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Dermatology Medical Billing and Coding Guidelines

Explore our comprehensive guidelines for dermatology medical billing and coding to ensure compliance and maximize your practice's revenue potential.

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dermatology billing guideline

Dermatology Billing & Coding Guidelines

Mastering Dermatology Medical Billing and Coding CheatSheet

An optimized healthcare revenue cycle hinges on the accurate use of dermatology CPT codes. When you apply the correct codes that align with the services provided and support them with detailed SOAP notes or medical documentation, your claims are far more likely to be accepted on the first submission.

Essential Dermatology CPT Codes

Understanding key dermatology CPT codes is crucial for effective medical billing and coding in your practice. Here’s a breakdown of essential codes related to skin biopsies and complete skin exams:

Skin Biopsy CPT Codes

When performing a skin biopsy, dermatologists remove skin samples for further examination. Accurate coding for these procedures is vital to ensure appropriate reimbursement. The essential skin biopsy codes include:

  • 11102: Tangential biopsy of skin (e.g., shave, scoop, saucerize, curette); single lesion
  • 11103: Tangential biopsy of skin (e.g., shave, scoop, saucerize, curette); each separate/additional lesion (List separately in addition to the code for the primary procedure).

Notes: (Report 11103 in conjunction with 11102, 11104, and 11106, when different biopsy techniques are performed to sample separate/additional lesions for each type of biopsy technique used)

  • 11104: Punch biopsy of skin (including simple closure, when performed); single lesion
  • 11105: Punch biopsy of skin (including simple closure, when performed); each separate/additional lesion (List separately in addition to the code for the primary procedure).

Notes: Code 11105 should be reported in conjunction with codes 11104 or 11106 when different biopsy techniques are used to sample separate/additional lesions. Each technique must be documented accordingly.

  • 11106: Incisional biopsy of skin (e.g., wedge) (including simple closure, when performed); single lesion
  • 11107: Incisional biopsy of skin (e.g., wedge) (including simple closure, when performed); each separate/additional lesion (List separately in addition to the code for the primary procedure).

Notes: Code 11107 should be reported in conjunction with code 11106 when different biopsy techniques are performed on separate/additional lesions.

  • 40490: Biopsy of lip
  • 69100: Biopsy of the external ear

Understanding Shave Biopsy and Proper Dermatology Coding

Accurate coding for dermatological procedures hinges on clear documentation, especially when differentiating between a shave and a biopsy. While the term “shave biopsy” may appear in medical records, it’s important to note that no CPT code exists for this procedure, as a "shave biopsy" does not exist as a standalone code. 

Instead, the service is categorized as either a shave or a biopsy, and it’s essential to determine which technique was used.

A shave involves a transverse or horizontal slice across the surface of the skin, much like shaving hair from the body. It removes the top layer of skin but does not penetrate deep enough to remove cells or roots below the skin’s surface. Importantly, a shave procedure does not typically require sutures. In contrast, a biopsy involves removing tissue for pathology.

Key Documentation for Proper Coding

  • Shave Documentation:
    • Location of the lesion on the body
    • Transverse/Horizontal excision technique
    • Lesion diameter (without margins)
  • Biopsy Documentation:
    • Notation of specimen sent to pathology
    • Use of punch or excision techniques
    • Lesion excision without margins or a specific technique

Example of Proper Coding

  • A 0.8 cm lesion on the right shoulder removed via transverse excision or shave should be coded as 11301 (Shaving of the epidermal or dermal lesion, single lesion, trunk, arms, or legs; lesion diameter 0.6 to 1.0 cm).
  • A 0.8 cm lesion on the right shoulder with irregular borders and color, removed for pathology, should be coded as 11102, 11104, or 11106 (Biopsy of skin, subcutaneous tissue and/or mucous membrane [including simple closure], unless otherwise listed; single lesion).

By applying these coding principles, dermatology practices can ensure proper billing and compliance while avoiding costly mistakes.

