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DERMATOLOGY MEDICAL BILLING FOR PHYSICIST

Jun 15

The largest organ in the body is the skin. It is the primary means the human body communicates with the outside environment. Dermatological research has evolved in recent decades to treat a variety of problems using a variety of treatments due to the skin's exposure to so many possible pathogens. Medical billing specialists specializing in dermatology medical billing and coding are well-versed in the ins and outs of each procedure and diagnosis in terms of payment. Third-party payers view some dermatological services as cosmetic, whereas others, such as basal cell carcinoma excision, are unquestionably life-saving.

No one claims that dermatologists' services aren't beneficial to patients. Still, dermatologists identify some procedures and conditions that aren't regarded as critical medical services for preserving function or improving health.

Because dermatology medical billing has changed so much over the years, it can be complicated to grasp. It needs a detailed explanation of skin sores, including the lesions' location, size, and number. Dermatology medical billing also requires meticulous documentation of the lesion's biopsy, removal, and excision.

Dermatology has altered quickly, in addition to the ever-changing patterns of insurance and payment policies. Dermatology has become more than just a medical and surgical specialty. It now comprises a wide range of cosmetic procedures.

To prevent being under-compensated or dealing with audits and fines, a dermatology practice must implement technology, seamless operations, and performance across many service lines. When you outsource your dermatology medical billing to a seasoned service provider, you gain access to a team of skilled professionals in end-to-end billing.

Skin tag removal (CPT 11200 and 11201) is generally considered a cosmetic operation, and most commercial insurers and government health programs do not cover it. A skin tag is benign hyperplasia of the localized skin and poses no risk to the patient's general health. Based on the recorded diagnosis and purpose for the procedure, a professional medical billing company can analyze the patient record to determine when CPT codes 11000 and 11001 are more correct. Suppose a dermatologist sends samples to a lab to rule out malignant cutaneous neoplasia. In that case, the diagnosis coding will disclose that the tags' nature was unknown at the time of removal and that they were sent to a pathologist for confirmation of the disease process. The treatment was a biopsy rather than a typical skin tag excision.

CPT has particular terminology. Biopsies have codes (11000 and 11001), and the method used to acquire the relevant tissue has no bearing on the coding. According to CPT, biopsies can be obtained through destruction, shaves, or excision. According to CPT, the surgical removal of an overall lesion is also included in the collecting of biopsy tissue. If the same lesion is involved, dermatologists should not bill for excision and a biopsy in the same visit.

Unfamiliarity with CPT's syntax and practice may lead a dermatologist to mistake an excision for a biopsy and vice versa. When it announces that sending representative tissue for pathologist assessment is a component of the shave, excision, or demolition of separate lesions, the American Medical Association (AMA), the body that administers the CPT technique, is explicit. Though physicians are advised to refer to the delivered service as an excision submitted for pathological investigation rather than a biopsy, an excisional biopsy is still an excision. If a healthcare claim is audited, this will clear things up. In the case of RAC audits, insurer QA audits, or appeals, clear documentation prevents confusion.

Understanding Modifiers in Coding:

The usage of modifiers is required for medical billing and coding. Modifiers are used in medical billing in a variety of ways. Some of the more regularly used modifiers are:

  • Modifier 25:

According to CMS, modifier 25 is used in medical billing for a "major, separately identifiable E/M (evaluation and management) service" provided on the same day by the same healthcare professional.

  • Modifier 59:

Modifier 59 is used in medical billing for a "separately identifiable, distinct non-E/M service," according to CMS. The codes are unbundled using modifier 59. As a result, it is the most misunderstood of all the modifiers. The X-modifiers were created to address this issue.

The X-Modifiers are as follows:

Based on the specific service given, there are four categories of X-Modifiers:

  • XE: A discrete service provided in a different or separate encounter
  • XU: A discrete service that does not overlap with the physician's primary service.
  • Windows XP:  If another healthcare physician provides the specific service
  • XS: If a separate organ is used to perform the specific service.

Dermatology Billing Medical Billing Codes

Medical billing for dermatological treatments can range from minor cosmetic procedures to large and complex surgical operations, including skin grafts. To avoid claim denials, medical billers must thoroughly understand the most often used dermatology codes and modifiers. This complicates dermatology medical billing even further. The most common dermatology procedures and their procedure (medical billing CPT) codes are shown below:

  • Biopsy of the skin:

A skin biopsy is utilized to determine the cause of any skin problem. The procedure codes for skin biopsy are as follows:

  • 11102 
  • 11103 
  • 11104 
  • 11105 
  • 11106 
  • 11107 

The designations mentioned above are based on the type of lesion found during a tangential skin biopsy.

