Dermatology practices face distinct medical billing and coding problems due to their specialty. Because dermatology needs both medical and surgical features, dermatology medical billing can be extensive and necessitates a thorough grasp of dermatological CPT codes, modifier usage, and other considerations.
With electronic health records, proper, appropriate coding and documentation have become an increasingly vital element of modern medicine (EHR). While electronic records bring certain benefits to physicians in terms of documentation, including readability and ease of inter-physician contact, they also pose significant coding concerns.
The Most Common Dermatology Billing Codes
The dermatologist billing codes listed below are some of the most widely utilized dermatology practices.
Biopsy of the Skin:
A dermatologist takes skin samples from the body’s surface during a skin biopsy. The cells collected are studied to learn more about certain skin problems or illnesses. Following Cpt, codes are used for a skin biopsy.
Cpt codes (11102–11103): Tangential biopsies such as shave, scoop or curette techniques are conducted with a sharp blade to extract a sample of epidermal tissue, with or without a part of the underlying dermis. Cpt code 11102 deals with a single lesion, whereas 11103 deals with each separate or additional lesion.
Cpt codes (11104–11105): Punch biopsies include using a punch instrument (performed using a circular blade) to extract a full-thickness cylindrical sample of skin.
Cpt codes (11106–11107): Incisional biopsies include using a sharp blade to extract a full-thickness sample of tissue through a vertical incision or wedge, penetrating deep into the dermis and into the subcutaneous region. Subcutaneous fat may be sampled using this approach.
When numerous biopsies are conducted on the same patient on the same day, only one main biopsy code may be recorded, based on the following factors:
- If numerous biopsies are done using the same procedure, record the primary code with the greatest RVUs, followed by the matching add-on code for the remaining biopsies.
- If numerous biopsies are done using various procedures, report the primary code with the greatest RVUs, followed by the add-on code for the remaining biopsies.
Pathology techniques use modern laboratory tests and technology to investigate skin and tissue at the microscopic cellular level.
Pathology CPT codes used by dermatologists range from 88300 to 88332. The following are the most commonly used codes:
CPT code (88304-88305): A pathologist generally evaluates a surgical pathology specimen. Accessing the specimen into the lab, which entails formally accepting the material, studying gross and microscopic aspects of the specimen, and reporting findings, are all part of the examination.
The difference between the above-mentioned codes is that in code 88304 pathologist does level III evaluation, whereas level IV evaluation is done in CPT code 88305.
CPT code 88312: CPT code 88312 or Group I is allocated to a particular stain when screening for microorganisms. The term microbe refers to any organism (e.g., bacteria, fungi, parasites, protozoa) in this usage.
CPT code 88313: When used to highlight glycogen, collagen, mucin, iron, reticulin, copper, and zinc in tissue specimens, code 88313 or Group II is allocated, although it does not cover enzymes, which is code 88319.
CPT code 88314: Pathology and Laboratory / surgical pathology are coded as CPT 88314. This code is often used for specially stained specimen slides to study tissue and frozen specimen processing, including interpretation and report.
In addition, if a particular stain normally reported with 88313 is applied to snap-frozen tissue rather than paraffin fixed tissue, record 88314 rather than 88313.
Laser Therapy Procedures
Laser treatment employs several laser wavelengths to address a wide range of skin diseases and aesthetic goals.
CPT Codes (96920 – 96921): To treat severe inflammatory skin illnesses such as psoriasis, the practitioner employs an ultraviolet B, or UVB, laser. For a treatment area of fewer than 250 cm2, use Cpt code 96920, and for a treatment area of 250 cm2 to 500 cm2, use code 96921.
Evaluation And Management Codes For Dermatology
Dermatology CPT codes for E&M are separated into broad categories: office visits, hospital visits, and consultations.
CPT Codes (99213-99214): Office or another outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: An expanded problem-focused history; an expanded problem focused examination; Medical decision making of low complexity. The only difference between the above-mentioned codes is that 15 minutes are spent face-to-face with the patient and family in code 99213, whereas 25 minutes are spent face-to-face with the patient and family according to code 99214.
Skin lesion removal is a treatment or operation used to eliminate skin growths. A skin lesion may be excised if it is excessively large, unpleasant, or uncomfortable. Alternatively, a lesion may be removed if it is malignant or precancerous. The doctor frequently removes superficial skin lesions during a normal appointment.
CPT Code 17000: This code includes the destruction of premalignant lesions via chemosurgery, cryosurgery, electrosurgery, or others. This value indicates the removal of the first or only lesion.
CPT Code 17003: The physician kills a premalignant lesion using treatments such as chemosurgery, cryosurgery, electrosurgery, or others in this add–on operation. This code is implemented to the second through the fourteenth lesion destroyed in an encounter, with one unit indicating a single lesion.
CPT Code 17110: The provider uses chemosurgery, cryosurgery, electrosurgery, and others to remove benign lesions. This code denotes the removal of one to fourteen lesions that are neither skin tags nor cutaneous vascular proliferative lesions.
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