Complete Skin Exam Coding

A complete skin exam can typically be coded as 99214, provided all necessary criteria are met. For a successful coding under this category, the following requirements must be fulfilled:

  • Physical Exam Requirement: The examination must cover at least 12 body areas. It is likely that a complete skin exam on an established patient will meet this criterion.
  • History Requirement: For CPT Code 99214, documentation must include:
    • At least four elements of the history of the present illness.
    • At least two systems were reviewed.
    • One relevant element from the past, family, or social history related to the patient’s current condition.

Lesion Removal Dermatology CPT Codes

Lesions can vary in nature, being benign, premalignant, or malignant, and can be removed using various methods such as electrosurgery, cryosurgery, laser therapy, or chemical treatment.

When multiple lesions are removed during a single session, you may apply several dermatology CPT codes to accurately reflect the procedures performed. Here are some key codes for lesion destruction:

  • 17000: Destruction (e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (e.g., actinic keratoses); first lesion
  • 17003: Destruction of premalignant lesions (e.g., actinic keratoses); second through 14 lesions, each (List separately in addition to the code for the first lesion).

Notes: Use code 17003 in conjunction with code 17000.

  • For the destruction of common or plantar warts, refer to codes 17110 or 17111.
  • 17110: Destruction (e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement) of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions

Using these codes appropriately ensures accurate billing and reflects the scope of services provided, facilitating optimal reimbursement for your dermatology practice.

Performing Multiple Procedures On The Same Day of Lesion Removal Dermatology

Here are two examples of how to accurately code for common dermatological procedures:

Example 1: Punch Biopsy and Actinic Keratosis Treatment

Scenario: The physician performs a punch biopsy and treats three actinic keratoses.

CPT Code Procedure Description RVUs

11104

Punch biopsy

3.52

17000-59

Destruction of premalignant  ant lesion (first lesion)

1.85

17003

Destruction of premalignant lesions (2nd to 14th)

0.16

17003

Destruction of premalignant lesions (additional)

0.16

Coding Notes:

  • Report 11104 first, as it has the highest RVUs and does not require a modifier.
  • Attach modifier 59 to 17000 to indicate it is a distinct procedure bundled into the punch biopsy.
  • The subsequent actinic keratosis treatments are reported with 17003 and do not require a modifier.

Example 2: Incisional Biopsy and Keratosis Treatments

Scenario: The physician treats three seborrheic keratoses and one actinic keratosis while also performing an incisional biopsy on a different lesion.

CPT Code Procedure Description RVUs

11106

Incisional biopsy

4.26

17110-59

Destruction of benign lesion (seborrheic keratosis)

3.13

17000-59

Destruction of premalignant lesion (actinic keratosis)

1.85

Coding Notes:

  • List 11106 first, as it has the highest RVUs.
  • Attach modifier 59 to both 17110 and 17000 to indicate that these procedures involve different lesions and are distinct from the incisional biopsy.

By following these guidelines, you can ensure accurate coding and maximize reimbursement for your dermatology practice.

Excisions of Lesions Dermatology CPT Codes

Excising a lesion entails the surgical removal of both the lesion and the surrounding tissue to ensure complete removal. Here are the relevant CPT codes for excisions in dermatology:

  • 11403: Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms, or legs; excised diameter 2.1 to 3.0 cm
  • 11603: Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter 2.1 to 3.0 cm

Proper use of these codes is essential for accurate billing and optimal reimbursement in dermatology practices.

Mohs Micrographic Surgery Dermatology CPT Codes

Mohs micrographic surgery is a precise procedure for removing skin cancer. It involves the staged removal of cancerous tissue, followed by a detailed pathological examination to ensure all cancerous cells are eliminated. The procedure is coded based on the location of the lesion and the number of stages required.