  • Removal of the lesion:

The following are some of the most commonly used procedure codes for lesion removal: –

  • 17000 
  • 17003 
  • 17110 
  • Mohs Micrographic Surgery (Mohs Micrographic Surgery):

The following are some of the most commonly used procedure codes for Mohs Micrographic Surgery:

  • 17311 
  • 17312 
  • 17313 
  • 17314 
  • E/M Service (Evaluation and Management):

The following are some of the most commonly used procedure codes for dermatological evaluation and management services:

  • 99231
  • +91-99213
  • 99128

Outsourcing medical billing is becoming increasingly popular to manage this significant loss of practice revenue. Outsourcing alternatives range from giant corporations to individual freelancers providing medical billing services from their homes.

When considering the various billing methods, remember that medical billing is sophisticated and necessitates much knowledge and experience. When a specialty, such as dermatology, is involved, the prerequisites for dermatology medical billing success become even more challenging. The medical billing company must have a knowledgeable team with the complicated criteria that insurance companies use to evaluate dermatology medical claims.

Medical institutions and dermatology clinics cannot afford to leave income uncollected by medical billing businesses or freelancers who are not familiar with dermatology billing as the cost of providing dermatology-related healthcare services continues to climb. It's also worth noting that while some billing organizations advertise themselves as huge dermatology billing service providers, dermatology billing is subcontracted to freelancers who operate from home. Hiring such organizations will result in revenue loss because of the lack of suitable processes, controls, and training.

One of the most significant disadvantages of using a medical billing business that does not specialize in dermatological billing is that they are unfamiliar with the processes and terminologies. Even if the medical billing organization works with one or two dermatologists, they will lack the depth and breadth of knowledge needed to bill dermatology successfully. Furthermore, if the hired organization does not specialize in billing for dermatology, they will lack the necessary experience to challenge claims or respond to insurance company questions successfully. For those who aren't familiar with dermatology billing, the concerns of bundling, medical necessity, and global periods can be particularly frustrating.

Dermatology procedures have substantially more sophisticated contractual changes than a standard family doctor or internist's claims, making it difficult for a corporation to identify underpayments without extensive dermatology billing experience. Furthermore, many billing businesses' billing software and system designs will often be unsuitable for the more detailed reporting and insurance follow-up requirements of dermatology billing.

Dermatologists face additional challenges than just insurance billing; patient billing is also more complex. Patients frequently have significant balances, receive complicated explanations from their payers, and do not comprehend all of their dermatologists' charges. A less skilled patient gathering attempt could result in less money and unhappy patients for the dermatologist. A billing organization with extensive dermatology billing experience has previously spoken with patients about such assertions.

The primary line is that using a billing business that does not specialize in dermatology is not worth the risk.

The Advantages of Dermatology Medical Billing and Coding Outsourcing

Here are a few reasons why you might consider outsourcing your billing and coding activities to a large company:

  • More attention to patient care

Spending an excessive amount of time on your RCM harms your core activities. Patient care should always be at the forefront of your mind. Allowing outside specialists to handle your billing operations will enable you to devote more time and energy to patient care.

Your clients will be happier with the service because you can focus more on patient care. Providing them with excellent service and an exceptional experience will result in more sales. They are also likely to come back to you at some point in the future to use your services.

  • Improved Cash Flow

Outsourcing medical billing and coding reduces your costs of recruiting new personnel and purchasing office equipment and software while increasing your collection. BPO firms and other billing and coding experts specialize in the claims filing process, allowing you to secure the highest possible reimbursements.

You won't have to set up an internal billing team, allowing you to put your cash into more productive endeavors. Expanding your office, hiring more specialists, purchasing or updating the most up-to-date medical equipment, or opening a new branch are all options.

  • Operational Simplicity

Outsourcing dermatology billing and coding necessitates a greater understanding of RCM on your part as a business owner or medical practitioner. For starters, the third-party vendor with whom you've collaborated will offer its experience and help you resolve many of the process's challenges.

Furthermore, BPO firms must keep up with the ever-changing norms and regulations in the healthcare industry. Your partner will keep you up to date on the latest industry news and trends. This will allow you to make smarter decisions to stay ahead of the competition and maintain consistent revenue.

Dermatology necessitates careful documentation of skin lesions, including their number, size, and specific location, and information on operations such as excision, biopsy, and lesion annihilation. Many dermatology CPT codes are susceptible to numerous procedural restrictions; thus, a complete understanding of modifiers and post-op duration is required.

Aside from the ever-changing and complex landscape of insurance reimbursement, dermatology has seen a shift in practice workflow. Most dermatological firms now provide a wide range of aesthetic, cash-based treatments and medical and surgical procedures. This necessitates strategies for implementing technology, developing processes, and managing performance across several service lines.

