for biopsies 2 through 11. You [...]

Reader Question: Steer Clear of ‘Seen and Agreed’ Note or Face Denials   (August 2011)

Question: Our physician works with residents each year. It’s very time consuming, but he does review their documentation and indicates whether he agrees with their findings. He doesn’t use a rubber stamp – he actually writes, “Seen and agreed” on the chart before he signs it. A consultant told us during an audit that documenting this way is unacceptable. Can you explain the problem?
California Subscriber
Answer: The consultant is correct. Although you’re correct in knowing that a [...]

Reader Question: Know When to Bill Secondary Payer   (August 2011)

Question: We have many patients with secondary insurance, some of which have deductibles on the secondary. In these cases, should we write off the amount of the deductible because it’s secondary, or do we bill the patient?
Virginia Subscriber
Answer: Most practices do bill the secondary insurance on behalf of patients, but if the patient has a deductible on the secondary insurance, you can and should bill the patient that amount.
You can find out about secondary [...]

Reader Question: Get Payer Advice in Writing Regarding Employee Copays   (August 2011)

Question: My physicians are looking at giving employees a courtesy for their co-pays but want something in writing stating it’s okay. Is this practice acceptable?
Kansas Subscriber
Answer: The only thing you can get in writing that will hold up is something from the payer(s) that the employees have insurance coverage with and that your providers purchase your employee insurance from.
Bottom line: If that payer says it is okay – in writing – your doctors can waive the co-pays. [...]

Reader Question: 12001-12007 Closes the Deal for Dermabond Closure   (August 2011)

Question: An established patient visited our office because of severe hyperkeratosis affecting both feet. The physician asked the patient to return a week later because we didn’t have Dermabond supplies in stock. The patient returned, and the dermatologist applied Dermabond to several skin cracks on her feet. How should we code the second encounter?
Wisconsin Subscriber
Answer: You can report and bill for the closure and supplies. Because the physician treated the problem with only Dermabond, you’re [...]

Reader Question: 90058 May Help You Collect Extra for Emergency Walk-Ins   (August 2011)

Question: We recently hired a new dermatologist who is questioning whether we can bill any extra codes for a walk-in established patient. He told us that his previous practice was able to collect for the office visit code and 99058. Is this accurate?
West Virginia Subscriber
Answer: Many practices do collect for 99058 (Service[s] provided on an emergency basis in the office, which disrupts other scheduled office services, in addition to basic service) when billed with office [...]

Lesion Repair: 13100: Layers Plus Complexity Brings Home More Pay   (July 2011)

Dig deeper to find the key to ’simple,’ ‘intermediate,’ and ‘complex’ closures.
Getting the wrong repair code could cost your practice plenty – for instance, you’d lose $214 for a 2.5 cm complex trunk closure wrongly billed as a simple trunk repair. And considering that some procedures include simple closure but allow you to separately bill for complex closure, you stand to lose even more if you don’t distinguish repair complexity.
Read on for our experts’ advice on [...]

Diagnosis Coding: Follow These 4 Steps to Master 940-949 Burn Diagnoses   (July 2011)

Proper ICD-9 coding for burn patients can require several codes.
Dermatology coders who cannot choose the proper diagnosis codes for each burn treatment patient could end up costing their practices time and money.
How? Let’s say your dermatologist provides local burn treatment for a patient (16000, Initial treatment, first degree burn, when no more than local treatment is required). If the claim contains an inaccurate burn diagnosis code, or no diagnosis code at all, the insurer could [...]

Version 5010: Get Your Practice Ready For the Upcoming Version 5010 Challenges   (July 2011)

The 2012 implementation deadline won’t change, so now’s the time to start preparing.
Over the next few years, the entire healthcare industry – including physician practices, hospitals, and payers – have the potentially overwhelming task of preparing for two industry initiatives: compliance with CMS-mandated HIPAA transaction standards and converting to ICD-10.
Many have compared implementation of these two initiatives to the Year 2000 (Y2K) initiative from more than a decade ago. However, industry experts suggest the HIPAA 5010 conversion [...]