Here are the relevant CPT codes:

  • 17311: Mohs micrographic technique, including removal of all gross tumors, surgical excision of tissue specimens, mapping, color coding of specimens, microscopic examination of specimens by the surgeon, and histopathologic preparation including routine stain(s) (e.g., hematoxylin and eosin, toluidine blue), head, neck, hands, feet, genitalia, or any location with surgery directly involving muscle, cartilage, bone, tendon, major nerves, or vessels; first stage, up to 5 tissue blocks.
  • 17313: Mohs micrographic technique, including removal of all gross tumor, surgical excision of tissue specimens, mapping, color coding of specimens, microscopic examination of specimens by the surgeon, and histopathologic preparation including routine stain(s) (eg, hematoxylin and eosin, toluidine blue), of the trunk, arms, or legs; first stage, up to 5 tissue blocks

Mohs Micrographic Technique CPT Code 17312

This code applies to the Mohs micrographic technique, which involves:

  • Removal of all visible tumors
  • Surgical excision of tissue specimens
  • Mapping and color coding of specimens
  • Microscopic examination of the specimens by the surgeon
  • Histopathologic preparation using routine stains (e.g., hematoxylin and eosin, toluidine blue)

Code 17312 specifically refers to Mohs micrographic surgery performed on the head, neck, hands, feet, genitalia, or any area where surgery involves deeper structures like muscle, cartilage, bone, tendon, major nerves, or vessels. It is used for each additional stage beyond the first, up to five tissue blocks.

Notes: Report 17312 in conjunction with 17311 for each additional stage following the initial stage of surgery.

Mohs Micrographic Technique CPT Code 17314

This code covers the Mohs micrographic surgery technique, which includes:

  • Removal of all visible tumor tissue
  • Surgical excision of tissue specimens
  • Mapping and color coding of the specimens
  • Microscopic examination of the specimens by the surgeon
  • Histopathologic preparation using routine stains (e.g., hematoxylin and eosin, toluidine blue)

Code 17314 applies to procedures performed on the trunk, arms, or legs for each additional stage after the first, up to five tissue blocks.

Notes: Report 17314 in conjunction with 17313 for each additional stage following the initial stage of surgery.

Using the correct codes for each stage and location ensures accurate billing and helps optimize reimbursement for this specialized dermatological procedure.

Pathology CPT Codes for Dermatologists

Pathology procedures allow dermatologists to examine skin and tissue at the microscopic level, helping to diagnose conditions based on cellular structures. The following CPT codes are commonly used for these pathology services:

88304 Level III - Surgical Pathology, Gross and Microscopic Examination

The following specimens fall under CPT 88304, which includes gross and microscopic examination for Level III surgical pathology:

  • Abscess
  • Aneurysm (arterial/ventricular)
  • Anus, tag
  • Appendix (other than incidental)
  • Artery, atheromatous plaque
  • Bartholin's gland cyst
  • Bone fragment(s) (excluding pathologic fracture)
  • Bursa/synovial cyst
  • Carpal tunnel tissue
  • Cartilage, shavings
  • Cholesteatoma
  • Colon (colostomy stoma)
  • Conjunctiva (biopsy/pterygium)
  • Cornea
  • Diverticulum (esophagus/small intestine)
  • Dupuytren's contracture tissue
  • Femoral head (other than fracture)
  • Fissure/fistula
  • Foreskin (other than newborn)
  • Gallbladder
  • Ganglion cyst
  • Hematoma
  • Hemorrhoids
  • Hydatid of Morgagni
  • Intervertebral disc
  • Joint, loose body
  • Meniscus
  • Mucocele (salivary)
  • Neuroma (Morton’s/traumatic)
  • Pilonidal cyst/sinus
  • Polyps, inflammatory (nasal/sinusoidal)
  • Skin (cyst/tag/debridement)
  • Soft tissue, debridement
  • Soft tissue, lipoma
  • Spermatocele
  • Tendon/tendon sheath
  • Testicular appendage
  • Thrombus or embolus
  • Tonsil and/or adenoids
  • Varicocele
  • Vas deferens (other than sterilization)
  • Vein, varicosity

Notes:

  • (Use 0752T in conjunction with 88304 when digitizing glass microscope slides is performed.)