In dermatology, revenue cycle management is more than just a medical billing process. Because it oversees all of the operations that affect your bottom line, your RCM should be more successful. Dermatology Medical Billing Service is a continuous procedure that begins with a patient visit and continues until you reach a point where you have no pending reimbursements from your insurer.

Because dermatology is considered cosmic and so expensive, as a dermatology practice owner, you should create your techniques to increase revenue without increasing your dermatological medical billing costs.

  • For dermatology medical practice, thinking big is ideal.

Like another healthcare specialty, Dermatology practices may be sensitive to economic downturns. As a result, dermatological practitioners should focus on anticipating and preparing for a decline in collections and lower revenue.

The more time you spend managing your revenue management cycle, the less time you spend in your office, resulting in a loss of energy and concentration on patient care.

Why should you hire a professional to handle your dermatology billing?

Outsourcing your dermatology billing to a professional medical billing company can help you improve income by 20%–30%, increase profitability, and streamline your billing process, enabling you to focus on your patients.

If your health necessitates it and you are determined to outsource your medical billing procedure, your external vendor must meet specific criteria and potentialities. To better assist you and improve your RCM, your outsourced partner organization should at least meet the following requirements:

  • Dermatology billing exposure
  • Billers and coders who are knowledgeable and experienced
  • Proven business performance and customer service excellence
  • Best practices require complete, integrated solutions, such as practice management, medical EHR maintenance, and inventory management systems.
  • Satisfied customers and a long list of references
  • Effective management and leadership
  • The company's history and commitment to providing service

Dermatologists Face Medical Billing Challenges

Dermatology is a multi-faceted specialist; thus, it's not rocket science to establish that it's one of the most complex medical specializations. Dermatological procedures, for example, can range from simple cosmetic surgery to more sophisticated skin grafting, all of which must be accounted for in medical billing. As a result, medical billing for dermatological practices is a complicated process. In addition, dermatologists typically see more patients than doctors in other specialties. As a result, to deal with the high volume of patients, medical billing and coding must be as accurate as possible to receive correct reimbursement.

Various coding systems

Both physicians and insurance payers benefit from coding systems since they identify the procedure performed and the amount of compensation given. Insurance companies often use the ICD (International Classification of Diseases) and CPT (Current Procedural Terminology) codes for dermatological billing and coding.

ICD-10-CM is the standard transaction code for diagnostic purposes under the Health Insurance Portability and Accountability Act (HIPAA). This transaction code is also used to track various healthcare statistics, including illness burden, mortality rates, quality outcomes, and billing. ICD-10 diagnosis codes are longer and usually start with an alpha character. They typically have 3 to 7 characters.

CPT codes represent all inpatient and outpatient operations and services in medical practice. Many of these codes, such as skin biopsies, Mohs surgery, and excision, are utilized by in-house dermatological procedures for billing purposes. There are also Evaluation and Management (E/M) codes within the CPT coding system to bill an inpatient or an office visit accurately.

Obstacles to Documentation

Medical billing documentation of any kind must be correct because it serves as a legal document justifying the services provided to patients and the justifications for such treatments. It is also an essential source for appropriate payment for procedures conducted. Such medical documents can also be used as evidence in a court of law.

However, there are several modifiers to apply in the medical documentation of dermatological practices. However, the 59 modifier is the most commonly used code because the other associated modifiers are not well known. As a result, many dermatological practitioners have had problems with medical documentation and modifier use in E/M and dermatology operations.

Patient records that are no longer valid

Many dermatologists are unable to obtain their patients' most recent insurance information. However, the administrative medical billing staff typically contacts the appropriate insurance carrier to avoid claim denials. As a result, before offering any dermatological services, it is critical to spend some time examining all of the insurance information. This will spare you months of waiting for your underpaid claims to be processed.

Medical Billing Compliance in Dermatology

Modifiers 25 and 59 may be overused due to a lack of fundamental billing expertise. On the one hand, "substantial, individually identifiable evaluation and management (E/M) service on the same day as the treatment or other service by the same physician" is characterized by 25 modifications. Modifier 59, on the other hand, is a District Procedural Service (DPS). It may be necessary to show that a service or method was independent and separate from other non-evaluation and management (E/M) services provided on the same day in certain circumstances.

According to an article in Dermatology Times, nearly 60% of physicians' E/M services are submitted with modifier 25. Around 25% of the remaining services are labeled "for the rest of medicine." As a result, any changes to the modifier 25 payment policy will significantly impact dermatological clinics more than other specialties.