Dermatology Billing, Coding and Documentation – Latest Updates

Hello and welcome to our podcast series. My name Is Meghann Drella and I am a Senior Solutions Manager here at Outsource Strategies International. Today, I will be discussing dermatology medical billing and coding.

Staying current on changing codes, billing rules, documentation requirements and payment methods is crucial for success with dermatology billing. Dermatologists provide many types of medical, surgical and cosmetic procedures and services, but getting reimbursed appropriately can be a challenge. In fact, responding to Medscape’s 2019 dermatologist compensation survey, dermatologists reported getting fair reimbursement and having so many rules and regulations as the most challenging part of their job. Up to 46% of dermatologists said they spent 10-19 hours a week on paperwork and administrative tasks, compared with 38% of all physicians.

Here are the recent and upcoming billing, coding and documentation updates impacting dermatologists:

New time reporting option for E&M services: More options for reporting E/M services came into effect beginning Jan. 1, 2019. In addition to using the current 1995 and 1997 documentation guidelines, E&M codes can be selected based on time or by using medical decision-making alone, regardless of the level of history or physical exam performed. Previously, selecting a visit based on time required documentation of the duration of face-to-face time with the patient and more than 50 percent of the visit had to be spent in counseling or coordination of care. The definition of time associated with E/M codes 99202-99215 has been changed from “typical face-to-face time” to “total time spent on the day of the encounter.” Starting in 2021, physicians will no longer need to establish how much time was devoted to counseling and coordinating on the day of the encounter. Code selection would depend on the total length of the visit even if counseling did not dominate the service time.

Changes in modifier payment policy: CMS and other payers constantly scrutinize how physicians are using modifier 25 and modifier 59 and whether there are instances of overpayment. According to an article in Dermatology Times, approximately 60% of E/M services performed by dermatologists are submitted with modifier 25 attached, compared to about 25% “for the rest of medicine.” This means that any change in modifier 25 payment policy will affect dermatology more than other specialties. Dermatologists must be knowledgeable about the specific requirements associated with the use of modifier 25 or risk recoupments resulting from post-payment audits. Modifier 59, which indicates a separately identifiable procedure done on the same encounter date on the same person, should not be appended to additional biopsy codes.

Medicare changing modifier rules to override claims edits: Traditionally, Medicare and other payers that use the National Correct Coding Initiative (NCCI) edits to bundle services provided to the same patient on the same date have required that any modifier used to override an edit must be applied to the “column 2 code” in an edit pair. Effective July 2019, Medicare has allowed the following modifiers to be appended to either code in the procedure to NCCI edits, when a modifier override is allowed.

Modifier – 59, XE, XS, XP, XU

Changes in biopsy coding: Dermatologists perform skin biopsies on a daily basis. In 2019, dermatology has a set of six new biopsy codes CPT 11102-11107, three types of primary biopsy codes, and three types of secondary codes.

Coding for photodynamic therapy (PDT): PDT codes have changed to incorporate physician work time and become more complex. Introduced in 2018, PDT CPT codes 96567, 96573, and 96574 are used to report nonsurgical treatment of cutaneous lesions using PDT. These codes can only be used once per patient per day, and only one of the 3 codes can be used on a given anatomic area.

New laser code sets: Two new laser codes was introduced in 2018 – 0479T and 0491T

These are Category III codes or emerging technology codes which may not be reimbursed by CMS or private insurance companies. Insurers can choose to pay at levels they consider appropriate for these codes. If widespread usage is confirmed, Category III codes may be reclassified as Category I codes, which insurers generally reimburse.

I hope this helps but always remember that documentation as well as a thorough knowledge of payer regulations and guidelines is critical to ensure accurate reimbursement for the procedures performed.

Thanks for joining me and stay tuned for my next podcast!