88305 Level IV - Surgical Pathology, Gross and Microscopic Examination

The following specimens fall under CPT® 88305, which covers both gross and microscopic examination for Level IV surgical pathology:

  • Abortion (spontaneous/missed)
  • Artery, biopsy
  • Bone marrow, biopsy
  • Bone exostosis
  • Brain/meninges (other than for tumor resection)
  • Breast biopsy (not requiring microscopic evaluation of surgical margins)
  • Breast reduction mammoplasty
  • Bronchus, biopsy
  • Cellblock (any source)
  • Cervix, biopsy
  • Colon, biopsy
  • Duodenum, biopsy
  • Endocervix, curettings/biopsy
  • Endometrium, curettings/biopsy
  • Esophagus, biopsy
  • Extremity, traumatic amputation
  • Fallopian tube, biopsy
  • Fallopian tube, ectopic pregnancy
  • Femoral head, fracture
  • Fingers/toes, non-traumatic amputation
  • Gingiva/oral mucosa, biopsy
  • Heart valve
  • Joint, resection
  • Kidney, biopsy
  • Larynx, biopsy
  • Leiomyoma(s), uterine myomectomy (without uterus)
  • Lip, biopsy/wedge resection
  • Lung, transbronchial biopsy
  • Lymph node, biopsy
  • Muscle, biopsy
  • Nasal mucosa, biopsy
  • Nasopharynx/oropharynx, biopsy
  • Nerve, biopsy
  • Odontogenic/dental cyst
  • Omentum, biopsy
  • Ovary (with or without tube, non-neoplastic)
  • Ovary, biopsy/wedge resection
  • Parathyroid gland
  • Peritoneum, biopsy
  • Pituitary tumor
  • Placenta (other than third trimester)
  • Pleura/pericardium (biopsy/tissue)
  • Polyp (cervical/endometrial)
  • Polyp (colorectal)
  • Polyp (stomach/small intestine)
  • Prostate, needle biopsy
  • Prostate, TUR
  • Salivary gland, biopsy
  • Sinus, paranasal biopsy
  • Skin (other than cyst/tag/debridement/plastic repair)
  • Small intestine, biopsy
  • Soft tissue (other than tumor/mass/lipoma/debridement)
  • Spleen
  • Stomach, biopsy
  • Synovium
  • Testis (other than tumor/biopsy/castration)
  • Thyroglossal duct/brachial cleft cyst
  • Tongue, biopsy
  • Tonsil, biopsy
  • Trachea, biopsy
  • Ureter, biopsy
  • Urethra, biopsy
  • Urinary bladder, biopsy
  • Uterus (with or without tubes and ovaries for prolapse)
  • Vagina, biopsy
  • Vulva/labia, biopsy

Notes:

(Use 0753T in conjunction with 88305 when digitizing glass microscope slides is performed.)

88312 Special Stain, Including Interpretation and Report

Group I for Microorganisms (e.g., acid-fast, methenamine silver)

This code is used for special stains that are performed to identify microorganisms in tissue, including:

  • Acid-fast stains (to identify bacteria such as Mycobacterium tuberculosis)
  • Methenamine silver stains (to detect fungal organisms, such as Pneumocystis or fungi in tissue)

Important Notes:

  • Use 0756T in conjunction with CPT® 88312 when digitization of glass microscope slides is performed.
  • Report one unit of 88312 for each special stain applied on each surgical pathology block, cytologic specimen, or hematologic smear.

88341 Immunohistochemistry or Immunocytochemistry, Per Specimen

Each Additional Single Antibody Stain Procedure

This code applies when performing an additional single antibody stain as part of immunohistochemistry (IHC) or immunocytochemistry (ICC) testing, which helps in identifying specific antigens in cells.

Important Notes:

  • Use CPT® 88341 in conjunction with CPT® 88342 for primary procedure.
  • When digitizing glass microscope slides, use 0761T alongside 88341.
  • For multiplex antibody stain procedures, report using CPT® 88344 instead of single stains.

