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Karen Posted 3 month(s) ago
My provider is a primary care physician who is purchasing a dermascope for the office. We were wondering if we are able to bill for dermascopy, and if so, what cpt code would be used.
SuperCoder Posted 3 month(s) ago

Hi,

 

Dermoscopy is a technique that may be utilized to see patterns and structures in lesions that are not perceptible to the naked eye, and is also known as dermatoscopy. 

 

Some payers consider this medically necessary when used for evaluation of members with a history or close family history of any of the following conditions:

1. Atypical nevi
2. Dysplastic nevi
3. Melanoma
4. Non-melanoma skin cancers


Many payers considers dermoscopy experimental and investigational for all other indications because their effectiveness for indications other than the ones listed above has not been established.

 

So you should confirm with your payers before billing it.

 

Please feel free to write if you have any questions.

 

Thanks.

Karen Posted 3 month(s) ago
What would be the billable CPT code?
SuperCoder Posted 3 month(s) ago

Hi,

 

I am sorry, I missed the code. Code 96904 should be used for dermoscopy if selection criteria are met.

 

Thanks.

Karen Posted 3 month(s) ago
The code states "Whole body photography". Do you think they say that just to include all body areas? For example, if my provider just views a lesion on the arm, will this code still be billable for that? Hope that makes sense, thank you!
SuperCoder Posted 3 month(s) ago

Hi,

 

If your provider views a lesion on the arm, then it will not be paid because dermoscopy is considered as experimental or investigational and cannot be billed separately.

 

Thanks.

Posted by Karen, 3 month(s). There are 6 posts. The latest reply is from SuperCoder.

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