How is Dermatology Billing & Coding Different?

December 1, 2021
by Admin

What’s so special about dermatology billing anyways?

Dermatology coding isn’t the most complicated thing in the world.

The claims amounts aren’t that big per claim.

They do a lot of the same stuff.

Simple right?

You can take the laissez faire route and lose some time, money, and potentially patience (probably also patients). ? Or you can tackle dermatology billing with knowledge of the pitfalls and take a proactive approach.

Looking to take the billing bull by the horns? We’re here to help. Take a deep breath. We got you.

Understanding Dermatology Coding

A dermatologist can identify and treat more than 3,000 conditions that involve the skin, hair, or nails ? (no mani/pedis are not covered…nor rendered by dermatologists as far as we’re aware…). This doesn’t mean all services are 100% covered by insurance though. This is where the nuance comes in.

Dermatology services that are considered cosmetic, elective, or self-pay treatments:

  • Age spots

  • Cellulite & fat removal

  • Hair removal

  • Wrinkles

  • Actinic keratosis

  • Red light therapy

  • Full body skin checks

Dermatology diagnosis that are typically covered by insurance include: 

  • Allergies

  • Dermatitis

  • Eczema 

  • Hives

  • Melanoma

  • Shingles

  • Skin cancer

  • Warts

This is still the aesthetic end of medicine folks. Knowing what is covered and what isn’t is huge, just like in plastic surgery billing. You also want to watch out for those retail transaction lines…can’t bill that to insurance and, more importantly, you certainly don’t want Jane Doe getting a Botox bill in the mail that John opens by accident (oops he didn’t know about the Botox).

Overall, dermatology may have fewer complex code combinations than many surgical specialties. Despite the smaller code set, you still need to know the difference between insurance and cosmetic services. This also means that appropriately billing consult codes, or evaluation and management services, at the right level and/or in conjunction with procedures is huge.

Dermatology is a Volume Game.

Every dollar and every cent count. In dermatology, the game is all about clean claims.?️ Minimize those front end rejections and denials with proper claim scrubbing!

So, get you a biller who can do both…code/bill and know the difference between insurance/cosmetic.

What Dermatology Billing Specifics do I Need to Know?

In dermatology billing and coding, it may not be all about the coding, but the devil is also in the details of the billing regulations

In situations known as incident-to billing, a practice might use a healthcare provider other than a physician to provide treatment (e.g., physician extender, AKA nurse practitioner or physician assistant). To have the treatment covered, there are specific rules to adhere to…otherwise you can get in hot water fast. A physician must initiate the plan of care and be present and available wherever the treatment occurs so that any questions can be answered and assistance is available if necessary. Not sure where the line is? We can help.

What about pathology and pass-through-billing? In short…don’t go there. It isn’t illegal in every state, but it is frowned upon in them all. If you’re reading your slides, there’s nuance here too…that’s above board and requires a 26 modifier!

There are indeed some special code segments for dermatology treatments, such as Mohs surgery, photodynamic therapy, radiofrequency treatments (RFT), all of which can be covered by insurance depending on the need. For example, Mohs surgery is effective at treating many skin cancers, depending on where treatment is needed on the body. The same is true for photodynamic therapy and RFT…if/when criteria is met. Even Botox can be covered for hyperhidrosis if medically necessary.

More Claims = More Patient Bills…

With a higher volume of claims, you’ll have a higher volume of patients to collect from and a higher volume of patient statements. You’ll need to be on your pre- and post-service collections game to avoid becoming a debt collector instead of a doctor. A few quick tips…

  1. Credit Card on File (CCOF) – Do it. Your patients will be fine. Everyone puts their credit card down for everything these days from Netflix, to Nespresso subscriptions…if they can put a card down for their coffee, they can put a card down for their health. Seriously, this practice is more and more commonplace and with proper expectation setting/communication, you can avoid statements altogether by running the cards after insurance processes through a CCOF Policy.

  2. Estimate and Pre-Collect – See if your tech stack allows you to plug in a solution like HealthiPass where you can collect what the patient will likely owe, before they check out from the visit. Note to self: this only works if the MD documents/codes before the patient leaves the room. CPTs are half of the estimation calculation.

  3. Stop Killing Trees (e.g., no more paper statements – Find a killer solution like InboxHealth to let patients pay with the click of a button on their cell or in their email. No one opens the mail anymore folks.

Dermatology Billing isn’t so Simple I Guess is it…

The complexity may not be in the CPT codes, but it is still there. Workflow is king in dermatology billing so experience and specialization matter. We’ve got both in spades, contact Auctus Group, we can help.

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