These codes provide detailed insight into the diagnosis and classification of skin-related conditions based on tissue samples.

Laser Therapy and Phototherapy Treatment CPT Codes

Laser therapy uses specific wavelengths to treat various skin conditions, including cosmetic procedures, while phototherapy relies on UV light to manage conditions like eczema and psoriasis.

Common dermatology CPT codes for these treatments include:

  • 96920 – Excimer laser treatment for psoriasis; total area less than 250 sq cm
  • 96921 – Excimer laser treatment for psoriasis; 250 sq cm to 500 sq cm
  • 96900 – Actinotherapy involves the use of ultraviolet (UV) light to treat various skin conditions, such as psoriasis, eczema, and vitiligo.

Notes: For rhinophototherapy (intranasal application of UV and visible light), use code 30999 for an unlisted procedure.

  • 96910 – Photochemotherapy; tar and ultraviolet B (Goeckerman treatment) or petrolatum and ultraviolet B
  • 96567 – Photodynamic therapy involves the external application of light to eliminate premalignant skin lesions and adjacent mucosa. This treatment includes the application and illumination of photosensitive drugs.

Notes:

  • Use 96567 to report photodynamic therapy when the physician or qualified healthcare professional is not directly involved in delivering the service.
  • J7308 – Aminolevulinic acid HCl for topical administration, 20%, single unit dosage form (354 mg)

Evaluation and Management (E/M) CPT Codes and Billing Guidelines for Dermatologists

When submitting claims using E/M codes, it's crucial to differentiate between new and returning patients:

  • New Patient: A patient who has not received any services from a physician or non-physician practitioner (NPP) within the same specialty at your practice in the past three years.
  • Returning Patient: A patient who has received services from a physician or NPP in the same specialty at your practice within the last three years.

You can bill based on either the time spent with the patient or the complexity of the case.

Time-Based E/M Codes

  • 99202: 15-29 minutes
  • 99203: 30-44 minutes
  • 99204: 45-59 minutes
  • 99205: 60-74 minutes

Complexity-Based E/M Codes

  • 99212: Straightforward complexity, minimal risk (10-19 minutes)
  • 99213: Low complexity, low risk (20-29 minutes)
  • 99214: Moderate complexity, moderate risk (30-39 minutes)
  • 99215: High complexity, high risk (40-54 minutes)

Modifiers for Dermatology CPT Codes

Certain E/M codes may require modifiers for accurate billing:

  • Modifier 25: Use this modifier only for established patients to indicate a significant, separately identifiable E/M service provided on the same day as a procedure. Avoid using it for new patients or in combination with other dermatology CPT codes.
  • Modifier 59: Attach this modifier to indicate that a service or procedure was distinct or separate from other services performed on the same day.

By following these guidelines, you can ensure accurate billing and compliance in your dermatology practice.

Why Choose BillingFreedom for Dermatology Medical Billing?

At BillingFreedom, we specialize in dermatology medical billing, providing a comprehensive suite of services tailored to meet the unique needs of dermatology medical billing practices. Our expert team is well-versed in the complexities of dermatological procedures, including excisions, biopsies, and laser therapies. We ensure accurate coding with a deep understanding of relevant CPT codes, such as 11102 for skin biopsies and 17311 for Mohs micrographic surgery.

Our commitment to staying updated with the latest coding guidelines and billing practices ensures that your claims are processed efficiently, minimizing denials and maximizing reimbursements. We utilize advanced technologies for streamlined operations, allowing us to focus on the specifics of dermatology billing, such as the nuances of modifiers like 25 and 59.

With our expertise in evaluation and management (E/M) coding, we help practices navigate the complexities of patient categorization, whether for new or returning patients. Choose BillingFreedom for a dedicated partner that prioritizes accuracy, compliance, and your financial success in the dermatology field.

For more details about our exceptional ob/gyn medical billing services, please don't hesitate to email us at info@billingfreedom.com or call us at +1 (855) 415-3472.

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